Relationship distress is one of the most pervasive and upsetting of human problems facing people today. One in five adults experience marital distress at any given point in time. About half of marriages do not endure. By “marital” I refer to the full range of committed couple relationships. Many adults in individual counseling identify that problems in their primary attachment relationship are the main reason for initiating help-seeking.

Relationship therapy can help to reduce distress or help prevent the occurrence or worsening of problems. The dollar costs and time invested in professional consultation (typically 12-20 sessions for a course of treatment) likely pale in comparison to the financial costs and toll on human wellbeing associated with unresolved relationship stress. Often a crisis in the relationship such as infidelity, problematic sexual behavior, or conflict regarding a major life decision leads a couple to seek counseling. I outline here a brief description of my approach to assessment and treatment of couple problems. If faced with a stressful crisis at the outset, I would carefully balance attending to history-taking and crisis containment according to the most pressing needs at hand. Similarly, I adjust the assessment procedures if a client attends alone due to a partner’s reluctance to participate.

A thorough assessment is the cornerstone of our work together, helping to focus the therapy agenda and activities, and optimize treatment outcomes. Assessment is based on the viewpoints of each partner in combination with my appraisal of the relationship patterns. A history of the strengths and weaknesses, ups and downs of the relationship is taken during initial sessions. Through interview questions and standardized relationship questionnaires you complete at home, our aim is to review how things operate in the three major domains of inclusion/belonging, control and intimacy. I also acquire impressions about your relationship dynamics by observing your interactions and asking you to examine and comment on feedback I provide about how you relate. Careful attention is given to gathering information about your positive attributes, successes and resiliencies, in keeping with a solution-focused stance. More specifically, I gather information aimed at understanding things such as:

• Cohesion; balanced connection versus disengagement or intrusive involvement
• Role definition and negotiation; equality; impact of gender socialization on attachment style
• Problem-solving and conflict resolution skills and patterns
• Communication; clarity of messages, emotional expression
• Adaptability; flexibility versus rigidity in adaptation to life and relationship changes
• Attachment comfort and associated attitudes and behaviors; empathy; affectional and sexual intimacy
• Compatibility in task accomplishment and play
• Control dynamics; how power and influence are played out
• Support for the relationship from family and other kinship networks
• Values and belief systems
• Motivation for relationship improvement; openness to self-appraisal, personal change and acceptance of differences
• Individual problems or history and their impact on the relationship
• Crisis in relationship (where relevant); nature of problem, possible reasons for occurrence, significance for relationship
• Ratio of positive interactions versus four common detrimental relational interaction patterns identified by one of the “deans” of couples therapy (John Gottman): defensiveness, criticism, contempt, stonewalling

My treatment approach is influenced by a combination of theoretically sound and empirically supported models of relationship therapy. They share similar ultimate goals of reducing distress and resolving difficulties, enhancing attachment and mutual support, developing capacity for overriding interactional volatility and emotional reactivity with more positive sentiments, and promoting relationship satisfaction and individual wellbeing. A brief summary of concepts and techniques drawn from some of the models I find useful follows:

Psycho-educational Couples Intervention

It can be said that there is no sure way to prepare for a committed union. The training occurs through the raw material of the relationship. Many folks can benefit from expanding their understanding of the skills and processes that characterize well-functioning couples. A common occurrence is that a person will evaluate the success of a relationship in terms of whether all of her/his needs are being met. In actuality, one true benefit of a relationship may lie in the call to pursue challenging personal and mutual growth brought about by the complexities of a primary attachment bond. Couples therapy can help provide education in which commonly occurring but provocative challenges for relationships can be identified and discussed.

Emotionally Focused Couples Therapy

EFT is a Canadian home-grown model of relationship therapy that has gained wide acceptance and acclaim. It emphasizes the critically important function of secure attachment, at all stages of life, as the central organizing principle of relationships. A key element is “softening,” the transforming of either partner from a blaming position to one of hospitably asking for attachment needs to be attended to. Moments of heightened emotion and entrenched positions such as occur in conflict cycles are used to signal the need for softening. Expression of needs for connected feelings is encouraged rather than obscured by angry feelings and distancing behavior. An emphasis on emotional soothing in the context of attachment injuries helps develop emotional steadying at times when it is needed most. Ultimately, raw emotion is effectively contained and reframed while the range of positive primary emotions constricted by emotional upset is broadened. In-session experiences promote adult attachment; the emergence of vulnerabilities underlying conflict and negative exchanges allows for opportunities for mutual empathic soothing to override tendencies to go into attack mode. Resistance to meaningful deep attachment and emotional engagement, for example rooted in earlier life experiences, is explored.

Cognitive-Behavioral Couples Therapy

CBT is essentially application of the concepts of psycho-education in action. The kinds of attitudes and skills required for successful handling of typical relationship issues are reviewed and practiced. Strong flooding emotion that can sidetrack relationship skills is specifically targeted.  Examples consist of speaker-listener communication techniques and talk-turn face-to-face enactments constructing optimal dialogue exchanges geared to win-win outcomes. Fair fighting techniques are taught so that the process of arguing is less upsetting even if some issues appear non-resolvable. An emphasis is placed on pacing, monitoring affect (feelings), and enhancing ability to accept influence from one’s partner.  Hand in hand, cognitive techniques function to change distorted or unrealistic thoughts that partners sometimes harbor about the relationship and that compromise the utilization of behavioral skills. Through in-session coaching and take-home work, strategies geared to challenge and oppose non-productive ideas are applied. Negative thoughts and situations are also “reframed” so that a more positive perspective can emerge.