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This course identifies and describes a host of effective interventions for use with couples, drawing from evidence-based practice, practice-based evidence, and theoretical clinical concepts. Although the knowledge, case studies and clinical vignettes provided may improve a participant's ability to enlarge and sharpen their clinical skills with couples – the how-to’s of assuming an active, interventionist stance; pivoting between being both neutral and partial in the alliance with clients depending on the presenting problems; coaxing the expression of vulnerable emotions; handling gendered communication issues sensitively; and rendering couples therapy more male-friendly – these are therapeutic skills that require ongoing development beyond what any single course can impart.
This course will cover helpful therapeutic ideas and procedures that lead to favorable outcomes in couples therapy. Couples often delay seeking therapy until their problems are dire, requiring the therapist to adopt an active, interventionist stance in order for treatment to be both viable and constructive. Among the interventions that help clients de-escalate conflict are: toning down the intensity of reactions in ways that allows for legitimate grievances to be recognized; agreeing to disagree; realizing the distinction between acknowledging and agreeing; reducing hyperbolic and inflammatory accusations; engaging in benign ignoring; and rewording criticisms as complaints and wishes.
What distinguishes the skilled couples therapist is their know-how when it comes to the core procedures endorsed by most schools of thought in the field: keeping the alliance with both partners relatively balanced; unlocking vulnerable emotions; and accentuating client strengths. Research indicates that if couples therapy with heterosexual partners is to avert premature drop-out and lead to favorable outcomes, the therapist needs to diligently construct a positive alliance with the male partner because he is more inclined to resist treatment, yet potentially may benefit the most. A male-friendly approach falls under the rubric of multicultural sensitivity and respects empirically based stylistic male behaviors such as “fight or flight” stress reactions, a transactional and logical communication style, and struggles with emotional expressiveness. Motivation to be more intentional in improving one’s relationship with a significant other can be derived from existential themes such as death anxiety and the desire to break intergenerational patterns of relationship dysfunction.
This course will address all of these topics in descriptive and learnable ways, as well as: what constitutes a marriage-affirming approach in couples therapy; the use of therapeutic guilt inducement to curate responsibility-taking behavior and apology rendering; and how humor can be capitalized upon to reduce conflict and engender good will. Case vignettes and therapist responses to client issues will be interspersed throughout the course to maximize the practicality and usability of the ideas and procedures covered.
Rarely do couples present for therapy with the noble goal of wanting to make a good relationship better. Mostly, therapy is put off until whatever problems exist have reached a boiling point with intimates feeling some combination of embitterment with or estrangement from each other. Studies show that couples deny and avoid their thorny issues for an average duration of more than two and a half years before seeking professional help. 1 By the time they enter the therapist’s office, the situation has become dire. In fact, one recent survey spearheaded by the Gottmans, based on a representative sample of heterosexual, gay, and lesbian couples entering couples therapy, discovered that: “Couples initiating therapy suffer from greater distress and many more co-morbidities than has been presumed in previous literature.”2
The pressure on the therapist is tremendous: to rapidly instill hope that negative communication patterns which have festered for years can be undone; to resolve tired old issues; to revitalize parched emotional and sexual connections; or to simply resist feeling pulled into colluding in desperation with one or both spouses who seem to have shown up for therapy simply to check the box, “done therapy,” before barreling toward divorce.
As we shall see, if the couples therapist acts too much like many non-directive individual therapists – being passive and neutral, sitting back and inviting unbridled open communication – the couple and the therapy itself can flame out. Old grudges on full display, back and forth blaming, and defensive interrupting can hijack the therapy, leaving spouses seriously questioning its usefulness. Is it any wonder the veteran psychologist, William Doherty once said: “If couples therapy were a sport, it would resemble wrestling, not baseball – because it can be over in a flash if you don’t have your wits about you.”3
All too often, couples therapy is over in a flash. Estimates of premature drop-out hover in the 40%-60% range.4 Those are dismal numbers. There are others. Only about one in five distressed couples contemplating divorce pursue therapy.5 This is confusing, given the widespread sentiment in Western cultures that calling it quits in a marriage without first pursuing counseling is considered irresponsible. Why are the drop-out and underutilization rates so high? The reasons are myriad. They include the stubborn conviction that couples should be able to fix their own problems; the fear that therapy will be nothing more than a forum to be blamed and verbally attacked; the scarce availability of therapists of color or of similar religious persuasion; therapists undertrained to provide quality care; the affordability of treatment; and the hold-out opinion that therapy is the place that troubled marriages go to die. Let’s deal in greater detail with the last two reasons.
Overwhelmingly, health insurance companies don’t consider marital distress a medically necessary condition worthy of coverage, nor couples therapy a reimbursable service. This often shifts the cost of treatment over to the couple, increasing the likelihood that they will forego or shorten it, for affordability reasons.
The fact that most health insurance companies don’t designate marital distress as a medically necessary condition is perplexing. Not only is marital distress a greater risk factor for health problems than smoking or alcohol consumption, but it has been strongly linked to chronic fatigue, reduced immune functioning, chronic pain, ulcers, hypertension, and cardiovascular disease.6 One conservative estimate of the medical offset cost of screening and providing treatment for marital distress uncovered a $1.48 return over a 12-month period for every $1 spent by insurers.7 The patients who were screened and given therapy for marital distress were far less likely to use costlier medical services for the conditions listed above. Until health insurance companies cede to common sense on this matter, people who desire to use their insurance for relationship-related anguish are left to petition their therapist to code its treatment as “family therapy,” which is covered. In a good-faith attempt to allow clients to use their insurance, many therapists do get around the billing constraints by relabeling couples therapy as family therapy. One member of the couple needs to be identified as the patient and given a diagnosis, which, ironically, can aggravate the blame game surrounding who bears the lion’s share of the problems in the marriage.
It turns out that the available science challenges the myth that couples therapy is where troubled marriages meet their demise. Overall, upwards of 70% of distressed couples can count on positive, significant change by undergoing therapy.8 Yet the myth persists. I suspect, in part, this stems from the standard couples therapy approach that practitioners are trained in for dealing with clients’ decisions to separate, divorce, or stay together. Therapists are trained to be “neutral,” which means their sole responsibility is to help couples communicate more openly, clarify what their issues are, and support independent decision making. Yet, for distressed couples seriously contemplating the dissolution of their marriage – about one in three of all couples entering therapy – divorce may be a forgone conclusion unless the therapist is prepared to take an affirmative stance surrounding putting off any decision about divorcing until therapy is given a solid chance.9
I’m not suggesting that a slow-things-down and don’t-give-up-too-soon therapy stance be prioritized in cases where relational abuse or extreme deception, betrayal, or exploitation exist. Nor am I suggesting therapists overwork to preserve a marriage where one or both parties manifest no ambivalence and have firmly decided to part ways. What I am suggesting is that in the 30% of cases10 where one spouse remains committed to the marriage and the other tilts in the direction of ending it, or both go back and forth chewing on staying together or ending their relationship, the therapist does well to propose that any decision to separate or divorce be taken off the table for a set period of time as a prelude to serious therapeutic examination of the viability of the marriage.
Therapists often feel they have an ethical duty to be autonomy affirming; to help couples make informed choices around maximizing each partner’s personal happiness. Frequently, this plays out with the therapist taking clients’ decision to separate or divorce at face value, respecting and working with presumed rational choices by independently minded adults. But, therapists may have a competing ethical duty to be marriage affirming – to advise beleaguered couples to postpone any decision around separating or divorcing until therapy is tried. The rationale here is that an avoidable separation or divorce safeguards a couple against some of the worst life stressors known to humans. The Holmes and Rahe Stress Scale, used by doctors for over half a century to rank stressful life events that predict illnesses in adults, places the death of a spouse, or child, at the top of the list. Numbers two and three happen to be divorce and marital separation. These are ranked more stressful and illness-producing than going to prison, sustaining a major physical injury, or having a close friend die.11
Some surprising statistics might also nudge therapists to selectively adopt a marriage-affirming stance, potentially enabling legions of couples to circumvent one of life’s top stressors. Anywhere between 26% and 40% of divorced people regret having dissolved their marriage, subsequently believing that either or both could have worked harder to preserve their union.12 Under duress, many married people, understandably, presuppose that they will be more happy divorced than partnered to their for-the-present unlovable spouse. Zooming out, some research counters this assumption. A nationally representative survey tracking more than 5,000 married adults over a five-year period found that, on average, unhappily married people who separated or divorced were no happier than unhappily married people who remained married. Remarkably, two-thirds of unhappily married adults who refrained from separating or divorcing rated themselves as happily married five years later.13
When the prospect of separation or divorce looms, there’s an ethical justification for therapists to stall and buy time with many beleaguered couples so as to test whether they’re going through a temporary rough patch which they experience for the time being as a hopeless predicament, or are neck-deep in irreversible estrangement or bitterness. For more couples than we want to believe, separation and divorce are later regretted and end up failing to provide the much-needed personal happiness imagined. This says nothing of the stress children encounter undergoing the breakup of their parent’s struggling, but otherwise bearable, marriage.
The best of what couples therapy has to offer creates space for non-destructive partners to slow the break-up train down and take stock of their union. Expanding outward from there, it helps unsettled couples regain hope by accentuating dormant strengths in their relationship, as well as acquiring kind and respectful patterns of communication, not merely refraining from hurtful and fruitless ones. It views the flourishing of one’s desire for fairness, as well as one’s potential to be the most loving person possible, as engines of positive relationship change. It fosters the use of apology-rendering, forgiveness, and humor to lessen ill-will and energize good-will. And, as we shall see, if couples therapy is to get off the ground and have a shot at success, male partners have to be actively engaged. In heterosexual relationships, an affable bond with the therapist is not only key to overcoming male partners’ resistance to participating in therapy, but can also heighten female partners’ hope that their seemingly irresolvable differences might not be so irresolvable.
If distressed marriages or partnerships are to survive and thrive – or end, with optimal damage control – they are best treated by a skilled therapist, not just a competent one. Finding a skilled couples therapist can be more of an ordeal than it should be. In general, psychotherapists are an overconfident bunch, believing they are highly skilled, not merely competent. A study spearheaded by Atlanta psychologist Steven Walfish discovered that 25% of mental health therapists view themselves as being in the top 10% and none consider themselves as below average.14
A classic don’t-ask-don’t-tell dimension to couples therapy involves clients wanting to know if their therapist has mastered with their own significant others the intimacy skills they hope to pass along to their clients. On occasion, brave clients raise this legitimate concern only to be met with the consummate therapist side-shuffle: “Hmmm, I wonder if the real issue here is that you feel discouraged about your ability to restore the love and trust you once had in your marriage?”
Clients should be emboldened to inquire about their therapist’ success at love, since research shows that therapist’ effectiveness is a direct outgrowth of their stable personality characteristics and relational skills, more so than their professional qualifications.15
Psychotherapy is one of those unique service roles where there is a great deal of overlap between a practitioner’s personal and professional selves. Personal growth can lead to greater professional expertise, which in turn can advance personal growth.16 Therefore, to be maximally effective, the couples therapist needs to have a reservoir of personal relationship knowledge to draw upon – what has been effective in their life as far as optimal communication, conflict resolution, intimacy preservation, equitable division of labor, and childrearing strategies. Not that it will map exactly onto what clients are dealing with and can draw inspirational wisdom from, but it serves as an experiential template that may or may not be brought to bear.
On the subject of therapists drawing upon favorable life lessons to inform their work, pioneer psychoanalyst Carl Jung once famously wrote: “… only what he can put right in himself can he hope to put right in the patient.”17 There’s more than a smidgen of wisdom in the notion that therapists are limited or potentiated in how effective they can be with clients relative to how well they have mastered similar life issues. It’s questionable how far Jung himself could have taken patients grappling with marital fidelity, or consensual nonmonogamy, for that matter. One of his lovers, Toni Wolff, a former patient, was a constant figure around the Jung household. A family friend was emphatic that this relationship was “a torture for Mrs. Jung to bear.”18
Psychotherapists are mere mortals when it comes to love and marriage. Studies show that their marriage adjustment is no better than that of non-psychotherapists.19 The same is true of their capacity to be securely attached – to be comfortable enough in their own skin so they’re neither overly needy nor overly detached in relationships.20 There is evidence, however, that the separation/divorce rates of social workers, counselors, and psychologists are higher than the U.S. national average.21 This may explain why a Minnesota poll tapping divorced peoples’ experiences with marriage counseling discovered that only 35% believed their therapist seemed invested in salvaging their marriage.22
I don’t subscribe to the extreme position taken by the intimacy expert Laura Doyle: “Some marriage counselors aren’t married. Others are divorced twice or unhappily married. Is this who you want to pay for advice? Would you take fitness tips from a 350-pound personal trainer who just had bypass surgery?”23 Channeling Jung, she adds: “If your marriage counselor doesn’t have the kind of relationship you want, she simply can’t tell you how to get it.” That said, I do subscribe to the reasonable position that therapists be forthcoming with clients about their biases around marriage and divorce so clients can make an informed choice whether or not any particular therapist is a good fit.
When asked, or when relevant, I usually disclose to clients some version of the following:
I’ve been married for nearly thirty years to a woman whom I adore and is also my best friend. That said, we have been to hell and heaven together, so I know first-hand the trials and tribulations associated with a long-term marriage, raising children, and building a life together – what can go right and what can go wrong. Since I am in a very good place in my marriage, having gone through some rough patches where we almost didn’t make it, I’m quite hopeful about married life.
If pushed, I don’t overshare about specifics, but add that my personal and clinical knowledge biases me in the direction of inviting clients to exhaust all options before separating or divorcing, especially if children are involved – unless there are personal endangerment issues, or the presence of considerable deceit, betrayal, or exploitation.
Other counselors with a pro-marriage approach have gone on record with comments they reveal to clients about their slant:
The issue right now isn’t whether you’re committed for life, but whether you can commit to working hard to salvage your marriage in therapy, with divorce off the table for the time being.
I can see that your hope for the marriage is very low. I see my job as holding that hope for you for a while, until you see whether it’s possible to rebuild your relationship.
I’ll be working for your marriage until one of you looks me in the eye and calls me off.24
The first order of business in initiating couples therapy is how to structure the sessions. Starting out, I usually strongly recommend longer visits (90 minutes) to avail clients adequate time to fully unpack their issues and maximize the chances that any noxious conflicts will be recovered from. If cost and scheduling are a factor, I typically recommend 90-minute sessions every two weeks rather than weekly 45-minute sessions.
There are varying viewpoints as to whether therapists should meet alone with each spouse or partner as a complement to the joint sessions. I make judicious use of individual sessions with each person to more productively gather his their personal history or strengthen an alliance that seems feeble. It’s always better to do what you can to build credibility with any member of a couple that’s slipping away. Being perceived as a force for good improves your chances that calling attention to the bad actions of either partner will be productive. Or, in psychoanalytic language, succeeding at being a “good object,” gives you the leverage to verbalize observations that can be “introjected” by the client, rather than written off as unhelpful because interpretive truth-telling renders you an “all-bad” therapist.
Sometimes, rapidly establishing credibility with a member of a couple who is ambivalent requires a cordial invitation to a separate meeting where he or she is extended an opportunity to unpack underlying concerns. The therapist then makes a wholehearted attempt to connect with that partner simply to bolster the chances that therapy will get off the ground. Wachtel aptly captures this concern: “ … the skeptical person, even if s/he has agreed to participate, needs, in a sense, to be “won over” fairly soon if the work is going to be productive. More so than in individual work, a few consecutive sessions that don’t go well can lead to discouragement and withdrawal from therapy.”25
Those frowning upon adjunctive solo sessions cite the dangers of favoritism – one member of the couple being sided with in an imbalanced way. There’s also the prospect of compromising secrets being divulged: “don’t tell my husband, but I’m having an affair with his best friend;” or “I don’t want my wife to know, but I used up all our equity line to pay off gambling debts. I just need some time to recoup these losses.” As for the first concern, my bias is that you don’t always need both members of a couple present to do couples work and maintain a balanced alliance. It’s possible to represent the interests of the absent partner in therapeutic ways. What I like to call “being the non-present partner’s ambassador:”
What’s Angela’s point of view on this? If Angela was here I could imagine her thinking … Does Angela agree with you on this? Knowing Angela’s position on these matters, I’m inclined to think she might feel …
On the topic of compromising secrets, it’s my habit to put clients on notice that anything divulged in the context of solo meetings with partners is fair game to bring up during joint sessions and that if serious secrets are confessed, sooner or later, in an agreed upon way, either myself or the confessor must come clean with their partner.
The consensus in the field is that therapists need to be more active and participatory during couples treatment than is typically the case when performing individual therapy. Many inexperienced practitioners assume that what might be effective in individual therapy – tracking and clarifying underlying feelings and needs – can be mapped onto couples treatment. In high-conflict relationships, this can spur rapid escalation of blaming and shaming during sessions that leave clients painfully demoralized and doubtful about continuing in therapy. In most cases, it is misguided to assume that couples possess the latent relational know-how to self-emerge out of serial rages, as if “venting” naturally incurs relief, a return to some calm set-point, and a renewed desire for benign discourse. From the onset, it’s pivotal that clients witness first-hand the therapist’s ability to gauge how much animus is productive, so that aggrieved partners feel sufficiently heard and affirmed due to legitimate past and present emotional injuries incurred by their mate, without sessions repeatedly devolving into mutually frustrating standoffs.
Therapists need to be poised and ready to engender more subject-to-subject – as opposed to subject-to-object – relating between antagonistic partners, by using their own moment-to-moment modulated affect to contagiously lower the couple’s heightened affect. Flooded emotional states are rarely a catalyst for the quality of self-reflection that enables people to be sensitized to, and sensitively deal with, other’s emotions. Clinical judgment is used to determine whether a soft or commanding voice is most effective in restoring calm:
Sorry, but I need to interrupt because I can see you are both talking over each other and hurting each other in ways you are unaware of. Both of you seemed to stop caring to care about your effects on each other! Can we take a moment … take a breath … try to dial it back.
Actively prompting loud and boisterous clients to “own their tone” sets the groundwork for less inflammatory conversations. An often-overlooked consideration with emotionally reactive spouses is how the intensity with which they deliver their grievances compromises the legitimacy of such grievances. Any shot at grievances being taken seriously – not just being heard, but acknowledged – necessitates a therapeutic focus on reactive clients dialing back their intensity:
Camilla, it’s understandable you are angry at Hugo because he is slow to show initiative at home, needing multiple reminders to help out with the children and do his share of housework. We do need to take a serious look at these issues in therapy. But I think your legitimate concerns get compromised by how loud your tone becomes. Is there a way to dial back the intensity of your frustration and say in a calmer way what you just said?
Periodically, a heavy-handed approach is required to cement the realization that somehow, in some way, on some issues, a couple must find a way to agree to disagree. Just this week, I boldly butted in with a couple who for the umpteenth time had become ensnared in disagreement over whether the husband was being insensitive in continuing a friendship with someone who had been repeatedly rude to the wife, or if the wife was being too sensitive in perceiving the friend as rude: “I’m not sure hammering away on this issue is getting us anywhere. Can we start from the premise that you both experience this friend very differently and accepting that this is, in and of itself, a sign of respect?” Once during a training workshop, the virtuoso psychoanalyst Phil Ringstrom told gatherers that during a fiery session with a couple where the husband kept loudly interrupting the wife, he stood up and commanded him to do nothing but stare into his eyes, breathe, and hear the wife out. A comfort level with assertively disallowing blatant disrespect needs to be part of a marriage counselor’s toolkit, even if accomplished softly: “I realize you’re furious that Billy forgot to pick up milk from the store on the way home – after you had called and texted to remind him. But I’m not sure calling him a self-absorbed idiot will make him remember next time.”
Underscoring with clients how “acknowledging is not the same as agreeing” can lay the groundwork for more active listening and less acrimony:
Jared: You came home late, greeted the kids and completely ignored me. Of course I was pissed! Who wouldn’t be!
Hannah: That’s not what happened! You were squirreled away in your office, like you usually are, keeping your distance from the family!
Dr. Gnaulati: Hannah, I know your version of events is different than Jared’s. Clearly, you don’t agree with him, but can we start by just acknowledging his point of view and feelings?
Hannah: So you think I greeted the kids and ignored you, and you were mad?
Jared: Yes!
Another therapeutic maneuver to reduce counter-reactive defensive interactions involves cuing clients to “benignly ignore,” or prompting them to exercise the option of choosing to ignore, provocative remarks, since electing to do so can represent a dignified expression of personal agency, rather than masochistic self-denial: “Elena, you can choose to ignore Brian’s remark since I think we all know it was a mean thing for him to say, best left unreplied to!”
A staple of couples therapy is addressing the use of totalistic or hyperbolic language (e.g., “You never help out around the house,” “You always jump in and take the kids’ side when I am trying to discipline them,” and “I can’t ever remember a time when you treated me kindly.”) and the need to use “I-statements” (e.g., “I wish you would do more to help me out around the house,” “I wish you would let me discipline the kids and trust I can do a good job,” and “I would like it so much if you would compliment me more.”)
Relatedly, in his immensely useful book, The Marriage Clinic: A Scientifically Based Marital Therapy, John Gottman differentiates between partners issuing a complaint, rather than a criticism, the latter being conducive to protracted marital conflict and dissatisfaction when frequently defaulted to.26 Sharpening clients’ awareness of this distinction and being poised to intervene and cue clients to reword criticisms as complaints can break destructive communication patterns:
Aime, I’m hearing you accuse George as self-involved and clueless for getting up in the middle of watching TV with you and going to bed without saying goodnight. Is there a way to say this more as a complaint than a criticism?
Ok. It upset me that you got up off the couch and stopped watching the show without saying why and dashed off to bed without saying goodnight. When you do things like that it really hurts!
Even more compelling is Gottman’s conflict-averting step of helping clients reformulate criticisms into wishes. For example, rather than “You’re always preoccupied and on your phone. Would it kill you to pay attention to me!” saying, “I wish I could have your full attention right now, that would be great.” And, rather than, “What’s wrong with you! Why don’t you ever clean up after yourself or help out around the house!” saying, “I wish I could get your help with clearing off the table and putting the dishes in the dishwasher. That would be a big help.”
In flooded, counter-reactive emotional states, couples often become oblivious to the reciprocal nature of relational existence, or the fact that we are always acting upon others and being acted on by others. Interpersonally speaking, the words couples choose – especially in flooded states – have consequences, and that to stop caring to care, and believing one can mouth off with impunity – what these days is called “radical candor” – is somewhat of an atomistic fallacy. It assumes that a state of complete autonomy is achievable where people are not responsible to varying degrees for the effects of their behavior on others. Prompting more modulated, less incendiary, kinder word choices on the part of the therapist can be an instrumental de-escalatory step:
Juan, you just called Maria a “selfish b-tch.” Can I please get you to take that back and describe what you’re feeling right now.
Lydia, calling Francisco an a – hole doesn’t help the situation. You know that already, I don’t have to tell you. What hurt you so much that made you want to strike back?
Camilo, George NEVER helps out around the house or you feel that things are unbalanced and he needs to do more at home?
An interventionist stance can be as simple as monitoring “airtime” to ensure that both parties feel the expression of their point of view, more or less, is evenly encouraged. It might entail the therapist commandeering a chaotic discourse to render it more productive: “It seems to me we have too many issues on the table right now. Can we pick up on one of them that you both feel is valuable to address?” Or: “That issue is so much of a hot-button one, I think we should set it aside until cooler heads prevail.”
On a more sophisticated note, the good couples therapist is conversant at reframing problems ascribed to any individual partner in terms of relationship dynamics:
Jamal, I hear what you’re saying about Grace being sexually unavailable. From listening to you both it seems more like a dynamic where you, Grace, need to feel Jamal is interested in you as a person, asks you about your day, helps out around the house, is nice to you, to get your sexual motor running. When he doesn’t act that way it lessens the chances you’ll be in the mood. You reject his advances. Jamal, you then feel rebuffed and withdraw, being even less communicative, hurting your chances that anything sexual will occur.
Even more sophistication is involved in determining and communicating what aspects of each partner’s attachment, personality, or communication style is potentially changeable, or needs to be accepted and accommodated as a hardened trait:
Sam, I notice it comes easier for you to tune in logically to what Tilly is communicating. Reading between the lines, emotionally speaking, is more of a challenge. Being a logical person is a big part of your identity and probably contributes to your success as a lawyer. Tilly, you wish Sam would get out of his head and feel his way into your experience. That doesn’t come anywhere as easily to him as it does to you. We have a dilemma here.
Cameron, I notice when Mary Anne is around more, you have lots of time to hang out or travel together, and have predictable access to her, you are a much calmer version of yourself. When she is busy working, gone a lot, comes home from the office at random times, you are more on edge and apt to become irritated with her. I think this is something for you both to be aware of and work with. I can tell, Aliyah, you wish you were not so quick to take things personally, to feel insulted and compelled to strike back. This tendency gets in the way of the type of partner you want to be. The good news is that you are aware of it and are committed to damage control measures like taking a personal time-out when you know you are in attack mode.
In fact, the latest consensus among leading researchers in couples therapy is that the field has moved from promoting change to engendering mutual acceptance with clients. The latter concerns itself more with helping couples reframe “defects” they see in their partner (to be eliminated), as “differences” (to be better tolerated, worked with and around, and accepted).27
Otherwise, what distinguishes skilled couples therapists is their know-how when it comes to the core procedures endorsed by most schools of thought in the field: keeping the alliance with both partners relatively balanced; unlocking vulnerable emotions; and, accentuating client strengths.
Maintaining a balanced alliance involves being watchful to mete out equal support, not overidentifying and siding too much with one partner to an excessive degree. When validating one partner’s grievance(s) there is always the risk the other will feel neglected or misunderstood. To even things out, sometimes this entails inviting a rebuttal immediately after providing one-sided affirmation:
I can tell, Priscilla, it’s irritating to feel it necessary to remind Sergio to help the kids with their homework, wishing he would show initiative and do it without reminders. Is there anything to this, Sergio, or maybe you see things differently?
Mostly, the therapist keeps a mental balance sheet in their head, an intuitive sense of how much one or both partners feel sufficiently or insufficiently supported, ever prepared to rebalance the situation with a nod here, a smile there, a passing supportive remark, or an emphatic gesture of approval.
Therapists are human. The whole enterprise of keeping things balanced implies they ought to warm to and like both partners equally, presupposing joint culpability for relationship predicaments. That’s more of a superhuman than human task. Scholars at the Family Institute at Northwestern University studying these matters discovered that 40% of the time, therapists engage in split alliances, getting caught up liking and showing preferential treatment to one spouse over another.28 Often, this gets acted out covertly more than overtly: a muted smile, a half-hearted gesture of recognition, an overly eager expression of praise, restless leg crossing, more animated listening.
Speaking from experience, when I find myself clicking with one spouse and souring over another, I try to be hyperconscious of the verbal and nonverbal signals I send out to diplomatically disguise this. I consider this a form of professionalism. I don’t hold back from conveying my genuine like for the liked partner. For the less likable one, I work at liking him or her more. I find it helps to search for tidbits of personal history that inspire compassion – things such as overcoming the odds to succeed professionally, dutiful in taking care of an aging grandmother, forced into a parental role as a kid due to paternal abandonment, afflicted with chronic pain after a skiing accident.
Strife in relationships is usually fomented when intimates reactively convert vulnerable emotions into invulnerable ones – shame into prideful rage, hurt into angry rebuttal. One of the most empirically substantiated couples therapy interventions that shows up across different models is the process of assisting clients move from self-righteous anger to humble acknowledgment of hurt caused. For instance, research in the emotion-focused couples therapy tradition underscores the therapist’s active role in setting the groundwork for clients to move from emotional invulnerability to vulnerability so as to restore intimate connection.29 Gottman Couple Therapy emotion regulation interventions aimed at reducing relational conflict and improving marital satisfaction often include coaxing expression of vulnerable emotions.30
Therapists need to be poised and tactfully ready to intervene to allow aggrieved partners face-saving opportunities to tap the underlying hurt behind angry outbursts, or in general, to ferret out when invulnerable emotions are operating, cue and prompt aggrieved partners to stay attuned to the vulnerable ones – when pride masks shame and anger is a foil for hurt, sadness, jealously, anxiety, guilt, or feelings of loneliness:
I realize you are mad because Helen accused you of being passive, staying in a job where you are underpaid and under-appreciated. Is any part of you also hurt or embarrassed?
Being called a control freak can’t feel good, but I don’t think it’s productive to go on the offense and call your wife wasteful and materialistic. Is it possible you’re nervous about how the kids’ college is going to be paid for and whether you are socking away enough for retirement?
Leona just said you were an uninvolved dad. You reacted by saying she is more married to the kids than to you. I’m wondering if she hit a nerve and part of you feels guilty you’re not there for the kids as much as you wish?
Right when Camila mentioned she’s lost weight and is proud of how she looks, you rolled your eyes. Maybe there’s some jealousy over other guys potentially giving her attention?
The all-important rationale for cuing and prompting clients to stay attuned to vulnerable emotions is that these tend to elicit empathy and compassion – mitigating conflict. Recently, a husband and wife I was treating were bogged down, slinging accusations at each other over whether the husband was too needy, or the wife too cold-hearted. She traveled a great deal for work. Post-retirement, he was nested at home with few outside obligations or hobbies. I probed a little, wondering if his anger masked loneliness. He denied it at first. Then in the middle of the argument he jumped ship and declared with noticeable gravity: “Enrico’s right. I’m lonely and I miss you.” His wife stopped herself and matched his vulnerability: “I miss you too.” The fight came to a grinding halt.
Admissions of guilt and wrongdoing can also bring fights to a grinding halt. Inviting and inducing clients’ guilt for their guilty actions, at first glance, seems moralistic and counter-therapeutic. However, we need to remind ourselves that guilt is a “social emotion,” healthily signaling us that it’s quite possible we have broken a connection with a significant other through our insensitive actions. Tuning into genuine guilt feelings becomes the emotional gateway to acknowledge wrongdoing and mend broken connections. Maurice Friedman captures this sentiment well: “Guilt is an essential factor in the person’s relations to others: it performs the necessary function of leading one to desire to set these relations right.”31 In essence, guilt involves feeling badly for having acted badly, with detrimental consequences, often to a loved one, and the subsequent emotional harm persists until some successful attempt at remedial action is initiated. Therapeutic guilt-inducement on the part of the therapist – as counter-intuitive as it sounds – can be an important skill for counselors to hone since it potentially aids in clients moving through protracted conflicts and restoring positive bonds faster. An example will elucidate.
Hillary mentioned during a couples session that she had taken great pains to make dinner plans to celebrate her and Gabriel’s wedding anniversary. On the night of their anniversary dinner, Gabriel had put in a distress call to Hillary asking if it would be alright to fill in for a friend, refereeing a youth soccer match in the neighborhood. Hillary was galled that Gabriel had forgotten about the anniversary dinner. While revisiting this chain of events during the session, Gabriel off-handedly uttered: “What’s the big deal? I came right home after you reminded me and we went out and had an enjoyable dinner, right?” Hillary was livid because Gabriel seemed to be making excuses for his insensitivity, which compounded the hurt she already felt.
I intervened with some therapeutic guilt inducement: “Gabriel, can you see how Hillary might have felt hurt and rejected having to remind you of the special evening she planned? Gabriel softened: “You are right. That was not me at my most sensitive.” I persisted: “You have said many times in here that you need Hillary to demonstrate more affection with you. She seems to have listened by planning the anniversary dinner. In an abashed tone, Gabriel continued: “I don’t know what I was thinking. Hillary was trying to plan an intimate evening, and by asking to stay out and referee the soccer game, I was being pretty thoughtless.” Crying, Hillary chimed in: “I ended up sucking it up and going out with you when you came right home, but having to remind you took all the sheen out of the evening. Gabriel was apologetic: “I’m so, so sorry.” He reached over and hugged Hillary, who collapsed into his arms, relinquishing the anger she felt over the transgression, implicitly forgiving Gabriel.
Gabriel’s overt guilt and regret are instrumental elements in the chain of reparative events. In a sense, Hillary feels better because Gabriel feels badly, or in the words of philosopher Herant Katchadourian, the aggrieved person’s “distress is easier to bear when it is more evenly distributed.”32 Gabriel’s apology is a sincere one and sensitively avoids common errors associated with an insincere one. There is no “but” tagged on that undoes the sincerity of the apology. Moreover, Gabriel remains open to Harriet’s hurt, reflecting what Harriet Lerner the sociolinguist defines as a true apology: “staying deeply curious about the hurt person’s experience rather than hijacking it with your own emotionality.”33 Gabriel shows the psychological wherewithal to listen to Harriet’s pain, knowing full well he contributed to it, rather than deflecting, avoiding, or defensively responding. Hillary refrains from pressing her case, nor does she turn the conversation into a character assault, instead keeping the focus on the single act of insensitivity on Gabriel’s end, all of which creates the ideal conditions for a true apology. It goes without saying that it is extremely difficult to acknowledge guilty feelings, humble oneself, and apologize, when one is being shamed as an unworthy person with a barrage of judgmental accusations. It is the rare person who refrains from defensiveness when the totality of their personhood is being defined by their worst mistakes.
Guilt can also serve an anticipatory function or signal us that we are about to act transgressively and potentially harm the relationship, whereby we catch ourselves and come to our relational senses.34 A capacity for anticipatory guilt is a sign of conscientiousness and discretion – virtuous human habits. It can involve a rapid subliminal processing of interpersonal events resulting in tactful communication. It might involve some version of an internal dialogue along the lines of: “Oops, if I say that, I know it will just make her feel badly, so why say it at all!” It is how interpersonally aware people try to balance honesty with kindness, or truth with tact, in their outward expressions. It shows a mature acceptance of the overriding existential imperative centering on balancing authentic self-assertions and sensitive communication to preserve and enhance close relational attachments.
In couples therapy, on occasion it is helpful to butt in and engender anticipatory guilt to circumvent an inevitable conflict; to reinforce the need for verbal discretion at times. Not uncommonly, this is a salient concern with clients who are either ill-disposed to act sensitively for malicious reasons, are empathy-challenged, in an emotionally flooded state, or just seem benignly oblivious. It amounts to a form of sensitivity training, or cuing and prompting clients to demonstrate the procedural knowledge or the know-how of acting with that all-important quotient of interpersonal sensitivity:
Bill, is this the right time to raise this issue? I’m not sure the timing is good. I think you can probably guess how it will make Marina feel!
Lisa, are you sure you want to finish that thought with those very words? Look at Joanna. Can you tell what she is feeling while you are talking?
I am sitting here hearing the words coming out of your mouth, Alan, and I can only imagine how Loretta is going to feel once you are finished!
Cameron, I know you are insisting that you’re just being honest. But, there’s got to be a way that you can say what you need to say in a way that does not leave George feeling rejected and unlikable.
Finally, another area where couples therapists may need to adopt an active stance pertains to pointedly acknowledging demonstrations of positivity on the part of partners. I resoundingly concur with findings out of Gottman’s Love Lab at the University of Washington: in troubled marriages, spouses are often poorly dialed into loving gestures that occur and overly dialed into the ways they disappoint each other.35 This may explain the logic behind the amusing Bob Mankoff New Yorker cartoon where an emboldened marriage counselor announces to a baffled couple: “It may surprise you to know, contrary to your experience, you’re actually very happily married.”36 Effective therapists are privy to how beleaguered couples make the worst of a good situation and are primed to step in when either or both spouses show signs of virtuous action or goodwill, no matter how subtle:
I’m impressed by how well you held back and just listened while being screamed at.
It’s difficult to acknowledge you are in the wrong when the other person is coming on strong, but you showed courage and did it!
You have a knack for seeing the humor in situations when you could get annoyed. You guys would be in more arguments if this was not the case.
I can tell that you both don’t stay mad at each other for long, even after the worst fights. Sometimes that’s what really matters, not overtalking the issues, letting bygones be bygones, and moving on.
You strike me as devoted parents who function amazingly well as co-parents. We just have to find a way to redirect some of that devotion to your relationship with each other.
Even though you find each other insufferable at times, bickering and overindulging your annoyances, you still find a way to have a mutually satisfying sex life. Kudos to you!
Frequently, the task for therapists is to reframe the negative impressions of clients into positive ones in ways that accurately call attention to benign rather than malicious intent:
You seem convinced that Bob is being controlling around finances. I wonder if this is just him doing something he has talent at to preserve the financial well-being of the family?
Jamal, I know it gets to you when Francisco calls you at work to share the details of his day. You say he’s being intrusive. What if it reflects his desire to keep a connection with you alive, because he considers you to be his best friend, as well as his husband?
I know you wish Peter was more communicative and keyed in to what you’re going through emotionally. But he seems to show his love through acts of service, like making you breakfast and picking up your dry cleaning. That might not seem like enough, but it’s something, not nothing.
I can tell you think Olivia is being unfair by insisting you consider coaching your daughter’s basketball team when you are stretched so thin at work. What if this is just her way of trying to strengthen your relationship with your daughter?
As contained in the section to follow, optimal handling of fairness and unfairness issues in therapy is often at the heart of the matter if couples are to regain hope in their vital bond being reestablished.
Let me begin with a case example:
Within days of being released from a rehab center, 63-year-old Landon called me to set up therapy for him and his wife, sheepishly disclosing that his marriage was in tatters; no less, he was determined to save it. His 55-year-old wife, Jill, would be joining in remotely, since she had relocated miles away to her mother’s house for safety reasons due to the events surrounding Landon being placed in rehab. The harrowing details were unpacked for me during the extended Zoom videoconference we arranged.
What was intended to be a night out for cocktails with some work colleagues turned into a nihilistic escapade. Landon binge-drank until he had no recollection of how he ended up passed out in his car in front of a “gentleman’s club,” sans shoes and wallet. He awoke the next morning and made his way home only to discover an empty house. After her repeated phone calls had gone unanswered, Jill suspected that Landon was on another self-destructive romp and decamped to her mother’s house. Landon called and pleaded with Jill to return. She was adamant this wouldn’t be in the cards until Landon swore he would enter treatment. Distressed and sounding incoherent, Landon pounced back, saying he had a gun in his hand and would use it on himself if Jill refused to return home. Jill hung up and contacted the police.
The dominoes fell from there. Landon was arrested and placed on an involuntary hold at a local psychiatric facility for a week. Once released, he flew to an out-of-state drug rehabilitation center and checked himself in. In shock, Jill elected not to have contact. Both her therapist and her mother urged her to focus on her own self-care, strongly advocating that Jill hold off contact until Landon completed rehab, sending him the unmistakable message that she would no longer tolerate Landon’s calamitous and alcoholic behavior. Humiliated and feeling all alone in the hospital, a sense of self-righteous indignation welled up in Landon. Adding insult to injury, he reached out to his mother and demanded she freeze bank accounts in his name to preempt any chance Jill would access them. He persuaded his mother that he was bent on divorcing Jill, maligning her as a “gold-digger” who would drain their accounts while he stood by powerless, hospitalized against his will. His mother not only froze the bank accounts, but took it upon herself to call Jill and rail against her for being a neglectful wife during Landon’s time of need.
Therapy kicked off with a palpable sense that it was the court of last resort. The responsibility to heed the ethical pull emanating from clients like Landon and Jill, mired in mistrust and despair, to help adjudicate accusations of fairness and unfairness, is both awesome and treacherous. It’s what seriously tempts therapists to double down on aspects of their training informing them to be neutral: stay out of the fray, don’t take sides, track and process feelings, just help the couple see “their dynamic.” Landon and Jill wanted more than a therapist who observed and helped them process feelings. They wanted a therapist who witnessed, and enabled them to adjudicate, their fairness and unfairness claims:
Landon, I know you felt abandoned and neglected when Jill remained at her mother’s house and cut off all contact, but can you see how this might be her being fair to herself, desperate to get you to finally address your self-destructive relationship with alcohol? All the scary and gloomy times you have put her through with your self-destructive behavior?
Jill claims her relationship with her mother-in-law is broken because you intervened, Landon, pegging Jill as a “gold-digger” and turning your mother against her. You tell me, is the relationship broken, or just damaged? Is there anything to be gained by reaching out to your mother and admitting you were out of line, acted rashly in a rage, redeeming Jill in your mother’s eyes? Assuming Jill is ready for this, or even wants this?
The reader has probably discerned that I was unequal in my initial interventions with Landon and Jill, siding mainly with Jill. I made a value judgment. I had to judiciously pick sides with Jill for the sake of the marriage, while not alienating Landon. This was the second marriage for both. The stakes were higher. At bottom, Landon adored Jill and saw a better relationship with her as crucial not only for his sustained sobriety, but also his hope for true companionship in old age. Jill found Landon hilarious (as I did, and told him so during our sessions) and adventuresome, and if the marriage worked out, she would be afforded a level of financial security never experienced before in her life. Yet, the egregiousness of Landon’s actions the night of his nihilistic escapade, and its aftermath, tilted Jill in the direction of seriously questioning remaining married; especially since her mother and friends were lambasting her as nuts for staying with him.
Clearly, I was not acting equally or even-handedly in the initial phase of therapy with Jill and Landon, though I was attempting to be equitable. That is, in my mind, Jill’s hope for the marriage working out was contingent upon Landon experiencing a real reckoning of the sort where he truly accepted that his culpability surpassed hers. To restore equity, Landon would somehow have to earnestly grapple with how unfair it was of him to leave Jill in the lurch while he endangered himself on a binge-drinking episode; to manipulate her into rushing home by threatening suicide; to unnerve her by necessitating she call the police to ensure his safety; and to malign her in the eyes of his mother. In a sense, Landon owed Jill this sort of reckoning because, for the time being, she was acting loyal enough by agreeing to therapy and staying in the marriage, against a chorus of disapproving friends and relatives. My holding Landon answerable to all these concerns emboldened Jill’s belief in the utility of therapy for the possible preservation of the marriage. She felt she was getting a fair hearing.
So much of therapist’ training cautions them against stepping into this tribunal role with couples, yet, in my experience, it’s unavoidable. In a therapy context, or even in a non-therapy one, it’s simply human nature to automatically contemplate fairness concerns when confronted with life stories like that of Landon and Jill’s. Whether consciously aware of it or not, therapists who open themselves up emotionally to the real dilemmas couples face, can’t help but get drawn into their ethical agonies: It sure looks like she’s under-giving and over-expecting, that’s unfair! She’s definitely over-giving and under-expecting, that’s not right! He’s owed more because of how much he gives, that’s unjust! He deserves better, look how much he gives, that’s so unbalanced! The trick is using these natural impulses caringly and carefully to help couples address the imbalances in what is owed and what is deserved that frequently underly marital problems.
One unique approach that subscribes to this way of working is Contextual Family Therapy, formulated by Ivan Boszormenyi-Nagy, a Hungarian-American psychiatrist. Raised in a household with multiple generations of lawyers and judges, he became intrigued with how issues of fairness and justice govern human conduct. I had one of his concepts in mind – for when the time felt right – to tip the therapy scales in the direction of Jill being more conciliatory toward Landon – “merited trust:”37
Jill, I can tell you are, understandably, reticent to consider moving back into the house with Landon. You’re not sure it’s safe, if he’ll relapse, if he’s serious about wanting to be a kinder version of himself. Does it help build some trust knowing he completed rehab, attends regular AA meetings and is transparent in emailing you breathalyzer readouts?
I hear what you are saying Jill, that even before Landon’s rehab stay he threatened to limit your access to family money when he was upset at you for any reason. I realize how demeaning this was for you. His rebuttal is that he did this when drunk and angry and he’s aware how demeaning this was. Does that make a difference?
Those working within the Contextual model label the therapist’s tendency to shift alliances based on in-the-moment determinations as to who has been harmed the most and is owed support, or whose conscientious efforts are deserving of recognition – as “multi-directed partiality.” Couples therapists are usually trained to see alliance building and maintenance as involving consistent neutrality and impartiality. However, working from a Contextual approach, alliance building and maintenance centers on siding with whichever partner has a legitimate fairness claim in ways that lessen the potential for the other partner to feel rejected or alienated. As already alluded to, unfairness claims often underlie relationship dissatisfaction and, based on the empirical work of Rashmi Gangamma in the Department of Human Development and Family Science at Ohio State University, if couples therapy is to be efficacious, the therapist has to find a way not to just identify them, but to engender communication and action that restores a sense of fairness and justice.38
At no time does the therapist need to be more partial to a client than when he or she is generous with goodwill. As we have learned from Gottman’s Love Lab, troubled couples often overlook kind actions – bids for connection – which can register as mini-rejections fueling below-the-radar, tit-for-tat withholding of affectionate praise and recognition. Being partial to whichever member of the antagonistic couple thaws, showing overtures of kindness, is an important attitude for therapists to adopt:
Landon, I just noticed that you, somewhat shyly, mentioned it was nice having Jill home this weekend. What about it made it nice?
You smiled, Jill, when Landon announced he’d be happy to babysit the dog this weekend. Can you elaborate on how this made you feel?
I’m impressed, Landon, by how well you took note of what Jill said last session about not pulling your hand away in public when she reaches out for it!
If vicious cycles of withholding praise and recognition are to be supplanted by virtuous cycles of outward manifestation of such gestures of appreciation, the therapist’s role in prompting couples to flesh out subtle signs of genuine positivity is instrumental. Couples who habitually neglect each other often think pleases and thank-yous are corny; yet ironically, these sort of intentional expressions of appreciation are the very antidote to their alienating neglect. The eminent Roman legal scholar Cicero opined: “There is no duty more indispensable than that of returning a kindness.”39 Sensing this duty to meet kindness with kindness, not as a moral prescription but out of loving desire for the sustenance of a marital bond, can be a turning point in therapy. That is, when it’s mutual.
Another important agenda in couples therapy pertains to both parties not only realizing but showing an ongoing willingness to explore how the emotional baggage from their past shapes their current relationship expectations. Not uncommonly, at first clients heartily endorse the reasonableness of this. Freud’s notion of “repetition compulsion,” which has seeped so thoroughly into popular culture, in ordinary terms pertains to the idea that if we ignore our past, we are destined to repeat it, at our own peril. The more nuanced version, utterly demoralizing at times, is that we bank on significant others in the present letting us down in the same way as caregivers did in the past. The even more nuanced version is not so demoralizing: we are split between expecting our current loved ones to disappoint us similarly to how early caregivers did, and holding out hope they will not.
Once clients dig into their distant past, they become embarrassingly aware of the grip old hurts have on them and of how often they contribute to new injuries in their current relationships. They often sour on historical discussions.
Take the case of Jackson and Sara, both university professors in their late forties. One of their “trigger issues” was Jackson being overcommitted to his work as a chemistry professor, which left Sara feeling neglected. Despite his Herculean efforts to enact his fair share in raising their daughter – drop-offs and pick-ups at school, as well as bedtime stories multiple days a week, fun outings, frequent “math puzzles” time which his daughter prized – Sara was routinely displeased when Jackson was required to travel for work, leaving her to “pick up the load.” He was a highly accomplished chemist, a rising international star in the research and development of cancer-busting drugs, who broke into a cold sweat when raising a discussion of his travel plans with Sara. Sara was no slouch. She was a well-established graphic artist who counted on time apart from parenting and household tasks to preserve her creative juices. Even though Sara tried in her own way to be affectionate and playful, Jackson often seemed blind to this and defaulted to perceiving her as relentlessly critical. I floated the following perspective to them:
It seems to me, Sara, that part of what’s going on here is some of this is due to unresolved issues with your father. He was a very ambitious attorney who was gone a lot when you were a kid. You felt neglected and resentful and carry this into the present. Jackson, your mother was often critical and disapproving, such that when Sara shows her unhappiness over your travel plans, you go into a panic, as if you’re a little kid in the presence of your mother, all over again.
Like most couples hearing about an “unconscious dynamic” from me for the first time, Sara and Jackson were receptive. They now had a framework for understanding a recurring source of vexation. They felt helped. Before long, exasperation set in due to the uncanny way in which this unconscious pattern from the past cropped up time and time again to disable their best intentions to do things differently in the present. Hence Freud’s unhopeful language: “repetition compulsion.”
It’s one thing to acquire insight into an unconscious relationship dynamic, or to entertain the sober assessment of philosopher Mari Ruti on how the past can color the present for couples: “ … when two couples come together in romantic alliance they are more or less guaranteed to arouse each other’s deep-seated unconscious patterns.”40 It’s something completely different to turn it around. It entails a sound awareness that the festering feeling of being owed you carry into the present, sets you up to collect from the wrong person, who is a somewhat hapless victim. Jackson may deserve a portion of Sara’s ire for being over-immersed in work too, but her rage over this is archaic in nature; it’s reminiscent of a girl furious at her father for not being present enough, aggravated by an over-identification with a mother who feels similarly. It may be annoying that Sara defaults to criticizing and disapproving, but Jackson’s deflation and panic is that of a boy overwhelmed by a wrathful mother in a family system where everyone’s fear of conflict allows mum to get away with bad behavior.
To undo the tenacious effects of a neglectful past on the present requires committing to a higher ethical ground. It entails heightened sensibility to the fact that it’s unfair to hold current partners responsible for mistakes made by caregivers. It involves – out of love for the person whom you are attached to in the present – intentionally and actively keeping one eye open for how he or she is actually providing what you need, not simply undermining it. That’s where good therapy can make a difference:
I know Sara can be hard on you, Jackson, and that’s hurtful. But, at times it seems to me you confuse her with your mother and get shut down in the ways you used to in the past. You get so shut down, I think, it blinds you to Sara’s affectionate gestures and playful ways of connecting to you.
Sara, I realize that because Jackson is such an accomplished scientist, he’s gone a lot, leaving you feeling neglected like you used to as a little girl with your father. However, when he’s around, I get the impression he’s an involved dad and is genuinely invested in his domestic contribution. So unlike your dad!
Therapists need to be mindful of how clients can weaponize historical understandings to avoid taking responsibility for how they act in the very way that a neglectful, disappointing, or rejecting caregiver did, or to be overripe in their accusations that a partner acts unpleasantly, like an early caregiver did:
Jackson: You need to deal with your “daddy issues.” I’m tired of being skewered just for being ambitious and furthering my career, which will always involve travel!
Dr. Gnaulati: Of course, it’s incredibly important that you be ambitious and ensure your career is on the right track, Jackson. But can you see how when you are too animated about this it takes Sara back to some very painful parts of her childhood, leaving her feeling neglected and alone?
Sara: I can’t believe I’m stuck in a relationship with someone who is no different than my father. Who is self-centered and prioritizes his career.
Dr. Gnaulati: I realize Jackson’s career is all-consuming, Sara. But, is it fair to compare him to your father in this way? From my understanding, he’s much more of an involved dad than yours ever was. Maybe your dad is more deserving of your anger?
When thorny fairness and unfairness claims take hold in couples therapy, proponents of a Contextual model offer some wise counsel as regards a constructive agenda: “To move clients away from the fantasy of unconditional acceptance to the reality of colliding entitlements.”41 In ordinary language, what this means is that effective couples therapy energizes a focus on clients “giving up the ghost” that unmet childhood needs to feel extra special due to inadequate care by caregivers cannot be met in exquisite ways by current partners – who have their own compelling reasons to unfairly expect their current partner to make them feel extra special for similar reasons. However, as we shall see up ahead, if couples can fully comprehend each other’s painful historical legacies, they can lovingly commit to honoring each other’s “triggers” or “sore spots,” avoiding hurting them in all-too-familiar old ways.
It can be useful for couples therapists to have in their clinical repertoire a working familiarity of gendered differences in communication styles that partners inaccurately assign malicious intent to, or malign, in ways that create conflict. I say “gendered” to allow for people identifying as more masculine or feminine in their communication style, rather than presupposing these reflect biologically based, essential male and female traits.
One overarching, pragmatically useful framework for thinking of gendered differences in communication style pertains to the “rapport-talk” vs. “report-talk” distinction coined by the sociolinguist Deborah Tannen.42 Characteristic female ways of communicating can privilege the need to build rapport and social connection as motivators, often as much as or more so than the need to get conversational information across. For many women, talk is interactional, democratizing, and bonding. There’s less a need to “one-up,” or stand out in some self-important way based on verbalized expertise or advanced knowledge. Interruptions with likeminded ideas, similar experiences, or affirming vocalizations are more likely to be experienced by women as an indication of conversational engagement and involvement.
Men, on the other hand, are more apt to approach communication from the place of information exchange, seeing it more as transactional than interactional. They may want the conversation to stay on point and arrive at a conclusion, preferably in a logically consistent way. Their approach to communication is more apt to be content- than process-oriented, listening for what can be informationally gleaned from the interaction, and omitting backchannel vocalization such as “uh-huh” and “yeah.” They tend to prefer non-interruptive turn-taking and experience this as conversational engagement and involvement.
Within this gendered framework, conflict looms when men assume women should speak and listen in characteristic masculine ways, and women assume men should speak and listen in characteristic feminine ways. I have found it immensely helpful to normalize diverse gendered communication styles when working with couples to counteract tendencies to see these styles as deficient.
Mary, I know you find it irritating when Jamal wants you to stay on point and asks for clarification and examples so he understands the message you are trying to get across, when you are just trying to have a lively conversation. You say he is uptight and a little OCD. To me, this reflects his different – a more masculine communication style – not a deficient one.
Another common source of conflict in intimate relationships revolves around disconnects in communicating love through what might be called “acts of service” as distinguished from “acts of sympathy.” Take the following example:
Roxanne: I’m so frustrated with my dad right now. He expects me to drop everything on a moment’s notice and drive him to his medical appointments.
Filipe: That’s a no-brainer. I’m free all week and can drive him.
Roxanne: I didn’t ask you to take that on. Can you just listen!
Filipe: Why are you getting mad at me, I’m just trying to be helpful!
In my office I have witnessed many a dispute between partners, one leaping into “fix-it” mode (more often than not a male) when the other prefers to be listened to with a sympathetic ear (more often than not a female). Sometimes these conflicts arise from clashes in what anthropologist-turned-marriage counselor Gary Chapman labels different “love languages.”43 Some people are more predisposed to communicate and anticipate the expression of intimacy through Words of Affirmation, others through Acts of Service. Research has demonstrated that Acts of Service is the primary love language for most men, and Words of Affirmation is deemed more important to women than men.44 In my experience when working with couples who successfully navigate these seemingly discrepant ways of manifesting and anticipating affection, there’s less acrimony due to the awareness that one’s partner intends to act lovingly in the way they know how, even if it’s off-cue as far as what the recipient really needs in the moment. Oftentimes, it’s the timing of a displayed love language that matters. In the example above, if Filipe had prefaced his solution-oriented comment with, “I can see why you’re frustrated. That seems so unfair” and given Roxanne a chance to feel her feelings, there’s a good chance the conflict would have been averted.
The takeaway is that therapists do well to prompt couples to be charitable with one another where differences in communication style exist. The task is not to avoidantly condone or aggressively condemn speech and listening habits that seem to occur naturally to significant others and are not intended to elicit annoyance. Rather, working with the frustration inherent in the otherness of how a partner talks and listens can be a veritable labor of love, keeping a partnership vital – when it’s a joint endeavor. In the words of Deborah Tannen: “Mutual acceptance will at least prevent the pain of being told you are doing something wrong when you are only doing things your way.”45
Transparency with feelings of affinity is crucial for therapists working with couples – showing you like them, as well as the whole undertaking of therapy together. Maintaining an openness to humorously engage clients is one way to cement goodwill and positive affinity with clients. Couples tire of their broken-record complaints with each other. They assume you feel likewise. A surefire way to disabuse them of this assumption is to laugh with them. Witnessing them enjoying you enjoying them is enjoyable. It subtly communicates you’re all in, unlikely to tire of them anytime soon. Something as elemental as greeting a couple in the waiting room with a smile, not gestures of over-professionalized formality, tacitly communicates: “It’s a pleasure to see you.” In her subversive book, Why don’t Therapists Laugh, author Ann Shearer sardonically states: “Of course psychotherapy is a serious business. But do we have to be so solemn about it.”46 I think: We don’t. In fact, it is only recently that couples therapy scholars are recognizing the ameliorative role of humor in treatment47 which is surprising given the abundance of empirical support in the literature underscoring links between humor and intimate relationship satisfaction, especially as couples age.48
Reciprocal laughter, when it occurs, can dissolve any power imbalance, or expected social hierarchy in the relationship, tacitly displaying that therapist and client share a common humanity. In this regard, shared laugher can democratize the therapy. It can also promote feelings of friendliness and trust which position the therapist as a credible figure whose input is valued.
When they hit the mark, humorous comments and exchanges with clients foster an all-important sense of we-ness, or relational goodness-of-fit, that adds an extra quotient of compatibility. A knowing smile, chuckle of recognition, or wry remark conveying common awareness of human frailty, covertly reassures clients that you, as the therapist, embody the sort of familiarity with their angst, and confidence in treating it, that augers well for the therapy.
Amusing comments that hit the mark can also reflect acute empathy or deep listening and recognition. They can embody an easy-going sense of I-know-that-you-know-that-I-know mutual awareness, or affective synchrony, that leaves clients feeling non-threateningly understood and better able to relax into the therapy. Due to the spontaneity involved, an element of surprise infuses the interaction, finding clients caught delightfully off-guard. An emotional channel gets changed and clients are primed to absorb sensitive personal information they otherwise would defend against. The playfulness and positive “in-tuneness” shown by the therapist momentarily inoculates clients against experiencing shame surrounding beliefs and actions that might otherwise be shame-inducing. A clinical example should clarify:
Percy and Catherine, a middle-aged couple, sought out therapy to address prolonged estrangement in their marriage, worsened after taking on the primary caregiving role for Catherine’s 90-year-old father. Rather than hire in-home health care workers, they decided to sell their house and move in with him. Percy was especially hard done by this. He was well acquainted with how opinionated and harsh his father-in-law was, but believed he’d soften under Percy’s devoted care. Before long, the father-in-law proved himself to be cranky, demanding, and unappreciative, to the point that the living arrangement had become unlivable. Catherine was fine with moving out and orchestrating her father’s placement in a nursing home. Percy remained adamant that “a promise was a promise” and felt they had no choice but to stay put. Side note: Percy’s susceptibility to passive resignation was a problem in the marriage.
Sessions often played out with Percy railing against his father-in-law’s cruelty, reflecting a kind of impotent rage accompanying a sense of passive resignation. During one such tirade, I couldn’t help myself: “Percy, you make it sound like you just got handed a life sentence with no hope for parole! Like your old soulmate (pointing to Catherine) is now your cellmate and you’re trapped together with no options! Catherine is telling you the cell door is wide open, and she wants to get back to being your old soulmate, not your current cellmate!” They both cut up laughing. When the cathartic moment waned, Percy admitted his passivity was a problem. He surmised that if he and Catherine were to find their way back to one another, not only would they have to exit his father-in-law’s house, but he would need to be more proactive in identifying and pursuing sources of enjoyment in his life, preferably ones that Catherine also might find appealing.
Good-natured teasing can non-threateningly shine a spotlight on a trait that renders a partner difficult to live with, influencing their mate to perceive it with more levity and acceptance. Recently, a self-admitted cantankerous husband I was treating referenced that it was hot where he was. I quipped: “Are we talking about the weather, Lance, or your mood this morning!” His wife, who was listening on, smiled, adding: “Probably both!” A wife I was treating, who had reached her limit with her husband’s incessant demands that she exercise more and lose weight, blasted back: “I’m never going to be an ultramarathoner like you!” I snarkily commented: “Heck, you’re an ultramarathoner of a different sort, sticking in through thick and thin with a husband who won’t let up on these issues!” Her husband smiled and sheepishly admitted: “Ain’t that the truth.”
Humorous wordplay can be disruptive, pleasantly jolting a spouse to loosen an attachment to some idealized version of a wished-for mate that’s getting in the way of greater intimacy with their real flesh-and-blood mate.
Sixty-three-year-old Betty often bemoaned in couples therapy that her identically aged husband, Peter, was difficult to connect with because he was a “naive optimist.” She, on the other hand, was palpably aware of the tragic dimensions of life. I reminded Betty that Peter had donated a kidney to her for a transplant operation she had undergone: “What can be darker than the idea of electing to serve up a kidney to keep you from dying, I’m no’s kiddin’s yae (with a Scottish accent)!!” This caused us all to burst out laughing, which greased the path for a more penetrating comment: “In all seriousness Betty, after all these years I think you still get stuck idealizing the kind of man your father was – a whip-smart conversationalist, high-brow cosmopolitan type of guy, full of personal insight and integrity – and by comparison Peter always falls short!”
No doubt, there are risks being comical with clients because there’s a thin line between acting spontaneously and acting impulsively. Risk abounds because the message nested in the witty remark is often taboo and the outcome of how it will land, uncertain. With poor timing, poor word choices, or bad intent, the therapist can misread the interaction, alienating couples. This says nothing of humor that is unquestionably inappropriate, such as when it is used to belittle or mock clients, divert attention away from a difficult problem faced by couples and onto a lighter subject, and when it’s tangential to what a couple feels is relevant, and is instead motivated by the therapist’s need for stimulation and amusement. All this said, when humor works, the emotional dividends can be great both in terms of bonding with couples and spurring them to non-defensively look at and accept limitations in their relationship. When the therapy is too staid, formal, and scripted, ludicrous things can happen! Take the joke: Client: No one ever understands me; Therapist: “What do you mean by that?”
A little-known scientific finding in the world of heterosexual marriage counseling is that whether the therapist is male or female, a successful outcome relies heavily on the therapist and husband cementing a connection.49 I suspect, in part, this is because wives are about twice as likely as husbands to be dissatisfied with the relationship, so when therapist and husband clinically bond, hope is revived for the wife that therapy might actually make a positive difference.50 It may feel like pulling teeth to get male partners to agree to therapy. After all, as noted by one counseling psychologist duo: “the requirements of the male role appear antithetical to the requirements of a “good client’s”51 – keep your feelings inside; appear invulnerable; fix problems, don’t just talk about them; get to the point and stay on point; resist getting too dependent. But, in most cases, if therapy is to get off the ground and stay in the air, engaging men is crucial. This is worth making a strong assertion about because in the research literature there are some data to suggest that split alliances, or asymmetrical therapist-client alliances, often occur disproportionately in favor of the female partner.52 Yet, if the therapist is to get “buy-in” from male clients early in treatment, and therapy is to start of auspiciously, robust evidence indicates that “men’s alliance is more predicative of outcomes at the beginning of therapy compared to women’s alliances.”53
The initial facade of resisting therapy often fades fast for men because they tend to rely more on marriage for companionship and life satisfaction than women, priming them to seize upon therapy to help preserve a marriage they’ve grown dependent on. Some data show the average husband benefits more from marriage than the average wife because there’s a greater likelihood she’s his primary confidant, link to outside friendships, source of household help, and health-check badgerer.54 Moreover, marriage seems to be equated with a healthier lifestyle for many men whereby the perseveration of marital bonds is a protective factor against alcohol, tobacco, and cannabis usage.55
The task becomes making couples therapy a male-friendly space. The field is rife with models that emphasize skills many women already possess, and many men don’t. Accessing vulnerable emotions, or “chasing the pain,” and deepening intimate connections – twin homerun goals of most models – are more female-friendly than male-friendly. Leading marriage expert John Gottman goes so far as to say: “News flash: Men, you have the power to make or break a relationship.” He sees marital improvement hinging on “ … the extent to which the male can accept the influence of the woman he loves and become socialized in emotional communication.”56 Which begs the question: Does a traditionally cisgender male have to conform to traditionally cisgender female communicative norms to make couples therapy work?
First off, diversity scholar William Ming Liu at the University of Maryland, would argue that failing to treat a cisgender man (or transgender man, for that matter) who is comfortable with many of the social expectations associated with what it means to be traditionally masculine is not practicing with multicultural competence.57 That entails a gender-sensitive approach where men are treated from within their masculine predispositions, guarding against biased attempts to superimpose onto them norms that come more naturally to the average cisgender woman (or transgendered woman). Which doesn’t mean having to collude around the uglier forms of manhood, or toxic masculinity – turning a blind eye to forms of male dominance, arrogance, aggressiveness, and sexual excess. It involves meeting men where they’re at, not shaming them for displaying what seems to come most naturally as regards masculine identifications.
Common socialized gender role expectations associated with traditional masculinity comprise, but are not limited to: 1) self-reliance and avoidance of dependency and help-seeking; 2) privileging of logic and analytical reasoning over emotions and “intuition” in interpersonal communication; 3) masking vulnerability and overemphasizing invulnerability; and, 4) competitive ways of thinking and acting, especially around other males.58 The challenge in offering a male-sensitive approach is to work with these tendencies – rather than work against them – for the betterment of the couple, at least in heterosexual and same-sex male contexts. The therapeutic stance adopted by the practitioner when working with those adhering to traditional masculine gender norms may need to carefully monitor excessive displays of nurturance and empathy, and embody more of an ethos commensurate with “coaching,” “action-orientedness,” and “problem-solving.”59 Language choices by therapists matter, such as words like “repairing” rather “healing,” and “backup” instead of “support,” as well as the idioms of “honor,” “loyalty” and “courage.”
Terms used to describe men’s emotional know-how in the culture at large are often tinged with shame – stunted, constipated, clueless. Several years back, the freelance journalist Tori DeAngelis wrote an article for Monitor on Psychology titled: Are Men Emotional Mummies?60 On average, we know men are less emotionally expressive than women, but browbeating them for it is not particularly therapeutic. Many psychologically healthy men experience what Professor Emeritus in Psychology at the University of Akron, Ronald Levant, labels “normative male alexithymia,” which literally means, “no words for emotions.” It’s estimated that almost 17% of men embody this emotional style, approximately twice the rate of women.61 Typically, alexithymic people come across as aloof, drawing a blank when asked what they’re feeling, are non-elaborative in their emotional responses (i.e., How are you feeling? Fine.), somewhat out of touch with what others are feeling, overvalue logic, and appear disconnected from their own needs and desires. These challenges tend to be more emblematic of men than women. I’m reminded of the Randy Glasberg marriage counseling cartoon where a well-meaning wife orients the therapist about her husband: “He’s pretty good at showing his emotions. A blank stare means he’s angry, a vacant stare means he’s sad, and a distant stare means he’s excited.” All joking aside, the issue with alexithymic men often is not that they’re incapable of identifying their emotions, it’s that they’re restricted in outward expression of them. That’s according to a 2009 Finnish study looking at alexithymia in over 5,000 adults across gender.62
Empirical data also suggest an interaction between male alexithymia and shame.63 Many alexithymic men vacillate between shame and anger when unable to describe what they are feeling with sufficient fluency and elaboration. They may emotionally implode and withdraw, or erupt in frustration, sometimes due mostly to the sense of demoralization that accompanies difficulties with expressive mastery of emotion, independent of any interpersonal sources of distress.
The situation can be especially pernicious for African American males, who not infrequently adopt an alexithymic, emotionless, hard-edged personae for survival reasons.64 Whether harmed directly by systemic racism in the form of denied employment or housing opportunities, or indirectly through microaggressions and negative stereotypes, African American men often acquire a quasi-alexithymic emotional style to protect against humiliation and disillusionment. It is important not to assume this is emblematic of an avoidant or dismissive attachment style, maladaptive defensiveness, or conducive to treatment noncompliance. Addressing the discriminatory experiences that set an African American male client up to become hardened to life, as well as the “survival value” in suppressing feelings to circumvent racism-based humiliations, becomes an important therapeutic focus. In the words of one group of researchers:
Attempting to get Black men to express vulnerable emotions using an attachment frame without attending to the racial component is uninformed and may reinforce internalized inferiority. They may need help to understand that emotional engagement is an explainable response to social distortions of Black manhood that keeps them from emotionally connecting with their partners.65
Overall, the takeaway for therapists is: when interacting with alexithymic-leaning male partners, patience and perseverance are necessary to draw them out emotionally. More directiveness applies, offering emotion-word choices and expanded verbalizations (e.g., “I hear you say you’re feeling blank, but I’m wondering if you’re frustrated since you told me Clarissa forgot to pay the internet bill and when your service was cut off you had no way of conducting Zoom sessions with work colleagues?). Over the years, I’ve learned to settle into ambling disclosures on topics tangential to marital problems – the abundance of cobalt in the Democratic Republic of the Congo for making electric car batteries, how inflation drives up wages for workers, China’s maritime justification for building the Spratly Islands – as a prerequisite to gaining trust with many men, allowing them ample space and time to communicatively unfold, to edge their way into their emotions. As a masculine-leaning man myself, I can hang in. I’m even guilty of being seduced into joint intellectual meandering. I sometimes ponder what this must be like for the average female therapist, who nowadays makes up over 75% of the mental health workforce in the US.66
Sometimes, compassion for alexithymic male partners can be generated by discussing the limitations posed by this neurodiverse predisposition. During a recent couples therapy session, I reframed the husband’s tendency to “not read emotions well,” “be emotionally flat,” and “not be emotionally in sync,” as him embodying alexithymia. I defined it as a “neuropsychological condition involving a person experiencing significant challenges accessing, labeling, and expressing emotions,” and used the more homespun definition, “emotional blindness.” It helped the wife to contemplate the idea that her husband was not purposefully tuning her out or showing malice by acting annoyingly detached and not being emotionally in sync with her, but “was wired” in ways where he possessed “emotional blind spots.” We then discussed how she could be a social ally for him, cuing him in sensitive ways and offering social behaviors he could adopt to minimize the risk of him alienating others due to emotional unawareness.
Watchfulness over privileging feminine preferences in couples work is important to keep men engaged. One area where this pertains relates to how men and women handle stress differently. When stressed, males are more likely than females to experience a fight-or-flight response. Their sympathetic nervous system and adrenal glands light up. A cascade of catecholamines get released into their bloodstream, preparing them to do battle or run for the hills (ancient ways of staying alive and ensuring a healthy number of the tribe survives). In therapy, discussions of unequal household chore arrangements, lack of sex, or who hogs the channel changer more, can result in men either exploding or shrinking into themselves. The latter is more common. Gottman claims a whopping 85% of stonewallers in troubled marriages are men.67 When stressed, men more than women are prone to fold their arms, clam up, avert eye contact, and give one-word answers.
Emerging scholarship shows that when stressed, women are more likely to “tend-and-befriend,” or cope by actions like calling a sister, or hanging out with friends to discuss what ails them. The release of the “bonding hormone” oxytocin plays a role in their stress response (an ancient bio-social mechanism aimed at building social connections and trust so others will have your back in times of danger).68 In couples therapy, heated issues tend to elicit a need in most women to exhaust every discursive avenue to resolve issues. They are more inclined to “talk then walk.” When stressed, men are more inclined to “walk then talk.” Insofar as a female therapist adopts the naturalness of a “tend-and-befriend” attitude, she may underestimate a male client’s need to emotionally withdraw to get his bearings, to temporarily have some immediate silence, change the topic, have it be acceptable for the therapist and the wife to dialogue alone for a while, hit the bathroom for a toilet break to calm his nerves, or any number of other steps that allow for temporary face-saving, respectful withdrawal. In other words, stonewalling is not always a hardened coping style that enduringly forecloses meaningful and productive communication. It can be a temporary self-protective measure such that meaningful and productive communication can be restored if the need to withdraw is recognized and handled sensitively.
Gender differences in tolerance levels for elevated and prolonged emotional expression have a bearing on the steps therapists can take to render couples therapy more male-friendly. Danielle Weber in the Department of Psychology and Neuroscience at the University of North Carolina at Chapel Hill spearheaded a study on heterosexual couples’ communication of emotion and discovered that women tend to be more satisfied during interactions if emotions remain sufficiently elevated and prolonged until returning back to their emotional baselines.69 This stylistic preference tended not to be shared by men, who were predisposed to react in ways that prematurely shut women down, resulting in mutual maladaptive distress. The authors of the study offer the following clinical advice: “Given that women may receive the most benefit from expressing emotions without disruptions from their male partners, it may be important to help men explore how they can best receive and understand women’s emotions.” In other words, the relationship seems to gain the most from male partners refraining from curtailing their female partners’ fuller expressions of emotion, with men being coached to listen more patiently, follow along attentively, and offer acknowledgement. Over my many years of practice, I have found it very useful, especially with over-logical men who get bogged down in the “factually correct and incorrect” content in conversations, to distinguish between “acknowledging” and “agreeing:”
Jamal, you know acknowledging is not the same as agreeing! It is possible to say to Yolanda, “I hear what you are saying … I get where you are coming from … I can understand why you feel that way … and still add: But, I see things differently … I have a different point of view.
Another area where privileging of the feminine might inadvertently shut men down involves their inordinate emphasis on physical attractiveness in romantic relationships. A large body of research buttresses the notion that physical attractiveness matters more in predicting husbands’ marital satisfaction than that of wives over the long arc of a relationship, not just during a courting phase.70 Most straight men visually zero in on female bodily characteristics, like smooth skin, large eyes, soft hair, full lips, and low waist-to-hip ratio as signs of physical attractiveness. They fret over wives keeping up their appearance as they age in ways that seem superficial. From an evolutionary perspective, these habits are far from superficial. They’re responsible for the perpetuation of the human species. Female bodily characteristics like soft skin and hair texture, and full lips, are considered “fitness factors,” signs of youthfulness and health that over the millennia eventuate in greater mating reproductive success. Superficial or not, natural selection designed the male brain to fixate on these “fitness factors.” Expecting men to willfully rid themselves of them is akin to asking men to override deep evolutionary brain programming. Which isn’t to say men can’t curtail, suppress, struggle with, disguise, or guiltily and self-sacrificingly renounce their preoccupations over what feels natural to them regarding what they find attractive in females – for the betterment of their relationship with their abiding significant other.
Several years ago, a couple in my office got into a spat over the wife’s inclination to cut her long curly hair. She found it oppressive dabbling with hair products and scheduling routine appointments with her stylist, mainly to accommodate her husband’s personal taste for long hair. Entering midlife, she felt it was long overdue for her to assert personal choice over how she styled her hair. He thought her long curly was sexy and suited her.
I know more than the Cliffs Notes version of feminist theory, patriarchy, and male hegemonic sexualization of women. I sat there stymied. I eventually offered a comment to the husband informed by my feminist-informed intellect, partial to the oppressiveness of the sexual objectification being asked of his wife to leave her long curly hair as is: “It seems important to your wife as an empowered woman to make whatever choice she sees fit styling her hair and not to be at the mercy of sexist notions of women being valued solely for their looks.” Then I coughed up another response directed at the wife: “That said, your husband finds your long hair sexy and I suppose him finding you attractive in this way has some contribution to sexual intimacy between the two of you?” The fact that the second comment followed the first, and I added, “that said,” revealed my male limbic brain was over-resonating with the husband’s limbic brain. Following much emotional processing of these concerns, the wife elected to leave her hair as is because it seemed awfully important to him and his sexuality. My male bias infiltrated. The verdict is still out whether this was a checkmark for perpetuating patriarchy and sexism, or one for bolstering the sex life of a couple heading into midlife where any reasonable measures taken to stoke the fires of love were worthy of consideration. It’s tempting to speculate how this exchange would have transpired with a woman therapist and the infiltration of female bias.
Thankfully, the present cultural zeitgeist leans toward dismantling toxic masculinity, holding men to account for entitled expressions of dominance, aggression, and sexual excess. In the midst of this dismantling, it’s extraordinarily difficult to cobble together any map of what a non-toxic way of expressing male sexuality looks like. The thesis floated by neuroscientists Ogi Ogas and Sai Gaddam, in their book A Billion Wicked Thoughts: What the World’s Largest Experiment Reveals About Human Desire, is disconcerting. They argue the male brain is designed to gaze in sexually objectifying ways, whether it’s trained on women in an opposite-sex context, or men in a same-sex context. Men’s sensitivity to visual cues – sexually checking out body parts – is rooted to a look-and-lust subcortical brain reward system. They wrap up their findings as follows: “ … men’s brains scrutinize the details of arousing visuals with the kind of concentration jewelers apply to the cut of a diamond.”71 Just the other day, palpitating with a mixture of panic and disgust, a young-adult male client confided in me that during a college counseling visit with a staff person who was his mother’s age, he became transfixed on stealing a glance at her breasts and fantasizing about sex with her. As a liberally minded, progressively educated young man he was revolted by this, believing it was deeply disrespectful to his college counselor. I invited him to share more about his fears and desires around this; what it revealed about his emerging sexuality; his relationship with pornography: when it satiates his arousal or turns the corner into galvanizing it; and, the key difference between indulging fantasies and acting on them. Telling him it might even be a form of respect he stole glances when the counselor was not looking – rather than lewdly stared – and labored to disguise outward evidence of the erotic drama staged in his head, seemed to disabuse him of the conviction that he was a vile human being, a would-be rapist.
These are conversations that men, especially in our bring-down-toxic-masculinity era, need to have. Since they are likely to be awkwardly had between male clients and female therapists, I suppose the onus is on female therapists to lean into such topics for multicultural competence reasons, inviting men to share their inner thoughts about what sexually turns them on and off, with due consideration, in couples therapy, to their female mate listening on. It can be shaming to female mates to hear their man prefers they be slimmer, keep their hair dyed and long, or wear clothing that accentuates their physical attractiveness. It’s also potentially shaming to men who might secretly need these steps to maximize their sexual attraction to a mate they love, only to be denied airtime in therapy to discuss it. What a Gordian Knot! This is the stuff of meaty couples therapy that differentiates the merely competent therapist from the skilled one, male or female.
An encouraging phenomenon occurred during the Covid-19 pandemic. Marriages got better. A large-scale survey out of Brigham Young University discovered that the share of spouses reporting their marriage to be in trouble dropped from 40% in 2019 to 29% in 2020. Among spouses ages 18 to 55, 58% indicated that the pandemic made them appreciate their spouse more, and 51% reported their commitment to marriage had deepened.72 I have a theory about this. It pertains to death anxiety. Confronted with the prospect of losing a spouse, legions of people reached inward and accessed their most loving self. Instead of bickering over trying to find toilet paper, making and wearing masks, and getting vaccinated, they cooperated. Keen awareness that your beloved can be stolen away due to an illness or accident lends urgency and immediacy to the desire to be a more attentive, decent partner. So too is the nagging realization that death comes to us all and we only have a finite amount of time to get it right. These aren’t morbid thoughts. They’re existential epiphanies that lessen the chance we will have chilling deathbed regrets.
It’s ironic that a recent Merrill Lynch Wealth Management/Age Wave study revealed that it’s not the accumulation of wealth and career success that adults 55 and older want to be remembered for the most (5% and 11%, respectively), but “the memories I’ve shared with loved ones” (70%) and “the quality of my marriage/partnership” (41%).73 Australian motivational speaker Matthew Kelly interviewed a group of hospice workers to document peoples’ deathbed regrets and, not surprisingly, among the most common were: “I wished I had loved more,” “I wish I had spent more time with the people I love,” and “I wish I hadn’t spent so much time working.”74
Conveying this existential well-spring of motivation to do love better during couples therapy periodically requires stepping into the role of wise counselor. Not in an off-putting, self-important, preachy way. At times, in a breezy, droll, fellow-life-sojourner manner:
Fast-forward to your deathbed. Are you really going to be wishing you had taken fewer vacations, stacked up more billable hours, or pushed more product? That you won more arguments with your wife? Or, die happier glad you listened more attentively across the breakfast table, humbled yourself and took more ownership of your part in arguments, did your fair share to help out at home and with the kids, strove to not sweat the small stuff, with your wife?
At other times, with more heartfelt self-disclosure and gravitas:
At the end of the day, what really matters the most? I don’t know about you, but I don’t want my wife to die with me left feeling I could have been kinder, more appreciative, more affectionate, less grumpy, traveled more and created joyful memories. I want to take solace from the fact that I strove to make her life a happier one.
On a different topic, spouses who are parents can draw motivation to work on their marriage from the realization that they have an opportunity to break intergenerational patterns of dysfunctional relationships and set their kids up for a brighter future in the world of romance and love. Paul Amato at Pennsylvania State University conducted a novel study looking at intergenerational legacies and found that when parents get mired in the following, down the road their offspring follow suit: jealousy, being domineering, becoming angry and critical too easily, being moody, and giving a spouse “the silent treatment.”75 A common shibboleth used by struggling spouses to goad recommitment to their marriage is “staying together for the kids.” The problem is this often functions as a moral prescription, valorizing self-denial. A flourishing, self-respecting legacy to hand down is one where spouses fully commit to keeping excessive anger in check, communicating more respectfully, conveying mutual appreciation, and seeing the humor in things. These more virtuous ways of relating can be motivated out of a sense of owing it, not just to yourself and each other, but to your offspring to be more adept at love. Therapists can raise spouses’ consciousness of this:
You know you have an opportunity to gift your children better conflict resolution skills for use with their partners down the road if you can commit to modeling for them more respectful ways of handling conflict.
Finally, in my experience, couples warm quickly to the idea that they have it within their power to avoid reinjuring each other based on childhood injuries at the hands of caregivers. Desiring to gift each other in this way acts as a motivator to be mutually mindful of and avoid replicating old familiar hurts. Therapy becomes a forum for uncovering and identifying each other’s “triggers” or sore spots: broken promises; financial irresponsibility; dismissiveness of personal achievements; empty praise; overprotectiveness; being ignored; being criticized; being raged at; being talked at; being talked over. Spouses then commit as best they can to steer clear of repeating these behaviors. This is a labor of love. Attempting, where possible, to intentionally correct for childhood injuries is also a labor of love: keeping promises; being financially responsible; celebrating personal achievements; offering genuine, targeted praise; being attentive; talking with, not at or over; using respectful, measured language when angry. Of course, this is predicated on the idea that the solution to getting the love you’ve always wanted, is to give the love your partner’s always wanted.
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1. William J. Doherty et al., “How Long do People Wait Before Seeking Couples Therapy? A Research Note,” Journal of Marital Family Therapy 47, no. 4 (2021): 882-890.
2.John M. Gottman et al., “Gay, Lesbian, and Heterosexual Couples About to Begin Couples Therapy: An Online Relationship Assessment of 40, 681 Couples,” Journal of Marital and Family Therapy 46, no.2 (2019): 218-239.
3. William J. Doherty, “Bad Couples Therapy: How to Avoid it,” Psychotherapy Networker, November/December 2002, 28.
4.John S. Ogrodniczuk, Anthony S. Joyce, and William E. Piper, “Strategies for Reducing Patient-Initiated Premature Termination of Psychotherapy,” Harvard Review of Psychiatry 13, no. 2 (2005): 57-70.
5. Alan Carr, “The Evidence Base for Couple Therapy, Family Therapy, and Systemic Interventions for Adult-Focused Problems,” Journal of Family Therapy 26, no. 2, (2014): 158-194.
6. Robb E. Clawson et al., “The Case for Insurance Reimbursement of Couple Therapy,” Journal of Marital and Family Therapy 44, no. 3 (2017): 512-526.
7. Ibid.
8. See Dianne Grande, “Couples Therapy: Does it Really Work?” Psychology Today, December, 2017, https://www.psychologytoday.com/us/blog/in-it-together/201712/couples-therapy-does-it-really-work.
9. Linda J. Waite et al., “Does Divorce Make People Happy? Findings From a Study of Unhappy Marriages, Institute for American Values, 2002.
10. Ibid.
11. See Homes and Rahe Stress Scale, Wikipedia, https://en.wikipedia.org/wiki/Holmes_and_Rahe_stress_scale.
12. Alan J. Hawkins, “Minnesotans’ Attitudes about Marriage and Divorce.” Provo, UT: Family Studies Center, Brigham Young University.
13. Linda J. Waite et al., “Does Divorce Make People Happy? Findings From a Study of Unhappy Marriages, Institute for American Values, 2002.
14. Steven Walfish et al., “An Investigation of Self-Assessment Bias in Mental Health Providers,” Psychological Reports 110 (2012): 0033-2941.
15. Erkki Heinonen and Helene A. Nissen-Lie, “The Professional and Personal Characteristics of Effective Psychotherapists: A Systematic Review,” Psychotherapy Research 30, no. 4 (2020): 417-432.
16. Camila Americo de Lima and Luc Vandenberghe, “The Couple Therapist’s Emotional Pain: Negative Affect and the Person of the Therapist,” Professional Psychology: Research and Practice 52, no. 2 (2021): 165-172.
17. Carl G. Jung, “The Practice of Psychotherapy: Essays on the Psychology of the Transference and other Subjects,” In R.F.C. Hull, The Collected Works of C. G. Jung (2nd Edition, Vol. 16), (New York: Bollingen Foundation), 116.
18. Quoted in Ronald Hayman, A Life of Young (New York: Norton, 1999), 186.
19. William J. Doherty, The Ethical Lives of Clients (Washington, DC: American Psychological Association, 2022), 122.
20. Burkhard Peter and Eva Bobel, “Significant Differences in Personality Styles of Securely and Insecurely Attached Psychotherapists: Data, Reflections, and Implications,” Frontiers in Psychology 11 (2020): 1-12.
21. See William J. Doherty, The Ethical Lives of Clients (Washington, DC: American Psychological Association, (2022), 122.
22. See William J. Doherty, Take Back Your Marriage (New York: Guilford Press, 2013), 102.
23. Laura Doyle, “6 Reasons Marriage Counseling is BS,” Love Works Solutions, December 12, 2012, https://loveworkssolution.com/blog/is-marriage-counseling-bs.
24. William J. Doherty, “Couples on the Brink: Stopping the Marriage-Go-Around, Psychotherapy Networker, March/April 2006, 30-39.
25.Ellen F. Wachtel, The Heart of Couple Therapy (New York: Guilford Press, 2017), 7.
26.John M. Gottman, The Marriage Clinic: A Scientifically Based Marital Therapy (New York: Norton, 1999).
27. Jay Lebow and Douglas K. Snyder, “Couple Therapy in the 2020s: Current Status and Emerging Developments,” Family Process 61, (2022): 1359-1385
28. Bernadetta Janusz, Feliks Matusiak, and Anssi Perakyla, “How Couple Therapists Manage Asymmetries of Interaction in First Consultations,” Psychotherapy 58, no.3 (2021): 379-390.
29.Ofra Kula et al., “The Effect of therapist’ Enactment Interventions in Promoting Vulnerability Sharing in Emotion Focused Couple Therapy,” Psychotherapy Research, (2023): Advance Online Publication. https://doi.org/10.1080/10503307.2023.2245961.
30.Jinashree Rajendrakumar, Manjula V. Naidu and Santhosh Kareepadath Rajan, “Process of Emotion Regulation in Indian Couples During Gottman’s Dreams-Within-Conflict Intervention: A Mixed-Methods Design Study, Contemporary Family Therapy, (2023): Advance Online Publication. https://doi.org/10.1007/s10591-023-09671-y.
31.Maurice Friedman, The Healing Dialogue in Psychotherapy (New York: Jason Aronson, 1985), 160.
32.Herant Katchadourian, Guilt: The Bite of Conscience (Stanford: Stanford University Press, 2010), 68.
33.Harriet Lerner, Why Won’t You Apologize (New York: Gallery Books, 2017), 29.
34.Enrico Gnaulati, “Supplanting Prideful Monologue with Humble Dialogue: A Dialogical Existential Approach to Couples Therapy,” The Humanistic Psychologist 50, no.2 (2022): 256-270.
35. John M. Gottman and Joan DeClaire, The Relationship Cure (New York: Harmony, 2001), 32.
36. Bob Mankoff, CartoonStock.
37. Peter Goldenthal, Doing Contextual Therapy (New York: Norton, 1996).
38.Rashmi Gangamma, Suzanne Bartle-Haring, and Tatiana Glebova, “A Study of Contextual Therapy Theory’s Relational Ethics in Couples in Therapy,” Family Relations: An Interdisciplinary Journal of Applied Family Studies 61, no. 5 (2012): 825-835.
39. Cicero, De Officiis, Book i, 15, 47.
40. Mari Ruti, The Summons of Love (New York: Columbia University Press, 2011), 28.
41. Ivan Boszormenyi-Nagy and Barbara R. Krasner, Between Give and Take: A Clinical Guide to Contextual Therapy (New York: Brunner/Mazel, 1986), 173.
42. Tannen, You Just Don’t Understand: Women and Men in Conversation (New York: HarperCollins, 2007).
43. Gary Chapman, The Five Love Languages (Chicago, IL: Northfield Press, 1992).
44. Andrew M. Bland and Kand S. McQueen, The Distribution of Chapman’s Love Languages in Couples: An Exploratory Cluster Analysis,” Couple and Family Psychology: Research and Practice 7, no.2 (2018): 103-126.
45. Tannen, You Just Don’t Understand: Women and Men in Conversation (New York: HarperCollins, 2007), 122.
46. Ann Shearer, Why Don’t Psychotherapists Laugh? (New York: Routledge, 2016), 2.
47.Wendy Talbot, “Humor in Couple Relationship: An Opportunity for Therapeutic Inquiry,” Journal of Systemic Therapies 40, no. 1 (2021): 1-16.
48.Alice Verstaen et al., “Age-Related Changes in Emotional Behavior: Evidence From a 13-Year Longitudinal Study of Long-Term Married Couples,” Emotion 20, no. 2 (2020): 149-163.
49. Dianne Symonds and Adam O. Horvath, “Optimizing the Alliance in Couple Therapy,” Family Process 43, no. 4 (2004): 443-455.
50.Lori C. Schade et al., “A Longitudinal View of the Association Between Therapist Warmth and Couples’ In-Session Process: An Observation Pilot Study of Emotionally Focused Couples Therapy,” Journal of Marital and Family Therapy 41, no. 3 (2015): 292-307.
51. Quoted in Matt Englar-Carlson and David S. Shepard, “Engaging Men in Couples Counseling: Strategies for Overcoming Ambivalence and Inexpressiveness,” The Family Journal 13, no. 4 (2005): 383-391.
52.Bernadetta Janusz, Feliks Matusiak, and Anssi Perakyla, “How Couple Therapists Manage Asymmetries of Interaction in First Consultation,” Psychotherapy 58, no.3 (2021): 379-390.
53.Kelley Quirk et al., “Commitment Uncertainty and Alliance Formation,” Couple and Family Psychology: Research and Practice 10, no.2 (2021): 136-144.
54. Joan K. Monin and Margaret S. Clark, “Why Do Men Benefit More From Marriage Than Do Women? Thinking More Broadly About Interpersonal Processes That Occur Within and Outside of Marriage,” Sex Roles 65 (2011): 320-326.
55.Jessica Salvatore, Charles O. Gardner, and Kenneth S. Kendler, “Marriage and Reductions in Men’s Alcohol, Tobacco, and Cannabis Use,” Psychological Medicine 50, no. 15 (2020): 2643-2640.
56. Quoted in John Gottman and Julie Schwartz Gottman, The Man’s Guide to Women (New York: Rodale Books, 2016).
57. William Ming Liu, “The Study of Men and Masculinity as an Important Multicultural Competence Consideration, Journal of Clinical Psychology 61, no. 6 (2005): 685-697.
58.J. Joel Wong and Stephen R. Wester, APA Handbook of Men and Masculinity (Washington, D.C: American Psychological Association, 2016).
59.Karen L. Springer and Robinder P. Bedi, “Why Do Men Drop Out of Counseling/Psychotherapy? An Enhanced Critical Incident Technique Analysis of Male Clients’ Experience,” Psychology of Men and Masculinities 22, no.4 (2021): 776-786.60
60. Tori DeAngelis, “Are Men Emotional Mummies?” Monitor, December 2001, https://www.apa.org/monitor/dec01/mummies.
61. See Abigail Fagan, “Alexithymia: Do You Know What You Feel?” Psychology Today, February 6, 2021, https://www.psychologytoday.com/us/blog/living-emotional-intensity/202102/alexithymia-do-you-know-what-you-feel.
62. Aino Mattila, “Alexithymia in the Finnish General Population,” (2009), http://www.antoniocasella.eu/archipsy/Mattila_alexithymia_2009.pdf.
63.Zac E. Seidler et al., “Men’s Shame and Anger: Examining the Roles of Alexithymia and Psychological Distress,” The Journal of Psychology: Interdisciplinary and Applied 156, no. 1(2022): 1-11.
64.Jennifer Young, Eman Tadros, and Alexis Gregorash, “Cultural Considerations for Using Emotionally Focused Therapy with African American Couples,” International Journal of Systemic Therapy 34, no. 2 (2023): 63-82.
65.Marjorie Nightingale, Christiana Ibilola Awosan, and Katherine Stavrianopoulos, “Emotionally Focused Therapy: A Culturally Sensitive Approach for African American Heterosexual Couples,” Journal of Family Psychotherapy 30, no.3 (2019): 221-244.
66.Garth Fowler et al., “Women Outnumber Men in Psychology Graduate Programs,” Datapoint, American Psychological Association, December 2018.
67.See “Self-Care: Stonewalling Part II,” The Gottman Institute, https://www.gottman.com/blog/self-care-stonewalling-part-ii-the-research/.
68. Shelley E. Taylor et al., “Biobehavioral Responses to Stress in Females: Tend-and-Befriend, Not Fight-or-Flight,” Psychological Review 107, no. 3 (2000): 411-429.
69.Danielle M. Weber et al., “For Better or Worse: Associations Among Psychopathology Symptoms, Interpersonal Emotional Dynamics, and Gender in Couples,” Journal of Family Psychology 36, no.2 (2022): 246-257.
70. Andrea L. Meltzer et al., “Sex Differences in the Implications of Partner Physical Attractiveness for the Trajectory of Marital Satisfaction,” Journal of Personality and Social Psychology 106, no. 3 (2014): 418-428.
71. Ogi Ogas and Sai Gaddam, A Billion Wicked Thoughts: What the Internet Tells Us About Sexual Relationships (New York: Dutton, 2012), 47.
72. See Gary Lewandowski, “The Pandemic Made Our Relationship Stronger,” The Wall Street Journal, June 26, 2021.
73. See Glenn Ruffenach, “The Battles Over Who Gets What When a Parent Dies,” The Wall Street Journal, May 5th, 2021.
74. Quoted in Stephen Nguyen, “24 Common Deathbed Regrets by Matthew Kelley,” https://stephenartphoto.wixsite.com/mysite/post/deathbed-regrets.
75. Paul R. Amato and Alan Booth, “The Legacy of Parents’ Marital Discord: Consequences for Children’s Marital Quality,” Journal of Personality and Social Psychology 81, no. 4 (2001): 627-638.
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