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Dave Denberg, MSW, CSW
an Information Guide
Dave Denberg, MSW, CSW
A Pan American Health Organization / World Health Organization Collaborating Centre
An Information Guide
. . . . . 38 2185E / 03-05 PM007 . . . . . . . . . . . . . . . . . 23 About separation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Suggested readings . . . . . . . . . . 16 Finding a therapist . . . . . . . . . . . . . . . . . . . . . . . . . . . . For information on other Centre for Addiction and Mental Health resource materials or to place an order. . . . 1 1 2 3 4 5 Couple Therapy: An Information Guide ISBN 0-88868-332-4 Product code: PM007 Printed in Canada Copyright © 1999 Centre for Addiction and Mental Health No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical. or by any information storage and retrieval system without written permission from the publisher — except for a brief quotation (not to exceed 200 words) in a review or professional work. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 What is couple therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .net Web site: www. . . . . . . . . . 10 Do we need therapy? . . .CONTENTS Introduction . 13 Common concerns about therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Some practical questions . . . please contact: Marketing and Sales Services Centre for Addiction and Mental Health 33 Russell Street Toronto. . . 25 6 7 Appendix . . . . . . . including photocopying and recording. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .net Disponible en français sous le titre Thérapie de couple : Guide d’information Factors that inﬂuence a couple’s relationship. . . . . . . . . . . . . . . . . . . .camh. . . . Ontario M5S 2S1 Tel: 1 800 661-1111 or 416 595-6059 in Toronto E-mail: marketing@camh. . . . . . . . . . . . . .
Also my thanks are extended to the many Centre staff who were instrumental in producing the publication. or you may have already decided to try it. The guide does not cover every aspect of couple therapy. for their questions. but are unsure of how to ﬁnd a therapist or what to expect. now a division of the Centre for Addiction and Mental Health. Often couples are able to work out these issues themselves. The appendix describes a number of couples who sought help. The information has been altered to maintain conﬁdentiality. This guide was written for those who are having difﬁculty in resolving issues in their relationship. every couple has difﬁculties with their relationship. Others stem from personality factors within the partners. my co-authors on the ﬁrst edition of this guide. Problems in a relationship have many causes. suggestions and comments on the original edition of this guide. Some problems originate outside the relationship.” “conjoint therapy. Couple Therapy An Information Guide 1 . and every relationship has unique aspects. MSW.” and “couples’ counselling” are other terms commonly used to describe a similar process. Still other difﬁculties may be related to natural stages in the growth of the relationship. This guide uses the term “couple therapy. and to same-sex as well as heterosexual relationships. The guide discusses questions that are commonly raised by couples in your situation. and what took place in their therapy.” “Marital therapy.ACKNOWLEDGMENT I would like to thank the couples who were treated at the Clarke Institute of Psychiatry. I would like to thank Pamela Blake. and Barbara Edwards-Evans. It also addresses some questions that frequently arise in the course of therapy. such as job loss. illness or conﬂict in the family. MSW. The information should be used as a general guide only. INTRODUCTION At one time or another. and Pamela particularly for her contribution to the current edition. You may be considering whether you would beneﬁt from couple therapy. The issues discussed apply not only to legally married couples but also to couples who are not married. but sometimes they are unable to do so.
and have had difﬁculty coping. Early retirement is becoming more common. Living with a partner is a complex and challenging experience. their parents may be looking forward to their own personal and ﬁnancial freedom. written centuries apart. Changing ideas of the roles of men and women in society have led These opposing views of marriage. the need for two incomes means that both partners carry a double load: family obligations. communion or company than a good marriage. economic stress results in emotional stress. In general. This can create enormous pressures for families who ﬁnd their expectations are not met. Alcestis (438 BC) “There is no more lovely. Changes in the job market affect people at all life stages. Meanwhile. or may themselves be going through major life changes. Changes in society over the past four decades have forced us to change the way we think about values and expectations. There is an atmosphere of insecurity and instability everywhere in society.1 FACTORS THAT INFLUENCE A COUPLE’S RELATIONSHIP “Never say that marriage has more joy than pain. such as childless couples. friendly and charming relationship. may have to make additional adaptations for their relationship to work. At the same time. but essential. as well as outside employment. and it can potentially be both rewarding and painful. Couples who vary from the “traditional” model of a heterosexual couple with children. many of which have occurred so rapidly that some people have been caught offguard. greater equality between the sexes. People in either situation are often quite unprepared for the ﬁnancial or emotional transition. Many young adults cannot ﬁnd suitable employment and affordable housing. making it difﬁcult for people to know how to protect themselves or their families. are as true today as they were in their authors’ time. The nature of a couple’s relationship is determined by the ways in which they deal with the various factors that inﬂuence that relationship.” — Euripides. which takes its toll on relationships. Economic and social forces have also led to dramatic changes in gender roles. Society’s inﬂuence on relationships: The impact of social change The world in which couples form and live out their relationships is different for each generation. In all these instances. and must remain in their parents’ home at a time when they may be seeking to establish independence. For many families. and that marriage and family life are relatively happy and conﬂict-free. the media actively promotes the impression that material possessions are not only attainable. and 2 Couple Therapy An Information Guide 3 . while other people are losing their jobs through no fault of their own. same-sex couples or relationships where the partners come from very diverse backgrounds.” — Martin Luther. Why should that be so? Alongside the positive changes in society there have been a variety of bewildering and often distressing changes. as well their own relationships. But rising divorce statistics reﬂect a picture of relationships that does not match up to these expectations. Table Talk (1569) greater tolerance of differences. couples today enter their relationships expecting to ﬁnd greater emotional and sexual intimacy.
to the promise of greater freedom and fulﬁlment for both sexes. both partners in a relationship often have to work outside the home in addition to sharing household and parenting responsibilities. Each of these stages gives rise to a range of pressures and potential difﬁculties. In some relationships one stage may merge with another. deciding whether or not to have children. during which they enjoy what they have established. A further complication is that many important aspects of these processes are fully or partly unconscious. the lack of ﬁt between their cultural and religious ideals of family life and the day-to-day demands of contemporary life can be an additional source of stress. Problems seem small or unimportant. while in others. and resolving issues or feelings left over from previous relationships are some of the issues that commonly arise. to live together. However. middle age to retirement — frequently there are variations. it is. the arrival of children. Although we think of these stages as proceeding in sequence — courtship. The impact of children on each partner may be experienced quite differently. growth. Couples may then reach a period of consolidation or stability. they have not yet established shared responsibilities. During this period. or to form a long-term relationship while continuing to live apart. productive years (which can include child-rearing. All of this is complicated by the fact that each of the partners is also likely to be going through his or her own complex stages of psychological and emotional 4 Couple Therapy An Information Guide 5 . During the child-rearing years the couple usually spends much more time looking after the needs of the children and may have limited time Stages in relationships Each relationship is unique and yet there are identiﬁable stages that most couples experience. The courtship stage may be followed by a commitment to marry. For this reason. such as second marriages where there may be children from previous relationships. As mentioned above. it is also a dramatic departure from traditional gender roles and can add to relationship stress — particularly if the partners’ willingness or ability to adapt to their expanded roles is unequal. In speciﬁc circumstances. the partners’ development may not ﬁt well. The time the couple spends together in this phase tends to be mainly fun and rewarding. business or other pursuits). is usually thought of as a happy period. For some. While this offers a varied and potentially more rewarding existence. or match with the stages of each other’s growth — or the growth of the relationship. Each individual and each couple has to work out how to adjust to the discrepancy. stabilizing career goals. or career. However. As individuals. Couples must reorganize their lives with the arrival of a ﬁrst child and it may take some time to adjust to their new lifestyle. Stages can begin and end abruptly or gradually. both physical and emotional. The initial courtship phase of a relationship is often “time out” from everyday life: a new relationship tends to make people feel very good about themselves and their lives. and in many instances. the stages may be markedly altered. the partners would have trouble identifying and discussing these aspects. commitment to marriage or a long-term relationship. certain stages may be skipped altogether. Often. changing gender roles have also led to confusion and frustration. What is frequently the next stage. it may also be a time of intense stress. the gender roles we learned when we were young are quite different from the roles demanded by our adult relationships.
many couples have to readjust to relating primarily to each other. At this stage of life people often take stock of what they have accomplished and re-evaluate their goals. The partners may be astounded to discover that some of their expectations of life as a couple are so far apart. Often. religious. They may or may not be happy and satisﬁed with what they have achieved. activities and relationships. The partners may be unaware of some of their expectations until they are disappointed or a conﬂict surfaces in the relationship. but for others this period can be difﬁcult ﬁnancially and emotionally. and the roles each should play within it. including those issues arising from their “difference” from the norm. This stage is obviously different for childless couples. interests. Once children leave home. Illness and the prospect of losing a life-long partner are among the most difﬁcult issues that arise in this period. Couples cope with their teenagers’ struggle for independence and may fear that their children are vulnerable to such dangers as alcohol or drug abuse. though others may channel their interests and energies into new careers. and a sense of frustration. who will focus their relationship differently and who face an array of different issues as a result of not having children. This can create additional pressures. as it occurs at a time when the couple are just beginning to feel that their children no longer rely on them so fully. As a relationship develops over time. and cultural. educational or family backgrounds and preferences. marry. 6 Couple Therapy An Information Guide 7 .to focus on their own relationship or may be distracted from doing so. Middle age is also a time when couples may ﬁnd their elderly parents need care. risky sexual activity or harmful companions. have children or one or both face signiﬁcant life stress. or the kind of family life each of the partners desires. the arrival of children sometimes brings up differences around child-rearing. life experiences. Some couples are also unprepared for the loss of structure and meaning that work provided in their lives. Often this occurs at a time of change: when the couple begin to live together. an initial attraction based on “chemistry” yields to a more complex relationship inﬂuenced by such factors as the personality of each partner and the “ﬁt” between them — their values. Each partner’s expectation of what the relationship should be. is a signiﬁcant inﬂuence. For some couples retirement is satisfying. and comes earlier than planned. and sometimes to the couple themselves. This is particularly true when retirement is not voluntary. In addition. People may admire different qualities in their partners at different stages in their lives. There are additional issues if the couple have children who enter the teenage years at this point. the couple were unaware of these differences earlier in the relationship. Finally. Some partners may experience a serious sense of loss without children to care for. people often look forward to their retirement years. The current trend of children staying longer in the home prolongs the sense of parental responsibility. Each partner’s experience in his or her own family of origin inﬂuences the current relationship in complex ways. People may be attracted to those similar to themselves or prefer those who have opposite or dissimilar characteristics. Speciﬁc inﬂuences Why two people are attracted to each other is often a mystery to others. Middle age may be difﬁcult for couples.
and whether seeking this kind of help implies some weakness or failure in the partners. Others may ﬁnd that they are continually unhappy with their relationship. Improving a relationship There is no universal. and sometimes seeking therapy soon after things get “stuck” prevents a buildup of frustration and disappointment. It is normal for couples to experience difﬁculties during periods of change until they can ﬁnd their own ways of adapting to the situation. professional help should be considered. If this is not working at some point. The aim of couple therapy is not only to help the couple deal appropriately with immediate problems. it does not necessarily mean that the couple requires therapy. A major physical or emotional illness in the family can have great impact. In such times. 8 Couple Therapy An Information Guide 9 . Often people have questions or misconceptions about couple therapy — what it is. ideal model against which a relationship can be evaluated. what form of therapy is most helpful. whether it is beneﬁcial. The following chapters will address many of these issues. Many couples only consider therapy as a last resort.Stress in life is inevitable. A “good relationship” is one that works for both partners and effectively supports them in achieving their goals. The number of stressful situations. All relationships tend to encounter problems during stressful periods and at different stages. It may however. and many couples are able to resolve their difﬁculties without professional help. Some couples ﬁnd that they are able to do so at one stage but not at another. A couple may be less able to adapt if they face signiﬁcant stresses in several areas of their lives at the same time. their length and severity and a partner’s individual capacity to cope. Sometimes one partner feels frustrated and misunderstood while his or her mate is totally unaware of the situation. but also to achieve better ways of relating in general. be helpful at any time. family support (or lack of it) and the involvement of friends will play an important role in improving or worsening the situation. If the couple are unable to resolve issues in a manner that is acceptable to both partners. Financial difﬁculties and loss of employment are other common stresses facing couples. are all factors that will affect a relationship.
to help them to do so. Couple therapy involves only the couple. such as an affair or apparent loss of affection and caring.) 10 Couple Therapy An Information Guide 11 . During the course of this therapy. or a traumatic event. sex therapy may be beneﬁcial. ﬁnancial concerns and conﬂicts about children. (See the Appendix for examples of the kinds of situations for which couples seek help. however. Children may be affected either directly or indirectly by problems in their parents’ relationship. but because they are unable to resolve them. for information on how to ﬁnd a therapist. become anxious and begin to exhibit their own problems. although not all of their difﬁculties necessarily stem from those of their parents. unfulﬁlled emotional needs. children would no longer be involved in treatment. a couple may experience sexual problems in an otherwise sound relationship. (see Section 5. They may. sometimes because there is some other issue or meaning underlying the conﬂict. Sometimes. and the quality of their sexual relationship is important to many couples. the focus may shift to the parental couple for a period of time. If this occurs.2 WHAT IS COUPLE THERAPY? What is the difference between couple therapy and sex therapy? Couple therapy focuses on the total relationship while sex therapy deals Couple therapy is a means of resolving problems and conﬂicts that couples have not been able to handle effectively on their own. Other problems within a relationship often affect the sexual relationship. which usually focuses on the relationships among family members rather than solely on the couple’s relationship. such as an illness or loss in the family. Other couples seek help as a result of a crisis in the relationship. as a result. If parents are wondering whether their children should be involved in the sessions. depending on factors such as their ages and the nature and severity of their parents’ problems. It involves both partners sitting down with a trained professional to discuss their thoughts and feelings. more speciﬁcally with sexual dysfunction. The children’s difﬁculties may improve as the couple’s relationship improves or the couple may become more conﬁdent in their own ability to help the children. they should discuss this with the therapist. frequent or constant arguments. to decide if they need and want to make changes. so this may be discussed in couple therapy. Some of the most common complaints include lack of communication. Couples often seek help not because their problems are different from those of other couples. questions 1 & 2. If this is the case. this is because of a buildup of frustration and disappointment over time. Therapy that involves both the couple and their children is a different process called family therapy. However. and to varying degrees. This treatment recommendation would be based on the therapist’s initial assessment of the problem. Are children involved in couple therapy? No.) The aim is to help them gain a better understanding of themselves and their partner. and if so. You may be wondering why these problems sound like common issues that many couples resolve without professional help. What kinds of problems do people usually bring to couple therapy? People seek therapy for a range of problems and every couple is different.
Finally. or whether their problems are “really serious enough. it is worth investigating. The couple may mistake the problems for a normal stage in the relationship. An intimate relationship is usually very important to a person and the thought that something might be seriously wrong with it can be quite threatening. some people have difﬁculty or feel embarrassed about asking for help. In an assessment. This enables the therapist to develop a deeper understanding. the therapist asks about the problems and how both people see them. and the individual histories of the partners.What will the therapist do? The therapist is a professionally trained. attempting to clear up misunderstandings in communication. 12 Couple Therapy An Information Guide 13 . the history of the relationship. the therapist’s interpretation of issues may offer the couple a new perspective. Once the couple enters therapy.” If you think you might need help. The couple then can decide whether to accept the therapist’s recommendations about whether or not to enter therapy and what kind of therapy to pursue. We are involved in a relationship that is just becoming serious. question whether they deserve it. The therapist may act as a mediator. Most therapists start with an assessment. This is often difﬁcult for people to do themselves because they are emotionally caught up in the situation. Is there anything we can do to prevent problems? Some members of the clergy and couple therapists offer “pre-marital counselling” for couples who are beginning their relationship and want to take a preventive approach to problems. 3 DO WE NEED THERAPY? Are our problems serious enough to seek help? For a number of reasons. which permits a change in feelings and behaviour. objective third party who will listen to both partners as they express their thoughts and feelings and help them identify and clarify problem areas. The better programs of this nature can help a couple anticipate and deal with some of the issues they will face before they become problems. Most therapists will discuss their impression of the situation with the couple at the conclusion of the assessment. Some people feel that the need to seek help is a personal failure and this view is unfortunately reinforced by the sometimes negative social attitudes that linger towards people seeking this type of help. couples tend to underestimate the severity of their problems. The therapist may also help the partners consider alternative ways of handling problematic situations.
Why can’t we sort out our own problems? Feelings are in a different realm from logic and cannot always be resolved on an intellectual level. Some of these patterns fail to solve the problems. Other people ﬁnd they are unable to solve their difﬁculties despite repeated attempts to do so. unconscious to begin with. Sometimes an objective third party is needed to mediate conﬂict. they increase tension instead. We’ve been this way for years. What good will couple therapy do? People develop patterns for handling difﬁculties. or to help clarify what the issue means to each of the partners. or if you can’t solve them in a way that is acceptable to both of you. consider possible solutions and start implementing those that ﬁt your situation. If problems in your relationship persist. and to obscure the original causes of feelings of anger or outrage. Although you and your partner may not agree on all of them. We’re ﬁghting a lot and can’t agree on anything. The aim of couple therapy is to clarify the important issues in your relationship. and is willing to. therapy may enable you to identify the most signiﬁcant problem areas. distance. People who ﬁght often feel as though they are going around in circles. The therapist may also be able to offer a perspective that is not obvious to you and your partner. If both of you recognize a need for change and are prepared to do something about it. Problems are easier to resolve before they become larger and when there are still positive feelings in the relationship. tolerate at any particular time varies. coldness. We’re intelligent people.Is this just a phase we’re going through or do we really need help? At one time or another all couples go through difﬁcult changes and stages and experience stress. There may be aspects of the original problem that were fully or partly 14 Couple Therapy An Information Guide 15 . Some people ignore problems and hope they will go away. If you feel your stress level is intolerable or that you have reached an impasse. How much stress each person can. dissatisfaction. These issues can become further obscured as both partners begin to resent each other’s anger. you should seek help. Unresolved issues that continue to bother a person can begin to colour everything. do not wait to go for help. etc. couple therapy can provide the extra support you may need during this difﬁcult process.
The outcome depends on many factors. seeking help is an appropriate and mature means of dealing with issues that. the therapist will be able to recommend either individual or couple therapy. In many cases. Examples of these might be low self-esteem. couple therapy might still What can I do if my partner refuses to seek help? Discuss the issue with your partner even if he or she has refused to participate in couple therapy in the past. Some people fear that seeking help is a sign of failure. This may. People are sometimes reluctant because 16 Couple Therapy An Information Guide 17 . help your partner to better understand your difﬁculties. This is unfortunate because it is best to go for help early before the problems become too great. if left unresolved. I think my personal problems are creating tension in our relationship. Generally speaking. In couple therapy you may come to understand yourself and your partner better and decide whether or not you are able to make changes to better your relationship. it is probably best for both of you to seek help. in fact. Should I go for help by myself or should we both go? Personal problems undoubtedly affect your partner and your relationship. Does it mean our relationship is over if we need couple therapy? No. If a relationship cannot be changed to meet the needs of both partners. there probably is a need for assistance. illness or work-related stress. if one partner feels the problem is serious enough to warrant getting help. motivation to change is required on the part of both partners to improve a relationship. For some people. could lead to considerable distress and possibly the breakdown of the relationship. Two of the most important are how much you and your partner want to work on your problems. Instead. If you stress your concern about the relationship.4 COMMON CONCERNS ABOUT THERAPY they feel that agreeing to go to therapy is agreeing that “you’re right. After an initial assessment of your situation. your understanding of yourself and your partner may change the way you feel about the issues that led you to seek therapy. your partner may be encouraged to consider ways of improving it. your reasons for engaging in therapy. This understanding may lead to greater acceptance of the relationship as it is.” This resistance can be increased if the suggestion of couple therapy is made angrily. Initially. Is couple therapy always successful? The answer to this question depends on how you define “success” and If I need help does that mean I’m crazy? Seeking help for your personal or relationship problems does not mean that you have a mental illness. being in a committed relationship may itself be a problem. such as one partner’s discomfort with a same-sex lifestyle. The decision to either separate or stay together may be seen as a successful outcome depending on the couple and the situation. I’m to blame. Same-sex relationships can be affected by other personal problems. It may also be helpful for the therapist to hear your partner’s perception of the problems. Usually. and how important the relationship is to both of you.
and this may lead to considerable gains. decide whether or not you want to continue the relationship. as is true of all relationships. Everyone has some feelings that are deeply personal and many people have experienced events or circumstances in their lives that they are not comfortable in discussing. the issues that arise in couple therapy are complex ones. may block progress in therapy if they are not discussed.help the couple end the relationship in a way that is not destructive to them or their children. For this reason it is important to be honest about your feelings and the issues that are signiﬁcant to you. which you may consider very private. there can be risks involved in revealing what has not been expressed before. other factors. Will the therapist understand my values? Therapists are trained to respect the values of others and not to impose their own values or to be judgmental in their work. it is part of the therapist’s job to identify an impasse when one exists. Finally. Some impasses can be resolved. What if the therapist thinks our relationship is over? A therapist cannot make this decision. you might experience a therapist’s comment as judgmental when that is not the therapist’s intent at all. It is up to you and your partner to Do I have to disclose everything about myself? If I don’t. and your reasons for feeling it should be discussed. Successful couple therapy. However. It may be very difﬁcult to decide how to handle information that you believe may hurt your partner or the relationship but that you think is important to discuss. This kind of experience can be part of the process and should be discussed with the therapist as it arises. However. you might be surprised to ﬁnd that your partner feels the same way. 18 Couple Therapy An Information Guide 19 . Will the therapist think I’m to blame or make me feel guilty? No one person is entirely responsible for the problems in a relationship. The therapist’s involvement may also help alleviate any misunderstanding that might occur and support you and your partner in continuing to talk together despite the difﬁculty. Nevertheless. However. the reasons you are reluctant to talk about it. you need to exercise discretion and carefully evaluate the signiﬁcance of the issue for the relationship. Your own discretion and comfort may help you decide when and how to introduce certain topics. You may feel guilty or singled out at some point in therapy. does not necessarily require that you surrender your privacy. Again. Any of these situations should be addressed with the therapist as they arise. and it is possible that the therapist might at some point not understand what a certain issue means to you. this does not necessarily mean that therapy cannot proceed or that there is no hope for further change. However. It is also possible that certain values or issues might require working out between yourselves and your therapist. Some things about you may not affect the relationship signiﬁcantly. will therapy be beneﬁcial? One of the most important ways in which couple therapy helps people is by enhancing their understanding of themselves and their partner. and a successful relationship itself. Again.
mental health associations and in some communities. you can contact any of the following individuals or agencies either for couple therapy or for a referral to someone who does couple therapy: • social service agencies such as family service associations.5 FINDING A THERAPIST • associations for marriage and family therapy. the Children’s Aid Society Can we try different therapists until we ﬁnd one we like? While it is helpful to feel some degree of ﬁt with a therapist. Who does couple therapy? Many social workers. it is important to distinguish between discomfort with the therapist and discomfort generated by the issues being discussed. It is best to see someone who has been specifically trained and is experienced in couple therapy. religious beliefs. such as The Ontario Association for Marriage and Family Therapy • social work or outpatient psychiatric departments of most major hospitals • family physicians • religious or faith organizations or leaders • employee assistance programs or employee health services • community information centres. namely through family and friends. How do we know what type of therapist is best for us? Trained and experienced therapists are able to understand and help peo- There are many people who offer to help people with relationship problems but who have no special training to do so. it is also important to give the therapist a reasonable opportunity to help. Associations such as the Ontario College of Certiﬁed Social Workers and the Ontario Association of Marriage and Family Therapists can conﬁrm the professional qualiﬁcations of the practitioner. 20 Couple Therapy An Information Guide 21 . How do we ﬁnd a therapist? You may ﬁnd a couple therapist in the same manner that you might ﬁnd a doctor or a lawyer.The process itself may be painful. ple regardless of whether they hold differing moral values. not all communities will necessarily have a therapist who is both a skilled couple therapist and meets your criteria. If they cannot help or if you do not wish to conﬁde in them. However. If you have very strong preferences regarding the type of therapist you want to see. rabbis and family physicians are also trained in this area. you should pursue those preferences. Feel free to ask about the therapist’s qualiﬁcations and experience. psychiatrists and psychologists have professional training and speciﬁc expertise in couple therapy. it is best to discuss this with the therapist. or ideas about what makes a relationship good. Some members of the clergy. If you are not comfortable with a therapist you are seeing. or the process of seeking help itself.
It is well worth thinking about this carefully and discussing it with your partner. Will my partner and I be seen separately or together? Some therapists prefer to see each person separately as part of the initial assessment and then see the couple together on future occasions. If you have any questions or concerns about this. Couple therapy may take from one or two sessions to months or even years. information disclosed in therapy is conﬁdential. Generally speaking. The timing may not have been right for you or your partner to tackle your problems. Still others use a combination of these formats during the therapy. How do we know if another one would be any good? There are a number of possible reasons for a bad therapeutic experience. Sometimes couple therapy is covered 22 Couple Therapy An Information Guide 23 . but there are exceptions. It is useful to be as clear as possible about what the problem was with your former therapist and to discuss this with a new therapist at the outset. Others prefer to see the couple together from the beginning. discuss them with your therapist How much will it cost? Costs vary depending on whether your therapist is in private practice or works for a social agency or hospital. Alternatively. you. before seeking a new therapist. if possible.We’ve had a bad experience with a couple therapist. 6 SOME PRACTICAL QUESTIONS How long does couple therapy take? The length of time varies depending on the way the therapist works and the nature of the problem. However. your partner or both of you may not have been comfortable with the therapist or his or her approach. Can the information that I reveal in therapy be used against me in legal proceedings? Like most other helping professionals. This can be discussed with the therapist. this rarely happens. couple therapists can be subpoenaed to give evidence in court under certain circumstances.
and they may suffer as a result. Therapy could help you come to terms with these decisions. While some social service agencies have a sliding fee scale based on ﬁnancial circumstances. professionals in private practice set their own fees. 7 ABOUT SEPARATION Should we stay together for the sake of the children? There is no easy answer to this difﬁcult question. Separation also greatly affects children. your partner may not feel as hopeless about the relationship and may decide to stay and work at it. We’ve already decided to separate. Costs should be discussed at the outset.in whole or in part by the provincial or medical health insurance plans. Some agencies and therapists schedule appointments outside normal business hours. you cannot keep someone in a relationship who is determined to leave. Couples must weigh the emotional costs of staying together against those of separation. Even if problems are not discussed with or in front of them. Some common issues facing people who decide to separate include: 24 Couple Therapy An Information Guide 25 . a decision that is right for them and their children. Can couple therapy help us? If you have made the decision to separate there may be some issues you still need to resolve and decisions you need to make. What if I want us to stay together and my partner wants to leave? If you can resolve some of your problems. children know when their parents are not happy with each other. However. employee assistance programs or private insurance programs. Each couple must make Is therapy always during business hours? Not always.
You should look for material that is relevant to you and your own situation. your partner. division of property and assets. The quality of this material and its applicability to your speciﬁc relationship will vary. and the different problems each may experience? Popular magazines frequently publish articles on marriage and marital problems. visitation rights. under certain circumstances. but it will also help the couple look more deeply at the meanings and feelings underneath the conﬂicts. Will the therapist continue to see me if my partner and I separate? If you separate it may be helpful for either or both of you to engage in individual therapy.• Who will have custody of the children? • How will family react? • What will happen with our friends? • How will I/we manage ﬁnancially? • How will we divide our possessions? • What will it mean to be a single parent. Some therapists. Mediation counselling aids in solving problems and making decisions. The best way to use these materials is to further understand yourself. 26 Couple Therapy An Information Guide 27 . and how the problems in your relationship developed. without bitter legal struggles. after having seen a couple together. loneliness. Couple therapy will address these issues. The self-help and psychology sections of bookstores and libraries often have a variety of books on these topics. What is mediation counselling? This is a speciﬁc kind of counselling for couples who have decided to separate and require help in resolving issues such as custody of children. However. but instead will refer them to other professionals for individual therapy. common-law or same-sex relationships. Some family agencies and private practitioners also offer this specialized service. will not see either of them individually. it is not helpful to use this information as a source of ammunition with which to blame your partner. The aim of mediation counselling is to avoid painful confrontation and to resolve conﬂicts fairly. Many religious or community organizations have material as well. failure? Where can we ﬁnd more information about marriage. to live on my own? • How do I deal with my feelings of anger. therapists may continue to see one or both partners on an individual basis. Mediation counselling may be available through the Family Court system.
He had worked ﬁve years before returning to school. When she told him this. A. It was pointed out that in reality they were experiencing many pressures but they could learn to handle them differently. would quit work to continue his education while Mrs. Mr. Mr. was very resentful that her husband often went out for a couple of drinks with his friends after class and arrived home late for dinner. He was older than his classmates. he began to go out with friends more often.. A. were seen in therapy sessions they were each given the chance to air their frustrations. and Mrs. Mrs. They had known each other ﬁve years 28 Couple Therapy An Information Guide 29 . Also. particularly since the couple’s future rested on his achievement there. where she was a secretary and he was an accountant. A. he was ﬁnding it hard to get into the habit of studying again and tional support. A came to couple therapy complaining of frequent arguments. They were encouraged to build on these feelings and to make some time to spend together regularly in some enjoyable activity. worked at a technical job. She thought he was taking advantage of her. As they listened to each other they were more able to give each other emo- When they came for therapy Mrs. After a year of marriage they agreed that. who were unmarried and without family responsibilities. and Mr. A. M. Both were so emotionally caught up in their own feelings they had not realized their partner was also under stress. which he liked but did not regard as his ultimate career. G. to achieve these goals. and resented having to ask his wife for pocket money or for her approval of how to spend it. When Mr. worried that he might not succeed at school. and Mrs. A. G. 28. 29. They found that in doing this they were able to have something to look forward to. Ms.APPENDIX Examples of ﬁve couples who sought couple therapy Mr. was budgeting her salary carefully in order to pay all the bills. Ms. In fact. Since being with his wife increasingly led to arguments. she had started taking her lunch to work to save money and was angry that her husband was spending money having fun while she was scrimping.. They met at their place of work. He often found himself torn between going out with classmates to relax and going home to be with his wife. Mr. M. It also annoyed her that on weekends her husband said he had to study while she was left to do the household chores on her own. A. was used to being ﬁnancially independent. she found that it did not change the situation. went to a therapist because they felt stuck trying to resolve a recurring problem in their relationship. A. Mr. felt that his wife was nagging him and said he often didn’t feel like going home after his classes. was worried about not doing well in his courses. which helped make the stressful times more tolerable. A. and Mrs. G. They were both in their mid-20s and had been married two years. They had hopes of one day buying a house and having a family. They talked about their original attraction to each other and found that these positive feelings remained. Mr. continued to work to support them. It became clear that each was under pressure: Mrs. A. was doing well in an entry position in a professional career she had chosen and for which she had trained. felt pressured being the sole breadwinner and handling the household responsibilities on her own. M. And Mr. Ms.
G. A few years after the separation. Mr. Mr. Ms. G. M. M. the couple had been instantly attracted to each other on many levels and had spent a lot of time together over a short period. considerate man who was mature for his age. and her mother had helped her while Ms. Mr. M. critical man with a severe temper. but he felt she had done her best to raise him well as a single parent. as Mr. was scheduled to leave very soon for an out-of-town job. G.. and they could talk for hours about anything from personal thoughts. began to understand the causes of their difﬁculties. This was devastating for Ms.and had been seriously involved for three years. However. He was also conscious of not having a career direction. grew up as an only child. G. While he knew that his childhood had not always been easy. The therapist explored what was going on at the times when Mr. moved out on her own. M. would begin to wonder whether the relationship was right for him. caring. The time they spent together was fun and stimulating — they enjoyed each other’s intelligence and sense of humour. values. M. which surprised and pleased her. The couple said that the changes seemed to follow a period in which things were good between them and there were no problems. In couple therapy Ms. Mr.. as she knew it hurt him. because of his own father’s problems and 30 Couple Therapy An Information Guide 31 . and ways of looking at the world. Mr. At that time. M. G. educated herself.. M. husband and father. M. Mr. G. However. Her father was a rigid. M. and lived on her own. The couple quickly resumed their relationship. Mr. was unable to continue his job and returned to the city for treatment that continued on and off for several years. backed off.’s change of feelings had no obvious cause in the moment. Ms. and to think about having his own place and traveling on his own. she tended to push him to decide one way or the other. and each time these feelings came up for Mr. became angry and rebellious toward her mother. and felt guilty that he had not been able to pull his weight ﬁnancially in the relationship. but he had lost his job opportunity. Both felt they had a very loving relationship that they hoped would last. thinking that they might never see each other again. was aware that his changed feelings hurt Ms. They argued a lot before Ms. and this turned into a career setback for him.. had felt at the time that her mother was intrusive and controlling. G. They had similar interests. M. Mr. His mother had been ill throughout his childhood. M. M. Mr. M. and he felt very bad about this. By her mid teens. recovered. Her parents argued a lot. Ms.’s father was an alcoholic who had left the family when Mr. M. and the limits she had set for him. It made her sad when she pushed him. He was very clear in his praise for her hard work. said that when Mr. He then became ill. felt grateful toward his mother and also felt protective of her. M. and Mr. and ﬁnally separated when she was 10 years old. Their relationship improved considerably after she moved out. G. he had temporarily moved back to his mother’s house. G. Mr. M. he did not resent his mother. they parted company. would begin to feel crowded and irritable. she had a full-time job. was very young and had never provided support. The couple had lived together several times. Ms. Both felt helpless to address the problem because they did not know what caused it. kept in touch with Ms.’s feelings changed. which he had worked toward for some time. from time to time. When they met. Despite this. When he left. although he was a loving. was an only child who became independent at an early age. feelings and tastes to world affairs. had an unconscious anxiety about his capacity as a man. G.
B. and Mrs. Two more children followed quickly. faced a major dilemma: knowing the differences between them they each had to decide if they had enough in common for the marriage to be satisfying. Mr. In his relationship with Ms. Excited about their future. Mrs. B. She felt that they were far more knowledgeable and articulate than she. they struggled over time to reach a decision to continue their marriage — accepting its limitations. while she had always enjoyed being independent and strong. She did accompany him to his business-related social functions. B. Having stopped her formal education when she married. Soon after they married. they saw that they had grown in different directions and now had distinct differences in their preferred lifestyles.abandonment of his family.. called requesting help for himself and his wife. found she was pregnant. home town. she had been unaware of a side of herself that was dependent and vulnerable.. Mr. Mr. she was not interested in becoming more active in her husband’s world. were given the opportunity to express their own viewpoints. M. wasn’t particularly interested in school and looked up to her future husband. was often away on business trips and courses. His hard work paid off and he was steadily promoted until he reached a management position. realized that. Mr. Mr. The couple met as adolescents in a small town where they both grew up. however. and agreed that they would return if they found they were stuck again. They agreed that their sexual relationship had been a strong point in their marriage from the start. Ms. Rather than express his negative feelings about what he missed out on as a child. G. she felt uncomfortable with her husband’s colleagues and their spouses. After a short time in couple therapy they decided that they could work on this together without the therapist. The demands of his career also increased. At this time. Mr. being loving and protective towards her but unable to recognize and express certain needs of his own. irritability and an urge to leave. Mrs. had been protective of his mother as a child. Also. rather than act them out. When Mr. was frustrated that his wife was not able to understand the demands of his job. but this meant that he missed out on some aspects of being a kid. they settled in the suburbs of the new city. B. Recognizing these dynamics helped the couple to pinpoint ways in which they could identify and talk about their hidden feelings. He was 44. The couple were delighted. B. but it was clear that she did not enjoy doing so. but also recognizing its strong points. accepted a job in a city quite distant from their 32 Couple Therapy An Information Guide 33 . had repressed his feelings. Her husband. Mr. were seen in therapy sessions. was not interested in pursuing a career and stayed home to look after their child. They saw that they shared a common interest in their children. When Mr. M. he repeated this pattern. who held a junior position in a large corporation. She was far more focused on raising their children and running their household. G. B. B. She was very pretty. and Mrs. because of the level of love and trust she felt for him. his repressed feelings would erupt into anxiety. and Mrs. They had been married 16 years and had three children. she was 39. It was important to him that his wife entertain his business associates and accompany him to out-of-town conferences. His job became a source of increased satisfaction to him. Periodically. His turning away from her was devastating because she had opened herself to him so fully. B. interests and goals. and Mrs. This hidden side came out during her relationship with Mr. He was a friend of her older brother and so was around her house a lot. B. While therapy helped them identify this dilemma. he did extremely well in school. M. Though shy..
In the ﬁrst few years of the relationship. affecting how much support they gave to each other and also affecting how they dealt with issues relating to Mr. was. They had been together 10 years and. and was unsure of his long term career plans. When he met Mr. J. Mr. felt that they had a good relationship. and the relationship was now accepted by both families. The doctor talked with the couple and it was clear to all of them that the problem needed further exploration. enjoyed Mr. Mr. A. A. and Mrs. His feelings of anger toward Mr. A. although each saw the other’s behaviour as the problem. in fact.. L. L. L. seek therapy on his own to deal with his personal issues. as an adolescent. he also had artistic interests.Mr. as Mr. they had grown to like him. at ﬁrst tried to ignore his partner’s gibes. L. A. L. as Mr.. at ﬁrst. was able to see that his anger had little to do with Mr. A. ignored feelings toward other boys and men until he became involved with another man in his late teens. He tried to discuss this with Mr. They did agree there was a serious problem in their relationship. angrier. still had strong mixed feelings toward his ﬁrst homosexual partner. A. and Mr. Mr. J.’s anger. A. could not make sense of Mr. displaced feelings toward his ﬁrst homosexual partner. L. and Mr. even in situations that seemed quite neutral. in some ways. Over a period of months. enjoyed sales. felt relieved that the issue had been addressed and that the relationship no longer seemed in danger. things had gradually changed. made an appointment with their family doctor to discuss a crisis in their relationship. L. L. The therapist recommended that Mr. A. felt justiﬁed in his anger. A.’s energetic. Mr. A. they were better able to deal with the problem in their relationship. spontaneous. but unconsciously Mr. and to acknowledge distress he had caused his partner. apart from their current problem. Mr. A. A. Mr. began to criticize and verbally reject Mr. enthusiastic approach to life. He thought that Mr. A. Mr. and Mr. Although Mr.’s family had been unsure of Mr. however. who respected his partner’s wisdom and stability. A. L. was trying to put him down or treat him as an inferior. Mr. L. more frequent and more intense over time. The doctor referred them to a therapist who was experienced in both couple and individual therapy.. A. a circle of friends. They shared an interest in arts and culture. He associated his ﬁrst partner with the shift in his orientation and his change in lifestyle. and an affectionate and considerate regard for each other. L. and his outrageous and irreverent sense of humour. a mentor to Mr. Mr. J. When the couple identiﬁed and discussed this dynamic. L. A. was in his early 30s and had a successful sales job.’s behaviour seemed both uncalled for and out of character. L.’s son from a previous marriage. but they became more hurtful. Mr.. Friends of the couple who saw these changes were both surprised and distressed. Talking about it only seemed to make Mr. L. During the assessment the therapist learned that Mr. 34 Couple Therapy An Information Guide 35 . A. sought help when they recognized that their arguments were getting out of control. Mr. Mr. was in his 40s and was a successful businessman. Although Mr. and Mrs. A. He had then decided that he was gay and entered into a gay lifestyle without exploring what it meant to him to give up the life he had been living before. It was at this point that they went to their doctor. were. their relationship developed well. had been comfortable as a heterosexual.
would get extremely angry and emotional. Mrs. blamed each other. which Mrs. because when he did not respond. to an extent. Both were very angry at this and felt that the child’s mother had all the power. in negotiation with the child’s mother and with respect to related child-rearing issues. His wife’s angry demand was that he take a strong stand with the child’s mother. Their relatively new relationship had been through constant stress. Mrs.Mr. Mr. At ﬁrst. her feelings would intensify when he waited. found her husband to be both attractive and a good person. J. she thought it was because of his lack of caring about the intense distress which lay beneath her furious front. they felt able to get back “on track” much sooner and with less damage to the relationship. was drawn to his wife by her looks. She saw the boy as overly demanding and a rival for Mr. they also had begun to talk together. the son’s mother was minimally involved and Mr. but he did not want to “make waves. felt caught. intelligence and his belief that she was a very moral person. The stability of the relationship was then greatly upset after the couple married. J. who was unusually concerned and thoughtful toward others. 36 Couple Therapy An Information Guide 37 . when the little boy’s mother sought joint custody. J. J. J. felt did not consider her own connection with the little boy. They also felt more effective. Although they sometimes fell back into the old pattern.’s affection and attention. interests and activities. throwing the couple into ongoing contact with the little boy’s mother. The joint custody arrangement was granted. The couple were quite upset and. grew to love the little boy. They also felt that they had beneﬁted from the chance to work on these issues in therapy. were both 26 years old and had been married for eight months after an 18-month courtship. They were highly motivated to make their relationship work. and despite all the contrary feelings. When they were seen for a follow-up appointment they felt that these gains had been maintained. both individually and as a couple. they did not doubt their basic caring for each other. This led to a long and painful court proceeding. A major focus of conﬂict between them was Mr. J. However. The couple were seen together in couple therapy. waiting for his wife to “cool down. Mrs. where a pattern was identiﬁed in which Mrs. The couple were helped to identify this pattern and the consequences it created in the relationship. J. Over time.” In actual fact. and with acknowledgment of each other’s feelings. J. had sole custody. They also felt compatible with each other’s values.” which he felt could hurt his son. This stress made them unable to work out issues which are usually negotiated in the early phase of marriage.’s young son. J. and Mrs. J. This enabled them to begin to discuss even the most emotionally loaded topics without blowing up. They realized that the considerable stresses they had been through had caused them to turn anger and frustration stemming from other sources onto each other. was not comfortable with the little boy. Mr. J. When the couple met. while her husband would remain silent.
New Jersey: Jason Aronson. Karpel.). Norton. (1982). Mark A. Canadian Journal of Psychiatry. A. Books and articles for professionals Carter. Holbrook. Wile. (1988). 92-97. New York: W.2. After the Honeymoon: How Conﬂict Can Improve Your Relationship. Siegel. 27. Clinical Handbook of Couple Therapy. New York-London: Guilford Press. Jacobson. Betty & McGoldrick. S. Paul. Evaluating Couples: A Handbook for Practitioners. Daniel B. Judith. 38 Couple Therapy . Monica (Eds. S. New York: Gardner Press. (1994). H. Northvale. N. (1988). Second Edition. Gurman. Massachusetts: Bob Adams Inc.). The Changing Family Life Cycle: A Framework For Family Therapy. (Eds. 2nd edition. (1995). New York: John Wiley & Sons. Getting to the Heart of the Matter: How to Resolve Ongoing Conﬂict in Your Marriage Once and For All. W. (1992). Repairing Intimacy: An Object Relations Approach to Couple Therapy. (1994).SUGGESTED READINGS Books for the public Coleman. Guttmann.. Transference and countertransference in conjoint couple therapy: Therapeutic and theoretical implications.
ON M5S 2S1 Canada Tel.camh. please contact: Marketing and Sales Services Centre for Addiction and Mental Health 33 Russell Street Toronto.: 1 800 661-1111 or 416 595-6059 in Toronto E-mail: firstname.lastname@example.org Web site: www.net cOUPLE THERAPY an Information Guide ISBN 0-88868-332-4 .A Pan American Health Organization / World Health Organization Collaborating Centre For information on other Centre for Addiction and Mental Health resource materials or to place an order.