In Consultation


In Consultation

Keeping Couples Therapy Upbeat

January/February 2018


Q: I often feel drained after a couples therapy session, and sometimes I sense the couples feel the same way. What can I do differently to make the experience better?

A: Doing couples therapy isn’t easy. In fact, there was a time, many years ago, when I’d leave my office and wonder if I was being paid enough to endure what felt like soul-sapping work. The hurt, the blame, the accusations—the fact that many couples couldn’t even agree on what was black and what was white—left my head spinning. I wondered if it was just taking too much out of me and I should instead focus on individual and child/family work. Fortunately, I hung in there and developed new methods, and variations on old ones, that have made my work with couples not only enjoyable, but most importantly, much more effective.

So how did this evolution occur, and what do I now do differently? First, I realized that one of the most distressing aspects of the work for me was when a couple left the session—even one I felt was particularly good—feeling discouraged or overwhelmed. Though most of my clients felt closer for having worked through some difficult feelings, it wasn’t uncommon for couples to also feel depleted and worn out, as if they’d been through the ringer.

Occasionally, despite my making sure that the session wasn’t about complaints but wishes, longings, and the dysfunctional cycles that both partners unwittingly got caught up in, one person would continue to feel that the work was all about the other’s dissatisfactions. Or at the end of the session, one partner would say something like, “We were doing okay until we came here today.” Or a person prone to feeling criticized might start the session by saying, “I’m nervous every time I enter this office because even though I think we had a good week, I find out that she doesn’t see it that way.” Others saw couples therapy as looking at the glass half empty instead of half full, reinforcing their spouse’s tendency to cling to old hurts.

In many such instances, I felt that the person wasn’t accurately describing our sessions, but that was irrelevant. As a therapist, I wanted to believe I was helping people feel better, and it was disheartening to hear the opposite. I knew I couldn’t prevent these kinds of reactions every time, but I wanted to do better: I wanted couples to leave sessions feeling that they’d accomplished something, and that the work hadn’t been arduous. I wanted them to be more optimistic when they left my office and to look forward to our next meeting. And I wanted to do this without minimizing or glossing over the extreme problems and dysfunction that often lead couples to seek help.

Perhaps this was a tall order, but I was determined to try. As it turns out, it was more achievable than I’d anticipated. Now, almost everybody who sees me for a first session wants to continue the work, and more importantly, it’s rare for anyone to drop out of therapy or hang in there with a suffering attitude. Plus, the changes I made in my way of working can readily be incorporated into any theoretical approach to couples therapy to instill hope, combat demoralization, and increase each person’s motivation to change. And as we know from research, hope is one of the essential ingredients for a successful outcome in couples therapy.

A Positive Start

My first goal became to make the initial visit a positive experience and convey that the work would be as much about the strengths in the relationship as it would be about what needed to be worked on. Most couples therapists aim for this, but the tweaks I applied to what I’d customarily done have made a big difference in making that goal achievable.

First, I’m now explicit with clients about what I call the occupational hazard of couples therapists, explaining, “It’s easy for therapists to focus so much on a couple’s difficulties that we forget about the things in the relationship that go well.” I then lay out the structure of the first meeting, saying, “To make sure that I really get the whole picture of your relationship, and not just your problems, I like to spend just 10 or 15 minutes getting an idea about the difficulties that brought you here, and then put those on the back burner. At that point, I like to use the remaining time hearing about what used to be good in your relationship and what might still be okay.”

Of course, finding out about what drew the couple to one another is standard procedure for couple therapists. But I started spending a much larger portion of the first session on that topic. Now, I’ll ask the couple to elaborate on the qualities they each described. If someone says, “he was very supportive,” or “we had the same values,” I’ll ask for an example to give me a fuller sense of what that person meant. Or I’ll ask questions that might result in more depth, such as, “As you got to know each other, what made it go from just having fun to feeling that you could go forward in life together and be partners in the inevitable ups and downs of the future?”

Often it’s been years since partners have heard each other speak positively. And sometimes they’ve never heard their partner articulate what traits they’d noticed and deeply valued. Generally, each person is deeply touched by what the other says, and for a few moments, they’re able to access loving feelings that may have been deeply buried for a long time.

After hearing what had drawn them to each other in the past, I’ll ask them if they ever still see any of those same qualities or have any of the same experiences with each other. Frequently, despite the negative feelings they may have mentioned at the beginning, they respond almost incredulously with “yes, of course, I still think he’s very funny,” or “yes, she’s incredibly loyal,” or even “yes, we can still go out and have a really good time together.”

Most couples think that therapy will be about venting their complaints and enlisting the therapist’s help in getting the other to change. One of my goals in a first session is to dispel this misconception and plant the seed of a way of working that’s likely to be far more gratifying. To this end, I often state, “Though our initial goal is to help you get along better and repair the hurts that have resulted in a frayed relationship, given what you’ve each said about what it was like between the two of you when things were good, I’m hoping I can also help you feel happy and lucky to be together. To get to that point, we’ll eventually be talking much less about the arguments and patterns that are making you so unhappy, and more about what you’re longing for from each other.”

Last, to dispel concerns that the work will be about faultfinding, criticism, and accusations, I ask them each to “think about what you know about yourself that makes you not the easiest person in the world to live with.” This simple inquiry packs a lot of punch, setting the tone for self-examination, rather than blame. Often people are eager to respond right away, but even so, I’ll encourage them to give it some serious thought, and I’ll return to it in future sessions. I tell them, “We all bring particular sensitivities and some not so great characteristics to relationships. These could be having a quick temper, or a particular reactivity to being told what to do, or closing off when worried about something, or holding a grudge. I’m not talking about things that your spouse, or even other people, might have said about you. I’m really interested in what you actually know about yourself.” The beauty of this question and subsequent self-examination is that neither the partner nor the therapist is pointing out the personality traits that contribute to the couple’s difficulties: instead, each person becomes the expert on himself or herself.

Choice Points

It’s all well and good, you might say, to look at positives in the first session, but how on earth do you continue to do that when couples seeking therapy are filled with painful emotions? Often they’re profoundly hurt, furious, and alienated from each other, and one session of focusing on more positive feelings in no way undoes the feelings that led them to seek help.

The key to continuing to locate and build on strengths lies in becoming acutely aware of just how many opportunities you have to influence the direction of the work. Virtually every statement uttered in a session presents the therapist with numerous decisions about what to pick up on. In choosing which path to take, I keep in mind that my intention is to facilitate some healing in each session. Perhaps you’re thinking, Of course, isn’t that obvious? But all too often therapists, especially ones trained psychodynamically, see their job as uncovering unarticulated or unconscious motives and getting at the deepest—and usually darkest—recesses of the psyche. Many therapists believe that things need to get worse before they get better, and however relevant that idea may sometimes be for work with individuals (frankly, I’m skeptical), it’s almost certainly an impediment to good couples work. So I’m always looking for moments that enable me to give positive feedback, shift the focus from criticism to wishes or yearnings, and foster self-reflection instead of blame.

Often there are implicit positives in statements in which the main point is anger, disappointment, and hurt. With practice, therapists can learn to pick up on the strengths that are embedded in painful emotions. It’s not that therapists should ignore the main point of what’s being presented, but that they should also notice and comment on other dimensions. It takes conscious effort to find the kernels of good interactions that can exist despite, or side by side with, the dysfunctional ones. Here’s an example of starting a discussion by focusing on the part of a statement that has the best chance of leading to some healing.

Joe, the husband, said, “I tried to talk with her about my day. That’s what she says she wants. So I gave it a try, and told her about how my boss had hassled me at work. Just as I thought would happen, within a couple of minutes, there was a distracted look on her face, and she said, 'Hold on, I just want to respond to my boss’s email.' I was really pissed off and needed to cool down, so I walked out—actually, I slammed the door and said, ‘Fuck you” as I left. Instead of apologizing to me, she said I was making a big deal out of nothing and was furious that I cursed at her. She can’t hear about anything that I’m upset about because she gets so anxious. Later, we had dinner and watched some TV together. She asked me about work again, but I didn’t want to talk about it. I’m not falling into that trap again. It’s bullshit that she wants more openness. Well, I think she believes that’s what she wants. But really, it’s pointless.”

A statement like this presents many obvious subjects that need to be discussed: the husband’s upset about what he experiences as his wife’s unavailability, his temper, her anxiety, what they’re each wishing for from one another, how in the future they could handle it differently. But before going into any of these topics, I needed to look for something in the statement that would enable me to start the conversation with a positive comment.

So I could say, “We need of course to understand what happened, but before we do that, I just want to mention that I’m struck by how, after what was clearly an upsetting interaction, you had dinner and watched television. You both didn’t let it escalate, and you found a way to reconnect, rather than withdrawing from one another. That’s not easy to do; it’s impressive.”

Another response that might foster self-reflection and individual responsibility would be to tell Joe something like, “Before we get into more detail about what happened, I just want to mention that I’m struck by your effort to calm yourself down. Despite your outburst and loss of temper, you did get yourself calm enough to be able to have dinner and watch TV without revisiting the argument.”

In the past, when Joe had stormed out of a room, his wife would follow after him and insist on talking, thereby inflaming him and interfering with his attempt to control his anger. So I might also point out that they were both trying hard not to escalate things—she by not pursuing him, and he by trying to calm himself down. Again, noticing these positives isn’t meant to downplay the hurt, anger, or problematic behaviors that the couple is revealing and discussing. Rather, these are asides, short detours that give them a pat on the back and make them feel good about themselves.

Being Generous with Praise

The use of compliments or positive feedback plays a big role in my work. Recognition of something the individual or couple is doing well or is getting better at is an extremely effective method for getting the best out of people. It also dramatically increases the couple’s tolerance for addressing pain, disappointment, and anger. When couples leave my office, I want them to remember some nuggets of praise. I’ve found that the more generous I am with authentic appreciation of each individual and their interactions as a couple, the happier we all are with the work.

Additionally, the well-known motivational tool of “catching people doing something right” is useful in getting the couple to have productive interactions in the moment. For instance, as the couple starts to talk about something difficult, I might stop them and say, “I’m struck by how you’re each trying hard today to listen nondefensively.” Or if one of them starts a discussion about anger or upset with a soft opening, I’ll interrupt for a moment and say something like “I’m struck by how you’re doing exactly what the research has shown to be a crucial element in effective communication between couples.” Or if partners who are often adversarial with one another are doing a little better at brainstorming instead of defending their original positions, I’ll stop them before they lapse back, and acknowledge how hard they’re trying to communicate in a collaborative manner. It’s the rare person who doesn’t respond well to approval, but this must be done with a light touch: making too big a deal of it can backfire, as it’ll sound inauthentic and undeserved.

You may be thinking, what if the couple hasn’t experienced any positive changes in their typical manner of interacting? That may sometimes be the case, but usually after a few sessions, couples have at least some brief moments when they’re interacting in new ways with one another. After all, they’re seeking therapy together because they want things to go better, and as they see sessions being about self-reflection and longings, rather than criticism and blame, they begin to break maladaptive patterns. If therapists have a mindset that looks for progress, they’re likely to find some instances of the couple taking small steps in the right direction.

It’s helpful to highlight changes each individual is making even when he or she isn’t quite aware of it. If a partner has described himself as not being good at talking about his feelings, pointing out moments when he’s expressing himself well encourages him to try harder and to begin to think of verbalizing feelings as a less risky endeavor. Or if someone who doesn’t usually acknowledge the part she played in an argument is a bit more open, the therapist can make an appreciative comment that may encourage even more nondefensiveness. It’s important, of course, to offer this type of recognition without emphasizing that in the past she has been defensive, because the compliment is then likely to be overshadowed by the implied criticism. Instead, the therapist could say something like “You’re being so open today. I wonder what’s enabling you to do that? Is your husband doing something differently so that it feels safer to be open to his criticisms?” The point is to look for moments that are going right, rather than wrong, and to reinforce those slight changes in a positive direction.

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I’ve emphasized here the things therapists can do to sprinkle positives into each session so the work is more pleasurable for everyone. But crucial to feeling good about the work is accomplishing something in each session. I’m not just “making nice.” Staying focused—not letting one topic morph into another and yet another—is essential. So, too, is keeping in mind the problems the couple came to therapy to solve, even when the conversation is strategically pointed in other directions. At the end of each session, I sum up what we did that day and what they’re going to try to work on before our next meeting. And if at all possible, as they get up to leave, I end the meeting with some additional positive feedback, like “We got off to a rocky start, but there were a number of moments when you showed real empathy for each other.” Again, you may be thinking, but what if there wasn’t much that was positive? I have two answers to that. First, if you incorporate some of what I’ve described, you’ll find that sessions will go better. And second, you need to cultivate an attention to the positives. Seek, and you shall find!

***

Ellen Wachtel, JD, PhD, is in private practice and gives workshops at home and abroad. She’s the author of We Love Each Other But… as well as a new book for therapists, The Heart of Couple Therapy: Knowing What to Do and How to Do It. Contact: wachtelellen@yahoo.com.

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