Dan comes to supervision super frustrated. “This couple just makes my head spin!” He feels like a failure because he can’t seem to get any traction with them. When I ask him about what’s happening in the session, there are often statements like, “Alex keeps rolling his eyes and I was thinking you need to quit doing that if you want a healthy relationship!” But when I ask, “And did you say that?” he looks a bit horrified. Dan, like most of us—even those of us with a marriage and family therapy designation—was taught to “follow the client, don’t give advice, don’t lead.” And like most of us, he only got one class in grad school specifically geared towards couples that was mostly theoretical.
Over time, Dan begins to understand that couples therapy is an entirely different modality than individual therapy, and following the client does not necessarily work. Following a couple is likely to lead you right into the maladaptive pattern that they already have and are trying to break. There’s a lot going on in a couple’s session, and letting the clients run the show is likely to leave you with head-spinning confusion. If Dan wants to specialize in couples, he needs to begin to gather the knowledge and gradually gain the experience to be able to speak as an expert and start running the session instead of allowing the couple to run it for him.
There are several basic requirements if you’d like to work with couples. You must be pro-active and assertive in your style. It’s a good idea to let the clients know how you like to work, rather than asking them what they would like to work on. For example, I often will summarize the issues clients are bringing to therapy, and then say, “Here’s how I envision working through these issues towards your goal.” Particularly for high conflict couples, often you will have to work on rules of engagement, boundaries, and self-regulation skills before you can really dive into the conflicts at hand. So, it’s important to let them know why you won’t be addressing the issues right away. Also, many couples come in looking to resolve problems, but entirely discount working on the positives, which can help them achieve their goals. I like to make it overt that we will be working on these things as well as unraveling the negative issues. Once you lay out and collaborate on these goals and the pacing of treatment, you can check in regularly to see how things are progressing.
With couples, you will need to practice regularly slowing them down so that they can contact the vulnerable emotions that lie beneath their reactivity. Couples tend to escalate quickly as they discuss their issues, and the couples therapist can model and require pacing that helps them to fully process through conversations instead of rushing to the next point. I like to ask them at the outset for permission to interrupt them or stop them if how they are working through an issue is counterproductive. Once you have this permission, it’s easier to halt the content and dive deeper. You’re looking for patterns and process rather than the topic itself. If you go for content, you’ll just be discussing the “fight du jour” every week. You want to be teaching your clients to process through issues on their own, without your help, and that is done through properly paced process.
In addition to taking charge of the session and controlling the pacing, there are a few other things you can do as well to help your development as a couples therapist.
Find a Supervisor Who Specializes in Couples
Hopefully you have some choice in your internship setting of supervisors who have different skills and specialties. If you don’t, it may be a good idea to invest in outside supervision in order to obtain supervision specifically geared towards couples work. Look for a supervisor whose caseload is at least 50% couples, and who has some kind of special training in couples therapy. If you know a particular theory that you like, you can look for someone who has experience in that theory (for example a Gottman or EFT-trained therapist).
Go to Conferences and Take Couples-Related Seminars
Look for conferences online or in your area that have seminars related to couples therapy. This is a good way to expose yourself to different styles and theories, without committing to a full training module that may cost quite a bit. In most states, you can log these seminars as workshop hours.
Take Level 1 in Multiple Modalities
I know there are people who swear by particular models and modalities, but if you’re going to specialize in couples, every single couple will be different and require different skills and interventions. In my opinion, no single theory can cover every situation, and it’s good to get exposure to a range of theoretical frameworks. When you’re a therapist in training, many workshops and certification programs offer a reduced fee for pre-licensed individuals so it can be cost-effective to take trainings and enlist in training programs before licensure. Remember that you’ll be able to obtain a higher fee and achieve better client retention if you’re a true “expert,” so the money you spend now will pay off later in client fees or job offers. Once you’ve exposed yourself to multiple theories, you may want to go further than Level 1 in one particular modality, but you’ll also be able to draw from your knowledge of other modalities.
Find a Couples Therapist Consultation Group
Before I was licensed, I found a couples consultation group and applied to be a part of it. I had to make my case as to why I believed I should join, since I was pre-licensed, but eventually my persistence paid off and they let me in! I learned a lot. Some consultation groups have a fee, if there is an educational component and the leader is doing a lot of psycho-education. Others are simply groups of practitioners getting together to share ideas and knowledge. If you can’t find one in your area, consider creating your own peer supervision group. Ask several people you know (licensed and/or pre-licensed) if they’d like to get together regularly to discuss what they’re learning and practicing related to couples therapy.
Read, Read, Read
This may not be helpful to everyone. Not everyone is a reader or learns best by reading. I am definitely someone who learns a lot by reading (sometimes more than listening in a training), so I read a lot in order to learn new skills. Not only can you read books written for therapists regarding couples work, but you can also read self-help books written for couples directly and try using some of the concepts that seem useful in your sessions.
Do Your Own Work
While this is true for all therapists all the time, there’s nothing like a couples session to activate your own attachment history, unprocessed feelings, and trauma reactions. You must increase your comfort level with intense emotions and some degree of conflict to effectively work with couples. You also need to continually work toward being fair in terms of understanding and advocating for each person in the couple. Many of our own biases, judgements, and defensive reactions surface when working with couples, and it’s critical for you to have a therapeutic space—with an individual supervisor or in a supervision group—to explore what comes up for you.
Lastly, it’s the nature of couples therapy for things to be a bit chaotic at times. It’s important to understand that how the clients are doing is not necessarily a reflection of how you are doing as a couples therapist. While true for all therapy, it’s particularly true for couples therapy that if partners don’t practice the skills you teach them outside of session, it’s unlikely that their relationship will improve. The best couples therapist in the world can’t save a relationship working on it one hour a week. In addition, many couples wait much too long before seeking help, and even a great couples therapist may not be able to save the relationship that’s been neglected for years. Also, not every relationship should be saved, and sometimes facing that truth is the work you’ll be doing with a couple.
Get comfortable with fast-paced, emotion-laden sessions, and develop the confidence to direct your couples to slow down and make space for whatever lies beneath their habitual reactive patterns. Challenge yourself to learn. Over time, not only will you call yourself an expert at what you do, you’ll enjoy the sense of professional pride and satisfaction that comes from genuinely helping couples thrive!
Photo by Timur Weber/Pexels
Lisa Gray, LMFT is a couples therapist in private practice in the San Francisco Bay Area, specializing in high conflict couples and chronic illness/pain. Lisa is the author of Healthy Conflict, Happy Couple: How to Let Go of Blame and Grow Stronger Together. She is passionate about teaching couples to practice healthy conflict, so that their relationships can thrive and grow. Lisa reads over 100 books a year and reviews self-help books on Therapy Book Nook. She lives in the Bay Area with her family and 3 large dogs. Learn more about Lisa on her website.