I like couples therapy because it is a very active process. The time goes by quickly. There are many ways to be helpful, and all of us in the room have an interest in making the relationship better. Some sessions are very intense, especially at the beginning, but as time goes by, there are usually moments of laughter and shared joy. What should you expect when starting couples therapy, particularly integrative behavioral couples therapy?
I’d love to say that we get right down to business and dive into reducing your conflicts, but that’s not how it happens. In that first session, I don’t know enough about both of you or your relationship to be that useful. Sure, some relationship problems are common and don’t take a lot of time to identify, but the missing piece is who each of you are and what you both bring to those conflicts. So, it does take a little patience in the beginning. Most couples appreciate that we look at the situation closely rather than spitballing solutions.
There’s usually several sessions focused on creating a treatment plan. For me, this generally means we all meet together once, and then I meet with each of you separately. During that time, you share what has been happening in the relationship, your history together, and a bit about who you each are as individuals. Even from the start, I may share what I’m hearing with you to help provide some clarity. For example, if your conflicts are focused on feelings of control versus helplessness, I might mention that. Or if there was past infidelity that is stirring up anxiety, I’ll put that on the table too.
After those first three sessions and after reviewing some surveys that you’ve completed, I create a summary of what I believe are the core issues and a plan to manage them. We discuss this at the fourth session, a feedback session. I’m looking to see that both of you are hoping that the relationship will improve and that you will take steps to help it improve as well. I might also describe the nuts and bolts of our work, weekly 50-minute sessions for 12-24 weeks.
After the feedback session, you may decide that couple’s therapy is not right for you. That’s right! After we meet to review my perspective and the approach, it’s possible that you don’t want to go down that road. It happens. Usually it happens because one of you disagrees with the approach, which often places joint responsibility on both of you. If one of you is stuck believing that your partner is the sole cause of the reasons for therapy, this can be a breaking point. Sometimes the evaluation sessions make it clear to one of you that the relationship is going to end and you no longer desire sessions to make it better.
I may also decide not to continue to the treatment phase. Remember how I mentioned that we have sessions alone with each of you? Those sessions sometimes reveal problems in the relationship that need resolution before couples therapy can begin. Having an ongoing secret affair is one of those issues. Disclosing significant violence or substance abuse are others. I may conclude that either one or both of you is not significantly committed to the relationship for the therapy to be beneficial at that time.
If we all decide to continue with couples therapy, we’re usually in a great starting place. We’re all aligned in terms of the core issues, your individual strengths and challenges, your level of commitment toward the relationship, external factors bearing upon you, and the pattern you follow when there is conflict. When we meet for that fifth session, we’re ready to go!