When I talk with potential clients in 15-20 minute phone consultations, they often want to know what to expect from me during therapy. This blog entry will answer that question in more detail than I get into over the phone and will focus on what to expect from me during couples therapy or marriage therapy. I am open to working with poly relationship systems but all the poly clients that I have served so far have been poly couples and individuals so I’m going to use dyad normative language in this post.
Relationship Therapy Intake Sessions
The most common way that I start relationship therapy is a meeting with both members of the couple. During that first session, I try to get a quick assessment from both members of the couple about the nature of the challenges. Then I turn the discussion to finding out about the strengths in the relationship. I do this by asking questions about how you fell in love or what you still love and respect about each other. Finally, I turn the conversation in the last 10-15 minutes to offering a new perspective, skill, or tool that you might be able to use after the session. That you walk out of the first session with something new try.
In the second and third sessions, I typically meet with each member of the couple once individually. This allows me to complete a thorough diagnostic assessment and history interview with each member of the couple and allows me to build rapport with each person individually. This assessment is a vital part of the therapy. Without a thorough assessment, there is a risk that I might work to help the couple in one particular way only to find out that there is a medical issue (for example) that will interfere with the effectiveness of those interventions. In these individual sessions, I follow up on the effectiveness of the intervention that I offered at the end of the first session and offer refinements, additional suggestions for the individual, and inquire about how things have been since I last met with one of you last.
In the fourth session, I arrive with a draft of the treatment plan to discuss with both members of the couple. This is my best summary of joint goals for the therapy, a description of what I’m going to do to help, how you will know if the therapy is effective as we go, and how you will know if those goals are achieved. The treatment plan also includes any diagnosis(es) that I have made, and the anticipated number of sessions (based on my experience or recommendations). Most of the time, my draft is close enough that the members of the couple sign it right away. In some cases, we do need to discuss the plan and make revisions. I view this as a client-centered process. If I’m misunderstood something, the treatment plan is one point on the way where you can give me feedback so that I get it right. From the fourth session on, I typically meet with both members of the couple. Sometimes it is helpful for me to meet with each individual later in the therapy too to help each individual to make the changes that the relationship is calling for.
Triage for Relationship Therapy
So, what are we working on in these couples therapy sessions? Decreasing Fighting? Communication? Intimacy? Over the years, I have developed a loose triage algorithm that helps me figure out what might be most needed from the session.
- Self-Care/Self-Soothing: Improving each person’s ability to manage their own emotions, reactions, and behaviors.
- Discernment: Helping each member of the couple remember why they want to be in the relationship and identifying what it will take to make the relationship work.
- Decrease Negative Interactions: Managing conflicts by preventing them from getting loud or hurtful. Helping the couple work towards solutions when conflicts arise
- Increase Positive Interactions: Improving the quality and duration of time time together, increasing empathy, attachment, and pleasure in the relationship.
- Relationship Development: Making the relationship a source of strength and joy in the partner’s lives.
I have skills and tools specific to each stage that I teach my couples. This outline helps me to stay client-centered, makes sure that my interventions are in-line with yours needs, and in-line with the goals that you are working on in each session.
These stages aren’t necessarily linear. In most sessions, a couple might be working on increasing connection but a particularly painful comment might require that we step back into self-care and self-soothing for a few minutes.
What Happens in Relationship Therapy Sessions
So, you might be wondering how I help in the session. Am I a therapist who sits back listening and then offers insights at the end of the session? Am I therapist who comes in with an agenda and tells you what you are going to learn from me today? Hopefully, I’m in the Goldilocks zone between those two extremes.
Before the session I review my note from the last session to recall what homework you had, or what we put on the schedule to talk about in the coming session. When we meet I check-in with the two of you to find out how things have been since the last session and if either of you have any agenda items for the session. If necessary, I will bring up the homework between sessions or the agenda set previously. Together, we prioritize the issues including things that might have come up between sessions and then we try to tackle as many of those issues as possible.
Once a topic is brought up, I am actively involved. I interrupt communication processes that are hurtful (even if it is not intended to be hurtful), I interpret or translate for couples across their communication style differences, I suggest interventions or skills that might be helpful, and I offer interpretations or diagrams of the processes as I see them to help you make sense of what is happening in session.
As the communication between the couple improves over time, I begin taking a less and less active role in the sessions. I shift my interventions from altering the process to congratulating you on what is working or on the positive impact it seems to be having.
Eventually, as my involvement diminishes more, I might suggest that we begin tackling other goals or topics that have been left behind or suggesting that we conclude the therapy.
How Couples Therapy Ends
At the end of couples therapy I will often review with the couple the issues they came in with, how that issue has changed, what the turning point in the therapy was, I ask each person what they learned, and I ask what they could do if the negative patterns emerged again in the relationship. This process is intended to prevent the problems from coming back after you leave therapy with me. It also gives you a set of responses to use if you hit a rough patch again. That way, you are more independent and don’t need to come rushing back to me at the first sign of a challenge. Hopefully, when you walk out of my office, you have the specific skills to handle not only the specific situation that brought you in, but also the metacommunication skills that will make your relationship more resilient against a wide variety of challenges.
I hope that this blog entry has given you some ideas of what you might expect if you decide to work with me in couples therapy. If we have a phone consultation, please feel free to ask me questions about what you have read here, or about how it might apply in your specific situation.
Call for a 15-minute consultation about therapy with me, 650-814-7823