Dear Stacy,
You are usually recommending that couples go see a therapist together. I am wondering what it would take for a couples therapist to say that he or she couldn’t work with a particular couple. Is everything under the sun fair game for couples therapy, or are there some categories of problems that are just considered too much or unsalvageable? What if one member of the couple is addicted to something? Does that mean couples therapy will not work? What if one member of the couple has a personality disorder? I guess I’m just wondering if this is a blanket recommendation for all couples, or if there are exceptions.
— Wondering
Dear Wondering:
You just might be on to something when you say I often recommend couples therapy. In the six years that I have been writing this column, I can imagine I’ve suggested couples work at least 100 times. Many therapists who see themselves as working out of a “relational” perspective prefer to see their clients within their coupled relationship. In other words, I find that if there is a diagnosis affecting one person, treating the issue within the context of the partnership — or at least recommending that my individual clients who are coupled find a separate couples therapist — can have a strong (and fast and long-lasting!) effect.
For me, part of this inclination comes from noticing that people are the most motivated to make changes when they see that their symptoms are taking a toll on the relationships that matter most. Whether it’s anxiety, depression, intimacy issues, etc., I’ve found that most people get better faster when we treat the issue as happening within the space between two partners. This means that, for me, even when one partner is affected by a personality disorder, the best chance for long-lasting change comes from developing a safe space for the couple to grapple with the impact of that diagnosis, together.
But there are some circumstances that make couples therapy difficult, if not impossible. Every therapist has her own philosophy around this, but from my advanced trainings in various models of couples work, I have learned that there are a few topics that contraindicate this approach. Ongoing violence or other forms of abuse will make couples therapy virtually impossible, as the threat of retaliation will make any efforts to create safety in the session unsuccessful. Active affairs and untreated addictions also make it difficult for true safety to be achieved.
If you are wondering whether your partnership would benefit from couples therapy, the best advice I can give is for you to shop around and ask these questions directly to any prospective counselor (or give me a call and I’ll be happy to point you in the right direction).
