Couple counseling is fascinating work!

If sitting in a room with one client is dynamic, imagine what it is like with two. The interesting part about couples work is that the couple, not the individuals, is the client. Sounds weird? It is a novel concept, but one that every therapist needs to bear in mind.

Say I am seeing a woman for therapy and after a time, she decides she wants to bring in her husband for therapy. To work on her marriage. Sounds simple. “Why not?” you say. “ Why start from scratch by going to another therapist when you already know everything and can begin the work so much quicker?”

You make sense, but such a scenario is a pretty sticky one and I will tell you why.

If my original client is the wife, then the purpose of bringing in her husband for couple counseling needs to be identified.

Is it a one or two time occurrence to work on a specific situation? If yes, I would not consider that couple counseling, but rather a collateral session in which the wife still remains my primary client and her husband is only there to help improve her life in ways in which he can. He is simply a collateral to his wife's therapy.

But what if the purpose of bringing in the husband is to stop individual counseling to work on couple issues?

If that is the case, then the entire dynamics of the therapy must change from individual work to couple work; and that means the wife is no longer my client, but the couple is. It may sound like simple semantics, but the way couple sessions would then evolve would be totally different from a therapeutic perspective.

Honestly? I don't like to make that shift. Even when the second spouse comes in only as a collateral to the individual work, there is much groundwork that needs to be laid to make sure that therapy remains a safe place for my client. If my client agrees to lose her individual therapy status and allow for the couple to become the client, I need to very careful to prepare her for that shift, how it may affect her, and how to navigate such a change. I do this rarely, and only when I assess it being in the best interests of a client who is asking me for this change. Otherwise, I do all I can to encourage transferring to another therapist for counseling, even if my client does not return to individual counseling as a result.

And if my original client wants to engage in couple counseling and then come in for individual counseling in addition to that, it becomes even more complicated. I don't say I would never do it, but it is a case by case evaluation how to ethically and responsibly balance these changes.

So how else is couple counseling different?

All therapists have their orientations as to how they view individuals and their problems that bring them to therapy. Similarly, when faced with a couple as client, there are different orientations we can adopt in order to understand the couple and its problems.

Here are some examples:

An object relations, attachment model of couple counseling will focus on each spouse's attachment patterns to their parents. Because according to this theory of therapy, a person will not marry the person they want, but the person that they need. We marry the person who will replicate or heal or control or cancel out or live as the parent we wished we had as a child. We unconsciously try to use our marital relationship to achieve that which was unfinished from our childhood.

It might look like this:

A wife is always nagging her husband to be on time to simchos. Her husband is a caring, responsible, helpful person who has a chronic lateness problem. The wife, who has subconsciously married a man who to rectify a past in which she never made it to any school parties or functions on time because of her's father obliviousness to her needs. Never mind that her husband is not her father and he comes through is many ways. Or that she is perfectly capable of driving her children to their functions, or she could easily afford to send her with a car, or they have many good friends who would happily pick her up (in contrast to her mother who could not drive, or did not have the money to afford car fare, or whose friends lived too far to get rides from). No. This wife is getting stuck on a specific aspect of unresolved issues with her father that is playing itself out with her husband's lateness that really does not need to impact her with the severity she is displaying.

A transgenerational model of couple counseling is when a therapist's views the couple's problems as part of a pattern embedded in the family over generations. If you do a genogram (an assessment tool that gathers information about not only a client but generations going back), for a example, what will emerge is dysfunctional patterns of familial functioning. A pattern, for example, of divorce in each generation that will also show a cut-off between the non-custodial parent and the children. So a therapist would look for those same patterns in the present in how the couple relate to each other.

Other models of couple's therapy are experiential approaches, such as Gestalt therapy, in which the therapist views the couple's issues in context of how each makes meaning of their existence in the here-and-now. As wife, as husband, and how those worldviews influence both their behaviors in the present and how they move into the future.

An example of this would be understanding how a couple understands their roles as a frum wife or husband, what is expected of him, and how closely aligned these expectations are with their spouse's, and most significantly with their own. If a woman wants to stay home and take care of her children rather than work, but her husband wants to learn in kollel, then these expectations will cause friction in the couple. An existential/experiential approach would address these role expectations.

Here's one more.

A structural model of couple counseling focuses on the transactional patterns of how the family is structured and relates to each other. Every family creates its own internal pattern of organizing itself, has a set of rules by which it operates, and has subsystems of relationships which allows for overall family functioning, whether functional or dysfunctional.

A therapist viewing a couple's problems through a structural perspective is interested in understand how the family works. Who brings home the money? Who takes care of the house? Who disciplines the children? The therapist wants to know the rules of the house. Like, creativity takes precedence over cleanliness. We wash our hands before dinner. Homework is important/not important. We visit Bubby every week; or, we never visit Daddy's parents. Spoken and unspoken rules that have evolved over the years and created this family's structure and behavioral patterns. Also, the therapist is interested in the family subsystems. Who is a pair in the home? Mommy and Totty? Or is it Mommy and Moshe, the oldest son, and Totty is ignored. Is it Totty and Chavie, the middle daughter and Mommy is ignored? When Mommy says no more nosh, do the children pair themselves up with Totty who says yes?

A couple bring drama into the room in a way that the individual, who only brings one perspective into therapy, cannot. And it is the therapist who becomes the director of this drama. But the therapist, as well as the couple, would need to know first which script they want to use.

 NOTE: THIS ARTICLE WAS ORIGINALLY PUBLISHED IN BINAH MAGAZINE

Look me up on LINKEDIN  https://www.linkedin.com/in/mindy-blumenfeld-a8067583   

Check out my book THERAPY SHMERAPY,  available in bookstores and through Amazon

Browse through my previously published articles on my former blog Therapy Thinks and Thoughts at frumtherapist.com/profile/MindyBlumenfeldLCSW

Read current articles in my bi-weekly column THERAPY: A SNEAK PEEK INSIDE in Binah Magazine, available on newsstands every Monday.