Sunday, April 1, 2012

Couples Therapy: It's Not For Sissies

In the March 4th issue of the New York Times, writer Elizabeth Weil penned a terrific article about couples therapy, and why it is that most therapists will acknowledge that it's much tougher to do than supportive individual counseling. In individual counseling, you build a therapeutic alliance with one person; you can be warm, empathetic, and client-centered. In couples therapy, you must be stronger and more active as a therapist. Your patient is really the relationship between the two of them, and you have to have your wits about you and jump into the conflict. You have to be brave, and "pilot your helicopter in a hurricane," as master couples therapists Peter Pearson and Ellyn Bader from the Couples Institute in Palo Alto, California describe working with high-conflict couples.

Weil's article was inspired by a November/December 2011 issue cover story in a professional magazine written for therapists, Psychotherapy Networker, which was titled, "Who's Afraid of Couples Therapy?" In it, couples therapy experts confirm that seeing couples is qualitatively a different experience for therapists. It is higher in conflict, includes more anger and arguing, and both people are watching your every move to ensure that you don't let their partner "win." The truth is, couples counseling is a team sport, and we win or lose together.

Elizabeth Weil is also the author of an interesting new book I just finished, called No Cheating, No Dying: I Had a Good Marriage. Then I Tried to Make It Better" (Scribner, 2012). In the book, Weil bravely opens up the details of her marriage, including what they argue about, and where there are strengths as well as weaknesses. She reflects beautifully, and at times with humor and vulnerability as she and her husband embark on a year-long project of trying different types of couples therapy and marriage education classes and workshops. They learn about how their issues from their respective families of origin contribute to their current relationship challenges. They discover better ways to communicate. They identify ways to not hide behind their work, or their two small children. They learn to embrace the differences between them, including how her husband pushes the limits of creative gourmet cooking and liberally decorates their small San Francisco home with his dropping of his brown socks. She has her own eccentricities. We all do.

Many aspects of therapy are different with couples. You have to be on your toes with couples. Timing is essential. You can't sit and regroup, collecting your thoughts as a clinician if you need to step in. You can't be passive. They could argue like that at home without you. You can't let the couple interrupt, demean, or talk over each other. You can't be afraid to speak up, strongly and with conviction, when one or both of them are doing something destructive to the relationship. You can't just sit there and nod.

Doing strong couples therapy requires a therapist move out of a classic, nurturing role and shift to a bigger frame with more moving parts and things to consider. There often isn't a good person and a bad person. Timing and feedback is important as a couples therapist. You can't hold secrets for the couple. You have to care about each partner individually, but also believe in their ability to do better as they know more about how their own individual behavior contributes to their dance of intimacy. Couples are dynamic. They don't stay in a steady state-- they are always moving closer together or further apart.

The average couple waits 6 years being unhappy before seeking guidance, according to University of Miami researcher and psychology professor Brian Goss. Most couples I see tell me they wish they had come sooner. Why suffer? It feels wonderful to help couples learn to communicate with respect and kindness, re-energize their physical/intimate relationship, have more fun together, learn to fight fairly, and celebrate and understand their differences.

Last week, I got an e-mail from a husband a few hours after a particularly tough, but important couples therapy session, letting me know he felt they had really made key progress that day. I really care about and believe in both of them. Seeing couples is deeply satisfying work to do, even if it's not for sissies. Being a part of making a couples' relationship closer and more alive is extremely satisfying, even though there are sometimes firestorms to get through on the way.

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