Thank you to everyone who responded to our January Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
January Quandary: I’m seeing a couple in which one partner is clearly disengaged in therapy. She shows up and says she’s interested in improving the relationship, but it seems obvious that she’s not willing to put in the work. Even in an individual session with her, in which I shared this observation, she maintained her stance. I’m at a loss for how to help them. What should I do? Has anything specific worked for other therapists in this position?
1) Focus on Goals
In my therapy practice, I don’t usually ask couples how hard they want to work on their relationship because the focus needs to be on specific aspects of their relationship they want to work on. When there’s an imbalance in a relationship, like there seems to be in this one, I take a very pragmatic approach.
First, I ask each partner to write down how committed they are to the relationship as it stands right now on a scale of 1 to 10 (10 being the most committed). I collect both responses and reveal what each partner wrote. This leads to a frank discussion about the relationship as it exists in the present.
Next, I ask both partners, "What would you need to bump up your commitment level up a number?" This leads to a discussion about what, specifically, might be helpful to the future of the relationship. It also helps each partner imagine what might make their current situation better.
Then, I meet with each partner individually to work on how they can achieve what they’d want to in the relationship. I also discuss personal goals and make sure partners know how to differentiate them from goals for the relationship.
Finally, I bring the partners together to work on improving the quality of their relationship based on the information we’ve collected.
Asking partners for practical, specific information on what is and what could be engages them in a relationship that they jointly rework to meet their needs. They do the work, I just witness the growth and development.
David Mensink, PhD, RPsych
British Columbia, Canada
2) Individual Time
It’s apparent to me that in this example, one partner is overly invested in either rescuing the relationship or trying to mold themselves into what the other person wants or requires.
My sense is that it's best to take aside the person who’s fruitlessly putting all the work into couples therapy and suggest individual therapy, where he could focus on himself for a bit and work through why he’s chosen to stay in this relationship or what it might take for him to leave it.
From what’s described here, it’s not a stretch to say that the disinterested woman seems narcissistic in her noncommitment to helping repair the relationship. I’ve found a number of things that may be responsible for narcissism that deters a client from participating in therapy.
For one, this client could be working through some sort of personal shame, in which case I’d also suggest that she come in for an individual session. Research shows that shame contributes to apathy and a lack of engagement, which could also be responsible for her apparent disinterest in therapy.
In our one-on-one sessions, I’d use a respectful, inquisitive tone to express just how hard it must be to be seen as the difficult, noncompliant partner in therapy. Maybe she feels unworthy, incompetent, weak, unlovable, or remorseful. These are all feelings we’d explore in more depth before we return to sessions with the other partner.
Bonni Johnson, counselor
Johannesburg, South Africa
3) A Void Contract
I think the problem here isn’t what you should do as this couple’s therapist,. There’s an implicit three-way contract here: these partners are working with you in couples therapy. Since it’s clear that one partner is clearly opting out, then there isn’t a proper contract between the three of you. You cannot help them, as one partner isn’t participating.
At the start of the next session, assuming both come, I’d say something like, “While she might have said originally that she’s interested in improving the relationship, she doesn’t seem to be acting on that statement. She doesn’t seem to be engaged in couples therapy at all. She seems to just be showing up and, in effect, paying lip-service to the whole concept.
Depending on the reaction, I might follow up by adding something like, “Therefore, the therapeutic contract is, in effect, void or just not working. Unless she agrees to explore her resistance to change, or to engage properly in therapy, or state her point of view much more clearly, there’s no real point in continuing.”
You could add something like, “Maybe I’m not the right person for her,” or suggest that the other partner could see you individually while she could see another therapist individually. Or, you could advise that they find a couples therapist who they both think would be a better fit. If the partners don’t both resolve to work with you then and there, either separately or together, it’s best that you suggest they terminate therapy with you.
I’d also strongly suggest that the therapist take this issue into supervision: What might be happening with him or her? What might he or she be projecting? Is there some sort of parallel process or countertransference going on?
Courtenay Young, UKCP, EABP, and EAP-registered psychotherapist
4) Slow Down
I’ve got two hypotheses about why the woman leaning out may be behaving this way. One, she could have emotionally left—or be in the process of leaving—the relationship, but she’s not yet ready, consciously or unconsciously, to split completely. Two, the partners could just be using the therapist to keep the marriage together for the time being, despite knowing it’s doomed to fail.
The risk here is that the therapist could be seduced into joining with the partner leaning in to change the other partner’s position. However, my suspicion is that this will only make her more disengaged. If she’s been able to resist her partner’s requests to help improve the relationship, she’ll likely have no trouble resisting the therapist as well.
In this situation, I might simply hold the space without expressing any need for change. Each partner holds equal authority, and my task is to provide a safe space for them to express their thoughts and feelings for as long as they see fit. At the beginning of each session, I’d ask what agenda each partner wants to cover, then facilitate a balanced dialogue, maintaining a focus on each partner’s equal power in, and responsibility for, the relationship’s survival.
Alternatively, I’d share how impressed I am with the fact that they’ve been able to maintain a well-balanced, albeit painful, relationship. Then I’d say something like, “I think there’s a wisdom here that I don’t yet understand. I sense that this is the best option for your relationship right now. So maybe it’s important to not make big changes, certainly not quick ones.” From there, the goal in therapy becomes to explore the wife’s resistance rather than make a rash decision.
Doug Sotheren, MTh, BA, DipRE, CCAA
East Gosford, Australia
5) Widening the Lens
In this therapist’s position, I’d first ask myself if I’m having any countertransference issues with the disengaged client. Is her lack of response making me upset? If so, is it getting in the way of the therapeutic relationship? I ‘d also ask the client and her partner if there’s anything that I, as the therapist, am doing or not doing that could be contributing to their lack of progress.
Assuming there’s nothing in particular that they’re concerned about, I might mention that as much as people want to work to improve their relationship, sometimes their busy lives get in the way of setting aside the necessary time and effort to work on it. Are there any obstacles in terms of family—say, children or in-laws—or work obligations that could be getting in the way?
Next, I’d conduct a motivational interview with each partner to determine where they are on the continuum of change. Their answers would guide my work, as each partner may be at a different stage of readiness to change. I might also consider doing a brief screening assessment with each partner to rule out any depression or anxiety that may be interfering with efforts to improve the relationship.
Donald Zappone, LPC
We'll post a new response to each Clinician's Quandary on the first Tuesday of every month! See how to submit to next month's Quandary here.
February Quandary: I’m treating Mark for anger issues, and find myself getting extremely reactive when he loses his temper in therapy. During our last session a few days ago, he called me “a joke” and stormed out of the room. I want to stand up for myself when he says things like that, but I don’t want to derail our work. Has anyone else faced something like this? What can I do to better manage my own emotions and help him?
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