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How to Find a Couples Therapist

Couples Therapy is Different

While there is certainly some overlap between individual and couples therapy, the latter is really a different animal.  (By the way, couples therapy, couples counseling, and marriage counseling are virtually interchangeable terms.) Individuals coming into therapy generally have some degree of motivation to work on themselves.  Partners coming into couples therapy are often initially motivated to change their partners!  “She’s always nagging me.”  “Well I wouldn’t nag him if he would just do what I asked.”  “Well I don’t feel like taking orders when you’re always nagging me.”  And so on.  This can make things difficult right off the bat since most people don’t want to be told what to do or how they should be.  However most stuck couples are exactly in the place of both trying to change each other.  That leaves both partners feeling frustrated that their partner is not changing, as well as feeling blamed not themselves changing.  No wonder couples get stuck!

In addition, each partner often wants to tell his or her story of events, and their stories often have very different points of view.  Not uncommonly, partners may have very different memories of the same event and then get into a secondary argument about who’s version is right or wrong.  And in the background of all this furor is a system of emotional interaction that gets lost in the crossfire.

Systems Thinking

How one thinks about a couple has to be quite different from how one thinks about an individual.  A couple is a system, in which each one influences the other in a reciprocal way.  A simple example can be seen in the above exchange where one partner nags and the other becomes less responsive.  The more one nags, the less responsive the other becomes, and it turns into a downward spiral.  It becomes impossible to separate cause and effect, because cause and effect are intertwined.   Did he start nagging because she was unresponsive, or was it the other way around?   This turns out to be an essentially useless question like the koan “What is the sound of one hand clapping?”   However, couples can spin themselves endlessly in circles on these topics. A deep understanding of systems and circular causality in emotional interactions is necessary to help couples untangle these webs and move forward.

Models and Research

There are a number of models that are very helpful in understanding the underpinnings of relationships.  Among them are Ellyn Baders’ and Pete Pearson’s developmental model of couples relationships, John Gottman’s model grown out of his foundational empirical work, and Sue Johnson’s attachment-based Emotionally Focused Couples Therapy.  A serious couples therapist should have either in-depth knowledge of one of the respected models, or at least a working knowledge of two or three.

So How Do We Choose?

Word of mouth from someone you trust is often the best place to start.  If you don’t know anyone who’s had successful couples therapy, then ask around–you might be surprised!  If you can’t find anyone you know, then start doing some research.  Begin by thinking about how you might describe the difficulties in your relationship in a way that includes your partner’s point of view as well as your own.  Examples might be, “I like a clean house and my partner doesn’t seem to care so much,” or “My partner wants to spend money and I want to save it,” or  “We have different views about parenting.” Also contemplate both what you think is missing in your relationship, and what you would like more of.   “We’ve lost some of the excitement and connection we used to have—I’d like more romance in our life together,” or “I don’t see my friends as much as I’d like to and I wish we’d do more fun things together.”

Psychology Today has lots of listings (to the point of being somewhat overwhelming) on their Therapy Finder site which allows fairly customized searches.  There are a number of other therapy search websites which you can explore, or you can go to other resource sites that might have therapist listings such as Natural Resources in Noe Valley.  You can try a Google search for couples therapy, couples counseling or marriage counseling.  Look over some websites and see what appeals to you based on your intuition and your answers to the questions above.  You can also look in local newspapers.  Narrow down to two or three possibilities and then start making calls.

Ask the therapist about their fees and whether their schedule will accommodate your needs as a couple.  If those things seem workable then you might want to give them a five minute summary of what’s going on in your relationship.  Ask the therapist what their training and experience in couples therapy are and what proportion of their practice is couples.  They should have some extended couples training over a period of years in one of the major systems mentioned above (more than a few weekend workshops).

Generally speaking you get what you pay for.  Therapists with more training, specialization and experience tend to charge more for their skills.  Therapists towards the beginnings of their careers are more likely to offer free first sessions and be on insurance networks.  A significant proportion of a couples counselor’s practice should be couples work in order to gain and maintain the kind of expertise necessary—perhaps 50% or more.  Once you find someone that seems right on the phone, make an appointment.

Meeting

The first session or two may involve a fair amount of background gathering on the part of the therapist.  However you should also be getting a sense that the therapist understands each of you to a fair degree and that he or she is starting to make sense of some of the things that are going on between you, The therapist might start having you and your partner interact and be making suggestions about how you can engage more fruitfully.  Two opposite problems in couples therapy are aimless drifting or unchecked conflict; if either of these seem to be happening, bring it up as a concern with your therapist and see how responsive the therapist is.   As you go along in therapy you and your partner should each ask yourselves three central questions.

  1. Do I feel heard, understood and respected by the therapist?
  2. Are we talking about and working on (at least to some degree) what I want to be talking about and working on?
  3. Is this therapist’s approach a good one for me?

On a one to ten scale your answers should be around 7-8.  If any of these fall at seven or below you should bring up your concerns with the therapist and discussing them to your satisfaction.

When to Seek Therapy

The short answer is if you’re thinking about it, it’s probably best to just go now.  Generally the longer you wait, the worse things get: more hurt or distant, deeper ruts, more entanglement to sort out, more time in therapy to repair.  The fact is, it’s very hard to have perspective on yourself or yourselves, and perspective is one of the most helpful things about therapy.  The three most general categories for seeking couples therapy are probably escalating hurtful fights, losing emotional connection (drifting apart), and some event or life transition that has shaken things up (such as a new baby, an affair, relocating, complicated death of a parent, etc.).   If any of these are worrying you for more than a few weeks then get a consultation.  A stitch in time saves nine!

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