When is it time for couples therapy?

No relationship is perfect. But in cases where it feels like there is a distance growing even further between you and your partner each day, you may wonder whether you should seek help from a professional to work on any underlying issues. There are many reasons for a relationship to break down and here one of our top psychologists Dr Nicky Kimber-Rogal explains why and when it might be to time for couples therapy.

How do we know when it's the right time to get relationship counselling?

First of all, we need to define the term ‘relationship’.

What is a relationship? It is a connection, a link and involves (at least) two separate entities. Human relations require self-awareness and self-disclosure (mutual self-disclosure in the case of intimacy). The psychological self develops in childhood and exists in relation to the other. This process involves language, dialogue, behaviour, thoughts and feelings and, and religious belief. Culture also plays a significant part.

Basically, we learn to love as children. Or more accurately, we are programmed to form attachments and we learn a style of relating which governs our adult behaviour when it comes to love(1). Early patterns of relating, which parents - with their best intensions - call love, may, unfortunately, be far from enactments of mutual trust, compassion, respect and individual development which are central to a good relationship.

Often, we can be unaware of this underlying style of relating – it governs our adult behaviour without our noticing. In a romantic setting the exciting thought, ‘this is the one for me’ may, sadly, not be the case. However, learning about oneself and the self in relation to the other is never too late and can lead to relationship reparation.

Relationships or the interconnectedness between two people has been significant in all healing since immemorial. It seems to be one of the significant features in any major change or ‘metanoia’ in people’s lives, whether this happens as a result of falling in love, being in crisis, educational development, religious conversion or effective psychotherapy.

Even if people are not together they can still have a relationship through imagination, projection and the ability to internalise aspects of another. But some are unable (or unwilling) to relate. Note that fixedness or obsession with the other is the opposite of the openness which enhances connection with another.

Counselling may take place in a setting with one therapist or two.
 

Which kind of problems do couples typically get help for?

Relationship counselling is often sought when communication is poor or has broken down. The individuals who were once alone have formed an entity called a relationship, but feel alone or lonely again. Problems can stem from one or other being too remote or preoccupied or untrusting that they will be ‘held’ in some way by their partner; this can mean literally being held or simply held in mind: thought of.

Others may be suffering from anxiety, depression or weariness in life. Anxiety and depression can be manifest in over-controlling thoughts and behaviours, jealousy, feelings of exclusion, abandonment or just not feeling good enough. Other factors include wider family group members, the arrival of children and general unforeseen life events.

Some people get together for the 'wrong' reasons: their partner may represent something lacking in them – something they never had; for example, attention, support, or a validation of their lives to their peer group or family. In other words, the partner can be chosen (not deliberately or consciously) almost as a ‘service’ to mend the wounds of their past.

Alternatively, a ‘healthy’ relationship – where ‘opposites attract’ – can work very well: an introvert may pick a more extraverted person and vice versa and relationships where both admit that they, themselves, have strengths and weaknesses and recognise these compassionately in the other are also positive unions. Also, some marriages work for a while, where one or both allows the other to “hide” emotionally, but this is not always sustainable. Outside influences can also cause a person to grow (that is, develop positively), or be a detriment to the relationship: people can be easily influenced and not always to the good of the unit.
 

How can couples therapy help?

Listening to both individuals’ stories, without judgement, is the first step in therapy. Individuals in a couple will come with their own narrative, thoughts, hopes, fears and expectations. Ideally, they will complement (and compliment) each other, building each other up with encouragement. Importantly, they can be encouraged by the therapist to see themselves as equals in the relationship - to see and accept the other for who they are, rather than who they want or expect them to be. Many relationship hopes and dreams are dashed by expecting too much.

Accurate empathy on the part of the therapist is very important, as is an emphasis on empathy for each other in the couple. Reducing entrenched defences and increasing trust is fundamental. In therapy generally, the client must feel recognised and heard and couples counselling is no different. Eclectic approaches and EFT are helpful but the most important aspect of therapy is the relationship between client/s and therapist or counsellor.

Cognitive Analytic Therapy (CAT) is a very good model for relationship counselling because it identifies different roles or identities that the person has grown up with and addresses how these ways of being are interacting positively or negatively. For example, your partner may be seen as a parental figure, but it is important to remember that they are neither mother, father, brother nor or sister to you; rather, another person in life who has chosen to share their journey with you.

Once unproductive patterns of relating are recognised, the therapist and couple can come up with different ways of thinking, feeling and acting to repair or change things; or in some cases, realise that the hurts or disappointments are too much, and that they must kindly and generously, go their own ways.

Honesty and openness – without deliberately hurting the other – are also fundamental, as is a desire for the relationship to work; or, in some cases, there may be a joint decision to prepare for an ending. Where children are involved, this must be considered thoughtfully, imaginatively, empathetically and gently.
 

How often will we need to have sessions?

Sessions are usually weekly. Sometimes the therapist will meet the two individuals for one session each separately at the beginning, but it is important that both clients are regarded equally and given the same attention throughout.
 

What is the success rate of couples therapy?

I cannot give a national figure on the success rate of therapy. It very much depends on what the goal is and the presenting problem. If the goal is to understand each other, oneself and how one impacts on the other, to live amicably, whether together or separately, I would rate it, in my experience, at between 75-80%.



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(1) In part, we learn the art of relating through modelling: observing how adults relate to each other. Clearly it makes a difference if a child’s parents relate negatively - for example, through mutual contempt or indifference. In terms of the child-adult interaction, the child learns about love by being loved. This love is arguably synonymous with attention and satisfaction of needs. Ways of getting these needs met may be dysfunctional – for example, children who receive attention through being irritating to establish a pattern, extended into adulthood, where closeness is linked to annoyance and rejection.



If you feel like you and your partner could do with some professional help and someone to talk to about your relationship problems, you can book an appointment with Dr Kimber-Rogal now via her Top Doctor’s profile here.