When couples are dissatisfied in their relationship, couple therapy has become one of the most widely practiced interventions. The effectiveness of couple therapy has been demonstrated by several studies (Shadish Baldwin, 2003). and in systematic reviews. Lebow, Chambers, Christensen, and Johnson (2012) summarized research findings indicating that evidence based couple therapy improves relationship satisfaction for 71% of participating couples at the end of treatment.
While couple therapy has shown to be significantly more effective than individual therapy in addressing relationship distress (Barbato & Avanzo, 2008), many people who seek help for couple-related issues are treated in individual therapy.
There are several reasons for this. For example:
• One partner is reluctant to attend;
• One partner may be reluctant to invite the other partner;
• Therapists might recommend individual treatment if one partner demonstrates clinical issues such as substance abuse, depression, trauma, etc;
• Individual therapy may be the only format of therapy offered by the service provider (organisational EAP programs, or therapist is not trained in couple therapy)
The current research raises three major concerns about treating couple problems in individual therapy (Gurman & Burton,2014): ...
- Therapists cannot accurately understand the interaction pattern of the couple without direct observation of the two together;
- Individual therapists may become biased by being drawn into the individuals’ one-sided story about a relationship that often depicts their partners in a negative light;
- Individual therapists may unwittingly undermine the relationship by asking questions like “Why do you still stay in the relationship if you are so unhappy?” and/or “Why do you think they want to control/hurt/ignore/ you?” – which implies that the partner is the problem.
- In empathising and validating the individual’s struggles the therapist reinforces the individual’s negative views about the relationship deepening despair and dissatisfaction with the relationship;
- Therapists cannot utilise interaction-oriented interventions when one partner is absent;
- It is impossible to activate the couple’s vulnerabilities (Scheinkman & Finshbane, 2004), or promote adaptive communication styles, or discuss the potential mismatch in their cognitive views, which are critical change mechanisms related to improvement in relationship quality;
- When individuals see the problem as either their partner’s fault or their own mistake, they cannot take shared responsibility for the relationship problems between them (Gurman, 2008).
Given the above concerns related to treating couple problems in individual therapy, it is not surprising that, compared to individual therapy, couple therapy is more effective in treating relationship distress (Barbato & Avanzo, 2008).
However, is it still possible to effectively treat couple problems within individual therapy? William Doherty, a professor at University of Minnesota, has developed a clinical protocol called Couple Sensitive Individual Therapy (CSI; Doherty, 2015) that provides clinical strategies to address the concerns raised by Gurman and Burton (2014). CSI is defined as individual psychotherapy that is aware of how therapy affects the client’s intimate partner and the couple relationship (Doherty, 2015).
Based on Doherty’s work Relationship Institute Australasia have developed a one day workshop to assist individual therapists to support their individual clients when they present with couple problems in a way that also supports the relationship.
Individual Therapy for Couple Problems (ITCP)
In this approach the focus is on learning to:
- Align with the client’s therapeutic goals and NOT aligning with them against their partner;
- Validate the client’s painful feelings rather than their beliefs about their partner;
- Understand evidence based theories and models relating to intimate relationships;
- Identify assessment processes and tools for use with individuals presenting with relationship concerns;
- To assess and address complexity in individual presentations including Axis 1 and Axis 2 concerns;
- To develop skills in implementing evidenced based interventions that address client concerns;
- To identify and manage issues with ‘fundamental attribution error’ using client centered and emotionally focused approaches that support emotional self-exploration;
- To create behavioural experiments and homework assignments to support relational growth.
If, like most of us, you find that over 80% of individuals attending therapy with you are naming couple problems as one of their top three presenting problems you will find this workhop is filled with a range of practical interventions to help you assist your client in making positive change in their relationship while also engaging in their own personal growth.
Click here for more information regarding professional training in this area.
References
Barbato, A., & D’Avanzo, B. (2008). Efficacy of couple therapy as a treatment for depression: A meta-analysis. Psychiatric Quarterly, 79, 121-132.
Doherty, W. (2015, October 9). CSI (Couple Sensitive Individual) Therapy: How to Avoid Colluding with Your Clients [Video File]. Retrieved from https://mncamh.umn.edu/clinical-training/webinars/csi-couple-sensitive-individual-therapy-how-avoid-colluding-your-clients
Gurman, A. S., & Burton, M. (2014). Individual therapy for couple problems: Perspectives and pitfalls. Journal of Marital and Family Therapy, 40, 470-483.
Gurman, A. S. (2008b). Integrative couple therapy: A depth-behavioral approach. In A. S. Gurman (Ed.), Clinical handbook of couple therapy, 4th ed. (pp. 383–423). New York: Guilford.
Lebow, J. L., Chambers, A. L., Christensen, A., & Johnson, S. M. (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy, 38, 145-168.
Shadish, W. R., & Baldwin, S. A. (2003). Meta-analysis of MFT interventions. Journal of Marital and Family Therapy, 29, 547-570.
Scheinkman, M., & DeKoven Fishbane, M. (2004). The vulnerability cycle: Working with impasses in couple therapy. Family Process, 43, 279-299. Widmer, E., Kellerhals, J., & Levy, R. (2004). Types of conjugal networks, conjugal conflict and conjugal quality. European Sociological Review, 20, 63-77.