How Does Couples Therapy Work?
Most courses of couples therapy focus on one of both of the following domains:
Teaching appropriate boundaries and communication patterns in the relationship
This aspect of couples therapy is usually obvious and straightforward, and can be accomplished in a fairly limited period of time. Effective communication is necessary for couples. Without it, a person cannot know what his or her partner is thinking or feeling, and hence cannot establish or maintain an intimate connection with that person. Humans require intimate connections in life in order to thrive. Failed communication leads to failed intimacy, which leads to a failure to thrive. Couples therapy can help with this.
Communication problems are often related to boundary problems in a couple. Everyone has heard the phrase "boundary problems," but the term can refer to more than just standing too close to someone in an elevator. Sometimes boundary problems refer to a kind of self / other confusion at a deep level. One partner may "caretake" or "act co-dependently" toward the other, often building up unspoken resentment at having to chronically sacrifice one's self for the other's perceived needs. Sometimes, one partner may feel chronically persecuted or verbally attacked by the other, and this may be happening in either fact or fantasy. Sorting out "what belongs to whom" and clarifying boundaries at the deepest emotional level is a common goal of couples therapy.
Unblocking unconscious inhibitions to utilizing these boundaries and communication skills.
The second aspect of couples therapy has quite a bit to do with at least three other essays on this website: "What Is Insight-Oriented Psychotherapy?", "What Is Psychodynamic Developmental Psychotherapy?", and "What Is Projective Identification?". We recommend that you read these articles for a more complete view of the issues. For our purposes here, we can say that one or both members of a couple may struggle with unconscious inhibitions in their ability to develop and maintain good communication skills and boundaries. What are these unconscious inhibitions? They are basically relational limitations that have roots beyond one's current understanding. For example, if a partner's early life involved significant caretaking of younger siblings and an unavailable, alcoholic parent , he may have difficulty identifying his own relational needs and tolerating being dependent upon his partner.
Couples therapy can illuminate how such inhibitions make life more difficult for the individual, as well as his or her partner. A therapist's interpretations of these dynamics can also focus on the process of clearing up and moving beyond these inhibitions.
This can be lengthy and complicated work, and there are limits to what couples therapy can do for each individual participant. After all, the "patient" in couples therapy is the "couple." Sometimes individuals in the couple may benefit from individual therapy as well. We are happy to provide referrals for such work.
Sometimes, however, there is enough time and space in the couples therapy to work out all these issues via the couples therapy alone. Couples work tends to be very demanding for both patients and therapists, as the "extra person" in the room (compared to individual therapy) means that there are (at least) twice as many dynamics to monitor and understand. Each patient may well have to become more patient - if you know what we mean - in waiting for his or her "turn" to be understood and attended to. A couples therapist has to simultaneously monitor the two patients' relationship to each other, as well as each patient's relationship to the therapist, and how all those differing sets of relationships compare and contrast with each other, and what it all means. It's the psychotherapeutic equivalent of playing a fast-paced video game.
Having said that, however, the "knots" of communication, boundaries, unconscious inhibitions, and multiple simultaneous relationships can begin to be untangled with patience and hard work. When this finally happens, what is left is a clear field of vision, an ability for each partner to think and feel with freedom, and, if all goes well, to love and connect with each other in deeper ways that were previously unavailable.