It Takes One to Tango
You Don't Need Both Partners to Do Couples Therapy
In our first session, Lynn, a sullen looking 27-year-old, had plenty to complain about. Her husband, Jeff, had been extremely critical of late and seemed emotionally distant from both Lynn and their 18-month-old son, Jason. Lynn felt that Jeff spent too much time with friends after work and on the weekends, and when he was home, he constantly picked on her. With little help around the house, no assistance on the parenting front and virtually no affection from Jeff, Lynn felt desperately unhappy, Lynn longed ' for things to be the way they had once been. "We were better friends back then," she recalled. "We spent a lot of time together and it really didn't matter what we were doing, as long as we were together." I asked, "Lynn, when your relationship was more loving, how was Jeff different?" Without hesitation, she replied, "He was thoughtful and very sensitive to my needs. He had a great sense of humor and was lots of fun to be with." "And how were you different, Lynn?" 1 asked. "I was a much happier person back then, no doubt about it."
"When you were a happier person, how were you different with Jeff?"
Lynn admitted that, because she was so unhappy, she was "crabbier" than she had been in the past. "I guess I used to be a lot nicer to him." She offered a long list of endearing acts of kindness, like putting love notes in Jeff's lunches or calling him at work just to let him know that she was thinking of him. She often used to initiate lovemaking, something she never did anymore. After thinking about the "old Lynn," she wistfully admitted that she liked herself more back then and disliked the angry, resentful person she had become much of the time.
As Lynn described the problems in her marriage, the circular nature of her interactions with Jeff became apparent. Were Lynn's crabbiness and standoffishness a result of Jeff's long absences from home and/or his criticisms of her, or were Jeff's absences and critical tone a result of Lynn's moodiness and withdrawal from him? Knowing that the correct answer was probably "both," I suggested an escape route out of their marital merry-go-round. "Starting tonight, no matter what you're thinking or feeling about Jeff, act like the old Lynn. Do the things you used to do when you liked yourself more, and watch Jeff very closely to see how he responds."
When she returned for our next appointment two weeks later, Lynn was eager to tell me about her experiment with Jeff. Right after our session, he had come home in a grouchy mood and made a critical comment during dinner. But instead of getting angry and defensive, Lynn simply agreed. She said that Jeff actually looked up at her in amazement and that the rest of the meal went without incident. In fact, Jeff discussed a situation at work that had been troubling him, something he hadn't done in months. When Lynn offered her opinion, he seemed unusually receptive. Lynn felt encouraged.
Later that week, Lynn realized that they hadn't spent time alone for months and reminded herself that she used to be a "social coordinator" of sorts in their marriage, and that Jeff seemed to appreciate this quality in her. So, despite the fact that she wasn't completely certain of how things would turn out, she arranged for a babysitter and made dinner reservations at one of Jeff favorite restaurants. Their evening went extremely well and when they got home, they stayed up late talking.
In the days that followed, Jeff seemed more relaxed and less critical of Lynn.
Nevertheless, the time between sessions was not without its rough spots. On a couple of occasions when Jeff made inflammatory comments, Lynn responded in kind and the tension between them escalated. Although Lynn felt discouraged when this happened, she was beginning to understand how her actions during these tension-filled times impacted on Jeff's when she allowed her buttons to get pushed, their unpleasant interactions got even more unpleasant.
She also recognized that no matter what Jeff did or said, no matter how his comments or actions "made her" feel, she was still in control of how she responded. She felt empowered by this realization, and in tense situations asked herself, "What's my goal here? What do I want to have happen?" and then quickly assessed whether what she was about to do would achieve those ends.
I asked Lynn to rate how well things were going in her relationship on a 1 to 10 scale, with 10 being great and 1 being the pits. She replied, "Four weeks ago I would have told you 2. In these last two weeks, I'd have to say 7. Then I asked, "Where on the scale would you need to be to feel satisfied?" She said 8 or 9. So I asked "What would be one or two things that could happen in your relationship that would bring you up to an 8?" and she said, "He would have to say, 'I love you' again and we'd have to make love." I urged her to keep being the "old Lynn," and take note of Jeff's reactions. We scheduled a third meeting and she left.
Two weeks later a very happy Lynn greeted me at the door. "Well, it happened. We made love and right after we were done, he turned to me and said, 'Lynn, I really love you.' It felt great because he hasn't said that in a long time. I can't believe he's changed so much so quickly." Lynn described quite a few things she had done to maintain the changes and divert unnecessary arguments in the last few weeks. As she spoke, I felt confident that she understood the "magic" behind the "new Jeff." To help her plan for future challenges, I said, "You will undoubtedly hit bumps in the road in the future. If things between you and Jeff start to go downhill, what will you do to get back on track?" With a huge smile on her face Lynn replied, "I'd remember everything we talked about here that I got things on track all by myself the first time, and that I can do that again." Lynn's look of confidence was striking. That was the last I saw of her.
From my perspective, there is nothing remarkable about this case. I helped Lynn figure out what she needed to do differently to spark a change in Jeff and in their relationship, and assumed that a positive change in Jeff would be so reinforcing that it would be the beginning of a solution avalanche. It was Systems Theory 101 "A change in one part of the system leads to changes in other parts of the system." Yet, when I discuss Lynn's case and others like it in the workshops I give on solution-oriented therapy, working with one partner to elicit relationship change isn't as mainstream a practice as I once believed. Many therapists question whether Lynn's reports of change were real. Some worry whether, since Jeff hadn't participated in therapy, the changes will stick. Others argue that the burden for relationship change should not have been left solely on Lynn's shoulders. But the most burning question turns out to be the most basic "How is it possible to do couples therapy with just one partner?"
This question stems from the fact that many therapists define the type of therapy they practice by taking a head count: if one person is present, they're practicing individual therapy; if two or more people are present, it's couples or family therapy. I believe this is misguided the key to determining which brand of therapy is in use at any given point lies in the therapist's orientation and focus, not the number of people occupying space in the room.
Individual therapy and couples therapy are based on very different premises and require completely different clinical skills. Individual therapists delve into intrapsychic processes. They help clients gain insight into themselves, their family of origin and how these childhood experiences have impacted on their present behavior, attitudes and feelings. It is the individual therapist's belief that insight is the vehicle for change; that is, once clients understand why they do what they do, they will then be able to change.
Couples/family therapists, on the other hand, are focused on the observable connections between people in the here and now. They're interested in patterns of interaction what people say and do with one another. According to this theoretical orientation, change is brought about not by going inward, but by changing observable interactions among people.
Another reason some therapists can't fathom doing couples therapy with individuals is that they are trained to believe that relationship problems are best resolved by helping people identify, process and express their feelings to one another. With this perspective as a starting point, it's easy to see why one would be skeptical about the possibilities for positive relationship change when only one partner is present. Teaching active listening skills to just one person in the relationship is like listening to the sound of one hand clapping.
But couples therapy with individuals is based on different premises. Although good communication skills go a long way toward creating healthy relationships, talking things out isn't the only, nor necessarily the best, way to resolve recurring problems. While we are affected by what our partners say to us, we are also greatly affected by what they do. For instance, although Lynn had tried for months to convince Jeff to be more loving toward her, nothing she said ever made a difference. It wasn't until she stopped talking and started changing her actions that Jeff became more responsive.
There might be a familiar ring to Jeff's tuning out Lynn's words, but not her actions. During the last few years, we've learned a lot about gender differences. In particular, we've become aware that women, in general, are more verbal than men, who tend to favor action over words. That's why when women tell me, "I talk until I'm blue in the face" or "I've told him a million times," instead of teaching them new and better ways to express themselves, I encourage them to say less and do more. And, since women are much more likely to come in to therapy solo, teaching action-oriented techniques should be tops on therapists' lists of things to do.
The fact that action-oriented techniques may work better with women under certain circumstances is no consolation to therapists who feel that doing couples therapy with women is a bad idea because it places all the burden of improving relationships on women's shoulders. "Why should women have to dream up ways of approaching men? Why can't men take responsibility for finding more creative ways of reaching women?" This position, in my opinion, stems from a lack of understanding of the systemic laws governing change. Change is like a chain reaction. She tips over the first domino, then he changes. When a woman who is dissatisfied in her relationship decides to change her method of getting through to her partner, she isn't doing "all the work." Assuming responsibility for creating positive change in life isn't working harder, it's working smarter.
Despite my emphasis on the merits of this approach with women, it's important to point out that I practice couples therapy with men, with similar results. Even when the marriage teeters dangerously on the brink of divorce, there is much therapists can do when the man is willing to change.
For example, Ben's wife had asked him to leave the house a week before she filed for divorce. When he scheduled an appointment, he had moved out and was desperately unhappy. He didn't want their 20-year marriage to end and wanted to know if there was anything he could do to make her change her mind.
I asked Ben, "If your wife were here now, what would she say you've been doing recently in regard to your marriage?" He said, "She would tell you that I've been pressuring her all the time and that she can't stand it anymore. I've been calling her several times every day and begging her to change her mind. I've been reminding her about all the good times we've shared and have sent her flowers four times. I leave Hallmark cards for her around the house." I asked if this was working, and he said, "No, I've been making things worse."
I explained to Ben that relationships are like seesaws the more of something one person does, the less the other person does of it. "If you do all the longing for your marriage, it allows her to focus only on the bad points. If you are the emotional one, it gives her room to be cold and withdrawing. So, if you want her to stop pulling away from you, you're going to have to stop pushing her."
I then asked him, "What could you do or say that would make Lois sit up and take notice?" Ben responded, "I guess I should stop calling her every day. I should stop saying 'I love you,' because I know it only makes her mad. I should stop asking her if she's changed her mind." I told Ben that he was on the right track and wondered what else he could think of to turn things around. He said, "I'm always so depressed around her. I guess that's not too attractive. If I were more upbeat, and even somewhat enthusiastic about anything in my life, she would really be shocked. That would be noticeable instantly."
I sent Ben home with the following-instructions. "Start experimenting by changing how you act when you are in Lois's presence. Do all the things you discussed here today. When you do, one of two things might happen. The first is nothing. When you change, it might not make a difference at all. That's a real possibility. Or she might be intrigued by your changes and start to show some interest in being with you. But I'm warning you, if you get overly enthusiastic and try to get her to move along quickly, she will definitely back off. You must move slowly. Don't discuss the future of your marriage at all for now. And don't move back home until the issues that separated you have been worked out."
Ben was lucky. When he gave Lois some breathing room, she did show interest in revitalizing their relationship. It was a slow process and required a lot of support on my part to keep Ben from becoming impatient. But in the end, without having Lois ever come in for therapy, they resolved some long-standing issues and he did return home. As far as I know, they are still living happily ever after.
My couples work. With individuals can be broken down into three simple steps. First, I help clients figure out what they really want from their partners by establishing clear, concrete goals that always remain in our peripheral vision. I urge clients to talk about what their partners will be doing differently when the relationship is more satisfying. I help clients picture a new, more positive relationship by asking questions such as, "When you start to feel closer and more connected to your husband, what will he be doing differently?" and "If I were a fly on the wall, what would I see the two of you doing differently when your relationship improves?" I emphasize observable actions rather than subjective feelings, to help clients develop clearer signposts for change.
The next item of business is to help my clients become "solution detectives." I want people to view their relationships as a trial-and-error process: when there's a problem, they do something to solve it. They then should watch closely for the results. If what they do is working, they should keep doing it. If not, they should switch gears.
Although simple in theory, this is not so simple in practice. People get glued to their favorite problem-solving strategies, believing that whatever they're doing to improve their relationships is the right thing to do. In fact, they think miserable results often signal the need to crank the particular strategy up a notch, i.e., do it one more time, with feeling.
Once we establish goals, the third step is to investigate what my clients have done in the past to accomplish these goals. I want to access what's worked and what hasn't. A trademark of the solution-focused therapy approach is to ask clients about problem-free times or periods that are the exceptions. For example, I might say to a client, "Tell me, I know you've been fighting a lot lately, but there must be times when you get along better. What's different about the times the two of you are more at peace with each other? What does he do differently then? What do you do differently then?" We begin to weed through the frustration and anger provoked by the problems in their relationships and discover what can be learned from the times they get along well. As clients identify what's different about the times things go well, the solution comes into view. My clients can then begin to do what works the moment they leave my office.
Although analyzing the good times is uplifting and informative, I also want to know what hasn't been working. To help clients ascertain dead-end strategies, I ask, "If your partner were here now and you weren't, and I asked, 'What does she do that drives you nuts,' what would he say?" I show them how their actions, no matter how effective they "should" have been in theory, have, in reality, caused their partners to dig in their heels even further. In other words, I train clients to pay attention to "what is" as opposed to "how things should be." Once we identify what would constitute a new and different approach to the ongoing problem, I send clients home to experiment.
In contrast to therapists who question the value of doing couples therapy with individuals, this approach is often my method of choice for a variety of reasons. I find it can empower people by showing them that they no longer have to play the waiting game of "I'll change if you change first."
Instead, they find themselves back in the driver's seat of their own lives. This is no small feat, given the helplessness arid hopelessness people feel when their partners present impenetrable walls.
Secondly, working with only one partner allows me to both join with arid confront that person in ways that wouldn't be possible if the other partner were present. For example, I can let my client know how well I understand what he or she is feeling about the relationship or about the other partner. It allows me to connect with the person without alienating the partner. On the other hand, because I'm perceived as an ally, I am at liberty to be bolder, more challenging and, at times, less balanced than would be the case if the other partner were present.
Furthermore, working with only one partner can avoid the unfortunate "ping-pong effect" in therapy, whereby one partner escalates his point of view, triggering the other partner to do the same and so on, until they're completely polarized. It has been my experience that when seen alone, many people are quite willing to take a closer look at their partners' points of view, since they don't feel coerced or that they're losing face. Once they put themselves into their partners' shoes, they're usually more conciliatory. Working with one partner doesn't work all the time, even in less challenging situations. This method is not a therapeutic panacea. There are times when one person changes and the other doesn't notice or, worse yet, doesn't care. Sometimes the relationship changes aren't in the desired direction or of the hoped-for magnitude. Occasionally, your client won't stop blaming his or her partner long enough to switch gears. But nothing works all the time. When my clients and I aren't getting positive results, we try something else. Working with one partner is only a good strategy if it works.
In the spirit of sharing what's worked for me, I want to encourage the skeptics I've encountered, and those I have not, to do a few things. First of all, stop telling clients, "Unless he/she joins us, therapy won't work" or, "If your husband isn't willing to come in, it means he's not committed to working on your relationship." Some people who are totally committed to their partners wouldn't dream of stepping into a therapist's office. (My own husband of 20-something years happens to be one of them.) Ascribing negative intent to those who prefer to steer clear of therapy is unfair, often incorrect and almost always hurtful to those who wish their partners would share their enthusiasm about the benefits of therapy. They end up blaming their partners even more intensely.
Furthermore, make a commitment to temporarily suspend judgment about the viability of working with individuals on relationship issues. Therapists who agree to work with individuals whose partners won't come in, but see it as a second-rate approach, worry me. We clinicians communicate our presuppositions about people and how they change when we do our work. If we begin therapy with a "this is better than nothing" attitude, we undoubtedly broadcast a pessimistic message about the possibilities for change.
Instead, the next time you hear, "My partner won't come in," try viewing the situation as an opportunity rather than a relationship death-sentence. Act as if you expect your work with your client to be successful. The results might be surprising! A change in you might just be a powerful catalyst for change in your clients.
This article originally appeared in the September/October 1998 issue of Psychotherapy Networker.
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