Couples therapy only works when both are willing

On March 4, The New York Times published Elizabeth Weil’s article “Three’s A Crowd,” a discussion of modern couples counseling and the purported stress therapists experience in delivering these services.

I love working with couples. The vast majority of us thrive best in the container of a healthy union. Conversely, nothing can faster poison an otherwise ordinarily mentally healthy human being than a conflicted, empty, contemptuous or pathological union.

When it works, couples therapy is the most satisfying part of my day. I was surprised to learn that not every therapist feels that way. Weil quotes Richard Simon, editor of the Psychotherapy Networker: “It’s widely acknowledged that couples therapy is the most challenging. The stakes are high. You’re dealing with volatility. There are often secrets. You often feel confused, at odds with at least one of your patients, out of control.”

She quotes clinical social worker Terry Real: “The traditional, passive uh-huh, uh-huh is useless. You have to like action. To manage marital combat, a therapist needs to get in there, mix it up with the patients, be a ninja. This is intimidating.”

Time to have a beer with Mr. Real. He gets it. And he is probably describing why I like it. It calls the warrior out of me.

Weil’s article talks about something I often notice: Therapists still have a wide range of prejudices about how to deliver the goods to a stressed, conflicted, or in-crisis marriage. Some therapists insist on seeing the participants first individually. Some therapists mix and match sessions, together or individually, as the couple chooses. I’m in the group that is a real curmudgeon, insisting they come together. With only a few exceptions, I won’t see folks individually while I’m seeing them together. It always comes back to bite me. I’ll turn to both and say, to each, “I’m not your therapist … and I’m not your therapist, either.” Then, pointing to the air between them I’ll say: “My patient is that space right there. The marriage. The ‘We.’ ”

Weir quotes William Doherty, professor of family social science at the University of Minnesota: “Let a couple interrupt each other for 15 seconds, and pretty soon you have them screaming at each other and wondering why they need you to do what they could do at home.”

Another beer, this time with Mr. Doherty. He gets it. I’m a taskmaster in couples sessions. The uber-referee. I’m the one who interrupts a lot, mostly to alert them in turn to stop interrupting. “But, he’s not telling the story right,” a woman complained recently. “I’m not interested, for the moment, in the accuracy of your husband’s story,” I said. “I’m listening more to how he’s telling the story, and why he needs/wants to tell it this way. You’ll get your turn.”

Nobody fights in my office. I simply don’t allow it.

Weir talks about the frequency with which modern spouses will offer the ruse of going to therapy, when in fact they are looking for a “therapist-endorsed divorce.” I’m loaded for bear with those types. I can spot them miles away. I blow that out of the water in the first session with this little speech: “There are three ways people come to marriage counseling. The first is folks who love each other, are deeply committed, and believe in marriage. They are here to make things better. The second are folks who might or might not still be in love. Might or might not feel committed. But they are ‘committed to the commitment.’ They are in session in the hope to resurrect what appears lost. With the last group, one or both parties are done. It’s over. They are here in part to assuage their guilt by providing their partner a safety net in therapy. They are here to find the courage to say ‘I’m done.’ They are here so that, five years from now, they can shrug and tell their friends, ‘We’ll, we tried therapy, but it didn’t work.’ ”

I tell them that I can work with Nos. 1 and 2, but that, if it’s No. 3, that will be pretty obvious in just a few sessions.

Weir notes a frustration common to most couples therapists, certainly to me. How do you get couples to come to therapy in time! After eight years of beating the emotional crap out of each other, ignoring each other, abandoning one another sexually … well, there’s only so much you can do.

If I could shout one thing to couples from a mountaintop, it would be: “Don’t wait. Come while there’s still a bond left to work with.”

Steven Kalas is a behavioral health consultant and counselor at Las Vegas Psychiatry and the author of “Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing” (Stephens Press). His columns appear on Sundays. Contact him at 227-4165 or skalas@reviewjournal

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