Love on the Brain: Couples Therapy 101

Love on the Brain: Couples Therapy 101

The past two years have pressure-tested the resilience of most aspects of modern life. Between the pandemic-induced lockdowns and the turmoil of political upheavals, little has been left untouched–especially romantic relationships.

The onset of COVID-19 has predictably caused a spike in breakups and divorces. Even without a public health crisis, there is an abundance of subjects couples tend to argue about, including money management, parenting practices, and home-making responsibilities. The added burdens of navigating chaotic health regulations, misinformation, and confinement due to the pandemic have created an increase in relationship stress

This valentine’s day, Lyra blended care therapists and clinical supervisors Tatiana McDougall, PhD, and Catherine Wallace, PhD, are examining one of the most common solutions to relationship turmoil: Couples therapy. 

“Couples therapy is very thrilling and exciting work,” said Dr. McDougall, “It’s extremely impactful to see couples literally change the way they relate to one another. In fact, it’s the most meaningful work I’ve ever been privileged enough to witness.” 

Similarly, Dr. Wallace said, “Being a couples therapist gives me the opportunity to help couples reach a place of deeper and more meaningful understanding of themselves and their partners, so that they can learn to prevent and address challenges more effectively and appreciate each other and the relationship on a different level.” She added, “I strongly believe that if we can improve the quality of our relationships, our own emotional health and that of those around us can also improve.”

In the following Q&A, they break down common myths about couples therapy, as well as some of the more nuanced pieces of information you might need to know if you and your partner are considering seeking counseling. 

What is couples therapy?

Dr. McDougall: Couples therapy is a form of treatment that addresses problems in an intimate relationship among adults. Couples therapy uses evidence-based treatments to help couples address the underlying patterns that are affecting the health of their relationship.

There are several different types of evidence-based couples therapy, which are therapies that have shown to be effective through research for many different types of couples; these include Emotionally Focused Therapy (EFT) and Integrative Behavioral Couples Therapy (IBCT). 

Dr. Wallace: Couples may come to therapy wanting to work on a wide range of issues, from frequent conflict and heated arguments to infidelity, parenting disagreements, intimacy concerns, sexuality, past hurts or betrayals, adjusting to major life changes, and clarifying expectations for the future of their relationship–among many other things. Therapy can offer couples clarity around their relationship goals and what their future together–or apart–could look like. 

What is the difference between couples therapy and individual therapy?

Dr. McDougall: Unlike in individual therapy, where a client often reports on circumstances that happen or have happened outside of the therapy room, in couples therapy the relationship is alive in the therapy room, so a lot of the work is done in the moment. This brings a very active and dynamic feeling to the work of couples therapy.

Dr. Wallace: Couple therapy works specifically on relationship-focused goals and both members of the couple engage in the therapy process during each session. Individual therapy, however, is focused on treatment for one particular person or partner, and most of the time, that person attends their sessions alone. 

What are some common goals for partners in couples therapy?

Dr. McDougall: The most common problem that couples want to discuss is communication. In my experience, I have noticed that eroding communication between partners often means that one or both partners are not feeling heard, seen, or understood by the other. The disconnection leads either to escalation (conflict) or avoidance (distance), and results in patterns of behavior that chronically disrupt their sense of closeness.  

Couples therapy then has two goals: first, to help each partner access the underlying patterns of emotions that are driving their ineffective behaviors, and second, to help the couple identify their patterns of conflict so they can stop blaming each other and unite. Once couples can notice and identify their patterns, the goal of couples therapy is then to teach them to share their emotions with one another so they can create a new pattern of communication that leads to a sense of safety, security, and connection. This can literally rewire their relationship. 

Dr. Wallace: The primary goal of couples therapy is to work on factors that are straining the relationship overall. I practice Integrative Behavioral Couple Therapy, where I work to help a couple gain a better understanding of what their main difficulties are, and how these problems are impacted by things such as the natural differences between each partner, emotionally sensitive topics, stress, and unhelpful communication patterns. 

In essence, couples can easily struggle with a variety of different things, because life is tricky. While a strong relationship can really help someone be resilient in times of stress, it’s very common for relationships to experience strain as a consequence of these stressors, too. For example, there has been an increase in relationship distress overall, due to the sheer number of life changes and stressors that we have all faced during the COVID-19 pandemic. In the end, many of the goals of couples therapy come down to helping a couple improve the quality of their relationship, and in turn the lives of each partner.

What are the benefits of couples therapy?

Dr. McDougall: The benefits of a healthy partnership are vast in terms of social support and social connection, which can positively influence almost every corner of our lives. A partner can help reduce the stress of dealing with everyday life. I often see partners in couples therapy rediscover the strength of their partnership as they learn to turn and reach for one another with more clarity, sincerity, and understanding. This reinforces their connection, and it can strengthen each partner from the inside out. A strong and secure connection with a loved one helps people feel more resilient to face a variety of difficulties, whether that’s external stressors or individual concerns, like physical or mental health challenges.

Dr. Wallace: Gaining a better understanding of your partner can help you be more emotionally connected and to appreciate the factors that lead to conflict. Many couples learn how to respond differently when conflict comes up, and they learn to approach the issue and each other more effectively and with more understanding. Couples therapy has been shown to help couples recover from infidelity and breaches of trust, and to preserve their relationship, if that is their goal. Some find that couples therapy can help them gain clarity of what they really want for themselves in the future, whether they stay together or decide to separate. Many studies have also shown that couples who benefit from couple therapy can maintain their progress over time. 

In addition, research consistently shows that couples therapy can also improve the health and well-being of each partner. For example, it’s common for one or both partners to report lower anxiety and depression by the end of an episode of couple therapy. When the couple dynamic improves, there is often a ripple effect that can have a positive impact on your relationships with your children, parents, friends, and other loved ones. 

Why do couples typically seek out couples counseling?

Dr. McDougall: Usually, couples will report feeling stuck and will notice that they need some support. Unfortunately, couples will often not seek counseling until they are considering separation or divorce. This can make sessions more difficult because it puts a lot of pressure on the work of therapy. That being said, within my practice, I work to instill hope for the relationship even if this is the case, and I’ve seen couples come back to a really joyful and connected place even if they came in wondering if they should separate or divorce. 

With that in mind, couples therapy requires openness to change, vulnerability, and sincere effort and commitment to changing your own patterns and responses to your partner–so the earlier a couple can seek counseling, the better. Just like taking regular care of your car, it’s easier to head off problems early on before you find yourself broken down on the side of the road. 

Dr. Wallace: Some couples come to counseling because they notice problems brewing and want to prevent them from becoming more significant, whereas others have been grappling with relationship challenges for some time and reach the point of feeling so stuck they aren’t sure what to do. Some couples come into counseling feeling committed to their relationship, whereas others are less sure of what their future together holds. There is no shame in seeking couples counseling. Relationships aren’t easy, and there are experts who have committed themselves to helping families and couples work toward a better life. So, why not give it a try? I think nearly every relationship can use a little fine-tuning now and again. 

What can a couple expect during their first couples therapy session? 

Dr. McDougall: Couples therapy typically begins with a three-session assessment: A session with the couple together, and two individual sessions with each partner. This first session is spent understanding the relationship. As their therapist, I am specifically looking for information that helps me understand how they respond to the threat of disconnection and how they negotiate closeness. 

In the individual sessions, I get a better understanding of each partner’s mental health history, ensure the safety of both partners in the relationship, and learn about each partner’s family history and early attachment experiences. The couple will also fill out a questionnaire about their relationship satisfaction that we will use to understand how treatment is progressing. Afterward, we meet all together again to go over the results of the initial sessions. I present my conceptualization of the couple’s relationship pattern and we review and agree on goals for treatment. Then the real fun begins! 

Dr. Wallace: In the first session of couples therapy, the couple will have the chance to share with the therapist about what brings them into therapy at this particular point in time, as well as the chance to start discussing what they hope to get out of therapy. At this point, couples can talk about what they’d like to see improve in their relationship and begin to create some goals. 

Many therapists appreciate the opportunity to have one or more private sessions with each partner alone to complete an additional assessment on their individual history and symptoms, and to get an unfiltered description of how each partner views the relationship, their commitment to working on the relationship, and their hopes for the future and goals. Many providers ask the couple to complete questionnaires when they are first starting and regularly throughout therapy. This helps the provider measure the couple’s level of relationship satisfaction so they can track progress over time and better understand the dynamics in their relationship.

If one person in a relationship is interested in starting couples therapy, how can they bring it up to their partner? 

Dr. McDougall: Make the suggestion a collaborative discussion rather than pointing fingers or blaming your partner. Share what you hope to get out of couples therapy, and focus on mutual goals. For example, you can say “I’m feeling like we are not connected right now, and I’d really love for us to get some help and find our way back to one another,” or “I really want us to be able to have fun together again.” When people are willing to acknowledge their own patterns, it makes the work of couples therapy more effective. 

Dr. Wallace: I think nearly every couple can benefit from couples therapy at some point in time, so I always urge people to describe couples therapy as an opportunity to strengthen your relationship and fine-tune or address things that may be getting in the way. An approachable way to bring this idea up to your partner is to suggest that “I think it could be helpful to get a checkup on our relationship; to see how things are going and find ways to make our relationship stronger.” It can be really meaningful to say that you want to understand your partner better and find specific ways to improve your relationship because you care about them and your life together. 

Some partners are intimidated about the idea of starting couples therapy, so it can be useful to normalize that many relationships would benefit from a little help, and that meeting with a therapist can be an important step for the relationship. Just start with the assessment and see what the therapist recommends from there. 

Is couples therapy only for married spouses?

Dr. McDougall: Absolutely not!  Anyone in a relationship can learn from couples therapy. Adult attachment is never a one-size-fits-all phenomenon, and anyone in a significant relationship can benefit. 

With that in mind, I do warn potential clients that couples therapy is a process that involves some pretty heavy emotional lifting, so it’s important to think through whether you are ready to do some hard work to change yourself and your relationship. 

Dr. Wallace: Couples therapy is for everyone! It can be helpful for a very wide range of romantic partnerships, including couples who are and are not married, couples who are newly together, those who have been in a relationship for years, and couples in monogamous or non-monogamous relationships. It can be useful for couples who are committed to staying together, and those who are not sure what their future together may hold. The main thing to consider when pursuing counseling is, are you committed enough to the relationship to try therapy and see what happens? 

How is cultural responsiveness applied in couples therapy? 

Dr. McDougall: Whatever mode of therapy we work in, we always have to examine our biases and assumptions about what it means to be “healthy.” In couples therapy, this means we have to check what we assume to be a healthy relationship, especially across cultures. This can include many different factors: how people are partnered, expectations for roles in a relationship, division of labor, levels of emotional vulnerability and disclosure, types of union, involvement of non-marital partners, relationships with extended family members, and so much more. There are multitudes of ways for people to be in romantic relationships–and all of them are valid as long as they work for both the individuals in the relationship.  

Dr. Wallace: A couples therapist should not have an agenda about what your relationship is “supposed to be.” They will value the individual differences of every couple with whom they work and want to get to know them as people. No one relationship is the same. Couples therapists who are trained in evidence-based couples therapy take a culturally responsive, individual approach to therapy, that is not “cookie-cutter” or trying to fit anyone into a particular box. Trained couples therapists are experienced in working with many different couple types, from a range of cultural and societal origins, genders and sexual orientations, and various forms of relationship agreements. The main goal, overall, is for each member of the partner to be free to come to couples therapy as they are.

If you want help connecting with a coach or therapist, Lyra can assist you. You can get started today if Lyra is offered by your employer. Sign up now.

For employers who want to learn more about how Lyra addresses network adequacy and quality issues, download our white paper on quality or get in touch.

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Tatiana McDougall, PhD, is a licensed Clinical Psychologist who teaches, trains, and conducts research on couples therapy. She is certified in IBCT, extensively trained in EFT, and an attachment theory nerd. Prior to working at Lyra, she created and led a couples therapy training clinic and still provides consultation on evidence-based treatments for relational distress.

Catherine Wallace, PhD, is a Clinical Psychologist and serves as a therapist and Clinical Quality Supervisor with Lyra Health. She has an expertise in couple therapy, having conducted research on relationship functioning and completed a specialized fellowship in couple & family health. Prior to joining Lyra, Dr. Wallace spent much of her career working to expand couple and family clinics and services for the VA Health Care System.

By The Lyra Team
11 of February 2022 - 13 min read
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