I’m sitting in my dimly lit office, staring out of my 13th-story window as I watch the red lights on a nearby skyscraper flash against the evening sky. It’s a meditation of sorts, and I need it. My heart is racing as I wait for my next couple, Laura and Madison. Just the thought of seeing them makes me nervous. Their sessions are always fraught with conflict. Their reactive dynamic feels so entrenched and intransigent that we all—me included—seem to end up feeling inadequate in the face of it. Maybe they won’t show up, I hope half-heartedly.
When I hear the door to the waiting room shut, I take a deep inhale and walk down the long, fluorescent-lit hallway and find Madison and Laura holding hands in chairs next to the water cooler. Oh, I think, relieved, Maybe tonight will be different.
I smile and invite them to follow me back to my office. “Where should we start?” I ask, feeling hopeful.
They pause for a moment. Finally, Laura breaks the silence by sharing that the week was fairly uneventful. At this, I feel my shoulders relax. This might finally be the week we can get somewhere. Perhaps they aren’t so angry tonight, and we can have a real conversation, I think. But as I turn my head toward Madison, I catch a glare.
“If Laura thinks this week was uneventful, then I don’t think therapy can do anything to help us,” she announces, shaking her head.
In an instant, Laura responds: “You’ve got to be kidding me. You just want something to be mad about!”
My shoulders tense back up and my stomach clenches. “Okay, it looks like you’re both feeling angry. Are you willing to practice active listening?” I ask. But it’s like they don’t even hear me. Not five minutes into our session, they’re talking over me and each other, volleying criticisms, each more vicious than the last, as their voices get louder and their mannerisms increasingly hostile. “You only care about yourself.” “I’m so sick of your self-pity.” “How can I be affectionate with someone who’s always judging me?” “You love seeing me weak because you’re insecure and power hungry.” I can hear my heart beating in my own ears, and I notice myself trying desperately to figure out what to do next.
“I need you both to stop,” I say. My heart races and from the heat in my cheeks, I assume my face has turned bright red.
“Fine!” Laura shouts. She stands up, looks at me, looks at Madison, and announces, “This isn’t working! Things have just gotten worse since we started therapy!” Then she walks out of the room. I gaze longingly at the blinking lights before turning to face Madison.
“I guess there isn’t any hope,” she says. “We can’t even behave here.”
I give her a sympathetic glance despite my own misgivings and do my best to communicate hope. “Something got triggered,” I say. “We’ll work through this.” But I don’t think my empathy or comforting words inspire much confidence.
“Thanks for trying,” she says. And with that, she stands up and leaves the room.
What makes this session different from our previous ones is that this time, Laura and Madison don’t come back, that night or ever. I wait for an email, a call, anything, but every time I think about them, I feel overwhelmed and ineffective. Sometimes, the shame I feel makes me wonder if I should even continue to work as a couples therapist.
When It Gets Really Bad
Several years later, I’m sitting alone in another dark room, only this time, it isn’t my office. It’s my son’s bedroom. He’s a few weeks old and never seems to stop crying. I rock him back and forth, back and forth. It’s another meditation, one I’m using to center both myself and my son. But it’s not working. I’m hopeful that my son will fall asleep at any moment, but if the previous nights are any indication, that’s unlikely. He just wants to be held.
I feel inadequate as a mom to my son, just as I did as a couples therapist with Laura and Madison. As I continue rocking, I start seething. I’m angry with my husband, who’s sleeping in the next room. His snores drift across the hallway, a stark reminder that I haven’t slept well in days. He and I have been arguing more than usual, and in a new, louder, crueler way. Who are we? I wonder.
Of course, I’m not alone in feeling this kind of distress.
Lots of couples—just like Laura and Madison, and even like my own husband and me—get into conflicts with each other but are otherwise happy. In most circumstances, they solve problems well, have fun together, and love and respect each other. But something changes as the stressors in their lives increase.
These couples don’t need me to teach them how to use active listening or tell them it’s unhelpful to criticize each other. They’ve heard about the importance of date nights. Most have even tried them, but the benefits don’t stick. The things I teach don’t seem to be taking root outside of therapy. When it gets really bad between them, the things I teach don’t even work inside the therapy room.
Physiological Flooding
My husband and I go to couples therapy as we face our own relational issues. During our couples sessions with different therapists, we argue. Then, we leave feeling underwhelmed and overwhelmed at the same time. “What was the point of that?” we wonder aloud afterward on more than one occasion while trying to soothe our jangled nerves and electrified nervous systems. During each of our sessions, I recognize that something is being overlooked—something I’ve also overlooked as a therapist. Whatever it is, I can’t pinpoint it.
I’ve taken a few Gottman Method Couples Therapy trainings before, but one day, I attend another one focused on the concept of diffuse physiological arousal (DPA). This is a term used to describe the heightened state of arousal people experience when they feel threatened. In this state, our heart races, adrenaline pumps through our body, and we’re less able to understand and process social interactions. As I listen to the trainer talk about stress hormones and their impact on our ability to communicate with others, the thing I’ve been missing as a therapist—and that my own therapists have missed with me—becomes crystal clear.
Aha, I think, excitedly scribbling insights in my notebook. When my couples fight, they’re dysregulated, and my husband and I are, too.
My couples had been experiencing stress spillover so excessive it depletes their self- and co-regulation skills. They enter and exit our sessions with dysregulated nervous systems. Even as a trained marriage and family therapist, I’d never been given the tools to deal with the issue of effective nervous system regulation. This is why so many couples therapists—myself included—wrap up our sessions feeling exhausted and overwhelmed, unsure about what to do better to genuinely support our “difficult couples.” In fact, the couples I’ve been seeing haven’t been too difficult to treat. I’ve been the problem! Or, to put it more accurately, my lack of awareness has been the problem. Asking people to actively listen, show curiosity, offer affection, or problem-solve when they’re emotionally flooded isn’t helpful in the heat of high-conflict moments when partners feel threatened and grow defensive.
Madison and Laura didn’t need to summarize each other’s positions—they needed to take some deep breaths. My husband and I didn’t need to be lectured by a therapist on using I-statements and feeling words, we needed to learn to soothe our nervous systems at key moments.
Soothing Dysregulation
Over the past few years, I’ve shifted the focus of my work to helping couples do two things: soothe their dysregulation amid an argument and reduce their stress outside of arguments. In session, when I notice signs that one or both people are becoming overwhelmed, I encourage them to pause. I teach them to pay attention to their physiological reactivity. This is crucial. It’s the foundation of all effective couples work. Before we can do anything else—discuss date nights, make room for more appreciation, explore love languages, debrief after a conflict, repair a rupture—partners need to effectively regulate their physiological reactions and feel safe in their bodies. Their nervous systems need to transition into a more receptive state.
This nervous system regulation work might include asking a couple to go through a meditation with me or do a body scan. It might mean one or both partners leave the office to walk down the hall or get a glass of water. I’ve learned to monitor and track signs of physiological flooding since it helps me know when couples need to pause, self-soothe, move, or take a momentary break from therapy.
These signs include shallow breathing, audible inhales and exhales, hugging oneself, bouncing a leg up and down, looking away from a partner more than usual, a red face, a dry mouth, shut down mannerisms (like turning away or not speaking), a louder than usual or quieter than usual voice, threats (“I’m done with therapy!”), an elevated heart rate (which can be monitored by a pulse oximeter), muscle clenching such as a tight jaw, hands in fists, or tightly crossed legs. By tracking these signs, I monitor my couples’ anxiety and stress levels. This awareness guides me to coach couples to pause before they make things worse for themselves, and in offering interventions that match their needs.
I’ve developed a three-step protocol for helping couples navigate stress better: shedding, preventing, and adapting. Shedding involves taking inventory of your stressors and deciding which ones you could let go of. I invite couples to make a list of all their stressors, big and small, and consider what they can “shed.” Maybe a couple loves spending money on home improvements but decides it brings more financial stress than pleasure. As a result, they decide to take a pause on any home updates and save money, thereby creating a greater sense of peace. Or maybe one partner values a clean house, but the time it takes to clean up eats into their time together relaxing, which becomes a stressor. The couple might then decide to pay a service to mow the lawn or delegate dishwashing to a teen in their household.
The second step, preventing, focuses on predictable—and therefore, preventable—stressors. After a couple figures out what they’d like to shed, I ask them to explore a new area: the stressors they can prevent by mindfully establishing healthy routines and rituals. New routines and rituals can reduce the likelihood that a couple will forget who was supposed to take out the trash or who agreed to make a meal. Eve Rodksy’s Fair Play system is a great tool for helping couples get clear on who does what in their home.
Adapting, the third step in navigating stress, is about accepting that there are certain stressors we have no control over. Jobs are lost, promotions are accepted, injuries and illnesses occur, accidents happen—and we need to be able to deal with these events as best we can. Unpredictable changes—whether good or bad—can be challenging and have a huge impact on our physical, emotional, and relational health. When couples are facing stressors they can’t change or didn’t foresee, we talk about how they can adapt to new circumstances with the help of coping skills, and practice acceptance and self-compassion.
These days, I no longer doubt myself as a couples therapist when partners get upset in my office or threaten to end our therapy. Instead, I’m confident I can help them. When they argue about the details of their unmanageable daily lives, or become angry, reactive, or defensive, I share with them the impact of stress on us as individuals, and on our relationships. For most couples, this information provides welcome relief.
“So, it’s not us,” they often say. “That feels good to hear.”
“That’s right,” I respond. “Now I want to teach you how you can join forces to fight against your stress instead of against each other.”
Elizabeth Earnshaw
Elizabeth Earnshaw, LMFT, CGT, is a licensed therapist, supervisor, and author of I Want This to Work, ‘Til Stress Do Us Part, and The Couples Therapy Flip Chart. She’s also the founder and Clinical Director of A Better Life Therapy.
