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Couples Therapy: 15 Essentials That the Best Therapists Do

Therapists: How do you score? Couples: Is your counselor a keeper?

This post is in response to
Couples Therapy: The Four Questions
(c) hjalmeida
Source: (c) hjalmeida

Couples therapy is not like aspirin; that is, not all therapy is equal. What are some of the principles that guide the work of effective marriage counselors and couples therapists?

If you are trying to choose a therapist—or wondering if the one you currently are working with can really do the job—check out these criteria. If you are a therapist yourself, how consistently are you covering these bases?

The impetus to write this post came from reading an excellent new book on couples therapy: The Heart of Couple Therapy: Knowing What to Do and How to Do It, by psychologist Ellen Wachtel. The book delighted me.

I myself have written on the topic of couples therapy skills, produced a video and audio on the subject, encouraged creation of an online interactive marriage skills learning site, and teach workshops around the globe to therapists who are learning or upgrading their couple therapy skills.

It, therefore, pleased me very much to see how similar Dr. Wachtel’s and my ideas are.

At the same time, The Heart of Couple Therapy re-clarified for me a number of guidelines that all therapists, including me, need to remind ourselves of from time to time to do our very best at helping couples to emerge from their relationship difficulties.

Here’s my list of 15 principles that I regard as especially vital signs that a marriage counselor will be effective.

After each of my principles, I share quotes from Dr. Wachtel’s book that express similar perspectives.

Do you as a therapist, or does your therapist:

1. Focus on the positives as well as the negatives?

“Choosing what to attend to… is fundamental to good work with couples. Therapists are often trained to notice deficiencies…” Equally important—or maybe more so—is for therapists to learn to “see what is going right as readily as to see what is causing problems.” (Wachtel, page 5)

2. Expect to facilitate at least one specific growth area in every session?

Each session should give you some relief from negative feelings, a new insight about why you have been doing what you do or feeling what you feel, an upgraded skill, or a win-win solution to a troubling concern.

“Couples need to feel that… they are fairly consistently making progress toward resolving the issues between them." (Wachtel, page 7)

3. Teach skills, and build the new skills into habits by practicing them within the session?

The job of a therapist is to cause “understanding to translate into change in how a person acts in the world… not only to facilitate new understandings… but to point the way to new behaviors that follow from these insights." (Wachtel, page 7)

4. Have a clear map of treatment—both of the treatment goals and of how to guide a couple to these destinations?

“The most important job of all is to keep the session on course.” That is, rather than get “swept along by the powerful force of the couple’s emotions,” effective therapists keep a tight rein, “taking charge of a session.” An effective therapist also “keeps the discussion moving forward in a useful direction,” which enables clients to feel safe and the sessions to feel productive.

5. Calm excessive emotional intensity?

“Even before there is a perceived need to calm things down,” the effective couple therapist, most of the time, “protects the couple from feeling that the session is… little more than the mutual accusations that all too closely resemble what happens at home.” (Wachtel, page 8)

“The therapist controls the emotional intensity of the sessions.” (Wachtel, page 33)

6. Keep a tight rein on how spouses talk with each other so that talking stays respectful, listening occurs consistently, and the dialogue stays collaborative?

“Each person needs to feel that his or her point of view has been heard and understood.” (Wachtel, page 32)

7. Keep the tone of all your interactions with clients warm and positive?

“Each person… needs to feel liked by the therapist.” (Wachtel, page 32)

8. Teach couples to problem-solve?

The therapist's job is “helping the couple to find their own solutions.” (Wachtel, page 33)

Therapists should not do the solution-finding for them. Offer solution ideas only if the couple has hit a dead end.

9. Teach spouses to forego the temptation to tell their spouse what they want them to do differently?

A couple first needs to discuss an issue enough to understand the concerns of both partners. Then, each of the partners needs to ask themselves, “What can I do differently to contribute to a plan of action that will solve this dilemma?”

Neither partner gets to criticize or tell the other what to do. Each is responsible for asking, “What can I do that will be responsive to my partner’s concerns?”

10. Ask questions that help the partners to discover—and thereby understand more clearly and compassionately—the earlier-in-life experiences that may have fed into their current difficulties?

“… the couple therapist helps them understand the role of family history, individual sensitivities, and different coping styles.” (Wachtel, page 33)

11. Replace finger-pointing, blaming, and fault-finding with an understanding of circular causation?

The couple therapist helps the couple to clarify “the repetitive vicious cycles that have developed.” (Wachtel, page 33)

For instance, one partner listens for what’s wrong with what the other says, pushing away the information he is trying to give her. He then feels frustrated, and begins to raise his voice in a subconscious attempt to get her to hear better. She becomes agitated, and starts accusing him of shouting, at which point he feels criticized and does shout.

12. Teach couples to use collaborative dialogue sentence-starter phrases like “I feel _____" and “My concern is ____”?

Effective therapists “focus on what each person is longing for rather than on his or her complaints… Wishes, longings and sadness… are much easier to hear than criticism.” (Wachtel, page 34)

13. Look back to learn what has been good in the relationship as well as to learn from the mistakes?

The therapist reminds the couple of “what had drawn them to each other and made them want to stay together.” (Wachtel, page 37)

14. Start each session by asking each spouse what they would like to address that hour—and end by assessing what they accomplished toward that goal?

“The first step in keeping the sessions focused is to ask the couple what they want to focus on overall, and again [at the outset of] each session.” (Wachtel, page 44)

15. Facilitate awareness of progress to build and sustain hope and optimism?

“Therapists give feedback about how they (the couple) are changing and becoming.” (Wachtel, pages 83 and 237)

Progress keeps us all learning and loving.

What if you yourself as a therapist, or a couples therapist you have been seeing, have some yes answers plus too many no's?

All is not lost. To the contrary, read The Heart of Couple Therapy to learn and grow. In fact, if you are part of a couple, whether or not you are either in therapy or a therapist, you are likely to find reading this book enlightening.

When my own book about how to do therapy, From Conflict to Resolution, was first published, one of my clients said she loved reading the cases in my books and also watching my audio and videos about therapy. "I find," she said, "that reading about or watching someone else's therapy is almost as helpful as going to my own therapy sessions."