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How can you know couples therapy actually works?

An article in the New York Times today is one of those articles that can be hard for therapists to read. It’s just one person’s account of her experience in couples therapy, but it’s pretty damning of my industry and craft. She offers cringe-inducing anecdotal reports from 30 years (off and on) of seeing couples therapists, who too often sound, well, like idiots.

But what bothered me the most about the therapists she described wasn’t the corny one-liners and trite advice they gave. It was the way they all seemed to be doing whatever they thought was the right thing to do, apparently without any set of guidelines or standards that all couples therapists follow. This can be messy work, and sometimes we don’t know if it was effective until we follow up with clients long after therapy has ended, but come on, really? Can’t we have some kind of assurance that every couples therapist will do (or not do) certain specific things, and with some reliable amount of quality control?

That’s why I’m in the certification track for Gottman Method therapy, and why, month by month, I work with a therapist supervisor one on one. I tell clients that our agenda matters a great deal to me, and I don’t want to do even one session with a couple without discerning clearly and thoroughly what we’re working on, how they’re doing, and what the specific next steps are. I also keep reading and integrating theoretical perspectives into my core approach.

Having said all that, I also know that there are moments in the room with couples when I need to follow my instincts and take the session in a direction that isn’t predicted or controlled by the various models and regimens I typically use. Sometimes I have an out-of-nowhere question for the couple that radically shifts the direction of our work.

So … how do I know that’s effective?

Well, sometimes it’s not. Other times—and this is true more often than not—it can be a breakthrough moment for the couple. One couple I worked with some time ago was coming to me with a lot of anger, particularly from the direction of one person in the couple, who seemed almost consistently irritated with our whole process. My approach was to ask about deep fears they both had, and how they were suppressing those fears in a way that fueled their pattern of anger and bickering. (That’s a fairly standard tack.) But my question didn’t come out of a textbook. It wasn’t vetted by a well-researched theoretical approach. It was something like, “You two sound pretty freaked out. Are you scared about your kids?”

Pause.

And off we went in a new direction. Thankfully, I was right. It could have been a false move. In that case, I would have thought quickly on my feet and pivoted us back on our previous course. But it’s tricky, this work. It can sometimes fall flat, or backfire. But when it works, it can truly change the life of a couple.

Mount Hood

Mt. Hood, as seen from Larch Mountain, 4056 feet. I climbed Larch the other week, perhaps in search of the big picture that I and my clients both need. 😉

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Stephen Crippen
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