Distress and Hope

 

According to research, by the time couples contact a potential therapist, problems in the relationships have persisted for at least several years, if not longer.

 

The couple, along with the therapist, certainly have their work cut out!

 

Simply arranging the first appointment may provide some hope that positive change is possible with the help of an objective third party whose expertise is in identifying, and altering, problematic dynamics in relationships.

 

But, sadly, this hope may prove to be fleeting.

 

Evidence suggests that a significant portion of couples therapies actually fail.  Forward progress on the issues that brought the couple to treatment in the first place does not occur.  Or, even more troubling, couples therapy sessions may end up making matters even worse, further entrenching the couple in conflict and frustration.

 

The Most Common Reasons Why Couples Therapy Fails

 

From an informal survey of the scientific literature on couples therapy I recently completed, here are the most common reasons why therapy with couples fails:

 

• Each partner blames the other for the problems in the relationship.

This is so common that a variety of terms including “projection” and “externalizing accountability” are used to describe it; it refers to the refusal or denial to acknowledge one’s own contributions to problems in the relationship and, instead, the compulsion to find fault in, and point blame at, one’s partner.

 

• The couples therapist fails to provide a conceptualization of what’s going on in the relationship to anchor and orient the therapeutic work.

A significant number of couples report that they were never provided with a framework or conceptual understanding by the couples therapist of what was not working in their relationship.  “We don’t communicate well,” for example, is an insufficient depiction of what is going on, merely a description of an obvious symptom or manifestation of underlying, more insidious factors.  In successful couples work, the couples therapist must provide a succinct, clear and usable framework or guiding metaphor for the couple that organizes their issues and captures what, exactly, hinders the couple’s potential.

 

• The couples therapist assumes or is placed in the position of judge regarding who is “right” and who is “wrong” in the relationship.

At times, unfortunately, the therapist accepts this role and, by doing so, forms a coalition with one partner against the other; when this occurs, it erodes trust in the therapist and usually does not solve, merely amplifies, the unresolved power dynamics in the couple’s relationship.

 

• “Circular causality” is a framework never introduced to the couple.

The capacity for each partner to identify and accept his/her own accountability for problems in the relationship is further assisted by understanding causal links or chains of reaction that plague the couple.  For example, if partner A approaches partner B with a critical or harsh tone of voice, it is more likely than not that partner B will respond negatively.  These chains are often quite complex with many contingencies, i.e., in the example above, partner A approaches with a harsh tone of voice because he/she has been upset or angered by partner B’s withdrawal from partner A the night before.  The ripple effect of unresolved disappointments and failed interactions can become quite heated and dramatic as each partner unknowingly influences the other in ways that increase the probability of negative blowback rather than neutral or positive engagement.

 

• The partners and/or the couples therapist cannot tolerate the exploration, expression and resolution of difficult emotions that may come up.

The experiences of rejection, disappointment, and hurt are often at the foundation of most couples’ problems, yet over time emotional pain tends to be covered over by frustration, anger, and resentment.  If couples therapy fails to dig below the surface level of anger and reach these underlying regions of emotional experience, little can be achieved.

 

• The couples therapy sessions become nothing more than a scheduled time and place for the couple to fight, and the couples therapist fails to redirect the partners.  

An unfortunate pattern frequently occurs in couples therapy in which each session begins with a description of the most significant issue or fight that has occurred since the last session; each partner provides his or her view of what happened, often in disagreement with the other partner’s portrayal, and a heated argument ensues in the session — relegating the couples therapist to the role of referee.  Even more problematic is the therapist’s hesitation or inability to de-escalate the partners’ intense conflict and reactivity in the sessions and failure to bring the couple back to a more calm and productive dialogue.  Once this pattern is established, the couple understandably becomes demoralized and resistant to scheduling additional sessions because the partners feel, understandably so, that they are simply getting nowhere, just digging themselves into a deeper hole.

 

• The partners do not see themselves as allies for each other, only enemies.

While partners have been hurt, angered, or disappointed by each other, often significantly so, something must occur in couples therapy that expands each partner’s view of the other to that of a benign source of goodwill and support who is committed to making the relationship better.  If each partner is able to see the other as an ally, together they will be able to tolerate the difficult work of couples therapy and approach it collaboratively.  Many couples therapies fail because the partners continue to experience each other as adversaries.  Consequently, they remain locked in bitter struggles for dominance and persistently discredit each other’s point of view and emotional reactions.

 

• The couples therapy gets bogged down by abstract ideas and psychological jargon; whatever insights are achieved do not translate into pragmatic changes in the relationship.

Couples want real-time positive change that improves the quality of their relationship and of their lives.  Most couples I have worked with appreciate gaining an understanding of what went wrong in their relationship and how it went wrong, but what they want most is guidance on what to do about it.  Linking new insights gained in the sessions to well-defined adjustments made outside of the sessions, and insuring that these new adjustments actually work and can be maintained long after couples therapy has ended, is a crucial determinant of the ultimate success of treatment.

 

The Couple in the Hands of a Skilled Clinician

 

While the issues outlined above can certainly hinder or entirely block the potential of couples therapy, all hope should not be abandoned.

 

Clearly, couples therapy requires a well-trained and experienced clinician who can avoid these common pitfalls and, more broadly, simultaneously assess, understand, and intervene upon several interlocking elements of the couple in distress.  These include each partner’s relational history and psychological make-up, as well as the nature of the dynamics between them that they have mutually constructed.

 

Moreover, the skilled couples therapist provides a clear treatment plan, a roadmap for the couple to see and track their progress toward their goals.  And progress, or the lack thereof, is regularly assessed and discussed, so that unhelpful couples therapy sessions do not continue endlessly, which can only demoralize and frustrate the couple.

 

Additionally, it seems that couples need, and benefit from, the direct and spirited contribution of their couples therapist.  Research of couples therapy shows that traditional notions of the therapist’s need to maintain a neutral stance and avoid candidly observing and commenting on his/her subject experience of the couple have actually not led to successful couples therapy outcomes.

 

In my practice, I have learned that couples want to know what I think about what’s going on and appreciate my direct, albeit respectful, feedback regarding who is responsible for what issue and how the dynamics between them are getting in the way of their relational goals.  The partners of a couple need to learn what they are not doing well in the relationship, as they often do not see it.  And they are helped by honest and direct feedback that identifies and facilitates the development of alternative, and more beneficial, attitudes and behaviors.

 

James Tobin, Ph.D. is a licensed psychologist based in Newport Beach, CA.  His psychotherapy practice consists of individual, couple, and family therapy, with an emphasis on interpersonal patterns and relational dynamics that obstruct one’s access to truth, fulfillment and intimacy. The executive coaching component of Dr. Tobin’s practice focuses on helping executives and teams identify and navigate psychological dynamics in the workplace.