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Couples counseling—do we need a fresh approach?
One of the top reasons people seek therapy or counseling is for relationship problems. Even in cases where this is not the stated reason for seeking help, I often find that relationships play a central role in most patient’s problems. A majority of adults who seek any form of mental health care have relationship difficulties as a major concern.
The traditional approach to couples counseling, conjoint therapy, is often as stressful and uncomfortable as the problems that drove the couple to counseling in the first place, however. Anyone who has been in couples therapy—on either side of the couch—knows that it’s a modality fraught with difficulties. It can easily devolve to a blame game and can often get very emotionally charged. The therapist may feel more like a referee than a healer.
It’s almost what you would expect to happen, given the sensitivity of the issues being explored and having both partners seeing the same therapist—sometimes, even at the same time in the same room. Three is an unstable number!
While not the solution for everyone, collaborative counseling using two therapists may be the best approach for many couples in distress. Using techniques from the business world, we developed Couples360 on a foundation of collaboration and feedback. We think it opens the door to treating a greater number of couples successfully by allowing them to sort through their issues far more effectively—and with dramatically reduced collateral damage.
Couples Therapy, Defined
Couples therapy, sometimes called marital therapy, can be defined as treatment for the relationship of the couple. Conjoint treatment—seeing the couple together—is the approach used about 80 percent of the time by therapists who identify themselves as doing couples or marital therapy.
My colleagues and I scoured the literature regarding individual psychotherapy for couples' relational problems and for collaborative teamwork among multiple therapists. We were surprised to find but one article that addressed this approach and decided to take the matter into our own hands.
The Collaborative Approach of Couples360 Counseling
When I completed my residency at Cornell and joined the faculty at University of Miami, I felt very insecure in my skills as a therapist, so I began weekly supervision with Michael Hughes, a seasoned child psychiatrist. I began treating a married woman who was having an affair, unbeknownst to the husband. During the early phase of our treatment, it became clear that her husband was suffering from an untreated panic disorder so I referred him to Dr. Hughes for individual therapy.
We continued supervision and both agreed that Dr. Hughes's contribution to my treatment strategies was greatly enhanced by having first-hand knowledge of my patient. Moreover, our discussions about both patients enabled him to provide better care to his patient, ironically and unintentionally. The couple ended up improving so much over time that despite the affair and subsequent divorce, they were able to reconcile and eventually remarry and create a very fulfilling marriage for both of them.
Subsequently, we made an effort to refer to one another whenever we saw a couple in distress. We used this technique effectively with many couples and have presented our work at the American Psychiatric Association meetings.
We now call this approach Couples360 and are pleased to have expanded our network of collaborating therapists. My hope is to inspire you to try out this technique.
Couples360, is based on individual therapy for couples, each with his or her own therapist and is augmented by careful collaboration between the therapists. We like to think of it as an enhanced way to focus on the relationship itself, because we not only saw the trees (with individual therapy) but also the forest, through collaboratively learning about the relationship’s dynamics while avoiding the blame game.
Couples360 will be explored in more detail in Part 2 (Couples360: Successful Elements of Couples Therapy).
