Why and How to Start Couples Therapy: Q&A with a Couples Therapist

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While we’ve talked a lot about therapy over the years at Corporette, we haven’t highlighted couples therapy before, so today we’re sharing tips on why and how to start couples therapy. We turned to an expert — Sara Miller, MS, LCPC, of Confluent Relationship Therapy in Chicago — for advice for readers considering couples therapy.

Miller answered our questions about signs you and your partner could benefit from couples therapy, various couples therapy methods, tips on finding/screening a therapist, and more.

So, before you dive into the trusty Psychology Today therapist database or start googling, check out Miller’s tips!

Why and How to Start Couples Therapy

Corporette: When are some signs that it’s time to try couples therapy?

Sara Miller, MS, LCPC: There is never a bad time to start couples therapy, or therapy in general! If there aren’t any presenting concerns that the couple is wanting to work on, preventative therapy can be used to ensure a healthy, long-lasting union. However, if clients are using couples therapy as an intervention for current relationship issues, there might be some signs that it’s time to seek help:

Many couples believe fighting is a warning sign of relationship destruction, but this is not necessarily the truth. What to look out for is the ability to work through or manage conflict. Every relationship has conflict, but what makes a functional relationship is the ability to communicate about it in a healthy way, overcome gridlock, and come to a compromise. If couples cannot manage or work through conflict, it’s time to see a couples therapist.

Also, within conflict, there are solvable problems and perpetual or unsolvable problems, such as personality differences. If couples can not navigate these differences together, it is wise to seek help.

Another warning sign to start couples therapy is if couples notice the following destructive behaviors that Dr. John Gottman of Gottman Method Couples Therapy labels, “The Four Horsemen of the Apocalypse.” These are: criticism, contempt, defensiveness, and stonewalling. All four are counterproductive to positive communication and a healthy relationship dynamic.

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What are the main types/styles of couples therapy, and how do you know which will work best for you and your partner? Should you ask therapists what method(s) they use?

The most commonly used that are practiced today include: Gottman Method Couples Therapy, Emotionally Focused Couples Therapy, Solution-Focused Couples Therapy, and Imago Relationship Therapy. Although there are more modalities and theoretical orientations, these are the most popular you hear clinicians using on a regular basis.

There are also variations of individual therapy modalities that can be formatted for couples work, such as Cognitive-Behavioral Therapy (Cognitive-Behavioral Couples Therapy), Narrative Therapy (Narrative Couples Therapy), and Mindfulness-Based Therapy (Mindfulness-Based Couples Therapy), but are less common. Many eclectic or integrative clinicians use multiple styles and tailor the approach to the needs of the client.

Additionally, there are clinicians licensed in sex therapy, but they go through specialized training and supervision to become certified sex therapists. There also is couples therapy for use in addictions work, but that is usually in the context of individual therapy where the clinician will utilize the partner to help with the individual treatment.

It would be hard for clients that do not work in the mental health field to know exactly which approach would work best for their relationship, but they can certainly do their research before starting with a clinician so they can participate in the treatment-planning process.

It would be beneficial for clients to ask about the clinician’s theoretical approach before starting, because there are some clinicians that strictly use a singular approach; however, most have multiple approaches. An ethical clinician will screen the clients through the intake process and if they do not provide the approach that is needed for the clients, they should be referring them to someone who is experienced in that area.

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How important is it to choose a therapist who specializes in helping couples? Is it better if they have a certain type of degree, such as LMFT?

The degree and license requirements vary by state, so the clients should do research first to know which clinicians are licensed in their state to provide couples therapy or therapy services in general. Usually, the degree does not matter as much as the license does, but in most states the clinician needs to have a master’s degree in a mental health field in order to be eligible to attain their license.

Licensed marriage and family therapists (LMFT) can certainly conduct couples therapy, but licensed counselors (usually LCPC, LPCC, or LPC), licensed social workers (usually LCSW), and licensed psychologists can specialize in couples work as well. There are also different titles for provisionally licensed clinicians and interns that are under supervision working towards independent licensure.

From all of the above licenses listed, there is no one that is better to suit couples therapy, but rather what a client should be looking for is experience and specialized training or certifications. For example, The Gottman Method has four levels of certification from the Gottman Institute.

How many therapists should you “try out” before settling on one?

Completely personal preference on this one. Sometimes clients will start with a clinician and realize they would rather be with a clinician that they can identify with, or who has a similar background to them. If the first clinician they try out feels like a good fit, it would not make sense to shop around. However, if both of the clients in the relationship are not able to establish rapport with the clinician, they could see if another person might be a better fit with their dynamic.

Outside of therapeutic modalities, most clinicians also have a specific interpersonal approach they use that usually aligns with their philosophy on the counseling relationship (i.e., directive, collaborative, etc.).

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What are the most important screening questions to ask?

1. “How long have you been doing therapy with couples?” This one is important, because sometimes clinicians change their specialty mid-career, so they could have 20 years of therapy experience but only a few years of experience specifically working with couples.

2. “What specialized training do you have in couples therapy?” Does the clinician have additional training specifically in couples therapy?

3. After you inform the clinician of what your relationship concerns are, ask the clinician, “Do you have experience working with couples that have our same relationship concerns?” For example, there are couples therapists that do not have a lot of experience working with infidelity or relationship trauma.

Also, if you are currently in a nontraditional relationship orientation, make sure the clinician has experience in working with that type of relationship. There are many couples therapists that do not have experience working with open, ethically non-monogamous, or polyamorous clients.

4. “Will I be working directly with you for therapy? And if not, who?” Sometimes at large group practices, the practice owner, an intake coordinator, or administrative assistant will conduct the phone consultation or answer initial emails, so it’s important to know who you will be working with. Find out information on the clinician you’ll be with before committing to start.

Once you start therapy, is it better to start talking about the big relationship issues you’re dealing with, or start slowly with more minor things?

Every clinician may have a different plan on discussing the relationship issues, but my philosophy is to lay it all out there on day one. During the intake process, I ask clients to list everything they want to work on so there are no hoarded feelings or resentments about the relationship that aren’t in the plan for discussion.

I also conduct quantitative relationship assessments that open up the dialogue for additional underlying relationship concerns or even dynamics that clients may not have been aware of themselves. With therapy in general, after all of the concerns are laid out and treatment has begun, it’s best to prioritize what is having the biggest impact on client functioning. However, there is no exact science, and every couple’s needs are different.

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Is there anything else you’d like to add — tips or otherwise?

I highly recommend all couples to also be supplementing couples therapy with individual therapy on their own. Sometimes we are limited in the work that we can accomplish in couples therapy if one or both partners are struggling with individual concerns that are impacting the relationship.

Another tip for couples therapy is to have patience! It takes time to make sustainable changes and/or undo years of a dysfunctional relationship dynamic. That’s why it’s always a good idea to start couples therapy right away before years of toxicity weighs a relationship down, otherwise it takes much longer to reverse the course.

Readers, do tell: Have you ever gone to couples therapy (or are you considering it)? If so, did it help with your relationship issues?

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