Practice Corner

What are most couples really seeking from a couple and family psychologist?

Real world issues in couple therapy.
By Terrence Patterson, EdD

Terrence Patterson Before I state my premise, I fully acknowledge that it does not apply universally to all therapists, theoretical orientations, presenting problems, settings or cultures, but I believe it to apply to most requests by couples to treating clinicians: Most requests for couple therapy are best met with brief clinical consultation. I state this for the following reasons:

  • Couples with relational difficulties rarely want psychotherapy; they want a solution to their problems.
  • One partner typically is reluctant to participate, making engagement in a full course of therapy difficult.
  • Hectic schedules impose major scheduling problems for three people.
  • When a major problem is solved, couples experience relief and often have little interest in "going deeper" or addressing related issues.
  • Financial constraints often intervene.
  • Relationship "coaches" seem more appealing and involve less stigma for many.

While recognizing the value of ongoing psychotherapy, a realistic view of what actually occurs when couples seek help today is that most are seeking clinical consultation, defined as a time limited, problem-focused assessment and targeted intervention. Consultation is a valued and highly useful modality of mental health practice, along with research, psycho-education, teaching, supervision and psychotherapy and highly appropriate in the CFP toolkit.

My emphasis on this issue also arises from the confusion that I believe continues to exist in the field — that psychotherapy inevitably involves long-term treatment focusing on developmental and "core" psychological issues, transference and insight. The Freudian aspects that have pervaded Western thought for over a century are still prevalent in popular culture, and I believe this misconception about the nature of therapy has led in part to the departure of many therapists from clinical practice to coaching.

Frequent statements by therapists who turn to coaching include: "It's easier for clients to understand coaching, and there's less stigma attached;" "I'm tired of the rigid ethical and legal rules we have to follow;" and "I can charge more for coaching." In my view, such statements belie a lack of understanding of therapy — that it has to be insight-oriented, long-term and probe "deeper issues." Cognitive behavior therapy (CBT), for example, is problem-oriented, generally short-term and considers completion to occur when faulty thinking and dysfunctional behavior are addressed and ameliorated. CBT thus provides a model which appropriately addresses the reasons many couples seek treatment — it offers efficient, effective relief.

The ambiguous use of terminology in the field also confounds our ability to correctly label what is actually being done. Psychotherapy often includes such methods as self-monitoring, problem-solving, psycho-education, behavioral activation and cognitive restructuring, which are the very essence of CBT and often included under other names in other orientations. While what is actually done in much of CBT, solution-focused therapy or strategic therapy is psychotherapy, many techniques are also in the realm of consultation. Clinicians who turn to coaching are often employing the same methods used in CBT and consultation, choosing to separate themselves from clinical practice.

The merit to identifying brief interventions as consultation is that we can focus more directly on issues clients bring to us in a time-limited fashion without expecting to address ancillary issues that couples may not have the time, interest or resources to tackle. The couple who brings family-of-origin issues to the relationship may not be interested in addressing events of early childhood but benefit greatly from improving communication and equity in their relationship. Couples with intimate partner violence will experience greater safety and relief from learning emotional regulation and de-escalation techniques even though other issues may persist.

In summary, I propose the following:

  • Let's acknowledge that consultation is a major clinical modality and what many couples are actually seeking — brief, problem-oriented resolution of their problems.
  • Let's free therapists from believing they have to address "deeper issues" in order to meet clients' needs.
  • Let's free therapists from believing they have to leave clinical practice and become coaches.
  • Let's promote couple consultation as a way to engage couples who may shy away from "psychotherapy" to obtain relief from their problems.

In order to effectively accomplish these goals, a coherent model of clinical couple consultation is needed, along with the requisite training. I pledge to be involved in developing such a model and challenge fellow couple and family psychologists to join me in this endeavor. Let's continue the dialogue by contacting me via email.

Additional Reading

Bradford, K., Mock, D. J., & Stewart, J. W. (2016). It Takes Two? An Exploration of Processes and Outcomes in a Two-Session Couple Intervention. Journal of Marital and Family Therapy, 42(3), 423-437.

Nyberg, Viveka, Damian McCann, and Krisztina Glausius. 2015. The Challenge of Developing a Brief Intervention Service for Couples. Journal of Couple & Relationship Therapy 14, no. 4: 301-321.

Whisman, M. A., Dixon, A. E., & Johnson, B. (1997). Therapists' perspectives of couple problems and treatment issues in couple therapy. Journal of Family Psychology, 11(3), 361-366. doi:10.1037/0893-3200.11.3.361