According to the American Psychological Association, healthy marriages can be beneficial for physical and mental health and for offspring’s well-being. Unfortunately, the APA also reports that 40 to 50 percent of marriages end in divorce. For any couple facing rocky times, professional intervention might help get the relationship back on track.
The grand themes that bring couples to therapy have remained the same through the years, although there are variations, according to Bruce Chalmers, Ph.D., private practitioner in South Burlington, Vermont.
“People come when there has been some kind of crisis,” he said, noting that common triggers include the death of a parent, birth of a child, sudden illness, having an affair, empty nest syndrome or the permanent arrival of in-laws, among others.
And technology has “…radically changed the way people get busted for affairs.” But basically, he believes that couples in trouble have “…a hard time tolerating intimacy because intimacy is inherently painful.”
According to Chalmers, to maintain a long-term relationship, couples need stability skills and intimacy skills, noting that both are extremely important but often in conflict with one another.
“Stability skills are generally the ones that lower anxiety,” he said, and involve earning a living, learning how to soothe each other, being trustworthy and faithful.
On the other hand, intimacy skills tend to raise anxiety. “It often involves being willing to say things that your partner may not like. To be willing to do that is important in preventing certain festering resentments from happening. It’s important in their sex life. It’s important to share how they feel, what they like and don’t like and express fantasies,” Chalmers said. “People have to learn to tolerate anxiety.”
Chalmers uses therapeutic conversation, actively engaging the couple. “I drive it, but am not telling them what to do with it,” he said. “People need to assume responsibility themselves. I don’t claim to know better than they do what they need.”
He also uses hypnosis and EMDR and is trained in trauma; he has found that past trauma might trigger some current issues.
Rather than prescribing assignments, Chalmers suggests couples reflect on discussions that took place during sessions. “People have to find their own meaning within the grander sense of obligations and everything that constitutes who they are and act on that,” he said. “I tend to find homework imposing. It takes them away from themselves instead of toward themselves.”
Jill Colman, Psy.D., private practitioner in Cambridge, Massachusetts, finds that, in general, poor communication is the primary issue that brings couples to therapy.
“Related to that, there could be underlying resentment about perceived inequalities in the relationship, the feeling that one person is doing more than the other or doesn’t value the other person’s time,” she said, adding that life transitions such as adultery and job loss could cause stress in the marriage.
Even when couples do seek therapy, Colman finds that getting “buy-in” from both partners can be challenging and is “more typical than not.” In such cases, her aim is to allow the resistant partner to talk, while she just listens.
“Maybe they just want to complain for a while,” she said. “I help the person feel more comfortable and do anything I can do to engage them. Often that’s what it really is, a process of acclimating.”
After obtaining a history that includes childhood experiences and how the couple met, she elicits information about the present status of the relationship.
“Past incidents in the family can drive what’s going on currently,” Colman said. “Some people are so scared of conflict they don’t talk about anything and that can be a big problem too. They have better understanding and awareness when they talk it out during therapy.”
Colman completed her post-graduate training at the Psychoanalytic Couple and Family Institute of New England and utilizes psychoanalytic thinking.
“That approach integrates psychoanalytic, unconscious motivation. People repeating patterns from the past and family systems trigger one another so the dynamics can be reinforced. How the past drives family is a motivating factor,” she said. This technique helps bring awareness and recognition of some of their issues.
Although Colman rarely assigns homework, when she does the emphasis is on spending “positive time together.” She said, “Homework can be a date night, just the two of you and not talking about the children, but about something else.”
An initial four-session evaluation helps Jill Hanson, LMFT, Psy.D., private practitioner in Collinsville, Connecticut, determine the couple’s goals, barriers and steps to achieving these goals. Using a tailored approach, she incorporates brain and body physiology education with each couple.
“I examine how we’re stirred up and can’t engage in meaningful communication. There are some very cohesive models that give good guidance,” she said.
For instance, Hanson uses Insoo Kim Berg’s Miracle Question, asking the couple to shape a vision for the future. She also draws upon the work of John M. Gottman whose study focuses on marital stability and relationship analysis through scientific direct observation.
“At some point, there was a flame. I help the couple find a way to see a real sense of value in each other again,” she said.
Hanson also utilizes talk therapy, cognitive behavioral therapy, dialectical behavior therapy, Imago Relationship Therapy, Emotion Focused Couples Therapy, attachment based therapy and examines the life stage/circle in her work.
“If we are working on something and not making progress, I may shift to another way to address problems. I’m not [set] one hundred percent on any particular model, but draw from several,” she said.
In between sessions, Hanson recommends reading some good couples books and refers couples to marriagebuilders.com where they’ll find a set of questions for discussion.
She offers the couple workbooks and may encourage more physical connecting and intentional behavioral change to increase sexuality and physiological interaction.
Regardless of the approach, therapeutic intervention may not always succeed in repairing a floundering relationship. “If the couple feels they’ve exhausted all efforts and resources, therapy might not be helping, or if things are getting worse, the couple might say we’re done. They might be ready to divorce or separate,” Hanson said.
“I believe people in couples’ therapy have to exhaust all opportunities and try everything or have regrets when they feel they’re done.”
By Phyllis Hanlon