Quandary: I just started seeing a couple for therapy, but getting one partner to engage in the process has been difficult. It’s clear that therapy wasn’t her idea, but her partner’s. How can I find leverage when one person’s not fully on board?
1) The Compliment Sandwich
Resistance in therapy is always difficult, but with the extra variable of a partner in the room, it can feel even more challenging. For therapists, lots of fears can surface: Will I alienate one partner while aligning too strongly with the other? Should I focus on “fixing” the one person’s resistance, or sitting with the couple’s general discomfort about being here?
When one partner isn’t on board with therapy, I sometimes take a classic “compliment sandwich” approach, addressing the more resistant partner directly by naming and normalizing their hesitancy, perhaps by saying something like, “Many couples have mixed feelings about being here for the first time; it’s understandable you’re not on the same page.” This can be both disarming and positively reinforcing. It also sets me up nicely to ask the other partner how much it means to them that their partner showed up in spite of being so resistant. A compliment can mean a lot coming from a therapist, but it holds even more weight coming from a partner! I might also add that showing up together really shows a lot of care and respect for the relationship.
From there, I’d get into the meat and potatoes of the session by using the couple’s here-and-now feelings as a teaching moment. I would ask if there are other times when the hesitant person feels like they’re not on board with their partner’s suggestions but feels pulled along for the ride anyway. Is that causing resentment? Do they feel able to express their needs to their partner? What would it look like if their partner understood where the resistance was coming from? Even if the couple can’t answer some of these questions right away, I might be posing a completely new line of thinking that validates their struggles outside of the session. More importantly, an open discussion can give hope that these are issues they can work through in therapy.
As my last positive send-off, I would reframe the partner’s hesitancy as a major strength, explaining that showing up in session, however they may be feeling, will eventually be an asset to their communication and their partnership.
Kara Lissy, LCSW
New York, NY
2) The Magic Wand Question
This is a very important matter for couples therapy. I’ve encountered it many times in my own practice. Short of doing cartwheels and headstands, I recommend the following interventions.
First, I’ll engage each person in conversation about anything but their relationship. For example, I’ll ask both partners about their work, their family of origin, their treasured moments, and so on. This can be helpful to get both partners “in the room.”
Second, I ask each partner the following question: “What would your partner say is amazing about you, what would they say if they were bragging about you?” This lightens the atmosphere and gives a chance for each partner to brag about themselves in the guise of their partner’s words.
Third, I ask both partners what I call “the magic wand question”: If a fairy who could grant all your wishes came up to you with a magic wand and asked you what a perfect relationship would look like, what would you say? This helps me understand what goals I can set for their relationship and brings both partners “into the magic.”
Fourth, when we get to the issues and points in need of change, I focus on both partners, not just one. This avoids blaming and makes both partners more likely to identify what might work for both of them in the future.
Finally, I positively reinforce any degree of participation, especially from the reluctant partner. Both partners need to know my deep gratitude and appreciation for their participation, which begins the moment they walk through the doorway to my office.
David Mensink, PhD, RPsych
Victoria, BC, Canada
3) Parts Work
Couples often enter therapy with different levels of engagement. If it feels appropriate, I might start the first session by asking, “So, who dragged who here?” This normalizes the imbalance and creates an opening for curiosity about the disengaged partner.
As an IFS Therapist, “all parts are welcome” (to quote IFS originator Dick Schwartz) and all parts have a positive intention, including those that shut us down. My job is to help clients recognize and appreciate this positive intention and learn how to speak for those parts rather than from them. Then, honest communication becomes possible.
With this couple, I’d begin by emphasizing my interest in understanding what happens for “Mary” just before, and when, she disengages. How does she decide when to disengage? Under what circumstances? What is the part that takes her “out” hoping to accomplish? (uncovering this will reveal the part’s positive intention). What is it afraid will happen if it doesn’t take over, if it allows her to stay engaged? Where did she learn to disengage? Did she observe family members shut down? What words does the part say to her? By asking these questions, we’re facilitating a relationship between Mary and her part. My hope is that my genuine interest will help Mary, and her parts, feel welcome.
Next, I’d ask “John” what parts come up for him when Mary disengages. Does he get angry? Quiet? Passive aggressive? What words does he hear in his head? What’s his impulse? How does he respond? Does his response result in him feeling closer to Mary, or most distant?
My intention is to map the cycle of John and Mary’s interaction. I suspect that Marys’ protector elicits Johns’ protector, resulting in even greater disconnection. My job is to help partners a) notice when they’re being hijacked by a protector part b) recognize the part’s positive intention c) learn how to “unblend” from it, which leads to self-regulation and greater likelihood for connection, and d) learn how to speak for parts rather than from them.
After gaining insight into their respective parts, John might say something like, “Mary, I have a part that gets angry and wants to yell when you disengage.” Mary might respond by saying, “I know, and when you get angry, my scared parts shut me down and I become more disengaged.”
The work of unblending has begun.
Tish Miller, LCSW
Germantown, MD
4) More Magic!
When one partner doesn’t want to engage in therapy, I’ll take one of two approaches.
Option one: I’ll try to identify the goals of the disengaged partner. I might say something like, “If you had a magic wand, what would you change about your relationship?” If they say nothing, I might respond with something like, “So you think you have a perfect marriage?” This often helps them identify at least something small they’d like to change. Then, I get them talking about the concern more and elaborating on what life would be like if it changed. Essentially, I’m using motivational interviewing to engage the partner in therapy.
Option two: if, despite the above tactic, the disengaged partner is still resistant to treatment, I might work solo with the other partner, or refer them out for individual therapy. In that case, I’ll help the partner assess two questions: Can they be an agent of change in their marriage, and if so, how? and b) Should they stay together? In some cases, the changes they want to create in the relationship are for its optimization and enhancement. In other cases, it might be for personal safety or fulfillment. It’s up to the therapist to help the disengaged partner determine their goals in the relationship and work toward achieving them, or help them make the decision to move on.
David Helfand, PsyD
St. Johnsbury, VT
5) Use an Activity
If one partner doesn’t share in the desire to work on a problem, the process of engagement in therapy becomes more difficult. Choosing psychotherapy requires investing not only money but personal time, emotional energy, and significant vulnerability into finding solutions for specific problems. This can feel frightening and invasive to some. Anger may be present, and open resistance to the therapeutic process may occur. The therapist is tasked with helping each person see the relevance of therapy in achieving the stated goals. In my practice, I find that engagement is most likely when there’s an activity in the first session that involves both parties. I use both Ecomaps and Genograms to elicit information, creating an open process where clients are acknowledged as the experts in their own lives and invited to share information. This not only increases engagement, but builds rapport and trust with the therapist and helps couples identify and understand dysfunctional patterns and create opportunities for change.
While there are computer models for this process, I prefer to draw thing out by hand, using a pencil so that information is shareable and can be elaborated upon. I find that the process itself is engaging. The Ecomap provides an opportunity for each party to share information on their current living arrangement and family system, social activities and friends, work issues, healthcare status, work and financial stability, spiritual life, and other relevant information. Extended family information is elicited through the Genogram, which outlines the current and past two generations of each partner’s family system. Basic demographic information, family member history and functioning, and family stories provide insight into transgenerational patterns of behavior, and allow us to review family conflicts, secrets, traumas, cultural and racial traumas, immigration issues, and more.
Throughout the process, the therapist supports and guides the couple in identifying personal and family strengths, as well as challenges. Asking each partner to reveal themselves so personally allows them to see their larger story, both individually and as a couple, and how it impacts the presenting problem. This exploration is a therapeutic intervention in itself. I believe partners who use Ecomaps and Genograms in therapy are more engaged in therapy, and more empowered as individuals and as a couple.
Janice Sandefur, LCSW, ACSW
Ocala, Florida
6) Pivot and Continue
Therapy that began as couples therapy is no longer couples therapy if one partner is no longer on board. We can call this individual therapy, and now there are two people on board: the therapist the participating partner. Sessions can be continued if the remaining partner wants to continue on their own. On the other hand, if he or she wants to quit, there’s no other option but to say goodbye.
If you’d like to attempt to continue therapy even without the disengaged partner’s input, it’s necessary talk to the engaged partner about the disengaged partner leaving. You might discuss how their partner’s departure impacts their motivation, as well as how it makes them feel and what thoughts come up. You can also discuss the engaged partner’s motivation to continue therapy. You should also discuss new therapy goals now that the work has changed.
Of course, you should always leave the door open for the disengaged partner to return. You should also make it clear to the disengaged partner that they can receive individual therapy if they’d like. Finally, you should remember that although sometimes therapy may not go as planned, we should always be planning therapy based on the needs of our clients.
Alper Karababa, systemic therapist and counselor
Mugla, Turkey
***
The next Quandary: I’m working with a couple where each partner says they aren’t happy in their marriage—and haven’t been for years—but also say they don’t want to divorce because they worry it could negatively impact their teenage daughter, and don’t have the money to support themselves on their own. How should I advise them?
Photo © iStock/PeopleImages
Psychotherapy Networker
The editorial staff of Psychotherapy Networker comprises clinicians, journalists, and writers with a passion for creating a community where therapists gather and grow. Learn more on our About Us page.
