Therapists: A Couples Therapy Conundrum
I’d love to get some dialogue going from therapists around the following:
How do you proceed with a couple who presents to counseling and one person’s goal is to rebuild the relationship – and the other is to get out the most smoothly? Both parties are rigidly set on their own goals – and both look to you to help them meet them?
Do you refer them out?
Do you take them and look for any sliver of overlap to work with?
I’ve talked to a few therapists who have both said they would refer out couples such as this – or simply tell them they can’t work with them. I’m still chewing on this and wondering if there’s any other way to help two people with such opposing hopes for their therapy experience and not create a “lose-lose” scenario.
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Lisa Brookes Kift is a psychotherapist and creator of Notes from a Therapist’s Chair: The Therapy and Counseling Blog; a feature of The Toolbox at LisaKiftTherapy.com. To stay updated on the most recent therapy / therapist related posts subscribe to Notes from a Therapist’s Chair Blog RSS Feed.
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Really interesting question! I’m actually an MFTi who also practices mostly from a systems perspective so hopefully I can be helpful. The first thing I thought of was that it almost seems like they’re triangulating you. It’s very interesting to me that they’re still together and are coming together to basically corner you to see how they can resolve mutually exclusive goals. I wonder if it would be an appropriate time to self-disclose how they make you feel (e.g. like you can’t help them because you’re always in trouble) and use that opportunity to explore if they have repeated that cycle other times in their relationship? Or maybe comment on the fact that they continue to come *together* but want opposite things? Clearly something is keeping them together or working toward the same goal…what is that? I hope this is somewhat helpful! I’ll keep thinking though and post more after I let it sit. :)
Hi Lisa,
Thank you for opening up this topic for discussion.
First, I want to say that I believe in marriage and like you will use psychotherapy sessions to support couples as individuals and to support the relationship. It is important to clarify early on whether the couple is in agreement that they are there improve the relationship, which you did. So you can offer to see them together if they want help dealing with separating.
Why would you want to refer one or both of them out? How long have you seen them as a couple? Do you routinely refuse to see someone individually if you have seen them as a couple? I think someone well versed in a systems approach can walk the tightrope so as not to be perceived as taking sides and can discuss with the couple how each would feel if one or both saw you individually. Many therapists do refer members of couples out. I do not take the position that this must happen routinely. It depends on several variables, some of which can be discussed with clients. How how long they have been seeing you and what level of trust has been established between each of them and you can factor into the decision as well.
A good systems approach includes doing one’s best to set up an arrangement to avoid triangulation in appearance and/or deed.
In fact, in only once case that I know of, did a couple who came to me end up splitting up, and that was an unmarried young couple that sounds like the one you mention where one person clearly wants to end the relationship and the other one does not.
By the second session, the man seemed to be saying that he no longer wanted to be in the relationship, and that he found her personality irritating. Finally, I asked him, “Is there any part of you that wants to continue in this relationship?” He said no.
His girlfriend had not heard the message clearly from him until then. She accepted it with sadness, but a few weeks later told me on the telephone that she was glad for the sessions because they brought closure to the relationship and she was ready to move on.
Maybe I see our work differently but I would not refer a couple like this out, there is something that has them coming in together, whether its a “drop off” therapy (you know the type, a spouse who is really there just to drop off the other one so they know they’ll be supported after they leave) or the fact that they just can’t deal with the fighting; the bottom line is that they came as a couple and there is almost always some common ground, no matter how small.
It can be such a tough scenario to deal with initially. Generally I find that I can get couples, even those really committed to their opposing opinions, to agree to use therapy as a way to get clarity about their relationship and its future. I usually pose it as an opportunity to understand each other better and use a specific time frame to help them both feel as though therapy is not going to be just more of the same– a never-ending battle of the wills. Maybe they agree to come in for 4 sessions or 3 months with a goal of just clearing the air, clarifying their position, and genuinely listening to the other person’s position.
I’ve had a number of couples like this and many times with a mutual goal of just decreasing conflict and increasing their understanding of each other the couple will find that they may not be so committed to their inital position. And for those that are sure that they want it to end, they have the opportunity to develop a more positive platform to move forward from.
I know as MFTs we are committed to working to “save” marriages but we all know that marriage requires that both partners want to be there. Sometimes I think the goal is to help them move forward– in whatever direction they choose- with some compassion and understanding. We’d love to help every couple learn to have a loving, authentic relationship but sometimes that is just not going to happen for them. Then I think its our job to help them separate (because that’s what they decided not because we think it wont work out) as peacefully as possible, especiallly if kids are involved.
Really looking forward to see what others have to say about this…
In addition to Esther’s excellent perspective above, and within a solid systems perspective, I’d add two “tools,” mostly to reinforce what I think you already know and do:
First, consider enhancing resonance (at a brain level) by having them do even just a simple mindfulness exercise — perhaps three minutes of simple mindfulness meditation, if they’re willing, followed by looking into each others’ eyes (may take a few minutes to get to anything “real”) and first, directing them to see each other as human and deserving of compassion — then, still looking, to look within themselves and see themselves as human and deserving of compassion.
Obviously, you have to use your judgment as to whether they can tolerate this.
Once you’ve got a bit of compassion and empathy in the room, consider getting each partner’s attachment style clearly identified (sounds like one may be anxiously attached, the other avoidant), along with how they each got there early in life. Then there’s some room to help them recognize how brilliant they each were to have found each other as the perfect vehicle for either setting a relationship up to keep the familiar, dysfunctional attachment styles going, or, if they want, to learn about doing it differently, even if just for future relationships.
This is such shorthand that it sounds a bit trite here, but as I said, it’s really just meant to support what I think you already know.
Some really great ideas here – it’s fun to see therapists come together and share their thoughts on this couples therapy issue!
Parijat: Yes, triangulation certainly appears to be relevant in these situations – which needs to be looked at.
Marcia: I also look at this work as trying to figure out how to support the individual and the relationship. I think the question of whether to refer out individuals in a couples therapy dynamic is a case-by-case determination. In the case of two totally opposing goals, I would not. If it appeared they both wanted to work on the relationship, I probably would see them in this way to get a better understanding of what they’re bringing in – and to help them both understand each other in this way.
Esther: As a MFT I am always hoping to help support and reinforce a relationship but if one person doesn’t want that – that changes things. I realize there are others who have a different position on this – which I respect – but doesn’t happen to resonate with me and how I work. I like your idea of limiting the number of sessions to “clear the air” and create understanding. If it goes on too long with two people rigidly set on their opposing goals, that’s when it gets counterproductive.
Marsha: Your ideas around mindfulness moments in session – and identifying attachment styles are great. You know I’ve been studying neuroscience and Interpersonal Neurobiology and I have much more to learn. I wonder how many couples would be open to (especially the two with such opposing goals) sitting and looking at each other in this way. When I get more confidant in this arena perhaps I’ll give it a try – but I’m not there yet!
I typically do a 4 session intake process with couples before giving direct feedback for how we are going to continue counseling. First session, together, 2nd and 3rd sessions I will meet with them individually to get both sides of the story. Fourth session they come back together. I use the fourth session to say we need to continue couples counseling or that I need to refer them both for individual counseling or we need to continue couples counseling AND one or both of them need to also start individual counseling. That would be the true team approach!
So, in regard to your conundrum. Sounds like you got one spouse in some measure of denial and another that is checked out. If they are checked out, then it is probably done. Then you really have the issue of helping the one spouse come to terms with their denial and begin the process of grieving the loss of their marriage. This would effectively be divorce recovery counseling/grief counseling and would be best handle within the context of individual therapy. Lisa, as we discussed via Twitter, if one of the spouses is showing a lot of anger toward you and/or the spouse, then you would need to assess if they would benefit or need some individual anger counseling. I do individual anger management counseling as well as couples counseling. Recently had another marriage counselor refer me a male client that needed anger counseling. This therapist told the couple that she would not continue to see them for couples counseling until the anger issue was addressed. It would be much the same with an addiction issue, couples therapy would be pretty unproductive if either spouse had an untreated addiction problem.
I would use the first four sessions to let them no that no matter how this turns out, they both are going to have some work to do, either in couples counseling or individually. If you want to divorce, fine, but dont divorce and learn ZERO about yourself in the process. I liked the above posters comment about drop off therapy. Never heard it termed that way but have most certainly seen that, over and over again. Typically there is some codependency issues in play if that is the case. If you could assess this quickly, then the spouse that is doing the “dropping off” could benefit from some individual counseling around codependency problems.
Hope this helps.
I will give a longer response later, but the first thing to do is do your homework.
The seminal book on this subject is:
WHEN ONE WANTS OUT AND THE OTHER DOESN’T: DOING THERAPY WITH POLARIZED COUPLES
ed. John Crosby, (Routledge, 1989).
http://www.amazon.com/When-One-Wants-Other-Doesnt/dp/0876305273
It’s a must-read, and Crosby integrates chapters by a number of therapists on the very subject you’re posing.
John – Really helpful feedback, thank you. I like how you nailed the fact that one of them needs help with grieving the loss of the marriage at some point to avoid spinning in unproductive circles.
This quote from you really stands out too:
“If you want to divorce, fine, but dont divorce and learn ZERO about yourself in the process.”
TGP – Thanks for the book tip, I have not come across this one yet. If anyone else has any thoughts on others please post them.
I’m glad everyone is now turned on to Crosby’s book. It is so on point, and the issues that his contributors discuss are so crucial and handled so well, that there’s almost no point on carrying on a discussion until you’ve read it. For example, Marcia Laswell’s chapter starting at page 153 makes the salient point that in the course of her thirty years of psychotherapy practice, she’s seen many, many more one-sided decisions to divorce than mutually-reached decisions to divorce.
There’s no reason to be shocked or surprised by the polarized situation in your office. It’s common. The challenge is, who’s the client in that room? It’s not the husband, it’s not the wife, it might not even be the marriage if the marriage isn’t going to last. I think the client is the ongoing and future relationship of the partners, whether they marry or divorce.
What I’d like to know is whether you’d prefer that the partners ALSO have individual therapists, or whether you’d like to control the therapy. I’ve seen situations where both parties have individual therapists in addition to their marital therapist, and the therapists do not want to consult with the marital therapist for a variety of reasons, some of them quite well founded.
Fascinating subject and relevant to my first ever client assignment. I am currently studying relationship counselling and have just lost a couple who had all the characteristics of this scenario. An affair caused this couple to come to counselling and they both presented as wanting to save and improve their marriage. He quickly showed dismissive attachment tendencies and after 4 sessions it transpired he was continuing his affair and had been hoping to let his wife down gently. She then changed from wanting to save the relationship to ending it. He accepted and I was left feeling short changed. I have learned not to listen so much to the words clients give you but pay more attention to non verbal and physiological signals embodied in their behaviour. I would appreciate any comments on how this could have been managed better.
Kevy,
I think listening to the words of the clients is crucial but in addition, the subtext of attachment blocks and yearnings of both parties. In this case, things weren’t the way they appeared in that the one who was unfaithful indicated a desire to save the marriage but in reality had other motivations. As much as we therapists try to make sense of what people bring in from their words, body language and other signals, we are not mind readers and don’t always detect dishonesty.
But – what stood out the most for me in your comment was when you said, “I was left feeling short changed.” It’s also important to observe our countertransference reactions to the people we see. Supervision might be useful for you to sort through your apparent disappointment.
Lisa Brookes Kift, MFT
The Toolbox
Thanks Lisa. As this was my first client assignment I had ‘attached’ myself to them and had placed a value for me in saving or improving thier relationship. I realise from your insightful comments the countertransference and will take it to supervision. Many thanks.