Therapy with couples, Part 2, the process

As a Marriage and Family Therapist, it probably comes as no surprise that a significant portion of clients are couples who want to resolve issues in their relationships. Although the kinds of issues that couples bring to therapy vary greatly, there are certain common elements to the process of working with couples that are quite different than the process of working with individual clients.

During the first session, I ask, “what is the primary issue that brings both of you to therapy?” 90% of the time, the answer from both is the same: “communication.” This is probably always true. Really, when you think about it, all couples at some time or another have “communication issues.” Communication is also pretty much never the whole story or even the main issue.

I often tell a couple in their first therapy session that I am very reluctant to focus mainly on communication. Here’s why. I learned a lot about communication issues in my legal career and in graduate school to become a therapist. I also learned some highly successful tools to use with couples to help them reduce hostile arguments, increase effective communication, and feel better about how they are able to talk about things. Some of the tools I learned were “time outs,” “avoid ‘mind reading,’” stay away from “you” statements by starting with “I,” and use a “talking stick” when interruptions become frequent on either or both sides. I am reluctant to put much faith in these tools as the way to help couples with communications issues. Don’t get me wrong, these tools actually work, and some of them work really well. The problem is they work in the wrong direction because they don’t actually get at the real problems. They just make the surface issues look a lot better without solving anything substantial. Focusing on communications issues as the primary goal in couples therapy is like cutting off a dandelion without getting at the roots—for a little while your lawn looks better (all green) but the problem (the dandelion) is just going to come back. In therapy, when a couple does good work on communication without resolving the underlying issues that made communication difficult, they will end therapy thinking things are fine. In a few months, they will be right back where they started before therapy. Except it’s worse now, because they could (understandably) look back at therapy as a complete waste of time and won’t want to try it again.

I will illustrate the point. A couple, let’s call them Chad and Melanie, comes to therapy only after realizing they cannot solve their issues on their own, they are frustrated, maybe even ready to give up on the relationship, or at least resigned to being in a relationship plagued with intractable seemingly unsolvable issues and conflict. As a last ditch effort, they finally come to therapy. This is unfortunately all too common (coming to therapy as a last ditch effort). They focus on communication. It works. They are talking more easily, more often, less fighting, less conflict, less tension, maybe even their sex lives improve, they go out more, and this all seems really great. It is really great. But, it isn’t enough. Chad is not interrupting Melanie as often when she starts to talk about his family. Melanie is more aware of how talking about his family with “you” statements is a trigger so she is doing it less often. Chad still feels hurt, though, about Melanie’s “cool” reaction to his mother last year when they were at her house for Mother’s Day. Now that Melanie is a mother too (they just had their first child, Ian), she resents having to go to Chad’s mother’s house like they always do. Melanie wanted the focus to be on her, not Chad’s mother. Even worse, they find it really difficult to discuss Mother’s Day due to unresolved conflicts that predate their marriage. Chad and Melanie met in college in Boston. Chad is from Minneapolis. Melanie is from California. During senior year, Chad found a great job back in Minneapolis, so when he asked her to marry him, it was assumed that they’d move here. They never really considered living anywhere else, even though Melanie never wanted to move to Minneapolis, and now lives 2,000 miles away from her parents and her sister.

Melanie has never told Chad that she is sure her family felt betrayed by her decision to follow him to Minneapolis instead of moving home after college. Melanie wants to talk to Chad about it. Melanie wants to ask Chad if he’d consider giving up his job, his hometown, his family close by, to move to California. She doesn’t bring it up. Melanie doesn’t say much about anything that might encourage conflict, that’s the way she was raised. Chad is the opposite, willing to talk about anything, especially if it really bothers him. That’s the way he was raised. So, he assumes (wrongly) that Melanie is glad to live in Minneapolis, which is why he gets so confused by Melanie’s cool behavior toward his mother. Chad had thought Melanie liked his mother. She does. But she resents Chad and can’t bring herself to talk about it. Melanie never mentioned any of this in therapy. Instead she hoped that, by working on the communication issues with Chad, they’d get to it later. They didn’t. Now, Melanie doesn’t want to go back to therapy. It didn’t work. She tells Chad she’s leaving, moving back to California, without him.

All of this could have been avoided if it had been addressed more directly in therapy—if Melanie and Chad had been willing to go deeper than just talking about how to talk, about communication. Communication is a necessary part of improving a relationship in trouble, but it is only a start. I often say communication is to a relationship like gas is to a car. Gas won’t do you much good if the car’s engine is misfiring and won’t run. Below is a table I created for couples to help them understand a more layered therapy approach to working on their issues.

I explain that we start with communication. I suggest some ground rules, like no verbal abuse (see my blog, “What is verbal abuse” for more information). I also often suggest they avoid threats of leaving or ending the relationship for the time being. I might ask them to identify any “hot-button” issues one or both of them do not think they can address without serious and damaging hostility. I ask them to avoid discussion of those issues wherever possible until they have some trust built back into their ability to resolve conflict.

When we have worked our way down the table for each person, they come to understand how they as individuals bring to the relationship specific issues and personality traits that limit their ability to resolve issues as they arise. We come up with coping skills to change these negative influences. At this point, we begin to work our way back up the table, to see the direct connections: how their individual personalities frame their sense of belongingness and trust, which in turn creates underlying semi-permanent unresolved issues that make it nearly impossible to resolve less protracted issues, which is why they haven’t been able to communicate.

Let’s go back to our example of Melanie and Chad. If Melanie could see that her conflict-avoidant family of origin relationship style is so engrained in her, she often fails to assert her needs, and did so long before she met Chad and worked on being more assertive, taking more risks and more responsibility for asking for her needs, she is likely to be less resentful. Meanwhile Chad increases his awareness of his tendency to ignore the needs of others if they are not communicated boldly and directly to him, which has also caused problems in his relationships prior to meeting Melanie. Chad asks Melanie if there is something underlying her resentment of his mother. She begins to disclose to him her feelings going back years to their decision to move to Minneapolis instead of California. She tells him she knows it isn’t fair to him to hold it against him since he didn’t know how much she resented moving to Minneapolis. Chad tells her he is open to reassessing where they should live. He’d rather stay, he says, but he can see how forcing her to stay if she doesn’t want to be here is not fair to her either. What they decide has little do to with communication. It has to do with a very different way of seeing themselves and each other in the relationship and their lives. They can begin a lifelong process of discovering more about each other’s personality, family style, and how to build a better sense of belongingness in the relationship.

This might sound too good to be true, especially in just one paragraph. Not all couples are able to make this kind of very significant turnaround. Some are though. The point is that almost no couple can do this in therapy unless they are willing to dig deeper than communication issues, to pinpoint why communication became such a difficult issue in the first place, and this requires at least some exploration of who each person is and how their own issues influence and limit conflict resolution. Put another way, couples therapy doesn’t work when either one person or both are unwilling to look at their own issues, their own self, or they are not interested or able to see the other person as a separate and distinct person who has their own issues as well.

Couples therapy works because it creates a place for both people in the couple to reassess their ability to feel safe in addressing issues that have become stuck in a flawed process of conflict resolution. If a couple is willing to do what Melanie and Chad did—both of them willing to take responsibility for the kind of person they are in the relationship and become more aware of who the other person is in the relationship—there is a good chance they will be able to work through some very thorny issues. My role is to facilitate the creation of a safe place for their exploration of themselves and each other. I also encourage them to gain more self-awareness while imagining what it is like to be the other person in the relationship. When both can do this, they are well on their way to completing couples therapy.

Copyright 2013, Michael Kinzer. Blog entries and other materials available on Jupiter Center’s website are only intended to stimulate thoughts and conversations and to supplement therapy work with Jupiter Center clients already in therapy. If you or someone you know suffers from a mental illness, you are strongly encouraged to seek help from a mental health professional. For further information about this blog, or Jupiter Center, contact Michael Kinzer at 612-701-0064 or michael(at)jupitercenter.com.