No matter what couple therapy model you use, the treatment of a couple will go through several stages. It’s important to keep in mind what stage of the treatment process the couple is going through for therapy to be more effective.

Couples vary in their motivation for treatment, how long they’ve been together, how much hurt there is, and what style of conflict they developed over time. These variables affect the way the couples go through the stages.

Often, couples regress and need to cycle back to the initial stage. Sometimes, couples move through the stages several times before solidifying their gains. Not all couples in treatment make it to the second or third stage. Many couples disengage from treatment after the first stage. And sometimes couples return months or years later, to check in, to deal with another crisis, or finish unfinished work.

Initial stage: Stabilization stage

The stabilization stage of the couples therapy process is the foundation for all subsequent work. How long it takes a couple to get stabilized depends on many factors. Some couples stabilize pretty fast, and others take longer.  This is the stage of the creation of the therapeutic alliance, which involves an evolving belief, on to the part of each member of the couple, that the therapist understands their issues and can help them with their problems. Only when couples believe the therapist knows how to help them, will they put themselves in the skilled hands of their couples therapist, and become open to his/her influence.

No matter what theoretical orientation the therapist has, an agreement on this issue is the crucial first step in the process. Confrontations are soft and tentative, to see how much the individual can tolerate feedback, which in turn, informs the stabilization process. The therapist establishes a strong leadership role in this stage of the treatment.

• Couples can get stabilized when hope increases that therapy can be helpful, and one or both members of the couple stop threatening the continuity of the relationship.
• Couple allows the couples therapist to guide them, and they trust that therapist has their best interest at heart.
• Therapists prepare couples for the work by providing psychoeducation about the brain, about what makes relationships succeed or fail, about gender and cultural issues that affect the bond, all of which helps explain to couples why they are in such distress.
• Therapists are able to shift client’s position from: “What do I need that I don’t get”, to “What kind of partner do I need to be”.
• Clients begin to talk about what makes them feel connected and what doesn’t, understanding that they have a role to play in getting their partners to hear their wishes.
• Therapists help couples to begin to own their own wishes, even if they still feel guilty about them.
• Basic interventions:
  • Work on commitment to doing the work.
  • Focus on individual change and happiness goals. What do they each need to do differently?
  • Discuss the vision of the relationship without the current issues. What kind of relationship do they want to achieve and how are they going to get there?
  • Begin differentiation work: How do they express their disagreements and disappointments?
  • Explain the conflict style to the couple.
  • Implement Basic Couple Maintenance: increase positive interactions, gratitude and connecting rituals.
• Couples learn about themselves and each other in ways they haven’t done before. They begin to look at their personal vulnerabilities and survival strategies. This will help to understand their dynamic.
• Couples learn to answer the question: What does it mean to be relational and collaborative? What is required of each to improve teamwork?
• Problem solving is premature in this stage, the focus is on how they communicate with each other about the problems, not on solving them.
• Begin use of initiator/listener dialogue skills to increase self-awareness and empathy skills.
• They learn to take breaks from fights when a conversation is not going well. They begin to talk about what’s acceptable and what’s not acceptable during a fight. They can plan a second conversation that goes better than the first.
• A “draft” of the interactional cycle can be articulated. When therapists begin to know the couple better, the draft can be revised, amplified and deepened.
• If the couple is in too much distress to tolerate this initial stabilization work, work on motivation and ambivalence regarding change takes precedence over any other interventions.

Second stage: Going deeper

When couples are more stabilized, they may begin to go deeper by becoming more self-aware. Increased self-awareness will lead to increased empathy for the partner. In this stage, there may be breaches of trust between the therapist and the couple, and repair work may be needed to help couples go deeper into their own self-exploration. When clients feel that their couples therapist gets them and sees them, they will be more inclined to do this difficult work, especially if they have not been in therapy before. Individual sessions may need to be combined with joint sessions to get to know each individual when they are not using their armored defenses around their partner.  Confrontations get more targeted as they each need to figure out their own contributions to the relationship distress. Couples can be in this stage for a long time, or regress to the first stage, needing further stabilization. Sometimes this is the stage when the couple needs help uncoupling well. They will uncouple better if they do this work.

• Continue shifting from seeing the partner as the enemy to consider that the partner is an ally.
• Deepening understanding of the personal vulnerabilities, survival strategies and protective measures.
• Begin to understand origin of survival strategies and protective measures.
• Begin to take risks becoming more vulnerable.
• Better understanding of the interactional cycle.
• The interactional cycle can get disrupted but it is still hard to recover, or is easy to slip into.
• Work on attachment history, family of origin to help each “wake up from the spell of childhood”.
• Work on relationship attachment injuries to understand triggers.
• Refining initiation and listening skills, so couples get to know themselves and each other better.
• Work on healing past wounds, repair, and setting boundaries.
• With continued increased differentiation, there is less mood contagion effect, and less intrusiveness.
• Continue working on triggers and responses to triggers: when partner A triggers partner B, what can partner B do instead of the usual?
• Help couple deal with and react differently to disagreements and disappointments.
• Begin problem solving if listening skills are better. Help create a blueprint for problem solving based on consensus, veto power, turf or other.
• Continue work on attachment security: what makes each feel connected, seen, prioritized, valued?
• Continue focusing on rituals of connection, positive interactions that are problem free.

Third stage: Progression and regression. Tolerating setbacks. Relapse prevention

In this stage of the treatment process, couples are nearing the end of the treatment. Their fights are less pronounced, and don’t lead to ruining an evening, a weekend or a vacation. They know how to disengage and re-engage. They navigate periods of disconnection better. They may regress, but the regression doesn’t last as long. If there’s been a lot of hurt, continue to encourage the couple to become “partners in healing.”

• They go through their cycle but can look at it from a different perspective.
• Going through the cycle is no longer a threat to the continuity of the relationship. Cycles tend to be shorter and less severe. They can recover and repair better.
• They progress and regress. But setbacks and crises don’t derail them as much anymore because they know what they need to do to reconnect and get back on track.
• Couples go deeper into family of origin issues, protective patterns and how they developed, continually refining their self-definition.
• Couples develop a simultaneous sense of independence and individual development, and togetherness and connection.
• They are more comfortable expressing vulnerability.
• They know how to manage their anxiety of difference better.
• They can deal with disappointments and disagreements.
• They do not attack their partner’s self-esteem
• They feel like they are a team and have each other’s backs.
• They know when to come back for a tune-up.