Category: Relationships

How Couples Therapy Works

3/12/2023

New clients are often curious about what happens in couples therapy saying, "I know how regular therapy works, but what about couples therapy?" I work integratively (as in, I integrate multiple modalities) with couples and am informed by Emotionally Focused Therapy, Psychobiological Approach to Couple's Therapy (PACT), Relational Life Therapy, and the Gottman Method . Below are some common interventions used in couples therapy and examples of what kind of problems these interventions fix.

Common problems addressed in couples therapy:
Communication + gridlocked conflict loops
Sex, Money, Family
Trust breakdowns
Intimacy and emotional distance (and different needs around connection)
Trauma
Transitions

Couples Therapy Interventions:

Identifying Feelings + Separating Thoughts from Feelings
Problems this may solve: Communication + conflict, intimacy and emotional distance, sex/money/family, trust

It's annoying when your therapist asks "how does that make you feel?" but it's pretty important to know why something your partner does annoys you; otherwise, you just end up blaming, shaming, and targeting smaller complaints rather than addressing a larger need or a pervasive pattern. A crucial relationship skill is distinguishing thoughts from feelings. "You don't care about me because you don't text me during the day," is a thought (and probably inaccurate mind reading). Anger, sadness, distrust, loneliness, disconnection are likely feelings. It's important to know the feeling and then to know how to communicate that feeling. Which leads to the next intervention...

Communication Training
problems this may solve: communication and conflict, sex/money/family

It's very common for couples to criticize each other versus speak from their feelings and needs. This may be because they don't know how to identify their feelings and needs, have shame about their feelings and needs, because they believe that whatever is causing them discomfort is bad, or are in a constant criticism/defense cycle, or all of the above. Transforming criticism into requests is the first step. "You're always late! I can't stand this anymore!" ---> "I feel stress and deprioritized when we are late. Can we talk about a way to make this happen less often" puts responsibility on the person who has needs and asks their partner to collaborate with them on helping them feel secure, safe, and considered in the relationship. Someone responding "well you never help with the dishes" does nothing to address someone's hurt feelings triggered by lateness but ensures no one's needs are met and a useless fight ensues. A couples therapist may help couples communicate in new ways and provide resources for more information and more practice outside of sessions.

Doubling
problems this may solve: Communication + conflict, intimacy and emotional distance, sex/money/family,

Doubling helps model both healthy communication and identification of deeper needs. A therapist "doubles" for one member of a partnership and communicates for them based on their observations, assessment, and understanding of the background information. Doubling can have a profound impact by cutting through increasing empathy for the partner being spoken for. Doubling models how successful communication and emotional attunement can diffuse conflict and increase intimacy.

Inner-Child/Trauma Work
problems this may solve: Trauma, intimacy and emotional distance, communication and conflict, trust, sex/money/samily

It is important to look at how our past is impacting our present because we end up enacting patterns of behavior from our family's of origin and overreacting to behavior's of our partners. Doing inner-child, family of origin healing, and trauma work lessen a trigger's impact on you and helps you take accountability for your own sensitivities. Doing this work in couples therapy gives your partner the opportunity to know you on a deeper level and become more compassionate to your internal experience.

Nervous System Regulation
problems this may solve: Trauma, communication and conflict, trust

High-conflict partners almost always need nervous system regulation to be able to access any communication skills. "Use I-Statements" is useless to learn if you go into fight or flight or freeze anytime your partner hurts your feelings. Once we are disregulated, the only focus should be on regulation so people can think and not feel threatened. Couples therapists can provide exercises and practices in session and resources to practice outside of session. Additionally, a therapist can coach partners on how to co-regulate each other and how to decrease triggering each other.

Changing Relational Patterns
Problems this may solve: intimacy and emotional distance, trust, sex

Daily rituals, weekly dates, quality time, directed present attention are all crucial parts of committed attachment-based relationships*. Your couples therapist can make sure these things are happening, satisfying to all partners, and hold couples accountable. Couples therapy can also help establish relational patterns like cultivating appreciation, respect, and generosity within the relationship.

Reframing Problems
Problems this may solve: everything!

Are you coming to a relationship, a conflict, or a problem needing solving in terms of what's best for you or what's best for the relationship? This simple reframe can dramatically change how you look at problems. Once you are in a committed, attachment-based relationship* the relationship's interest is incredibly important, maybe the most important.

“The particularities of your parents’ limitations and dysfunctions became the imperfect “holding environment” you adjusted to. That adjustment, that adaptation, becomes your particular version of you and me consciousness, the imprint on your limbic system of your unique Adaptive Child.” --Terry Real

“Managing triggers is another important component of creating secure attachment with yourself. Triggers are events that happen in the present that activate painful or traumatic experiences from our past that have some resemblance to what’s happening in the present moment. When this happens, it’s extremely difficult to tease apart what we are reacting to in this moment that is real and legitimate and what past stuff is coloring our interpretation and reactivity.” --Jessica Fern

“The greatest gift a parent has to give a child—and a lover has to give a lover—is emotionally attuned attention and timely responsiveness.” ― Sue Johnson

“Converting a complaint into a positive need requires a mental transformation from what is wrong with one’s partner to what one’s partner can do that would work." ― John M. Gottman

“Love doesn’t just sit there, like a stone, it has to be made, like bread; remade all the time, made new." —Ursula K. Le Guin

“Your personal growth depends on your relationship remaining safe and secure at all times, because if either of you feel the least bit unsafe, untrusting, or insecure, you won’t have the internal resources for personal growth. Instead, your mind and body will be preoccupied by doubt and threat.”
--Stan Tatkin

*You keep talking about "attachment-based relationships." What do you mean by that?
By "attachment-based relationship" I mean an intentional relationship where you agree (or less ideally, it's implied) that you show up regularly for each other, prioritize the each other and the relationship, and are committed to the relationship. This can mean answering calls of distress during your work day, being an emergency contact, responding to emotions, building a domestic life together.

Sue Johnson says it best:
"Underneath all the distress, partners are asking each other: Can I count on you? Are you there for me? Will you respond to me when I need, when I call? Do I matter to you? Am I valued and accepted by you? Do you need me, rely on me?"
Attachment-based partners should answer an enthusiastic yes to all these questions. If not, couples therapy can help!

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