Steven Adams, Psy.D., Clinical Psychologist
Cornerstone Counseling & Consulting, P.C.
Springfield and St. Louis, MO
By far couple therapy is one of the more complicated and challenging types of work for most psychotherapists. For this reason many mental health professionals do not offer this type of service. Effectively working with couples involves far more than listening and working on communication. Each person in the relationship comes from a different background and presents unique personality differences. Sometimes underlying mental health problems, such as depression or a personality disorder, need to be addressed that affect the relationship. Effective psychotherapy with couples also involves more than identifying areas of conflict, such as finances, communication or sexual problems. Instead, it is important to help couples discover effective ways of dealing with problems in their relationship. The emphasis should be how more than what.
The initial stage of therapy with couples is an assessment of each person and their relationship. Each person’s personal background, health history, occupational history, experiences as a parent, mental health history, dating history, marriage history (including prior relationships) and spiritual history are discussed. The history of their relationship is discussed, especially how they met, what attracted them to each other and various life events that have affected the relationship. At this stage the couple will be seen together and separately. Sometimes questionnaires are used to further assess the relationship and each person.
Once issues of concern have been identified the therapy process begins which may involve guided behavioral change, skills-based interventions, changes in expectations and about beliefs about the relationship. Emotions can be distressing to some people, especially in relationships. For example, anger is an emotion we sometimes avoid due to a variety of reasons. Couples can be taught how to express and manage emotions to their benefit. Quite often when a person expresses anger they are actually experiencing some other deeper emotion such as hurt or fear that needs to be addressed.
Four ways of relating in relationships have been identified by scientific research with couples as being quite destructive and predicting divorce (Gottman, J.M. and Gottman, J.S., 2015). These include:
- Criticism – describing problem behavior as actually a character flaw.
- Defensiveness – trying to self-protect by counterattacking or whining.
- Contempt – making statements or insults with a sense of superiority, thus implying the other person is inferior, less intelligent or not deserving of respect.
- Stonewalling – emotional withdrawal from the other person. Men often do this when they feel overwhelmed or “flooded.”
Sometimes infidelity must be addressed in sessions. About 40 percent of couples seeking help do so because of infidelity. Typically, the party in the affair must end that relationship in order for couple therapy to proceed. This may take some time and require some individual sessions. At some point in time it is important to understand what led up to the affair, so it can be prevented in the future and to better the relationship.
Ending treatment should be determined by the couple and their treating therapist. Having clear treatment goals can help determine when to end couple therapy.
In preparing to enter couple therapy it is important to determine what you would like different about the relationship. Secondly, you might consider how you could contribute to those changes. It is easy to state how you would like your spouse to change, but it is far more helpful to consider how you could change that would result in an improved relationship.
Gottman, J.M. and Gottman, J.S. (2015). Gottman Couple Therapy in A.S. Gurman, J.L. Lebow and D.K.
Snyder (Eds.) Clinical Handbook of Couple Therapy (pp. 129-157). New York: Guilford.
Fighting For Your Marriage by Howard Markham, Scott Stanley and Susan Blumberg (2010).
Published by John Wiley and Sons.