The New Couple Therapy: How We Can Be More Effective

Timothy West, Ph.D., MFT

(415) 892-7330

Dr. Timothy West, a Marriage & Family Therapist, provides couples counseling through-out Marin County, California. With offices located in Corte Madera, he also serves the communities of Sausalito, Mill Valley, Tiburon, Greenbrae, Larkspur, Kentfield, Ross, San Anselmo, Fairfax, San Rafael, Terra Linda, and Novato.

Couples Clinic Marin

500 Tamal Plaza, Suite 528

Corte Madera, CA 94925

The New Couple Therapy: How We Can Be More Effective

By Timothy West, Ph.D, MFT

As a graduate student years ago, I often wondered why there weren’t any courses devoted exclusively to couple therapy. Now, as a clinician in private practice, I think I understand why. First of all, couple therapy, according to surveys of therapists, was the most challenging of all modalities, and especially stressful when the therapist was traveling without a good theoretical roadmap. Secondly, when I was a student, the theoretical roadmaps for couple therapy were notoriously poor (Johnson, 2008). In fact, studies showed that clients in those days rated couple therapists as the most ineffective of all mental health clinicians (Gottman, 1999a) !

But things have changed. In the last fifteen years, attachment based therapy, neuroscience, and the research of John Gottman, Susan Johnson, and others, have given couples work a practical structure and provided quantifiable steps toward the goal of greater emotional connection between partners. We now know that negotiation, behavioral exchanges, and “active listening” are not sufficient by themselves to generate lasting change (Johnson, 2008). Gone are the days of only using one-on-one therapy techniques with two people. We may employ earnest, client-centered, empathic skills to connect with and heighten the emotional expression of each partner, but unless we know how to choreograph a corrective emotional experience between the partners, producing the so-called “change event”, we haven’t arrived at the “heart of the matter” (Johnson, 2004). In couple therapy, if one (or both) partners tell you “I wish I could take you home with us”, it is not a sign of ultimate success.

We now know that most distressed couples suffer from some form of attachment anxiety. Research has shown that adult love relationships present their own form of the anxiety, protest, and depression cascade that young children exhibit when taken from their mothers or primary caregivers (Johnson, 2004). For infants, it is a matter of life and death (Bowlby, 1988) and for adults a similar sort of “primal panic” can set in when romantic and emotional attachment to a beloved is threatened. In fact, distressed couples produce the same “fight or flight” hormones that any human being produces when their lives are being threatened (Panksepp, 1998).

This is why many struggling couples can appear so tense and combative when they present for therapy. At their core, they feel they are fighting for their lives or, in more progressed cases, they may have given up and embraced a profound hopelessness.

As therapists, we must learn how to boldly interrupt the panic cycle, and focus primarily on how couples are talking to each other rather than what they are fighting about. By teaching them to be aware of their process, they are less likely to be unduly triggered by the content. This allows them to take a breath, create some “space” in the conflict, interrupt their absorption in negativity, and replace the destructive behavior with friendship-based habits (Gottman 1999a). The goal is to teach the couple to be guardians of their own relationship, helping them describe their negative cycle and the associated feelings so that they can notice and stop this destructive pattern on their own at home, manage their tendency to escalate, and even end up soothing themselves and their partner.

The problem for many therapists who see couples is that they don’t quickly intervene in a confident and profound way to teach friendship skills and address the key attachment questions that the couple may be afraid to ask for themselves, such as “Do I matter to you?”, “If I love you, will you love me?”, “Am I a good enough person so that you won’t leave me?”, etc. It must be understood that most of the partners we see are initially terrified to ask these questions of each other, usually for very good reasons from their personal history.

The therapist must work through the avoidance and panic behavior (including their own) and turn the couple toward each other, while shaping a sense of safety and secure connection between them. This is the art and skill of marital therapy: to empathically draw out each partner’s attachment wound, heighten it and, at just the right moment, turn the partner toward the other to express it, facilitating the corrective experience, the change event. This is what begins to transform the relationship (Johnson, 2002). It is an organic endeavor to be sure, with starts and stops, steps forward and backward, a process that often takes considerable therapeutic patience and skill to manage. Yet once the emotional connection is made, it can be very satisfying and the effects appear to be permanent.

Neurobiologists are now discovering that healthy emotional connection and secure attachment between partners (and their earlier caregivers) is essential for proper brain development (Cozolino, 2006). Emotional intimacy creates a “neural net”, releases oxytocin, and activates “mirror neurons”, a process that builds and organizes healthy brain structure in such a way that we simply will not relinquish it (Cozolino, 2006) (Siegal, 1999). And why should we? Emotional attunement to a beloved partner is our key to optimal functioning (Johnson, 2008).

It is indeed ironic (and sometimes tragic) that something as desirable as emotional intimacy is often so difficult to bring about in wounded couples. Yet with the proper roadmap, with understanding and confidence, it is eminently achievable. The trick is to gently ease the partners out of their “life or death” panic to the point where they can experience relational safety. With the therapist’s empathic modeling and carefully paced, attachment-driven conjectures, we can create the conditions which allow us to turn the partners toward each other, revealing their vulnerabilities in completely new ways.

To be successful at this takes experience and training. Each couple presents a unique dance of love which can often be riddled with confusing defenses. Attachment phenomena is so sensitive that partners will sometimes fight tooth and nail before revealing their vulnerability. But when given the opportunity of safety and security, partners will reach for deeper connection because “attachment longings are wired into our brains and the tendency to reach and to trust and to comfort and care are always there, even if unrecognized or denied” (Johnson, 2008). Or, as a very withdrawn husband once exulted in my office, after his wife had broken through her own anger and was able to share, for the first time, more sensitive feelings which brought them closer together: “This isn’t so bad… this is good for us!”.

Here are some therapeutic principles that the new research on couple therapy has generated in my own approach:

Teach Friendship. Long-term attachment relationships are only satisfying when certain basic elements of positivity and friendship are in place (Gottman, 1999a). Many of us come from families in which we did not learn friendship skills or emotional intelligence. Gottman’s research-based approach builds what I call “marital mindfulness”: the daily and weekly rituals of simple habits which, when practiced, create a “bank account” of positivity (Gottman, 1999b). This provides a buffered container of safety which allows the partners to reveal more deeply of themselves.

Understand Attachment. Facilitating the expression of attachment yearnings between partners is essential for couple therapy to be effective. Therapists must know how to gently heighten this sensitive material in all its forms and then guide the dyad toward their own unique expression of these feelings, even though they can initially be very resistant. Susan Johnson is the master of patience and perseverance in the face of fearful clients in this area. Her tapes and books are indispensable.

Help your couples analyze their fights and their distress pattern.

This is a must in order to properly de-escalate the couple and gain some distance from their absorption in their negative cycle. We want our couples to understand how they become angry and want to attack their partner and how they may be afraid and want to withdraw. What are they reacting to in themselves (the attachment vulnerability) which is so unbearable that they would behave in such a way? Couples that can talk about their fights and about how one feeling leads to another have taken a significant step toward intimacy and physiological soothing (Johnson, 2004).

Keep Turning the Couple Toward Each Other.

In the initial stages, partners are often too wounded to risk any sort of deep and vulnerable disclosure with each other. The therapist skillfully works with each partner to draw out the truth of their individual hurts – and then in good time, must have each partner turn directly to the other and express it. This happens organically, in starts and stops, but the process does not rest until the hurts are fully expressed and fully responded to. Eventually, consistent eye contact is essential, though this, too, comes along intermittently. The point here is that the therapist must skillfully “choreograph” these dyadic exchanges. Simply nurturing an empathic one-on-one relationship between the therapist and each partner is not enough.

Help the partners find each other’s “core issues”.

I agree with Stan Tatkin that each partner has two or three basic, and perhaps lifelong, “core issues” or woundings that they are trying to heal in their relationship. These are usually reflected in the attachment history of each individual, and can often be the triggers in the couple’s present fights as well. Examples are core attachment anxieties like “I’m not important to you.”, “You think I’m a failure.”, I’m never enough for you.”, “If I get close to you, you’ll leave.”, etc., which have often been generated by early relationships with parents. By heightening and elucidating these primary themes, the therapist teaches each partner to be aware of, and empathize with, the specific content of each other’s struggle to become intimate. This develops mutual compassion which can help de-escalate the partners’ conflict when they become triggered.

Normalize conflict and teach your couples to slow down, take breaks, and repair.

The best of marriages experience conflicts because it is the nature of the intimacy “project” to bring up fears of abandonment, fears of not being adequate, of being engulfed, etc. Increasing closeness inherently generates the heat of intense feelings, positive and negative. What separates the “masters” of marriage from the “disasters” is not the amount of conflict in the relationship, but how their fights are managed and resolved (Gottman, 1999b).

It is important for the therapist to normalize the couple’s conflicts and relieve the partners of the certain level of shame they may feel because they are having marital problems. Part of de-escalating the fight-or-flight syndrome of distressed spouses is our ability to slow down the rush of the couples’ panicked interactions, teach them to take timeouts when they feel emotionally flooded or ineffective, and ask them to come back to their partner at a predetermined time to make repairs. These skills of self and relationship regulation need to be practiced consistently, in session with therapeutic guidance, and then at home. This becomes increasingly easier as primary, attachment-based communication is increasing and is having its own calming effect in sessions. The ability of partners to be able to soothe themselves and each other during triggering events is essential to long-term marital satisfaction (Gottman, 1999a).

References

Bowlby, J. (1988). A Secure Base. New York: Basic Books.

Cozolino, L. (2006). The Neuroscience of Human Relationships. New York: W.W. Norton & Co.

Gottman, J. (1999a). The Marriage Clinic. New York: W.W. Norton & Co.

Gottman, J. (1999b). The Seven Principles for Making Marriage Work. New York: Three Rivers Press

Johnson, S. (2008). My How Couples Therapy Has Changed: Attachment Love and Science. Psychotherapy.net

Johnson, S. (2004. The Practice of Emotionally Focused Couple Therapy. New York: Brunner-Routledge.

Panksepp, Jaak (1998). Affective Neuroscience: The Foundations of Human and Animal Emotions. Oxford: Oxford University Press.

Siegal, D.J. (1999). The Developing Mind: Toward a Neurobiology of Interpersonal Experience. New York: Guilford Press.

Timothy West Ph.D. M.F.T. is the founder of the Couples Clinic of Marin and has been in private practice for over twenty years. He is a certified Gottman Couple Therapist and Workshop Leader and has done advanced training in EFT with Susan Johnson. He leads a professional consultation group for couple therapists on Friday mornings in Corte Madera and will be co-presenting a weekend Gottman Couples Workshop to the public in Mill Valley on April 24 and 25, 2010. You can visit his website at www.couplesclinicmarin.com .