Tools for Managing Effective Couples Therapy

Bringing Struggling Couples Out of Their Comfort Zones

Ellyn Bader and Peter Pearson

With the help of fascinating advances in brain science in recent years, we now know that people are neurobiologically interconnected with a speed and intricacy far beyond what psychotherapists--those presumed experts on relationships--once imagined. We've learned how easily one partner's tone of voice can trigger the other's amygdala, how the mirror neuron system can instantaneously shape our ability to grasp each other's inner world, how few of the countless implicit messages passed between people in any interaction are conveyed by language or even become conscious.

So here's the question for clinicians: if we now recognize how inescapably relational and interconnected people are, why do most of us continue to work primarily with individuals--most of whom grapple with serious, persistent problems in their intimate relationships?

Part of the reason, of course, is that so many clients themselves avoid couples therapy. Sometimes they resist because they aren't motivated, or because they fear the unpleasant things their partners might say about them. Often they resist because they want to avoid the unwelcome challenge of self-confrontation that accompanies hearing their partner express dissatisfaction with them and their relationship. Besides, why should partners risk exposing their deepest vulnerabilities with the very person they may see as the cause of their emotional struggles?

By contrast, individual therapy seems like a safe haven. Clients want, and usually get, plenty of empathy from their therapist, and they don't have to share this special relationship with anyone else. They have the freedom to work on issues that they select, on their own timetable. If they aren't ready to deal with a problem--a struggle with selfishness, deception in an intimate relationship, addiction--they can simply minimize it, or never bring it up at all.

How do we construct a bridge of understanding between people who may disagree hotly about what's wrong, resist self-awareness in the service of blaming each other, have unequal motivations for change, and continue to be terribly unkind to each other? Being an effective couples therapist requires us to develop skills we may not come by naturally and to spend a lot of time feeling unsure of our capabilities.

Fear of Inflicting Pain: Ellyn's Experience

When Tom called for an appointment, he told me that he and his wife, Betsy, were just having a few communication problems. As their first session began, Betsy described a 30-year marriage in which she felt shut out by Tom's tendency to "space out" and spend a lot of time away from the house.
"Tom," I began, "what do you think your anxiety is telling you?"

He replied, "I've been anxious for years, especially when I get into bed at night. Now, since we decided to get therapy, I barely sleep at all. She thinks I have an intimacy issue."

I turned to Tom. "Sometimes spouses are afraid to grow and change, while other times they're afraid to reveal something painful," I said to him. "I wonder which of these is more true for you?"

At this, Betsy sat up straighter and looked directly at Tom, who grew silent for what seemed like an excruciatingly long time. Still he said nothing. He appeared to be deliberating whether this was the time to wreak havoc on his marriage. My dread was mounting and I imagined his was, too. Finally, he said, "The last thing I'd ever want to do is hurt Betsy."

I nodded. "You deeply value the friendship you've created with her," I said. "Are you concerned that you might say something that will hurt Betsy or lose something meaningful?"

Eventually Tom revealed what he'd been struggling to contain: he didn't want to be married to Betsy anymore. For years, he said, he'd given up his desires for long backpacking trips into the wilderness, returning to Wisconsin to live on the lake where he'd spent his childhood, and leaving the business world to become a chef.

Betsy began to weep uncontrollably. "I thought you were finally coming to therapy so we could get some help," she sobbed. Tom slumped in his chair, rubbing his face with his hands. I sat with them in the rawness of the moment. I was watching a dream being crushed, and felt I'd somehow helped to trigger its destruction.

Over the next few months, I'd witness more heartbreak and raw emotion as Tom finally dropped another bombshell: he'd realized that he was gay and had secretly begun to explore relationships with men. He'd been wrestling with his gayness for years, fearing rejection from his kids and friends.

Over time, we continued to slog through the grief and sadness of ending their marriage. They did eventually divorce, but with hard work, they preserved much of the good from their marriage, and I've since watched them share weddings, graduations, and grandkids with mutual kindness and good spirits.

Before beginning my work with couples, I had no idea how much could suddenly be at stake in a single session. I hadn't become a therapist to inflict pain, but I've since learned that sadness, anger, shock, and disillusionment can be part and parcel of therapy with couples in serious trouble. Good couples therapy sometimes hurts.


Make no mistake: in our work with couples, we sometimes feel like we're bringing a water pistol to a gunfight. But more often than not, we get inspired by couples who make the difficult journey, falter, stumble, and rise again--just as we therapists do. When they express difficult truths with loving honesty, it gives us the courage to keep stretching ourselves, and in a profession in which burnout is a prime occupational hazard, perhaps the only feeling that we rarely experience in our work with couples after all these years is boredom.

This blog is excerpted from “Facing Our Fears." Want to read more articles like this? Subscribe to Psychotherapy Networker Today!

Topic: Couples | Anxiety/Depression

Tags: addiction | amygdala | brain science | communication problems | counseling | couples therapist | divorce | emotion | empathy | relationships | therapist | marriage | love | partners | burnout | practice | sessions

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