GPS: Couples Therapy

Therapy With Couples
(last updated February, 2008)

Home>Services>Therapy>Couples

Dr. Myles Genest on his work with couples:

Couples' Problems:

Usually, when couples seek professional help, they have been living with their difficulties for a long time and feel discouraged about solving them. Some couples are locked in conflict that erodes their feelings for each other. Others have avoided conflict but feel they have drifted apart. No matter what the problem, it is hard for a couple to step outside the pattern of behaviour that has developed and to find new ways to work together to tackle their problems.

improve relationships

improve effectiveness of communication

resolve conflict constructively

resolve sexual problems

increase intimacy

develop problem-solving strategies

When I ask couples what their most significant problem is, they most often answer communication, or conflict or both.

Disagreements and problems are normal in a relationship. When a couple doesn't have ways to tackle these constructively, the relationship is in trouble. Difficulties grow and conflicts escalate. This can lead to a cycle of negative interactions that damage the love that is needed for a relationship to last. Couples get locked into negative things like emotional distance, anger, blame, sarcasm, withdrawal, negative interpretations, put-downs, jealousy, sexual problems, and a search for caring and understanding in other relationships. Depression, extra-marital affairs, violence, and physical health problems are serious potential consequences of chronically dysfunctional relationships.

As an example of the potential health consequences, a study in the Journal of the American Medical Association (2001, 284:3) reported that women with prior heart problems were almost three times as likely to have to have further coronary problems if they reported high levels of marital stress.

After an affair, couples often seek help in order to try to save their relationship, or, sometimes, to decide whether they can save it. Therapy can provide a safe, confidential, and balanced environment, in which all work together to rebuild the relationship.

The affair is top priority when the couple arrives in the psychologist's office. But successful therapy must also eventually address problems that predate the infidelity and may have contributed to the risk. This work can be hard-going. I have found, though, that some couples not only survive this crisis, but in working through it, they achieve a level of harmony, satisfaction, and honesty in their relationship that they never had before. A website with good information concerning this therapeutic work is www.aamft.org.

It is important that the individuals feel safe...to talk freely and feel treated with respect.

Initial Meeting:

At our first meeting, I ask the couple what brings them to see me. When they have introduced their greatest concerns, I then see each person alone. Although couples want to resolve their difficulties as a couple, they often have concerns they want to express in privacy with the psychologist. For some partners, it is a relief to be able to speak freely about concerns, fears, vulnerabilities, history, family background, and so forth, without having to worry about the impact on the other person. Sometimes, when a couple is very open with each other and find it easy to talk with each other in the room, this is less important (although I never omit this opportunity).

Sometimes, couples are apprehensive about therapy because they are concerned about getting into conflict during sessions. Anger is often felt by one or both partners, and if so, it is important to address it openly during counselling and therapy. At the same time, it is not productive for a therapy session to turn into a battleground. In fact, it is important that the individuals feel safe in my office to talk freely and feel treated with respect. As a result, I intervene quickly if the situation begins to escalate into conflict and we explore other ways of dealing with the anger and its source.

Following individual interviews, we again meet together. We review major concerns and issues; I answer questions; and we discuss how to proceed. It is often not possible in the initial session to do more than gather this information and provide a bit of a preview about what might follow in therapy.

The Course of Therapy:

Couples differ in the problems that bring them to counselling or therapy and so the approach to their problems must be sensitive to the uniqueness of each partnership. Because counselling and therapy differs in each case, it is difficult to describe exactly how it will proceed. In most cases, however, therapy focuses on two things, the problems that the couple are experiencing and the process of resolving them.

Both [partners] need to take joint ownership of the couple's difficulties, and both need to focus on their own efforts, rather than on blaming,

The process is usually the most important focus because the aim of therapy is to give couples the means to solve their own problems. Initial sessions typically involve having the couple talk with each other about some current (but not the most difficult) issue, while I work with them to speak constructively, in non-blaming ways and to hear each other non-defensively. The aim is to avoid escalation of conflict and ensure that the one speaking feels understood. This simple-sounding step is often the most difficult part of therapy. It is crucial, however, and very often couples find that the first three or four sessions open up a whole new dimension to their relationship. Occasionally, couples are impatient with the idea of learning how to solve problems and repeatedly focus on the problems themselves. There are few problems that can be quickly solved in a therapy session and generally couples have already made many unsuccessful attempts at solutions. For this reason, I encourage developing effective communication before taking on the most difficult problems.

Of course, each couple's communication problems are different. Common difficulties include feeling that one's concerns are ignored or too readily dismissed; having anger interfere with both speaking and listening; having the sense that one goes around and around the same discussion without progress; feeling overwhelmed by the emotional intensity of the partner; feeling that the partner is disengaged and uninterested; and having one topic lead to another and another, in an escalating sequence of conflict.

I help both parties to focus on their own communication style, their own feelings, and their own problems in conflict situations. Both need to take joint ownership of the couple's difficulties, and both need to focus on their own efforts, rather than on blaming, instructing, and giving direction to their partner. Often, an obstacle to progress is the initial view of one or both partners that only the other has to change, to do what he or she believes is right.

As we work together, we begin to tackle the big issues, which sometimes involves exploration of earlier parts of the relationship, and sometimes also earlier relationships and other unresolved issues. Although the focus is on here and now, the past usually needs to be examined just enough to understand and alter what is happening in the present. For many couples, understanding earlier problems, and feeling understood, is important in order to progress to forgiveness of the partner and of oneself and it is crucial for them to go forward.

I often recommend readings for a couple, and they work through specific materials as part of the work in therapy sessions. We work together to find appropriate ways to follow up the therapeutic session with "homework" that enables practice and further progress with what has been accomplished.

Some couples find that two or three sessions are sufficient to get them on track or deal with specific problems they are having. More typically, therapy lasts 10 or 12 sessions, or longer.