therapist_talkingCorinne is 26 years old and has been married to Ted for 5 years. She worries that her marriage isn’t what it should be. She thinks her husband is working too much and is distancing from her. She has tried to talk to him but he has suggested that she is too needy. Corinne has become increasingly depressed and irritable. She started therapy, thinking maybe he has a point. Maybe she is too needy.

Corinne’s therapist is kind and compassionate but has little training in couples work. She listens to Corinne’s complaints and validates her feelings. She suggests that Corinne trust her instincts about her marriage and says that maybe what she needed when she met Ted as a teen isn’t what she needs now. She should think about it. Further, the therapist doesn’t think neediness is the issue but is concerned about Corinne’s depression. She suggests that Corinne’s depression might be rooted in her discouragement about her marriage. She therefore refers Corinne to a psychiatrist for some medication.

When Corinne gets home, she tells Ted she’s not too needy and that their relationship is causing her depression — her therapist says so.

Ted feels defensive and angry that someone he has never met is judging him. He and Corinne have yet another argument about his commitment to his work. Corinne wishes that Ted would be as understanding as her therapist.

Over the some 40 years I’ve been a therapist, I’ve become increasingly convinced that people who describe their primary problem as conflict with their spouse are ill served by individual therapy. I’d even go so far as to say that, unless the therapist is skilled in couples work as well, individual therapy when someone is in a distressed marriage is likely to tip the balance to divorce.

Why? Because individual therapy focuses on the pain of the individual. The therapist has only the client’s reports about his or her spouse — which may be inaccurate or, however unconsciously, self-serving. Transference issues bloom as the client comes to see the therapist as the person who understands, cares and supports in ways the spouse does not. The client tries to get the spouse to do things differently — as the therapist has suggested in session. The spouse begins to wonder what her or his partner is telling the therapist and may become anxious, distrustful or resentful. The client accuses the spouse of not supporting the therapy and wonders “Why can’t you be as compassionate and wise as my therapist?”As the relationship with a third party, the therapist, becomes deeper, the spousal relationship becomes less so. This sounds very much like an “affair” to me — with all the destructive power that an affair can wreak.

The problem is compounded when there is a therapist for each partner. Now there are two sympathetic therapists listening to individuals complain “my spouse doesn’t understand me.” Instead of learning to understand each other, each member of the couple is turning to someone outside the marriage to listen to their feelings and offer solace.

Let’s say that Ted, in the story above, gets a therapist of his own. Ted tells the therapist that he loves his wife but is concerned about her depression. He adds that he has done all he can but Corinne seems to always want more. Further, he says, he hasn’t changed since they married and that it frustrates him that Corinne seems to want to change him.

The therapist affirms Ted’s feelings, telling him that he is fine just the way he is and that it is unreasonable for Corinne to try to change him. He suggests that Ted be patient because it may be that Corinne’s medicine hasn’t reached therapeutic levels.

When Ted gets home, a conversation goes something like this:

Corinne: I’m so glad you’re in therapy, too. What did your therapist say?
Ted: My therapist says that you should accept me as I am and not keep trying to change me.
Corinne: Well, my therapist says my feelings are important, too, and right now I’m feeling pretty hopeless about our marriage. You never have time for me.
Ted: Well, maybe if you weren’t so depressed, we’d have more fun. My therapist wonders if your medication is doing all it should.
Corinne, starting to cry: Maybe you’re right. I don’t want to split. I just want things to be different.

Skilled therapists know better than to make judgments on the basis of one spouse’s report. They are sensitive to the possibility of being represented by the client as taking sides. They work hard to keep the partner’s needs present in the sessions through careful questions and techniques that help the client see the spouse’s point of view. However, the therapist can’t control what the client communicates to his or her spouse and has to rely on the client to accurately report their spouse’s perspective and responses as well as their progress (or lack of it) between sessions.

These challenges disappear when both people are present in session. The result often is a more accurate understanding of the couple’s problems and why, despite love, intelligence and good intentions, they haven’t been able to solve their conflict on their own.

To avoid introducing an unintentional emotional affair via therapy into a marriage, it is wise to move to couples work when the problem is something about the relationship. Why? Because when there is distress in a marriage, the marriage is the “client,” not just the two individuals. A therapist cannot accurately see the dynamics of a relationship by report from only one of the parties. One partner cannot accurately and fully read and report the spouse’s point of view, even if trying very hard to be fair and reasonable.

If, instead, both people are present, the therapist can observe up close what goes on between them. During sessions, the therapist can note the strengths in the couple as well as the problem interactions and draw on existing interpersonal skills. The couple can be helped to see where their relationship has become stuck and how each contributes to the problem. New skills in communication and problem solving can be taught and practiced under guidance from the therapist. Each member of the couple can learn how to support the other in dealing with hurts and fears from difficult childhoods, former relationships, and current confusions. In the process, the intimacy and trust in the relationship increases where it should — between the two members of the couple, not between each member and their therapist.

Should all therapy sessions with married partners be with the couple? Not necessarily. It may be important for the treating therapist to see each member of the couple alone now and then. Sometimes one or the other member of the couple wants to rehearse how to share something with the partner. Sometimes extra individual sessions help someone through a stuck place that is grounded in their pre-couple history. However, when such sessions occur, the therapist must ensure that the content eventually comes back to the couple. Otherwise, the therapist is holding information the spouse doesn’t have. This can result in the partner losing trust in both the therapist and the other partner.

Of course, there are marriages that can’t and shouldn’t be saved. When one member of the couple is being abused or exploited by someone who sees no reason to change, it is advisable, even essential, for a therapist to advocate for at least a “time out” and maybe an end to the marriage. In such cases, the goal is to help the couple do so with the least chaos and emotional harm possible. Both the victim and the abuser should be offered individual therapy to help them each recover and learn from the experience so they can move on in a healthy way.

Related articles and video:

http://psychcentral.com/lib/how-to-beat-the-odds-tips-from-the-very-married/

http://psychcentral.com/lib/meta-communication-what-i-said-isnt-what-i-meant/

http://psychcentral.com/lib/he-said-she-said-why-couples-would-rather-fight-than-get-along/?all=1

http://psychcentral.com/blog/archives/2012/04/28/video-what-is-couples-therapy/