Case Study

When Couples Therapy Causes Emotional Pain

Coming to Terms with Inflicting Emotional Pain in Order to Provide Good Couples Therapy

Ellyn Bader and Peter Pearson
When Couples Therapy Causes Emotional Pain

Before beginning to work with couples, most therapists have no idea how much can be at stake in a single session. We don’t become therapists to inflict emotional pain, but we eventually learn that sadness, anger, shock, and disillusionment can be part and parcel of therapy with couples in serious trouble. Good couples therapy sometimes hurts.

This was certainly the case with Tom and Betsy. When Tom called for an appointment, he said that he and his wife, Betsy, were just having a few communication problems. Barely 10 minutes into the session Tom began to talk about how anxious he’d been feeling during the past week as he anticipated this session.

“I don’t really know what’s bothering me,” he said. “I just seem to stay at work later and later. I don’t feel much desire to rush home.”

I got a sinking feeling in my stomach as years of couples therapy screamed out to me: “He’s here to end this marriage, but he won’t say it.” It wasn’t just his words; he barely made eye contact, and he was emotionally flat, yet perspiring profusely.

Betsy was determined that all they needed was to learn to talk about their issues and was thrilled that Tom finally agreed to seek counseling. Looking slightly past her, Tom said, “Yes, we do need to learn to talk better. I’m just not good at talking.”

As he said this, every fiber of my being was signaling, “This is a man with a secret.”

When I asked Tom what he thought his anxiety was telling him, he replied, “I’ve been anxious for years. Now, since we decided to get therapy, I barely sleep at all. She thinks I have intimacy issues.”

“Sometimes, anxiety has to do with not wanting to be in therapy at all,” I replied. “Sometimes, anxiety has to do with fear of moving into high-conflict topics. And sometimes, it has to do with not having the desire to respond to your partner’s request. Can you tell me what percentage of each is true for you?”

Tom immediately began rambling on about how compatible he and Betsy were, how he valued her friendship, and what good parents they were together. But not a word was said about what his anxiety might be signaling.

I could have postponed my probing and hope that Tom might overcome his fear of confrontation and tell Betsy the truth between sessions, but my instincts told me that wasn’t going to happen. Plus, they had some to me for help, not for self-protective silence. After years of doing couples work, I knew that sometimes what we must offer, at least initially, is emotional pain.

Eventually Tom revealed what he’d been struggling to contain: He didn’t want to be married to Betsy anymore. Now that their youngest child was graduating from college, he wanted to explore a new life. “I’ve worked for years to support you and the kids at a job that’s bored me to death,” he said to Betsy.

As the dawning realization of a devastating emotional pain spread over Betsy’s face, I wondered what I should do now. I’d spent many hours role-playing how to help couples compromise, but here was no easily resolvable agreement. Tom had been preparing himself to make this speech for a long time. His mind was made up.

While keenly aware how much easier it would be to let them go and avoid the emotional pain of watching them dismantle their 30-year marriage, I insisted they return. So much was left unsaid between them. These weren’t two people who hated each other; they were two people who didn’t know how to process intense feelings. I knew that unless they could process this complexity together, they’d never preserve their friendship and care for each other. And I knew that, left alone, they’d never process feelings they’d avoided during their marriage.

Ellyn Bader, PhD, and Peter Pearson, PhD, couples therapists for more than 25 years, are the founders and directors of The Couples Institute and creators of the Developmental Model of Couples Therapy. They’re the authors of In Quest of the Mythical Mate: A Developmental Approach to Diagnosis and Treatment in Couples Therapy.