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Couples Therapy:
Why So Many Therapists Avoid It

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Couples Therapy: Why So Many Therapists Avoid It

BY E L LY n Ba D e R & P ete R P ea R s O n

ith the help of fascinating advances in brain science in recent years, we now know that people are neurobiologically interconnected with a speed and intricacy far beyond what psychotherapiststhose presumed experts on relationshipsonce imagined. Weve learned how easily one partners tone of voice can trigger the others amygdala, how the mirror neuron system can instantaneously shape our ability to grasp each others inner world, how few of the countless implicit messages passed between people in any interaction are conveyed by language or even become conscious. As Dan Siegel has put it, weve moved from a single skull model of the brain to the neurobiology of we. So heres the question for clinicians: if we now recognize how inescapably relational and interconnected people are, why do most of us continue to work primarily with individualsmost of whom grapple with serious, persistent problems in their intimate relationships? Part of the reason, of course, is that so many clients themselves avoid couples therapy. Sometimes they resist because they arent motivated, or because they fear the unpleasant things their partners might say about them. Often they resist because they want to avoid the unwelcome challenge of selfconfrontation that accompanies hearing their partner express dissatisfaction with them and their relationship. Besides, why should partners risk exposing their deepest vulnerabilities with the very person they may see as the cause of their emotional struggles? By contrast, individual therapy seems like a safe haven. Clients want, and usually get, plenty of empathy from their therapist, and they dont have to share this special relationship with anyone else. They have the freedom to work on issues that they select, on their own timetable. If they arent ready to deal with a problema struggle with selfishness, deception in an intimate relationship, addictionthey can simply minimize it, or never bring it up at all. Another, less-discussed reason that most psychotherapy today is focused on the individual is that many clinicians themselves prefer it. When working with an individual, we get to establish a one-on-one relationship thats usually pretty rewarding for us. Most of our individual clients feel positive toward us; many express appreciation for our efforts. We get to apply skills that we think were already good at: active listening, understanding, and acceptance. If a misunderstandCouples Therapy: Why So Many Therapists Avoid It

ing or power struggle emerges with a client, theres usually far more calm predictability in the process of addressing it than happens when angry spouses square off against each other in our offices. Couples therapy, by contrast, can feel like piloting a helicopter into a hurricane. When we started doing couples therapy, more than 25 years ago, full of hope and enthusiasm, we were unprepared for the hostility, bitterness, distrust, and occasional homicidal rage that wed witness. (One of Ellyns clients once sprayed her allergic husband with insecticide, hoping it would close up his airways and kill him.) Brain research suggests that the part of the brain that processes an emotional assault is the same part that processes a physical assault, so when an individual is verbally assaulted by a partner, the brain responds as though he or she is being punched in the stomach, prompting the same toxic mix of fear and rage. How, then, are we to proceed? How do we construct a bridge of understanding between people who may disagree hotly about whats wrong, resist self-awareness in the service of blaming each other, have unequal motivations for change, and continue to be terribly unkind to each other? Being an effective couples therapist requires us to develop skills we may not come by naturally and to spend a lot of time feeling unsure of our capabilities. It may be dangerous for us to continue as we are, closeting ourselves mostly with individual clients. Lets lay the basic premise of this article on the line here: we believe that individual therapy can be hazardous to a couples health. The calm, understanding environment of one-on-one sessions too often leaves a client ill-prepared to take on the gritty, emotion-charged real world of a troubled relationship. In sessions, individual clients arent learning how to listen, stay calm when triggered, negotiate actively, or stretch to empathize with an intimate partner who intensely annoys and frustrates them. The client may leave the therapists office with valuable insights, but that may not help much when she opens her own front door to find her spouse standing in the hallway, angrily flapping the latest credit-card bill in the air, and accusing her of spending more than they earn. Again! Before therapists consider inviting more couples into their offices, they need to understand their own resistance to the work. Weve chosen three cases (we could have chosen
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many others), each of which gets to the heart of some of the fears and insecurities with which couples therapists regularly wrestle.

Fear of Inicting Pain: Ellyns Experience

When Tom called for an appointment, he told me that he and his wife, Betsy, were just having a few communication problems. As their first session began, Betsy described a 30-year marriage in which she felt shut out by Toms tendency to space out and spend a lot of time away from the house. Barely 10 minutes into the session, Tom began to talk about how anxious hed been feeling during the past week as he anticipated our session. Before long, I got a sinking feeling in my stomach. I dont really know whats bothering me, he said. I just seem to stay at work later and later. I dont feel much desire to rush home. Years of doing couples therapy screamed out to me: Hes here to end this marriage, but he wont say it. It wasnt just his words: he barely made eye contact with either Betsy or me; he was emotionally flat, yet perspiring profusely. We need to learn how to talk about our issues, Betsy responded, in a determined but hopeful voice. She put her hand on Toms. Ive wanted to do this for years, she said softly. Im so glad you finally agreed to come and get some help. Looking slightly past her, Tom said, Yes, we do need to learn to talk better. He stared down at the rug. Im just not good at talking. Ive never been good about talking. As he said this, every fiber of my being was signaling, This is a man with a secret. Despite his protestations about his difficulties with communication, he was talking just fine in my office. Could it be that, for some reason, he just didnt want to speak his truth? My head was spinning. Would he be willing to be direct? Or would I be the one who had to ask? What was the secret that was going to be revealed? Tom, I began, what do you think your anxiety is telling you? He replied, Ive been anxious for years, especially when I get into bed at night. Now, since we decided to get therapy, I barely sleep at all. She thinks I have an intimacy issue. Inching into unknown territory, I replied, Sometimes, anxiety has to do with not wanting to be in therapy at all. Sometimes, anxiety has to do with fear of moving into highconflict topics. And sometimes, it has to do with not having the desire to respond to your partners request. Can you tell me what percentage of each is true for you? Immediately, Tom began rambling on about how compatible he and Betsy were. I really value her friendship, he said. And weve been good parents together. Not a word about what the anxiety might signal. The temptation was to allow him to continue on like this, especially since Betsy was nodding along as he spoke, seeming not to pick up on what I was sensing.

Could I postpone my probing for the real story? After all, I was tired. I could slow down for now and hope that between sessions, Tom might tell Betsy the truth. But my instincts told me that wasnt going to happen. Plus, theyd come to me for help, not for self-protective silence. After years of doing couples work, I knew that sometimes what we must offer, at least initially, is pain. I turned to Tom and simplified my earlier question. Sometimes spouses are afraid to grow and change, while other times theyre afraid to reveal something painful, I said to him. I wonder which of these is more true for you? At this, Betsy sat up straighter and looked directly at Tom, who grew silent for what seemed like an excruciatingly long time. Still he said nothing. He appeared to be deliberating whether this was the time to wreak havoc on his marriage. My dread was mounting and I imagined his was, too. Finally, he said, The last thing Id ever want to do is hurt Betsy. I nodded. You deeply value the friendship youve created with her, I said. Are you concerned that youll say something that will hurt Betsy or lose something meaningful? Eventually Tom revealed what hed been struggling to contain: he didnt want to be married to Betsy anymore. For years, he said, hed given up his desires for long backpacking trips into the wilderness, returning to Wisconsin to live on the lake where hed spent his childhood, and leaving the business world to become a chef. Now that their youngest child was graduating from college, he wanted to explore a new life. He said to Betsy; Ive worked for years to support you and the kids at a job thats bored me to death. I could see Betsy struggling not to break down into tears. Tom looked glum, barely moving a muscle. I could see the dawning realization of a devastating awareness spread over Betsys face. What was I to do now? In graduate school, Id spent many hours role-playing how to help couples compromise and arrive at mutually agreeable goals, but here was no easily resolvable disagreement. Tom had been preparing himself to make this speech for a long time. His mind was made up. Betsy began to weep uncontrollably. I thought you were finally coming to therapy so we could get some help, she sobbed. Tom slumped in his chair, rubbing his face with his hands. I sat with them in the rawness of the moment. I was watching a dream being crushed, and felt Id somehow helped to trigger its destruction. When the hour was up, they got up heavily. Well, I guess thats that, Tom murmured. While keenly aware how much easier it would be to let them go and avoid the pain of watching them dismantle their 30-year marriage, I insisted they return. So much was left unsaid between them. These werent two people who hated each other; they were two people who didnt know how to process intense feelings. Over the next few months, Id witness more heartbreak and raw emotion as Tom finally dropped another bombshell: hed realized that he was gay and had secretly begun to

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explore relationships with men. Hed been wrestling with his gayness for years, fearing rejection from his kids and friends. To Betsy, it seemed impulsive. I knew that unless they could process this complexity together, theyd never preserve their friendship and care for each other. And I knew that, left alone, theyd never process feelings theyd avoided during their marriage. Over time, we continued to slog through the grief and sadness of ending their marriage. They did eventually divorce, but with hard work, they preserved much of the good from their marriage, and Ive since watched them share weddings, graduations, and grandkids with mutual kindness and good spirits. Before beginning my work with couples, I had no idea how much could suddenly be at stake in a single session. I hadnt become a therapist to inflict pain, but Ive since learned that sadness, anger, shock, and disillusionment can be part and parcel of therapy with couples in serious trouble. Good couples therapy sometimes hurts.

Fear of Fatal Errors: Peters Experience

Over more than three decades in the field, Ive studied and practiced just about every therapeutic approach on the planet. Ive worked with all types of couples in all kinds of configurationsfrom weekly therapy to ongoing couples groups to workshops of all lengths and stripes. Over time, Ive become adept at helping partners connect in the office and take their connection home with them, but I can still blunder so badly that I lose a pair of clients, and for the couple dropping out of therapy without having faced basic issues in their relationship, the stakes are much higher, more potentially damaging, than the loss of clients is for me. Id been working with Richard and Tina off and on for about four months. During their 11-year marriage, Richard had done a slow disappearing act on his family responsibilitieswhich had caused grinding tension between them. But wed started to make progress on this front: Richard was cutting back on playing weeknight and weekend basketball and hockey games, and was taking on more parenting and household chores. Then, early one Thursday morning, as the couple walked in and took their usual seats, I saw their faces were tight with misery. Tina began the session in a trembling voice, telling me that shed caught Richard on the Internet looking at porn. I cant believe youd do this to me! she hissed at him. You need to stop and stop now! I will not allow that filth in my home, and I will not tolerate you looking at it! Richard nodded, his hands clasped tightly between his knees. I wont do it again, I promise. I know it was wrong, he said, sounding like a severely scolded child trying to convince his parents hed be good from then on. I now had two problems. First, I knew that Richard would be unlikely to keep a promise made on the hot seat. Second, Tinas edict left no room for discussion. What now? I could go along with Tinas demand and Richards promise and
Couples Therapy: Why So Many Therapists Avoid It

pretend the issue had been tolerably managed, or I could risk going further and try to open up a fruitful discussion of a taboo subject. When the timing felt as good as it would get, I asked Tina to describe her reaction to the pornography. I wanted to know whether she was upset about the porn itself, about the fact that Richard looked at it in their home, or about the frequency of his use. Knowing I had to bring this up in a way Tina could hear, I felt as if I were about to walk through a minefield blindfolded and barefoot. Tina, Id like to ask you a question, I began. Its a question to understand how a part of you thinks. I know that the issue of porn upsets many people, but they often differ as to why. Can you say why its so charged for you? She looked at me for a long time, her lips pursed. Of course youd try to make it my problem, she said, her voice dripping ice. Youre a man. Id just exploded a land mine. Four months of goodwill suddenly vaporized, and it never returned. We met twice more. The sessions lost their spontaneity and energy. Tina and Richard became excruciatingly polite to each other. I speculated on the consequences of avoiding difficult discussions. When these speculations went nowhere, I joined them in being polite. They ended therapy with Richard repeating his promise never to watch porn again. After they left my office, I felt sadness and guilty relief at escaping a case with such an uncomfortably high level of tension: I no longer had to sit in the presence of so much unresolved pain, but I felt that Id failed. Since then, Ive worked with other couples dealing with the porn issue, whove managed to explore their attitudes without a blowup. Is that because I learned something from this failure, which helped me avoid a repeat? Maybe, but I doubt it. All therapists like to think they learn from experience, but the reality of couples work is that the responses to interventions are far more unpredictable than in the controlled atmosphere of individual work. One of the devilishly perplexing facts of life for a couples therapist is that, sometimes, no matter what you say or do and how skillful you become, there still will be troubled endings.

Fear of Confrontation: Ellyns Experience

Throughout my childhood, my parents carefully avoided open conflict and taught me to do the same. Whenever my sister and I began to raise our voices in disagreement, we were sent to our rooms with When youre ready to be nice, you can come out. To this day, I prefer to sidestep conflict whenever possible, but thats not an option in couples therapy. Whether brought on by infidelity, passive-aggressive behavior, drug and alcohol problems, gambling, or partners being cruel to each other or making outrageous demands that cant possibly be satisfied, we frequently need to confront our clients. However
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conflict-avoidant we may be, we must risk the possibility that one partner, or perhaps both, will become openly angry with us. Thats an experience that any couples therapist who wishes to move beyond being a perpetually warm and empathic listener can be sure is ahead. When I first saw Jill and Joe, theyd been in a power struggle for 10 years. Theyd seen several therapists and gotten nowhere. Their fights were escalating, most intensely about Jills weight. To my eyes, Jill seemed only slightly overweight, if at all. Furthermore, she hated Joe for nagging her to diet. By now, she was angry enough to consider having an affair, partly to demonstrate that she didnt need to lose weight to be attractive to men, and partly to get revenge on Joe for attacking her self-image. As soon as their struggle became apparent, my first thought was Im the wrong therapist for this couple. How will I avoid imposing my own issues on them? Throughout my childhood and adolescence, Id been fat. My mother had constantly pushed me to lose weight, and Id despised the pressure she was putting on me. Over and over, Id dieted, snuck food, and lost and gained weight. Id wanted to be thin, but I wasnt about to forego the ice cream and chocolate treats that soothed my pain when I sat at home on weekends while my friends went out on dates. I knew untangling Joe and Jills struggle would take skillful confrontation, yet the prospect of confronting them directly on the issue of weight made me shudder, and I secretly hoped theyd shift their focus to something else. They didnt. I tried to delay the issue by offering to teach them some skills for talking about tough topics before they embarked on this problem. That worked for a little while, but early one Monday morning about three weeks into the therapy process, they sat down on the couch and angled their bodies sharply away from each other. I knew this was going to be the day of reckoning that none of us could avoid. Joe said gruffly: I just get angrier if I dont say what I want. Is it OK to say it? Go ahead, Jill snapped. What is it? I want you to lose weight so we can stop fighting about it. Ellyn: What do you do when you dont talk about it? Joe: Get sarcastic, take pot shots, but if I try to talk about it, she tells me to fuck off and get lost. Oh, boy. I set about trying to structure their dialogue so that they could begin to discuss the issue in a more contained way, but Joe remained focused on Jills resistance and how selfish he thought she was. She wants me to think shes beautiful, he said, but I think shes pretty self-centered if she wont make any effort to be attractive to me. By now, Jill was crying. Why cant you love me as I am? she wept into her facial tissue. I knew it was show time. I could no longer postpone confrontation, but how could I intervene without tangling them up in my own issues? I was deeply aware of my desire to rescue Jill. Joe turned to me, hoping to gain an ally. If I try to talk
Couples Therapy: Why So Many Therapists Avoid It

about her weight at home, she just tells me to shut up and that if I keep talking, our sex life will be dead forever. Its always okay to speak up about what you desire, I said carefully, and then took a baby step toward confrontation. But when you speak up, is having Jill lose weight really the result you want? Joe ignored my question. I guess in an ideal world, her body type wouldnt matter to me, he said, but shes gained weight since we got married, and it does matter! I knew that giving him my honest response wouldnt work right now, since it was on the order of Slow down. Back off, Bud Instead, I decided first to try and enlist Jill in the process of confronting her husband. Jill, how about if you talk with Joe about your weight and let me feed you some questions? When she nodded, I said: Will you ask him what your weight symbolizes, and what he thinks should happen once hes asked you to lose weight? Youll lose weight, Joe cut in. Probably exercise more, and maybe go to Weight Watchers. You know, buckle down and get it done. And it symbolizes your selfishness. Id suspected that Joe would take an its-your-problem, dear approach and that confronting this would be part of our work together. Many partners make incessant angry demands without realizing their own part in whats going on. Joe kept suggesting that Jill was lazy and selfish for not doing what he wanted, as if it had no connection to his own attitudes and behavior. As a slightly overweight female therapist, I wasnt sure I could handle this situation without his concluding that I was simply siding with Jill. I decided to start by eliciting more of Jills side of the story. How do you respond to all this? I asked Jill. What happens inside when Joe talks about your being overweight? She began to cry again. I am overweight; even my doctor says that Im about 10 pounds too heavy. Now, I could feel the buzz of my own early history, my feminist sensibilities, and my disdain for the American glorification of stick-thin women. This must mean more to each of you than just going on a diet, I suggested to Jill. Turning toward Joe, I said, Will you ask Jill why this is such a struggle for her? When he dutifully asked her, Jill responded: Ive always had weight issues, and Id like you to keep that in mind, Joe. It bothered my parents, and its not so easy to lose weight. She dropped her eyes to her lap. And youre so rejecting: you say critical and demeaning things about my body. Joe said, Its pretty simple: Id just like you to lose the weight, and I dont want to be responsible for how your parents treated you. The session was heating up. Clearly, resolving this struggle was going to involve more accountability from each of them. Although I wanted Joe to take more responsibility, this tugof-war couldnt really all be about his wifes perceived refusal to lose weight; I knew hed ditched other therapists over how theyd handled this issue. At the same time, Id need to light a
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fire under Jill to get her to acknowledge her own part in what was going on. Id like you to back up again and stay with Joe for a minute here, I told Jill. Will you ask him about his role in working on this problem? Jill, still tearful but a bit more composed, turned to Joe. So, what would you do to help me? Joe all but rolled his eyes. It seems like this one is in your court, he said. I cant exercise or lose weight for you. Its not that easy, I interjected. When you bring up a desire like this one, you cant just sit back and wait for her to comply, Why not? Because youre the one experiencing some discomfort here, I said bringing to bear the full weight of my experience with couples handling struggles like this. This is a complex issue that has as much to say about you as about her. Are you able to tell Jill what her weight really means to you? How it affects your own self- esteem? How your own aging might play into this? Why wont you support me? said Jill, sensing an opening to score some points. Because I think you want to withhold from me, replied Joe, eager to switch topics to return to an old argument. So you withhold support from her, I said, quickly bringing the session back on track. You ask for a significant change and then wont support her in creating it. You could cook, pack lunches, give positive words of encouragement, stay with the kids while she exercises, introducing some possibilities he hadnt previously considered. Joe looked startled. I was definitely starting to get his attention. I turned to Jill again. Ask Joe if hed try to change your sons behavior by doing nothing, or by rejecting him. Would you? she asked. For a long moment, there was silence in the room. Then Joe said grudgingly, No, I wouldnt. Heartened by this small opening, I decided to push a little harder. Youre asking Jill to do something for you, I said. The two of you can solve this together. Its gone on for so long, it wont work anymore for you to do nothing. Joe was quiet for a moment, shaking his head, his whole demeanor softening. Ive never talked, or even thought, about any of this. Why wont you support me? Jill asked as if uncomfortable about the prospect of Joes actually making some of the changes shed long wanted. Because I think you wont do it just because I want it. Thats why you refuse to lose weight: you just dont care at all about what I want. As so often happens with couples at this stage in the change process, things were sliding backward again. I now needed to confront Jill. Are you willing to explore your role in creating this struggle? I asked her.

Jill nodded yes and I continued. Do you know why youre resisting Joe? I asked. I dont know, she said softly. Sometimes I just feel stubborn about it, but I dont really know why. I decided to take her through a Gestalt dialogue to help identify both sides of her own conflict and rebalance the session by giving Joe a chance to get out of the hot seat himself. Lets dialogue for a minute between the part of you that wants to lose weight and the part that doesnt. What does the part say that does want to lose weight? Jill: Id feel better and look better. Ellyn: What does the part say that doesnt want to lose weight? Jill: Im angry at him. Damned if Im going to do it for him! Ellyn: Why not? Jill: I want to be loved as I am. I want him to think Im gorgeous, to tell me Im gorgeous, like he did when we first met. Ellyn: And what would that mean to you? Jill: That Im special; that, he loves meall of me. Ellyn: And who else did you want to love you so unconditionally? Jill (after a moment): My dad. Ellyn: So you want to matter to him the way you wanted to matter to your dad. So this is very emotionally loaded for you; way beyond just the two of you. (She nods.) I wonder what youd experience if you could imagine losing a few pounds just because Joe wanted you to? Jill: No. . . . Id be copping out on the part of me that wants unconditional love. As the session drew to a close, the energy in the room had shifted. Joe and Jill no longer saw themselves in a hopeless power struggle. They were beginning to embrace possibilities that could take their relationship in a new direction. It hadnt been easy, but Id had to confront both of them over an issue freighted with psychological meaning for me. Many years ago Im not sure I could have found the right mix of gentleness and strength, or kept my footing and my focus, but at least for this hour, I could feel the difference that 25 years of couples work made in my own clarity and sense of inner direction. At the end of the hour, it was as if all three of us had experienced a victory over the power the patterns of the past have to constrict the more expansive possibilities of the present.

Make no mistake: in our work with couples, we sometimes feel like were bringing a water pistol to a gunfight. But more often than not, we get inspired by couples who make the difficult journey, falter, stumble, and rise againjust as we therapists do. When they express difficult truths with loving honesty, it gives us the courage to keep stretching ourselves, and in a profession in which burnout is a prime occupational

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hazard, perhaps the only feeling that we rarely experience in our work with couples after all these years is boredom. For both of us, being couples therapists hasnt permitted us to be complacent about our own marriage. Doing this work has pushed us to grow and develop ourselves as spouses and therapists in ways we never have imagined when we began. Being a couples therapist isnt for the faint of heart! As Sir Edmund Hilary, who with Tenzing Norgay was the first person to climb Mt. Everest, said, It is not the mountain we conquer, but ourselves.
Ellyn Bader, PhD, and Peter Pearson, PhD, couples therapists for more than 25 years, are the founders and directors of The Couple Institute and creators of the Developmental Model of Couples Therapy. Theyre the authors of In Quest of the Mythical Mate: A Developmental Approach to Diagnosis and Treatment in Couples Therapy.

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