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What a clinical therapist wants you to know about couple's therapy

I welcome a new couple to my therapy office. They are in their late 20s. He gives a smile, seeming apprehensive. She reaches for his hand and appears anxious to begin.

"So, what I know about relationships is that we all have our own experiences," I start. "Because of this, it is important that I hear from both of you today about what is going on. Who would like to start?"

They look at each other.

After a pause, she says, "We are here to find out how we can help our relationship before we get married. We want to know more about ourselves, and our relationship so we will be better equipped to deal with conflict in the future." She continues, "And, we hope to develop a relationship with you so that when we struggle in our marriage, we can come back to work through it."

Here's what we know about relationships. It is not IF you will struggle in your relationship. It is WHEN you will struggle with the one you love—and that's completely normal.

When we enter romantic relationships, we open ourselves up. We share our innermost longings and secrets with the person sitting across from us, becoming more vulnerable. We take risks and we hope they will "catch us" in our times of need.

But here's the catch.

The moment your partner means something to you is the very moment they have the ability to hurt you. This is an important point. Your partner will hurt you—it's inevitable. When we hold out our hearts to the ones we love, who we so long to be accepted and valued by, we open ourselves up to being hurt.

No one individual can meet all your needs—our partners are not perfect. They will make mistakes and this is okay. It is not about having a perfect relationship without difficult moments. Rather, it is about repairing the hurts and mistakes that happen so we do not keep repeating them.

Repair is important. And sometimes we need help to repair really tough moments. This is why my mind silently cheered for this couple in my office—they were preparing for their tough moments, becoming more informed and ready to face adversity—together. As a couples therapist, this was music to my ears.

When we hit tough moments in life or in our relationship, we want to know:

  • (A)re you there for me?
  • Will you (R) respond to me?
  • Are you (E) engaged with me?

Dr. Sue Johnson, the creator of Emotionally Focused Couples Therapy and author of best-selling couple books Hold Me Tight and Love Sense, calls this the A.R.E conversation that helps create security and connection between couples. It is what we look for in our partner during times of stress.

But when couples are distressed, they have difficulties responding to each other in this manner. Dr. John Gottman, couples therapist and author of The Seven Principles for Making Marriage Work, has studied over 3000 couples and describes four toxic patterns of communication:

  1. Criticism
  2. Contempt
  3. Defensiveness
  4. Stonewalling

When couples are distressed, they fall into these negative communication patterns that consist of negative displays of emotions, blame and hostility and withdrawal. These cycles become entrenched into a repeating, cyclical pattern that continues to be reinforced over time. And often, while a couple is having an argument about different issues, the pattern of communication is the same.

For some, this may look like "I blame because you withdraw" or "I withdraw because you blame." In these patterns of communication, couples experience emotional disconnection, increased negative affect and unmet needs and longings. This further perpetuates insecurity and feelings of rejection and abandonment.

Couples who are unable to resolve problems stay stuck in their conflict. According to Dr. Gottman, these negative communication patterns are linked to higher rates of divorce.

Couple’s Therapy: What is it and how can it help us?

Couple's therapy, and therapy in general, is becoming more widespread and accepted. We see this in the general discourse of famous couples – Kristen Bell's recent "Love Ballad" to her therapist, and her and Dax Shepard's openness about seeking couple's therapy to enhance their marriage—just one example of public figures opening up about seeking relationship support.

Despite more and more couples willing to attend therapy together, I often hear misconceptions from others about what couple therapists do, and this stops them from seeking help.

“Why would I want to talk to a stranger about our private issues?” “They will just give advice that I already know.” “They will take your side.”

Couple's therapy is not an advice-giving, blaming experience. Instead, therapists work to develop a safe and collaborative relationship with both partners. It is key that both individuals feel heard and validated. Their experience of the relationship is real and in order to help change, it must be understood.

Therapists also act as process consultants, slowing down interactions and observing patterns that the couple may not be able to see. Couples often think they can get out of these patterns themselves; however, these patterns are entrenched and have been reinforced over the lifetime of the relationship. It becomes hard for both partners to change.

As an objective third person, therapists provide insight into what is keeping them stuck, communication errors, and aspects about each individual that is contributing to the distress. Tools are also provided to couples.

When did you take a course titled "Relationships 101?" Yet, we know that our relationships are one of the most important parts of our lives. This is why we fight for them—we fight to matter, to feel heard and validated. But we never learn how to do this.

In addition to getting out of sticky patterns, couple's therapy can help build increased emotional closeness and physical and sexual contact. It can address complex feelings between you and your partner, or perhaps from past relationships that are impacting your relationship today.

Therapy can also help restore trust between partners, perhaps from a difficult emotional event, or from an emotional or sexual affair. It can also help improve communication, problem-solving and negotiation skills. These skills can also be used to help couple partners improve their parenting ability.

Finally, sexual intimacy is key in our relationships but so often partners do not know how to communicate about and resolve sexual difficulties. Therapists can help resolve some of these issues, perhaps related to desire and orgasm, or sexual pain, or to enhance sexual practices.

“Therapy is too expensive and time-consuming.”

Yes, it is. I do not challenge others when they say this. What I do ask, however, is that they consider how important their relationship is to them and if a meaningful life includes a connected companionship.

Our relationships do not come easily to us—it is okay to struggle in them, but it also means we must work at them. We are not born "good communicators." We need to learn how to do this. Like any skill, we need to put time, practice and effort into it.

While therapy is expensive, so is a vacation. What if one year you postpone the vacation and invest in your relationship? Perhaps then you will have a lifetime of connected vacations.

Many of the couples I see in therapy have date nights after our sessions to continue to connect and discuss key issues. Perhaps the babysitter stays for an hour longer. Or, other wants are put on hold to prioritize the relationship. You make this choice to engage and invest in your relationship.

“We’re not that bad. Why would we go now?”

Dr. Gottman's research shows that the average couple will wait six years before seeking help. Waiting this long further entrenches your negative patterns and can have significant consequences for you and your relationship.

Research shows that relationship distress can cause adverse effects on both physiological (i.e., cardiovascular, endocrine and immune functioning) and emotional health (i.e., mood, anxiety, and substance use disorders).

When couples attend therapy prior to years of significant distress, they can learn to communicate and discuss difficult issues before they become unresolved arguments. This is a prevention model, rather than a treatment model.

In addition to helping to improve the relationship, couple's therapy has also been shown to help individual emotional and behavioral problems, as well as mental and physical health disorders. Think of couple's therapy as prevention, regardless of where you are in your relationship, we can all benefit from learning how to better connect with our loved ones.

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