Couples Therapy Basics
The following is a brief introduction to couple therapy, covering some fundamental attitudes and basic skills.
It is intended for associates who are beginning to work with couples. Those who continue to work with couple might find an inspiration, a pregnant idea or a new path to try.
We want to establish trusting therapeutic relationship with both members of the couple. Toward that end, we want to not take sides and clearly convey that balanced position. Internally, the therapist needs to develop a sense of the couple as an entity, the “Mary-John thing.” Externally, it is essential to first tell the couple clearly that the therapist is not taking sides, and repeat that assertion over several sessions. At least unconsciously, the members of the couple are checking, whose side the therapist is on.
It is equally important to regularly move the gaze and the eye contact between the two people and make sure they both have more or less equal time and equal attention. Often, one of them is more talkative, more extroverted or having greater needs. When that person takes a breath, ask the other what they heard, or what is their response, or how they view the situation. As a rough measure, try to shift between the members at least once a minute.
The Frame: What will Constitute a Good Outcome?
Making sure that the Couple is the Client, also leads to setting shared direction for the therapy, by establishing clear and tangible indicators for a successful therapy. I like to ask: “How will you and I know that our work is done?” The partners can have different goals, visions or ideas of successful completion; yet, these goals or ideas need to be complementary, not contradictory.
That question and the ensuing conversation are already therapeutic and will provide a lot of useful information about the couple, their challenges and their dynamics.
Why Are They Together?
Every couple that maintained a committed relationships for a significant time, a year or more, have developed a bond that is based on the initial mutual attraction, on common values and interests and on shared experience. They might take that for granted. As the issues that brought them to therapy became more pressing or more severe; they might have forgotten that connection,
Yet, it is important for the therapist to understand that basic bond. A successful therapy might end with separation or with staying together. In the latter case, it usually includes a restored trust in the connection and the togetherness of the couple. Alternatively, it might be based on a deeper or broader understanding of their connection. Either way, the therapist needs to understand more deeply what makes this specific couple a unit or a clearly defined entity.
Communication, NVC, Needs and Wants
When asked about the reason for coming to therapy, many couples explain that they need to learn to communicate better. This might indeed be a central issue and it can be a vague umbrella, hiding a more fundamental problem. The frequent shifts between partners and the invitations for each to comment or respond to what the other says, is an opportunity for observing their communication skills and style.
Non-Violent Communication (NVC) is a good framework for teaching couples how to communicate more honestly and more effectively. https://www.cnvc.org/learn-nvc/what-is-nvc
There might be a need for preparation by removing name calling, blame and distorted views. Even before learning the simple practices of NVC, the therapist can teach the couple to use “I statement” and to distinguish feelings from thoughts. NVC focuses on feelings as indicators of basic needs, which are universal and non-negotiable. I.e., one cannot argue with another person’s need for safety, connection, support and love. It can take many therapy sessions to teach couples to distinguish observations from theory and “mind reading.” Sharing a list of feeling and needs can help couples learn to pay attention to their needs and slowly learn to consider the needs of others. Once they learn the basics, it is possible to direct the issue at hand into an NVC framework that includes an observation, feeling, need and request or offer.
The Four Lists Exercise
When I have the impression that a couple has a good basic bond and the prospects for renewing that connection are good; I sometime offer them the following exercise which spreads over four sessions, and usually spans a month.
In the first week, they are asked to make a list of things their partner does for them. I suggest finding and writing down between three and nine items. They should keep the list private; not share with the partner.
In the second week, they make a list of things they are doing for the partner, with similar conditions. Three to ten things, and kept private.
The third list consists of things each partner would like the other to do for them; things that they are not currently doing.
In the fourth and last list, are things each partner is NOT doing now for the other, but might be willing to do with some negotiations. These are things each believes the other would like them to do, i.e., possibly part of the other’s third list.
After the four lists are created, which can take more than four weeks, we start reviewing them together. I always make sure that the couple is ready for the review and ask for their permission. Occasionally we wait a week. Starting with the first list, one of them shares first and reads one item. I invite the partner to respond. Did they know the other appreciates they are doing that thing for them? Is the person sharing surprised by the other’s response? Then I invite the second person to share one item. Sharing three or four items each and responding to them can easily fill a whole session, and bring a lot of material for future conversations. Generally, it sheds light on various needs met and unmet. It also clarifies their communication style and their underlying value system.
I approach the second list similarly. That list can be challenging when one partner says “I do X for my partner” and the other either did not notice or does not value X very much.
The third and fourth lists require even tighter holding, as the sharing can be challenging. At the same time, it can lead to positive negotiation. The key is going very slowly, paying attention to body language and facial expressions, listening carefully to tone of voice, to the choice of words and to any subtext.
When one partner says “I would like my partner to do X” I might just repeat the words and ask the other to also just repeat. “<name> would like you to do X… do you understand what they are asking? Is this something negotiable? I.e., is there a possible world where you do X?” “Would you like to respond in any way to their wish?”
Again, slow down, take long breaths, and make very clear that there are no obligations. Only good will and free choice.
Successful negotiation of even one item from the fourth list, signifies a major breakthrough in the couple’s relationship and can be celebrated. Beyond the specific activity being discussed, the willingness to say something like: “if you do this, I am willing do that,” opens a door to a new level of exchange, sharing and possibly intimacy.
Talking about sex and intimacy
Anything related to Love Making is potentially sensitive. It is essential to gauge the level of safety and trust in the therapy relationship before diving into such conversations. At the same time, it is important to convey to clients from the start that the therapist is comfortable talking about sex and even welcoming such conversation.
Very often, clients use Intimacy as euphemism for sex. As in “we were not intimate for several months…”
I try to educate clients about the difference. There can be great intimacy that is not sexual. There can be sexual activity that is devoid of intimacy. Of course, good sex is intimate. Thus, couples who do not know how to be intimate, or afraid of intimacy, often experience barriers to sexuality.
I try to use the expression Love Making instead of Sex, acknowledging that the latter is usually over used and often misleading. Using the idea that S.E.X. is an acronym for Sacred Energy eXchange, can open the clients’ mind to broader visions and better conversations on the topic. It is an invitation to explore their individual vision of sharing sacred energy, which can be done in many ways. These can lead to better intimacy and better sex.
The expression “into me you see” is familiar in the general culture through popular songs. It is a simple description of the experience of intimacy. To be intimate, one needs to be transparent, open, sincere and vulnerable. That implies some level of trust in the other participant. It is possible to be open and vulnerable out of fear, such as a young puppy showing its belly to a frightening older dog, but that can hardly be described as intimate.
Intimate relationship is not necessarily symmetric. Meaning, one partner can be open, vulnerable and trusting while the other can be somewhat closed or afraid. Such unbalanced relationship is problematic if it endures for some time, as the one who is open and vulnerable will sooner or later feel hurt by the lack of reciprocity.
A common lead to the conversation about Love Making is differences of desire. It is rare for couples to wish exactly the same frequency of love making. Almost always, one wants more and the other less. That imbalance can change over the years. The one who wanted more becomes the one who wants less. These differences can lead to conflict, resentment, or to productive negotiations. It is important to note that as in any such difference, the one who wants less has the upper hand; the power to say ‘No.’
Understanding these dynamics and normalizing them can bring a great relief to the couple. It can allow the one who wants more to request instead of demand or be resentful.
Couples often remember favorably an early period in their connection when both were hungry for lovemaking. For most couples, that hunger is eventually satisfied. Then the deeper dynamics start to show up. This is another aspect where normalizing and awareness can bring relief. There is no need to go back to an earlier period, rather look for cooperation and joy in the present.
One reason I want to understand early what makes the couple an entity, is the potential need to deal with questions about separation. It takes only one partner to break the union. It takes two commitments to stay together. This is a trivial truth that many couples need to hear and internalize. Occasionally, a couple comes to therapy expecting a break-up and the partner who wants to keep the union expects the therapist to “make the other” stay or recommit. That is often an unconscious expectation. Thus, it is useful to repeat, that “it takes two to Tango.”
When the subject of possible separation is raised, I try to explore it impartially, promising the couple that it is their decision, and I will support them either way. I often ask what will separation solve. It might be valuable to convey to the partners that their individual unresolved issues are going to remain present in the next relationship. Yet, sometime the hurt and the accounts are too heavy to resolve in the context of a strained relationship, and separating is a sensible outcome.
Taking time to imagine future scenarios, for example 5 years from now, both together and apart can help the individuals understand more deeply the nature of the decision to be made. They need to know that there is suffering implied by both options. Imagining the future is best done in a trance state. Take time to get both members into a calmer and more meditative state, possible with closed eyes if they are willing to try that. Then invite them to imagine the future time in both scenarios: together and separated. Name many details, starting with the year and the month. For example:
“Imagine it is March 2027, the early spring is in full force, the daffodils are blooming, the Robins and the squirrels are nesting, you are now 45 and 42 (or whatever their age will be in 2027, and you are not together…where do you live? What state? What city or area? Who lives with you?” If there are children, I mention the name and age of the children in the future time, and ask what are they doing. “What are you doing when you wake up? What are doing that you are not doing now? What are you doing now that you are no longer doing?” Allow your knowledge of the couple, and your creative imagination to guide them into a more detailed description. Then, after 5-10 minutes, repeat with the other scenario, i.e., they do live together. Then spend time exploring what images and thought came up for them. This can easily fill a whole session.
When the couple remains stuck in between staying together and deciding to separate I might suggest a trial separation. This can be a very good path for some to explore the options without facing irreversible consequences. The most important condition for a successful experiment is to truly not know the results. If even one of them already decided what the outcome is, the experiment will not add anything new. If both are willing to experiment, the next thing is to define very clear boundaries. The time for the experiment needs to be long enough to experience separation and short enough to allow the possibility of returning to being together. I usually suggest 3-6 month, invite them to decide and set a firm date to discuss the outcome, with or without me involved.
The next firm boundary is about sexual and romantic relationships. Whatever they decide needs to be clearly defined, and clearly supportive of the experiment. I.e., if one of them feels that external romantic or sexual involvement will doom the relationship, it is clearly not allowing the experiment to go forward. However, if both are open to and comfortable with other romantic experimentation during the trial, this can bring clarity to the decision about staying or parting.