Would you go to an eye doctor for a broken leg? Of course not. Yet all too many people go to individual therapists when the problem is a couple problem. That can be a serious mistake. Here's an example of why.
Multiple years ago, I enjoyed working as the clinical psychologist for a lovely woman, let's call her Adrienne, who was warm, witty, and insightful. Adrienne came to me for help with depression. Her self-centered and irritable husband, she concluded in our individual therapy treatment sessions, was a part of the problem.
Eventually I suggested that Adrienne invite her husband, let's call him Tom, to join us for a conjoint treatment session.
Watching Adrienne and Tom interact in my office, I was stunned. Adrienne bickered with Tom, criticizing him in a manner that I never would have imagined given how delightful she had always been when she was interacting with me. From time to time, Adrienne also erupted in geysers of anger such as I surely had never witnessed when the two of us had been working together in her individual therapy sessions.
While I keep tight control of sessions so that they stay safe for both partners, I saw enough of Adrienne's criticism, anger, and emotinoal volatility to realize that I had been missing key data regarding her problem.
Tom, meanwhile, was in fact a dismal listener. His oppositional listening style triggered Adrienne's anger in a way that a therapist, trained as a professional listener, would not. No wonder that I had not seen her anger in our sessions. Tom also often spoke in a manner that sounded both irritated and defensive, attitudes which would be demoralizing for any spouse to hear on a regular basis.
At the same time, I also saw in Tom, when he was interacting with me, a man who, when he felt safe, seemed to be warm, generous, and fun.
Equally surprising to me was the concern that Tom voiced about what had been feeding persistent resentment toward his wife. For months Adrienne had refused sexual contact, taking away what had once been one of the most positive areas for him of their relationship. Tom felt unfairly punished, cheated vis a vis what he thought their marriage contract would include, and chronically sexually frustrated.
I learned a big lesson. A couple therapy treatment format is essential if a therapist is to help married individuals.
Adrienne and Tom taught me that a therapist must see married clients interacting in order to understand the full picture of each spouse's contributions to their own and the other's emotional distress. Until I saw Adrienne in my office dialoguing with Tom, I had no idea of how provocative, negative, and emotionally over-reactive she could be nor of what Tom was bringing to the situation.
Adrienne had not purposely hidden her argumentative side from me. She herself had remarkably little insight or awareness of her contributions to the mutually demoralizing marital interactions. Structurally, I had made a diagnostic error. I had assumed that I understood Adrienne before I had witnessed firsthand her interactions with Tom.
Until seeing both spouses, I also had no idea of the upsides of Adrienne's choice of life partners. Tom, like his wife, had fine strengths that he would be able to share increasingly once the negative interactions between the spouses were gone.
Furthermore, until Tom joined our sessions neither Adrienne nor I understood the source of Tom's perpetual negativity. It was from the demise of their sexual life. Adrienne's withholding of sex was a profoundly mistaken and totally counter-productive strategy for encouraging Tom to become a more receptive listener and enjoyable marriage partner.
Marriage therapy is most likely to succeed when both spouses participate.
With a more full understanding of Tom and Adrienne's relationship, including my new awareness of the sexual deprivation facet and also of the couple's communication skill deficits, I initiated a two-pronged course of action. I encouraged the couple to resume their previously gratifying sexual relationship. I simultaneously coached them in skills for talking together about concerns in cooperative, win-win formats.
As Adrienne felt heard and was no longer being subjected to resentment from Tom, her depression lifted. She could return to enjoying Tom's many virtues.
With sexual gratification back in the picture, Tom felt more relaxed and happy. He also flipped from defensive parrying of whatever his wife said to wanting to listen to her and delighting in their partnership.
Learning cooperative communication skills for dealing effectively with concerns as they arise prepares couples for future challenges.
Couples must row together down the sometimes gentle stream and intermittently tumultuous rapids of their lives. Research has shown that higher-level partnership communication skills increase the odds that, whatever life challenges present themselves, spouses' attachment bond will grow ever-increasingly more loving and strong.
A couple treatment format prevents therapy from harming the marriage.
Treating Adrienne for depression without including Tom in the treatment sessions would have risked unbalancing their relationship. If Adrienne had become less depressed without Tom growing simultaneously, she might have concluded that she would be best off dumping her seemingly perpetually negative spouse. That would have meant that the individual therapy success came at the cost of the death of a marriage and destruction, from the point of view of the children, of the family unit.
If unbalancing a relationship, that is, fostering asymmetry of growth from treating just one spouse, can lead to the toppling of a marriage, that's a seriously bad outcome. I'll say that even more strongly:
Iatrogenic (doctor-induced) divorce can be a potentially lethal (to the marriage) side effect of individual therapy with married clients.
Many studies confirm this iatrogenic damage potential. In my book, From Conflict to Resolution, which sets forth my treatment methods, I list these studies in detail on pages 176-184. I also detail in these pages when individual treatment sessions are appropriate and potentially very helpful for married adults.
Suffice it now to summarize the consistent conclusion in these research studies: Individual therapy for a married person that does not include a solid couple therapy treatment component risks creating negative responses such as anger, depression, anxiety, or addictions in the spouse and/or unraveling of the marriage.
My policies now on individual versus couple treatment.
Having learned from my experience with Adrienne and Tom, when new clients call for treatment I ask if they are in a long-term relationship or married. If so, I explain to then that my policy is to have both partners attend the first session at least.
We then together co-design a treatment plan that incorporates both couple and individual treatment components. One therapist handling both aspects of treatment is essential.
At the same time, sometimes one spouse simply won't or, for work or other reasons, can't, join in on going to couple therapy. (I've added this point in resonse to Comments from readers. Thank you Mary and John!)
My earlier blogpost on "No way Jose will I go to therapy with you" discusses the options for this kind of situation.
There are cases too where an individual tells me that there are issues for which the privacy of an individual therapy session is necessary I believe them and schedule it with them. Usually that means there's something like an affair, abuse, or other problem that the person needs to think through on their own with a therapy professional being ready to embark on couple treatment.
The worst way to get marriage "help."
Want to be sure to wreck your marriage? Get two individual therapists, one for each of you. That's a recipe for the highest odds that your marriage will end in a divorce.
In sum, Adrienne and Tom led to my becoming a crusader for more therapist training in couple treatment intervention skills, and for producing therapy training materials like the book From Conflict to Resolution and the videos The Angry Couple and The Win-Win Waltz.
Thank you Adrienne and Tom for teaching me this lesson!
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