What Happens in Couple's Counseling

by Carol Campbell, MFT

What happens when a couple goes to see a therapist for couple's counseling? That depends upon the therapist. Doing therapy is an art form, and it is shaped by the particular theoretical orientation of the therapist. Most therapists are taught to draw upon a range of techniques and ideas, but how it is delivered will be unique to each therapist and with each couple. In this brief article I will describe what generally is going through my mind when I work with a couple in therapy.

My connection with the couple starts with their first contact with me. I notice which person is the one to make the call, and how that person is thinking about the problem for which they are seeking my help. Does he minimize the seriousness of the difficulties? Does she seem to be overly upset by an issue most people could handle fairly easily? Is there blaming of the other person either implied or directly? Does there seem to be some capacity for looking at the person's own behavior as part of the problem?

Next I listen for issues of safety. Generally speaking if I detect that domestic violence is involved, I prefer to postpone working with the couple until they have each had some individual therapy. Couple's counseling is usually working to strengthen a relationship, and I do not want to strengthen something that is toxic. The batterer and the battered need to be seen separately in most cases in order to truly intervene in the cycle of violence, whether it is physical or emotional.

Some therapists will have the patients fill out forms to gather history. Some even leave the forms in the waiting room to be filled out there, or actually send them in the mail ahead of time. My style is much different. I want all the information to emerge when we are together in the room. What the people choose to talk about is very helpful to me in understanding their ways of relating. For me to intrude with a list of my own questions about them sends a message that they are there to take care of me and my need to know. Part of being an adult is tolerating the unknown, so I want to model for the couple that I can tolerate not knowing a great deal.

Conversation starts when someone begins to tell me something. For me to ask if they had trouble finding a parking place, or some similar social chatter, tends to send a message that I think they are incapable of figuring things out, or that I think we are there for a social gathering, or that I am needing to put them at ease because I can't tolerate anxiety. A gentle amount of anxiety is very helpful in getting down to the challenging business of figuring out what is not working so well in a relationship.

As each person has a turn to tell me what is going on between them and for them, I look for signs of strength and weakness in the relationship. I insist that each person speak for him- or herself , and not try to tell me what the other person is thinking or feeling. I shift the whole concept of couple's counseling to the idea that each of them is there to find out how they each can do things differently in order to help the relationship. This often stands in contrast to an assumed goal: "Fix my partner!"

I like to help the partners see how they habitually project figures from their families of origin onto the partner, so that they are not actually relating to the person standing before them, but unconsciously trying to address hurts from decades earlier. If one person complains, for example, "You spend all your time at work and I just get the leftovers," I would not be surprised that we end up talking about how neglected the person was by a parent. Some degree of that person's upset might indeed be about how work-preoccupied their partner is, but a great deal of it might be about a childhood issue that needs to be grieved and accepted. Once a partner understands how a particular behavior has the effect of ripping open a tender emotional place in the partner, they may be less inclined to use that behavior.

Therapy is about accepting reality and being a grownup. When it becomes clear that one or both partners have issues from childhood that have derailed their ability to be mature and have appropriate concern and regard for others, then I will refer the patient for individual work. We are all doing the very best we can with what we have at the moment, and sometimes what we have is frankly inadequate. Individual therapy can often change that situation remarkably, and bring about an enlarged capacity for rich emotional experience and expression.

Couple's counseling is not a magic bullet. Some relationships are simply beyond help. Some couples wait far too long to seek professional help, being caught up in the myth that we should be able to solve our emotional problems on our own, in the great cowboy tradition of self-sufficiency. But most of the time, people who come to see me for couple's counseling are very grateful and wish they had come sooner.

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Carol L. Campbell, MFT, is a licensed marriage and family therapist providing psychotherapy and psychoanalysis for individual adults and couples in Palo Alto, California. She has degrees from Brown University and Santa Clara University and has been licensed since 1991. Carol is a graduate of the Palo Alto Psychoanalytic Psychotherapy Training Program sponsored at Stanford by the San Francisco Center for Psychoanalysis and was a candidate at the Psychoanalytic Institute of Northern California in San Francisco from 2010-2011. She is also a clinical member of the California Association of Marriage and Family Therapists and the Northern California Society for Psychoanalytic Psychology.