Couples therapy

Definition

Couples therapy is a form of psychological therapy used to treat relationship distress for both individuals
and couples.

Purpose

The purpose of couples therapy is to restore a better level of functioning in couples who experience
relationship distress. The reasons for distress can include poor communication skills, incompatibility, or
a broad spectrum of psychological disorders that include domestic violence, alcoholism, depression,
anxiety, and schizophrenia . The focus of couples therapy is to identify the presence of dissatisfaction
and distress in the relationship, and to devise and implement a treatment plan with objectives designed
to improve or alleviate the presenting symptoms and restore the relationship to a better and healthier
level of functioning. Couples therapy can assist persons who are having complaints of intimacy, sexual,
and communication difficulties.

Precautions

Couples who seek treatment should consult for services from a mental health practitioner who
specializes in this area.

Patients should be advised that honesty, providing all necessary information, cooperation, keeping
appointments on time, and a sincere desire for change and improvement are all imperative to increase
the chance of successful outcome. Additionally, a willingness to work "towards" and "with" the process
of treatment is essential.

Description

Couples therapy sessions differ according to the chosen model, or philosophy behind the therapy. There
are several models for treating couples with relationship difficulties. These commonly utilized strategies
include psychoanalytic couples therapy, object relations couple therapy, ego analytical couples therapy,
behavioral couples therapy, integrative behavioral couples therapy, and cognitive behavioral couples
therapy.

Psychoanalytical couples therapy

Psychoanalytic therapy attempts to uncover unresolved childhood conflicts with parental figures and
how these behaviors are part of the current relationship problems. The psychoanalytic approach tends
to develop an understanding of interpersonal interactions (at present) in connection with early
development. The success in development of early stages dictates the future behavior of interpersonal
relationships. The essential core of this model deals with the process of separation and individuation
(becoming a separate, distinct self) from mother-child interactions during childhood. A critical part of
this model is introjection. The process of introjection includes introjects (infant processing versions) of
the love object (mother). The developmental process of introjection forms the basis an unconscious
representation of others (objects) and is vital for development of a separate and defined sense of self.
The psychoanalytic approach analyzes marital relations and mate selection as originating from parent-
child relationship during developmental stages of the child.

Object relations couple therapy

The object relations model creates an environment of neutrality and impartiality to understand the
distortions and intrapsychic (internalized) conflicts that each partner contributes to the relationship in
the form of dysfunctional behaviors. This model proposes that there is a complementary personality fit
between couples that is unconscious and fulfills certain needs. This model supports the thought that a
"mothering figure" is the central motivation for selection and attachment of a mate. Choosing a
"mothering" figure induces further repression (non-development) of portions of personality that were
not well-developed (referred to as "lost parts"). This repression causes relationship difficulties.

Ego analytic couples therapy

Ego analytical approaches utilize methods to foster the ability to communicate important feelings in the
couple's relationship. This model proposes that dysfunction originates from the patient's incapabilities
to recognize intolerance and invalidation of sensitivities and problems in a relationship. According to this
model, there are two major categories of problems. The first category of problems relates to
dysfunction brought into the relationship from early childhood trauma and experiences. The second
involves the patient's reaction to difficulties and a sense of unentitlement (a personal feeling that one
does not deserve something). A patient's shame and guilt are major factors precipitating the thoughts of
unentitlement.

Behavioral marital therapy

Behavioral marital therapists tend to improve relationships between a couple by increasing positive
exchanges and decreasing the frequency of negative and punishing interactions. This model focuses on
the influence that environment has in creating and maintaining relationship behavior. Behavior
exchange between partners is flowing continuously and prior histories can affect relationship
interactions. Behavior therapy in general is based on the idea that when certain behaviors are rewarded,
they are reinforced. The amount of rewards (positive reinforcers) received in relation to the amount of
aversive behavior is linked to an individual's sense of relationship dissatisfaction.

Integrative behavioral couples therapy

Integrative behaviorists help couples by improving behavior exchange, communication, and the couples'
abilities for problem-solving skills. The integrative behavioral therapy approach examines functioning of
the couple and is more flexible and individualized to specific problems in the relationship than behavior
marital therapy. This approach examines problems and interactions that are repetitious (acts that are
repeatedly done causing relationship problems).

Cognitive behavior marital therapy

The cognitive approach therapist educates and increases awareness concerning perceptions,
assumptions, attributions or standards of interaction between the couple. The central theme for
understanding marital discourse using cognitive behavioral therapy is based on the behavioral marital
therapy model. A couple's emotional and behavioral dysfunction are related to inappropriate
information processing (possibly "jumping to conclusions," for example) and negative cognitive
appraisals. This models attempts to discover the negative types of thinking that drive negative behaviors
that cause relationship distress.

Emotionally focused therapy

Emotionally focused therapy assists patients to acknowledge, assess, and express emotions that are
related to distress. This model views emotion and cognition (thinking) as interdependent and that
emotion is a primary "driver" of interpersonal expression. The primary theme of emotionally focused
therapy is that couple distress stems from unexpressed and unacknowledged emotional needs. The
dysfunction arises from negative interactions from emotions that have been withheld from disclosure
from each partner.

Structural strategic marital therapy

Structural strategic therapists will challenge existing negative perceptions and present alternative
possibilities and behaviors. These alternate behaviors encourage positive perceptions by role-playing.
This model views relationship progression in developmental stages. According to this model, the
couple's distress reflects difficulties in coping mechanisms related to life changes— either environmental
or personal change. Despite relationship dissatisfaction, the couple will tend to resist change,
maintaining status quo, and attempting baseline functioning to keep the system going.

Preparation

Couples should be informed that cooperation is vital for the process. Couples should have a desire to
modify and/or change dysfunctional behaviors. Honesty and emotional openness is a necessary
component for treatment. Results cannot be guaranteed. The psychotherapist would typically provide
an extensive assessment process during the initial appointment. This couples assessment process
usually includes in-depth information gathering concerning the presenting problem, and assessment of
occupations, schooling, employment, childhood development, parental history, substance abuse,
religion, relational, medical, legal, and past psychological history, in the form an interview. The
psychotherapist can then devise the best course of treatment planning. Further psychological tests and
measurements may be indicated initially or as the need arises during the treatment process.

Aftercare

Treatment usually takes several months or longer. Once the couple has developed adequate skills and
has displayed an improved level of functioning that is satisfactory to both, then treatment can be
terminated. An awareness of relapse prevention behaviors and relapsing behaviors is important.
(Relapsing behaviors refer to the return to the behaviors that the couple is trying to change or
eliminate.) Patients are encouraged to return to treatment if relapse symptoms appear. Follow-up visits
and long-term psychological therapy can be arranged between parties if this is mutually decided as
necessary and beneficial.

Risks

The major risk of couples therapy is lack of improvement or return to dysfunctional behaviors. These
tend not to occur unless there is a breakdown in skills learned and developed during treatment, or a
person is resistant to long-term change.

Normal results

A normal progression of couples therapy is relief from symptomatic behaviors that cause marital
discourse, distress, and difficulties. The couple is restored to healthier interactions and behaviors are
adjusted to produce a happier balance of mutually appropriate interactions. Patients who are sincere
and reasonable with a willingness to change tend to produce better outcomes. Patients usually develop
skills and increased awareness that promotes healthier relationship interactions.

Abnormal results

There are no known abnormal results from couples therapy. At worst, patients do not get better
because they cannot break away from self-induced, self-defeating behaviors that precipitate marital
dysfunction and distress. The problems are not worsened if treatment is provided by a trained mental
health practitioner in this specialty.