Couples* work differs somewhat from individual therapy because the focus of the work is on the relationship itself. As a couples therapist I am functionally monitoring the needs of three clients: each of the partners and the relationship. Finding new ways to communicate is most often at the heart of the couples counseling work.
If necessary, we may work deeply. Most couples come to therapy having the same fight. It can be about anything (often they’ll tell me it started over “something stupid”), but the dynamic of hurt, attack & defense is the same. Some couples say they don’t really “fight” but have a dynamic of hearing something hurtful, disagreeing a little but then withdrawing for a period until they’ve “moved past” it. Whatever the dysfunctional complaint, there is a pattern.
To address this, some of my couples work utilizes an adaptation of Internal Family Systems (IFS) for couples called Intimacy From the Inside Out (IFIO). It allows us to access the dynamic pattern of hurt & reaction that each of the individuals sets off in the other. With IFIO we have the tools to interrupt the cycle and address the specific experiences of each member. It’s here that new communication skills (drawn from a variety of communication and relationship approaches), empathy and compassion are infused. Clearing up the communication does not mean that the couple will choose to stay together, but will have a much easier time moving forward into a better situation for each of them.
When fights follow not only the same sequential pattern, but recur repeatedly about the same topics, we might also prioritize working directly with the way the couple has set up their external environment. We do this by exploring inherent problems with current agreements in place for how finances, career, cooking, chores, childcare, etc, are handled. Then, together, we co-create more conscious and functional systems for the couple.
Most often (but not always) when couples come to counseling with sexual issues there are other deeper communication issues involved. Many find that when this first level of intimacy (mutual, effective disclosure of feelings) is smoothed out, that sexual experience between them flows more easily. This is especially true for partners who have had any level of sexual trauma or shame that is affecting their current relationship. Opening up communication so sexual experience can happen in a way that is mutually aware and safe for both partners is key.
Sometimes the couples work uncovers issues in one or both of the partners that warrants individual work. When this is the case, suggestions for individual counseling will likely be made. Sometimes couples work may need to be halted until the individual issues are addressed. Other times it is appropriate to do the couples work simultaneously. Often a couples counselor will ask to coordinate work with the individual therapists of each partner.
As a couples therapist, I am concerned with the health of the interactions between the partners, rather than the fate of the relationship. In other words, even when healthy interaction is achieved, a couple may decide they need to part. The couples work can help them arrive there amicably. Conversely, a couple who has had the same horrible fight (or silence) for years, may end up staying together when new communication patterns take hold and the relationship deepens. It’s important to understand that my role as the couples therapist is to help shift the problematic dynamic between the partners so that they can interact more effectively. It’s not however, to become invested in keeping the relationship together, nor advising separation. (However, if it becomes clear that overt abuse (either emotional or physical**) is happening, I will not hesitate to be quite frank about what I am seeing and the outcomes*** and options I see open to them. As well as the conditions around which I will agree to continue the work.)
*If the primary partners are in a polyamorous relationship, therapy could potentially include other partners depending on the issues of focus and the configuration of the relationship. For the purpose of this webpage discussion, the term “couples counseling” will be used as inclusive of polyamorous partnering.
**I ask that couples be honest with me upfront about any physical violence between them. As a private practitioner, using the approach I take, I am not equipped to tackle this level of relationship discord.
Frequency & Length of Sessions
At Self-Awareness Counseling, I only see couples in 80-min or longer sessions. This is because when working with more than one person it simply takes longer. I’ve found that it’s not effective to get part of the way into a session only to have to end. Ideally, we start with weekly sessions and as progress is made, are spaced further apart. The length of time in therapy can vary widely depending on the issues we are dealing with and the rate of progress. A trusting, healing therapeutic relationship can take some time to develop, depending on your history with each other, and each of your family and interpersonal histories. It is something that is ever evolving but is a key healing element running throughout the counseling process and critical to the success of therapy.
Confidentiality issues specific to Couples Counseling
1) Release of Information: If you would like me to release information about your couples counseling to an outside party, both partners need to sign the release.
2) There may be times in couples counseling when it is appropriate to see each partner individually to discuss their experience of the relationship without the other present. Sometimes information is revealed that significantly affects the relationship and is unknown to the individual’s partner. If this happens, the work can’t proceed until the information is disclosed. I will work with that person to tell their partner themselves, or offer support in a joint session to do this, but as a therapist for the relationship, I can’t hold secrets.
3) ***If fights escalate to the level of physical abuse, it may be necessary to call in other agencies to handle the situation. I may be mandated to report it if children are involved in the physical abuse or are witnessing it in any way.
Health insurance does not cover couples counseling per se. There are codes for family therapy and there are codes for individual therapy with family member(s) present. In each case one person in the couple or family is diagnosed with a mental health disorder, they are referred to as the “identified patient”. If you would like to use your out-of-network insurance benefits to address issues in the partnership, I would have to see evidence of a diagnosis like this in the couple. If you are wondering about this, we can discuss whether this is appropriate or not in your situation during the introductory consultation to discuss whether working together is a good fit.
(Follow this link for more information about using your out-of-network health insurance benefits .)
My singular role as your Couples Therapist
If you are working with me as a couple, I am your Couples therapist only. This means that it is likely I wouldn’t take on a client that you were very close to. Even if I was sure I had the skill to hold therapeutic space thoroughly between you, I would have to be absolutely sure you felt safe for me to agree to see them. There may be times when it might be fine for your friend or acquaintance to see me if we have covered the bases and made sure we had a plan if it ever started to impact our work. Of course, since counseling IS confidential, if two individuals or couples who knew each other started therapy with me without telling me that they knew the other, I would not be at liberty to disclose to either of them that I was treating the other.
Similarly, if I am currently your couples therapist, I typically wouldn’t agree to also be the Individual therapists for either of you. ( It may be appropriate to see you individually if we have ended couples therapy and you are no longer in that relationship.) Follow this link for more: Counseling FAQs: Can I see you for couples and individual counseling?
The Boundaries of the Therapeutic Relationship
This also means that as your therapist, I won’t be engaging in other social roles with either of you. To do so would create what is called a “dual relationship”. Ethically this is not allowed in the mental health profession if it can possibly be helped. To give some examples, I wouldn’t knowingly make or accept friend requests from either of you on personal social media platforms. I wouldn’t be entering into any regular social gift or card exchanging routines with you. I might step down from a committee if I discovered either of you were on it.
If at any point during the counseling process, these boundaries become confusing, please bring it up in your session. Having said that, as your therapist, I don’t expect you to always know when a line is being crossed because again, although we will engage in many friendly & socially customary ways in our interactions, the relationship and its purpose is not the usual social one. Therefore, it is my job to understand where the lines are, and bring it up with you, if we need to redefine them.
Please follow these links for more information about why it is critically important in therapy to hold these boundaries : the The Therapeutic Relationship, Counseling FAQs: Seeing a therapist you know
For More Information:
Click on the images below (or on the right), or see the pages under the “Specializations” and “About Counseling” menus.