“One more thing,” Sarah said as we were wrapping up. It was my first session with her and her husband Mark, and we were meeting over Zoom.
Sitting together on their living room couch, Sarah and Mark had just spent the hour describing the unhappiness in their relationship. Sarah had cried about how detached and distant Mark had seemed since his mother passed away four months earlier. He was spending multiple hours a day playing video games. Mark felt that Sarah was being overly critical and demanding of him, which he found insensitive given his recent loss. He was also upset that for a year they’d rarely touched or had sex.
“What should we do now, for the rest of the night?” Sarah asked me. “We don’t have enough space in the apartment to be alone, so how should we interact?”
Pre-pandemic, couples sometimes asked if they should talk about therapy between appointments, but this was a different situation. After our session, this couple wasn’t going back to separate offices or running to workout classes; there was no subway ride or walk home during which they could decompress or recharge. On that cold February night, neither of them was going to be able to “get some air” after our intense session. They’d have to sit on that very same couch for the rest of the evening.
Since the pandemic began, many of us have been meeting with clients virtually, peering into their lives through the window of a screen. But what happens when the Zoom call ends, the laptop closes, and clients are left to deal with raw, complicated feelings in close proximity to the very person whose presence stirs up those feelings? Negative post-therapy interactions can add salt to newly exposed wounds, which may slow down progress or discourage couples from continuing therapy altogether. While the end of the pandemic is hopefully in sight, teletherapy seems here to stay. That means that guidance about post-therapy interactions will remain critical to how our clients integrate their work in therapy into their lives and relationships. It’s important that we explicitly provide strategies to our clients.
Couples facing different challenges can benefit from different strategies post-therapy. High-conflict couples may need as much space as possible post-session and should be encouraged to not talk about what happened in therapy, because they may not yet have the skills to diffuse conflict. Post-therapy “alone time” is also a great opportunity for high-conflict couples to practice self-regulation and self-soothing. This could include reading, journaling, stretching the body, or any other solo activity.
Disengaged couples, on the other hand, may benefit from having a reflective conversation after each session to build intimacy and connection. One couple I worked with, Trevor and John, who had been drifting apart for years before getting help, agreed to have dinner together after therapy, without the usual accompaniment of the television. Over dinner they would each share three main takeaways from the session.
Alternatively, pursuer-distancer couples may gain from the distancer in the relationship initiating a joint activity after therapy, such as exchanging shoulder massages or looking at old pictures together.
Of course, each of these strategies is especially difficult for these couples to pull off! If a distancer knew how to suggest a joint activity, or high-conflict partners knew how to walk away, they probably wouldn’t be seeking our help in the first place. This is why we need to be explicit when talking with clients about post-therapy interactions. Without a plan for when the session ends, couples may fall into the very patterns they’re trying to avoid and lose hope and confidence in their relationship.
Here are six ways to help couples plan for their post-teletherapy feelings:
Bring it up. For new clients, raise the topic as part of early administrative or treatment planning conversations. You can explain that what goes on after therapy is as important as what goes on in therapy, and that this is especially relevant to discuss in the context of teletherapy. For couples you’ve been seeing for some time, ask about their habits after therapy sessions to learn what’s working for them and what isn’t, and to help them develop alternative strategies where needed. When I revisited the topic with Sarah and Mark during their second session, they came up with a plan to watch Netflix together after therapy—a comfortable activity that made them feel like they were on a “date night,” albeit one that required minimal interaction.
Facilitate an agreement about post-therapy interactions. A clear agreement about what to do after online therapy gives couples one less thing to worry about or clash over. It’s also an opportunity for couples to practice making agreements and sticking to them. You can share with clients what you’ve observed of their relational style (high conflict, disengaged, pursuer-distancer), and provide suggestions for post-therapy interactions that may not be intuitive to them. For example, you might ask the distancer in a pursuer-distancer couple to make a list of joint activities to choose from to initiate post-therapy. If a couple is communicating well enough, it can be a useful exercise for them to spend some time during a therapy session to formulate their post-therapy plan together. You can also ask couples to create their plan as a homework exercise. A couple that is struggling to communicate may require more specific instructions. For these couples, it can be helpful to do an in-session role play of how they’ll interact when the session closes, and provide coaching as needed. Here, I ask couples to pretend that the session has finished and I’m not there. This provides an opportunity for me to give constructive feedback (“try it again with a gentler tone”) and for them to practice communication skills.
Help clients get creative with post-session rituals. Rituals are a great way to transition from one space (literal and metaphorical) to another. You can encourage couples to design a post-online therapy ritual, such as taking ten minutes for a debriefing conversation, listening to a song together, making tea, or each having a bath or shower. You’ll notice that all of these incorporate some form of self-care, which is a good way to phrase it to couples when brainstorming ideas. Rituals are a point of connection, so even if their post-therapy routine involves being alone, it’s still connecting for partners to have a mutual understanding that “this is what we do” post-therapy.
Pick an optimal day and time to meet. Does the current appointment slot allow the couple time for their post-session ritual or routine? Would an earlier session give the couple a better chance to be alone afterward? Should a Friday evening session be avoided so the partners aren’t stewing over the weekend? There won’t always be a choice about therapy session timing (especially when kids are involved, and therapists’ schedules are packed) but teletherapy often makes things more flexible.
Give options for dealing with uncomfortable post-session feelings. Crisis or not, being in couples therapy can bring up difficult thoughts and emotions, which is particularly challenging when partners are with each other 24/7. One couple, Shelley and Michael, who were getting over an infidelity, had a ritual of hugging after online therapy before going separate ways to “process,” but their ritual went out the window when we had a session in which Shelley brought up ending the relationship. They continued to argue in their tiny Manhattan apartment for the rest of the day. It took weeks before either of them was willing to be vulnerable with each other in session again. I recommend providing couples with supportive resources, in case their usual plan isn’t effective.
To manage post-session discomfort, strategies that clients can use include:
- Writing stuff down. Clients can note their worries and struggles in a journal or on their phone and bring it to the next session if they wish, or they can discuss it together at a time of the week at which they’ve both agreed to talk about their relationship.
- Visualizing a “therapy box.” Partners can use their imagined box or container to safely store thoughts and feelings that come up, to create a sense of containment. We can open and explore the box together in session.
- Practicing mindfulness. I share mindfulness resources with couples such as guided meditations and breathing exercises, and suggestions for mindfulness apps (e.g., Headspace, Calm) to support them between appointments.
- Emailing me. I’d rather clients rant to me over email than take their anger out on their partner and potentially damage their relationship. Eileen and Paul came to couples therapy with the presenting problem of Paul’s alcoholism. Simultaneously, Eileen was working on her anger and was enrolled in an anger management course. When Eileen felt enraged at Paul (about once a week), I asked her to free-form her thoughts and feelings to me in an email. I let her know in advance that I don’t provide therapy via email or send lengthy responses, but that I would read what she sends, and that we can discuss it when we next meet.
Review and revise post-therapy agreements. If all goes well, post-therapy routines may change. Check in with couples to see how their routine is going and provide an opportunity for them each to express if they want to try something different. One couple I worked with had a ritual of meditating to calm down after our online sessions, but once tensions dissipated in their relationship, they decided to take post-session walks together instead. If a post-therapy agreement isn’t working for a couple, it’s important to explore why not. If one or both partners aren’t complying, the agreement may need to be revised, or there could be some work to do on motivation and commitment to the therapy process.
When couples experience an effective post-therapy interaction, the therapy work continues well beyond the time limits of a session. Clients begin to experiment with new ways of interacting, without the therapist being there, which deepens their connection and makes changes more sustainable. Plus, these tips help our well-being as therapists, because both we and our clients can relax in the knowledge that when the session ends, even if in the midst of a heated debate, the couple has a clear game plan of what to do next.
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Talia Litman, MFT, is a marriage and family therapist and author specializing in couples and sex therapy. Contact: taliamft.com
Photo © iStock/Ridofranz
