When should a couple seek conjoint couple counseling?

 

By John Christensen

 

Marriage/couple counseling services are becoming increasingly in demand by consumers.    Concern about the problems of divorce and the national attention placed on couples in popular television shows such as “Dr. Phil” and “Oprah” have brought couple counseling to the forefront of American consciousness without the stigma of individual psychotherapy. Conjoint couples counseling has long been established as an effective form of treatment for psychiatric disorders. Research reviews indicate that 70-75% of couples that receive couples counseling show a significant improvement in their relationship. A substantial portion of new referrals looks for couples counseling. Poor marital satisfaction is directly linked with depressive, anxiety, and somatization disorders. There also appears to be a strong two-way connection between suicide, domestic violence, substance abuse; and marital discord. However, potential abuse of clients can occur when untrained clinicians attempt to provide couples/marital counseling. Different approaches, techniques, and ethical considerations are required to do couples work as compared with individual work.

 

Conjoint Couples counseling is a highly effective approach to many problems that face families, marriages, and individuals because the system or milieu of the couple is being altered along with the mental and emotional state of the individual. Sustainability of treatment progress is improved.  

 

Three levels of couple difficulties may arise and would benefit from couples counseling, The Distressed Couple, The Dysfunctional Couple, and The Dyspeptic Couple. Each level represents an increasing severity of difficulties that can and often lend to discord and perhaps eventually divorce or separation when their are no interventions to modify the faulty couple interactions and communication patterns   

 

The Distressed Couple:

 

This a couple that has begun to experience marital dissatisfaction inevitably leading to feelings of depression and anxiety. The difficulties are expressed as a conflict-based approach to each other and/or a conflict-reducing avoidance of each other. Either or both of these marital difficulties have begun to occur as a result of a significant incidence or set of incidents, or they have begun to occur over a more extended period of time, maybe slowly over the years. The source of the distress may be readily observable, such as an affair, a serious physical illness in one of the individuals of the couple, or an emotional de-compensation by one member. The source of the distress may also be insidious and difficult to pin to any one event or series of events, but rather has evolved over time as a result of day-to-day circumstances and stresses and normal life difficulties, such as aging, loss of capacity, changes in family structure through death, marriage, or natural maturational changes.

 

·        Individuals love their comfort zone, and hate change. However couple relationships are constantly evolving, changing, and reinventing. The result often leads to conflict.

 

·        Conflict-based approach: The couple’s approach to each other, both verbal and non-verbal becomes less and less positive and more and more neutral or negative, argumentative, and critical. The couple, as a working unit, the “us or we” becomes weaker and less effective, especially in working out or negotiating differences.

 

·        Conflict-reducing avoidance: The couple avoids each other, both verbally and nonverbally to avoid conflict, criticism (perceived or real), and arguing. This also weakens the effectiveness of the couple, and begins to reduce the couple to “roommates with benefits” (an associated pair of individuals who share some sex, tasks, experiences, and labors of life for their own personal benefit) instead of “teammates” (if I win, you win, and if I lose, you lose).

 

·        A significant source of distress for a couple is the realization that their partner is very different from them, and that they are not going to be able to change him or her to be like them or like the way they need.

 

·        When someone joins an organization, including a marriage or a family, an individual has to be willing to give some things up, sometimes those things may be cherished ideas, deeply engrained perceptions, or intergenerational ways of doing things. When an individual in a couple is unwilling to give anything up for the good of the couple, the couple becomes distressed.

 

·        Event based distresses:

-Affairs

                        -Sudden financial setback

-Deaths or sudden loss

-Sudden onset of physical illnesses

-Difficult children

                        -Major religious change

-Failures of adult children

-Addictions (discovery)

-Sexual disorders

-Parent, extended family problems

                        -Domestic violence

                        -Onset of an Axis I Disorder

 

·        Insidious based distresses:

-Chronic physical illnesses

-Chronic interference or enmeshment of extended family

-Constant financial problems

-Poor communication skills

-Gradual obesity of either partner

-Increase or decrease of religiosity in either partner

-Falling out of love with partner

-Addictions (recognition or had enough)

-Assertiveness acquisition

-Individual psychotherapy (particularly psychoanalytic)

-Moving or job change

-Acquiring new friends (especially of the opposite sex)

-One partner’s education, new hobbies, new healthy lifestyle

-Chronic Depression (had enough)

 

The Dysfunctional Couple:

 

The dysfunctional couple is a distressed couple that has progressed to a point of becoming unable to function as a couple, and one or both of the partners are unable to continue to function at their normal level outside the couple in their personal life. In addition to being distressed with conflict-based approaches to each other and/or conflict-reducing avoidance of each other, the dysfunctional couple is now reduced to an “adversarial” (the perception that if you lose, or I beat you, I win) position as opposed to the “roommate with benefits”. The benefits are gone and partners are living with their opponent. The dysfunctional couple spends a lot of energy competing with one another. Their approach to each other is to put the other one down, to hurt them, to push their buttons, to fight, and to intimidate each other. Their avoidance takes on a punitive role, not to reduce conflict, but to hurt. Intimacy and sex are purposely used to manipulate each other. The couple does not function as a couple to complete tasks or accomplish mutual goals. The individuals in the dysfunctional couple become secretive and very private. 

 

·        Former mutual involvement with children, friends, or relatives ceases. Mutual financial arrangements and accounts are dissolved in favor of individual ones. 

 

·        Dysfunctional couples are often one step away from divorce, but not always. The couple may have resolved to stick it out as a marriage because of the children, financial reasons, or unwillingness to go from the “frying pan into the fire”.

 

·        One member or both of a dysfunctional couple will often have a sharp decrease in their work performance, parenting performance, and/or performance of their social life.

 

·        Alcohol abuse, illegal drug abuse, and prescription painkiller abuse often increases in one or both members.

 

·        Sexual indiscretions are more likely to occur as couples become dysfunctional.

 

·        As couples evolve from merely distressed to dysfunctional, couples are increasingly likely to tell or imply that their partner is wrong, bad, or stupid.

 

·        Dysfunctional couples have increasingly intense arguments/fights where anger escalates to rage and rage to violence.

 

·        The attributes of a dysfunctional couple first described by Virginia Satir include:

 

-Control: One partner comes to assume the position of control, after a battle for control. The need for control is high in one partner, while the other partner allows himself or herself to be controlled, enabling them to not take responsibility.

 

-Perfectionism: One partner sees himself or herself as perfect or as nothing, usually the former. The other member of the couple is also seen as perfect or as nothing, usually the latter. Perfect according to whom- according to the one in control. It is not okay to do things mediocre or different from how the one in control does things.

 

-Blame:   When things go wrong, somebody has to be blamed.

 

-Feelings: No one is really allowed to express their feelings.

 

-Communication: Couples quit talking.

 

-Individuality: Individuality is discouraged.

 

-Laws and Rules: The laws and rules of the couple are strict, inflexible, and often present a double standard. It doesn’t matter if a rule doesn’t work, it must be blindly adhered to.

 

-Agreement: Agreement by the couple is more important than accurate expression of emotion and desire.

 

-Differences: Differences cannot be tolerated, negotiated, or compromised.

 

The Dyspeptic Couple:

 

The dyspeptic couple is defined as where one or both partners are bad tempered, ill-natured, ill-humored, crotchety, hot-tempered, irritable, irascible, short-tempered, mean, choleric, touchy, sour-tempered, cantankerous, grouchy, crabby, grumpy, ornery, fractious, disagreeable, disobliging, malicious, perverse, unfriendly, unkind, unpleasant, annoyed, brooding, complaining, fiery, dissatisfied, easily offended, fretful, gloomy, grumbling, hasty, huffy, hypercritical, morose oversensitive, peevish, petulant, plaintive, querulous, resentful, shrewish, snappy, snarling, testy, tense, surly, contentious.

 

·        One or both partners of the dyspeptic couple may initially appear as highly attractive, intelligent, charming, and charismatic.

 

·        At least one member of the couple has some type of a personality disorder. Usually the other member of the couple will either be depressed, anxious, or fearful.

 

·        While dyspeptic couples are very dysfunctional, they are often temporarily stable in that they may not be seeking to divorce, or change. Both parties like they way they are, and they thrive in the chaotic confusion of high drama

 

·        Dyspeptic couples enter counseling to engage in more drama. They want the counselor to side with them, and they both want to present their best case why the counselor should exonerate him or her as the victim, and convict their mate as the persecutor. They want the counselor to be a judge and rescuer. Each member of the couple wants the counselor to rescue them by absolving them of fault and siding with them against their mate.

 

 

·        Significantly different counseling techniques and therapeutic mindsets must be employed if a counselor or therapist chooses to work with the dyspeptic couple. 

 

·        Dyspeptic couples often terminate counseling within the first few sessions and blame the lack of success of counseling on the counselor. However, those that continue beyond the first couple of sessions are either: 1) Finally ready to make some modest changes, or 2) Have engaged the counselor in their drama.

 

·        Dyspeptic couples have a high incidence of illegal drug and alcohol abuse, and mutual violence.

 

·        Dyspeptic couples are usually dyspeptic from the beginning of their relationship and often were raised in a dyspeptic home as a child.