If you work with couples, I’m sure you’ve experienced this; You wish that a couple you are working with didn’t come back for treatment or didn’t show up for a session.
You know which couples I am talking about. They don’t do their homework. They cancel at the last minute. They say they don’t know what they want to talk about today. They don’t remember anything about the last session-the one you thought was a breakthrough in the case. They fight. They blame.
I'm no different than other couples therapists even though I've been working with couples for decades. Sometimes, I wish that they didn’t show up for a session or that they stopped coming altogether.
Nowadays, I take that as a wake-up call to review what I have been doing with them and make some tweaks to the process.
Sometimes, after my tweaks, the couple quits the treatment (that may not be a bad thing). In other cases, the couple reengages in treatment. In yet other cases, we have go back to the drawing board and redo first stage of treatment interventions that we haven’t reviewed in a long time.
No matter what I end up doing, one thing is clear: I cannot ignore these unpleasant feelings and I have to do something about them! The temptation to ignore these feelings is totally understandable. Wishing that a couple didn’t show up makes me feel somewhat guilty and affects my own self-image as a competent and effective therapist.
Overtime, I discovered that what I end up doing has to be personalized to each couple, so it’s hard for me to give a formula about what to do that will apply to all couples. But I’ve compiled a list of reasons why I feel the sense of dread with some couples. Here is a partial list of reasons that were behind some of the cases I wish didn’t show up. I explain some of what I have done about each situation.
- They say they want to get better, but at least one or both partners haven’t stopped blaming the other.
This is the most common reason I used to dread some couples. Nowadays, I request and individual session with the one who is not doing the work and make a confrontation. Or I confront them jointly. Either way, I usually give them a version of the Change Speech that I learned from my mentors Ellyn Bader and Peter Pearson from the Couples Institute in California.
Here is a version of the change speech:
“You have some choices. Choice number one: You can keep repeating the same destructive, draining and self-protective behaviors and suffer more of the miserable consequences. Choice number two. You can do the difficult work of breaking these patterns by learning to resist the impulse to interrupt, blame, or disengage and withdraw into your cocoon. You can make the effort to become a skilled listener. You can actively learn what you do that makes it so difficult for your partner to be more giving to you. And you can learn to represent yourselves well without assaulting one another. Choice number two consists of meeting the challenge of changing your focus from defensiveness to collaboration. I sit here wondering which choice you will make”. (© Ellyn Bader and Pete Pearson).
- There is no clarity of their individual change goals.
This is also very common. When that happens, I have joint or individual session to review what they are each working on, what the barriers are to achieving their goals, and we make a plan for practicing the goals in future sessions. If one person identifies that “listening better” is a goal, I try to find way to practice “listening better” in a session. If one person says they are working on being “more affectionate” or “giving more praise”, I help them practice that in the sessions. I also find ways of keeping them accountable in and out of session for what they say they are working on.
- There is a mismatch between my goals for them, and what they want for themselves.
This is less common for me now, but it’s a very common issue for many of my students and supervisees. This mismatch generally results in a rupture in the therapeutic alliance. I define the therapeutic alliance as an ability to answer these questions with a resounding: Yes. Do the partners and the therapist have alignment on goals and tasks? Is there an agreement on what needs to be fixed and how? Does the couple believe that the therapist can help them? Does the couple trust that the therapist is invested in the well-being of each member of the couple? Does each member of the couple allow the therapist to influence them? If your answer to any of these questions is no, your couple will question your motives and your strategies and it’s a sign that an honest conversation is needed to re-align goals and beliefs. Usually, a feedback conversation about what’s been helpful and what’s not helpful is sufficient. Other times, we talk about where they were, where they are now, and where they want to go next is sufficient and how they see my role in their progression.
- They are not being honest about their own wishes to end the relationship
This will require some careful probing and assessment. This can be done individually or jointly, depending on the case, but in general, the idea is for the therapist to be able to state clearly the imbalance between the member of the couple who seems to be doing much of the work, and the other partner who appears to be checked out. You are going to have to confront the checked out partner and request that they be more honest.
- One of the partners (Partner A) has a mental health condition or an addiction that is not being assessed, diagnosed and/or treated.
This will require helping the partner without the addiction or the mental health condition (Partner B) to be clear, specific, open and honest in a non-blaming way about the ways in which the addiction or the mental health condition is affecting them in a way they may have not disclosed before.
There are other reasons why I may wish a couple not to continue, but the above have been the most common in my practice.
I may conclude that they may not be motivated to engage in couples therapy at this time, or I may be called to help them uncouple. Helping a couple separate or divorce well is an important skill for a couples therapist and will be the subject of another blog.