I’ve been doing couples work for more than 40 years. Most of the couples I treat are reasonably well-intentioned people who come to treatment because they are unsatisfied with their relationship or there has been a crisis of trust. They are hurt and disappointed with themselves and each other. They wonder where their love has gone or why it doesn’t seem to be enough. They say they want to stay together. They come to me instead of to a lawyer because they still have hope or they are sufficiently committed to their commitment to try again to make their relationship work.
My initial training in the 70s was in Adlerian theory and treatment. That was enriched in the 80s and 90s by considerable study of family systems work in all its variations. Like most therapists, I’ve tweaked my theoretical foundation with the good work that has been developed since. I find the resulting assumptions to be helpful as a framework for my work with couples.
A Framework for Treating Couples
1. Whatever is going on makes a kind of sense. People simply don’t keep something up unless it “works” (or they think it will work) in some way. Perhaps it shores up the person’s self-esteem or hides their insecurity. It’s possible it serves as protection of some sort. Maybe it gets the other person to back off. I often remind myself that I don’t have to understand the sense behavior makes completely in order to start dealing with it. Sometimes the understanding emerges from the dealing.
2. When people are in the grip of mental illness or addictions, the behavior may be the illness talking, not necessarily the core person. In such cases, the illness or addiction needs to be addressed directly. The couple work can carry on in the meantime. However, it is important for both me and the couple to understand how the illness of one or both just might contribute to the kind of sense their relationship makes. Sometimes it does. Sometimes it doesn’t. But it’s important to explore it.
3. What is happening, however painful, is in fact the couple’s attempt to solve a problem. I believe it was structural therapist Savador Menuchin who talked about this idea. He found that that distancing, fighting, correcting, blaming, even infidelity or indecisiveness may be the only way the couple has found to deal with whatever is stressing them. Sadly, such efforts bury the problem under feelings and frustrations born of the ineffective and hurtful “solution”. Our job is to help the couple step back from it so they can get back to solving the core problems.
4. A major effort of therapy is to get the two people on the same side, fighting against the problem instead of on different sides, fighting each other. Whatever has become a problem for them has called into question their ability to work as a team. It is often helpful to spend time supporting them in remembering times they have been a successful team before. Often, teams respond to some coaching to get back in their zone.
5. Either person can initiate change. All couples that have been together for at least a few months have developed a “dance;” a cooperative way of interacting. Some steps of the dance are beautiful. Sometimes, they step on each other’s emotional and psychological toes. Some efforts result in major pratfalls. But all steps are a result of their attempts to cooperate. That means that either side can change the way the pattern continues or doesn’t. Either individual can change elements of the “dance.” Both will then need to embrace the change in the steps for the new choreography to stick.
6. When people make an agreement and then one of them “breaks” the agreement, they didn’t really have an agreement. Sometimes people agree just to get out of the fight. Sometimes one or the other person is too caught up in being a “pleaser.” Sometimes they agree without fully appreciating the implications. Sometimes the agreement is just too, too difficult. Whatever. It is not helpful to assign blame to the person who apparently broke the agreement. Instead, we need to back up and frame it as an opportunity for the couple work on an issue until an agreement can be found that is genuine from both sides.
7. Sometimes a couple is stuck in conflict because of influence from other people in the family system. Never underestimate the power of in-laws, for example. If the in-laws disapprove of the relationship or are over-involved, they may be exerting direct or indirect pressure. Ditto when working with senior couples whose adult children or stepchildren may be making things difficult for them. It’s important that we always ask about the couples’ relationship with both families and how it impacts their couple-ness.
8. Change always occurs in steps. When a dance has been well-rehearsed and practiced for some time (as with long-term couples), it is unlikely that they will simultaneously have such an “ah ha” experience that they both will make a major change that sticks. Often, change breaks down or old patterns reassert themselves because a step has been skipped or something wasn’t adequately explained or understood. It’s important that we take time to help couples learn how to be supportive of each other while they practice what they’ve learned until it becomes permanent.
9. Treatment can get stalled or bogged down if one or both people (or the therapist) starts believing that there is only one way to solve the problem. There is always, every time, more than one way to look at a situation or issue and more than one way to change what happens next. Part of our job as therapists is to open up those possibilities. The art of reframing is one of our most valuable skills.
10. It’s important to take time between sessions to review these assumptions and how they are being played out in treatment so that we stay on track. It’s so easy to get caught up in the crisis or even celebration “du jour” at the beginning of a new session. It’s critical for me to stay aware that I could be inducted into the couple’s “dance,” their discouragement, or premature optimism that they are ready to end treatment.
Over time, each of us therapists develops a framework based on our training, instincts and experience that guides the way we do our work. I don’t presume to suggest that everyone should or could embrace the assumptions I find so useful. I do hope that sharing my framework prompts others who perhaps haven’t articulated how they work to think more concretely about their own.