cOUPLE THERAPY

Dave Denberg, MSW, CSW

an Information Guide

cOUPLE THERAPY
Dave Denberg, MSW, CSW

A Pan American Health Organization / World Health Organization Collaborating Centre

An Information Guide

CONTENTS
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1 2 3 4 5
Couple Therapy: An Information Guide
ISBN 0-88868-332-4 Product code: PM007 Printed in Canada Copyright 1999 Centre for Addiction and Mental Health No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without written permission from the publisher except for a brief quotation (not to exceed 200 words) in a review or professional work. For information on other Centre for Addiction and Mental Health resource materials or to place an order, please contact: Marketing and Sales Services Centre for Addiction and Mental Health 33 Russell Street Toronto, Ontario M5S 2S1 Tel: 1 800 661-1111 or 416 595-6059 in Toronto E-mail: marketing@camh.net Web site: www.camh.net Disponible en franais sous le titre Thrapie de couple : Guide dinformation

Factors that inuence a couples relationship. . . . . . . . . . . . . . . . . . . . 2 What is couple therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Do we need therapy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Common concerns about therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Finding a therapist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Some practical questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 About separation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

6 7

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Suggested readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

2185E / 03-05

PM007

ACKNOWLEDGMENT
I would like to thank the couples who were treated at the Clarke Institute of Psychiatry, now a division of the Centre for Addiction and Mental Health, for their questions, suggestions and comments on the original edition of this guide. Also my thanks are extended to the many Centre staff who were instrumental in producing the publication. I would like to thank Pamela Blake, MSW, and Barbara Edwards-Evans, MSW, my co-authors on the rst edition of this guide, and Pamela particularly for her contribution to the current edition.

INTRODUCTION
At one time or another, every couple has difculties with their relationship. Problems in a relationship have many causes. Some problems originate outside the relationship, such as job loss, illness or conict in the family. Others stem from personality factors within the partners. Still other difculties may be related to natural stages in the growth of the relationship. Often couples are able to work out these issues themselves, but sometimes they are unable to do so. This guide was written for those who are having difculty in resolving issues in their relationship. You may be considering whether you would benet from couple therapy, or you may have already decided to try it, but are unsure of how to nd a therapist or what to expect. The guide discusses questions that are commonly raised by couples in your situation. It also addresses some questions that frequently arise in the course of therapy. This guide uses the term couple therapy. Marital therapy, conjoint therapy, and couples counselling are other terms commonly used to describe a similar process. The issues discussed apply not only to legally married couples but also to couples who are not married, and to same-sex as well as heterosexual relationships. The guide does not cover every aspect of couple therapy, and every relationship has unique aspects. The information should be used as a general guide only. The appendix describes a number of couples who sought help, and what took place in their therapy. The information has been altered to maintain condentiality.

Couple Therapy

An Information Guide

FACTORS THAT INFLUENCE A COUPLES RELATIONSHIP

Never say that marriage has more joy than pain. Euripides, Alcestis (438 BC) There is no more lovely, friendly and charming relationship, communion or company than a good marriage. Martin Luther, Table Talk (1569)

greater tolerance of differences. But rising divorce statistics reect a picture of relationships that does not match up to these expectations. Why should that be so? Alongside the positive changes in society there have been a variety of bewildering and often distressing changes, many of which have occurred so rapidly that some people have been caught offguard, and have had difculty coping. Changes in the job market affect people at all life stages. Many young adults cannot nd suitable employment and affordable housing, and must remain in their parents home at a time when they may be seeking to establish independence, as well their own relationships. At the same time, their parents may be looking forward to their own personal and nancial freedom, or may themselves be going through major life changes. For many families, the need for two incomes means that both partners carry a double load: family obligations, as well as outside employment. Early retirement is becoming more common, while other people are losing their jobs through no fault of their own. People in either situation are often quite unprepared for the nancial or emotional transition. There is an atmosphere of insecurity and instability everywhere in society, making it difcult for people to know how to protect themselves or their families. Meanwhile, the media actively promotes the impression that material possessions are not only attainable, but essential, and that marriage and family life are relatively happy and conict-free. This can create enormous pressures for families who nd their expectations are not met. In all these instances, economic stress results in emotional stress, which takes its toll on relationships. Economic and social forces have also led to dramatic changes in gender roles. Changing ideas of the roles of men and women in society have led

These opposing views of marriage, written centuries apart, are as true today as they were in their authors time. Living with a partner is a complex and challenging experience, and it can potentially be both rewarding and painful. The nature of a couples relationship is determined by the ways in which they deal with the various factors that inuence that relationship. Couples who vary from the traditional model of a heterosexual couple with children, such as childless couples, same-sex couples or relationships where the partners come from very diverse backgrounds, may have to make additional adaptations for their relationship to work.

Societys inuence on relationships: The impact of social change

The world in which couples form and live out their relationships is different for each generation. Changes in society over the past four decades have forced us to change the way we think about values and expectations. In general, couples today enter their relationships expecting to nd greater emotional and sexual intimacy, greater equality between the sexes, and

Couple Therapy

An Information Guide

to the promise of greater freedom and fullment for both sexes. However, changing gender roles have also led to confusion and frustration. As mentioned above, both partners in a relationship often have to work outside the home in addition to sharing household and parenting responsibilities. While this offers a varied and potentially more rewarding existence, it is also a dramatic departure from traditional gender roles and can add to relationship stress particularly if the partners willingness or ability to adapt to their expanded roles is unequal. Often, the gender roles we learned when we were young are quite different from the roles demanded by our adult relationships. Each individual and each couple has to work out how to adjust to the discrepancy. For some, the lack of t between their cultural and religious ideals of family life and the day-to-day demands of contemporary life can be an additional source of stress.

growth. As individuals, the partners development may not t well, or match with the stages of each others growth or the growth of the relationship. A further complication is that many important aspects of these processes are fully or partly unconscious. For this reason, the partners would have trouble identifying and discussing these aspects. The initial courtship phase of a relationship is often time out from everyday life: a new relationship tends to make people feel very good about themselves and their lives. Problems seem small or unimportant. The time the couple spends together in this phase tends to be mainly fun and rewarding; they have not yet established shared responsibilities. The courtship stage may be followed by a commitment to marry, to live together, or to form a long-term relationship while continuing to live apart. During this period, stabilizing career goals, deciding whether or not to have children, and resolving issues or feelings left over from previous relationships are some of the issues that commonly arise. Couples may then reach a period of consolidation or stability, during which they enjoy what they have established. What is frequently the next stage, the arrival of children, is usually thought of as a happy period, and in many instances, it is. However, it may also be a time of intense stress, both physical and emotional. The impact of children on each partner may be experienced quite differently. Couples must reorganize their lives with the arrival of a rst child and it may take some time to adjust to their new lifestyle. During the child-rearing years the couple usually spends much more time looking after the needs of the children and may have limited time

Stages in relationships
Each relationship is unique and yet there are identiable stages that most couples experience. Although we think of these stages as proceeding in sequence courtship, commitment to marriage or a long-term relationship, productive years (which can include child-rearing, or career, business or other pursuits), middle age to retirement frequently there are variations. Stages can begin and end abruptly or gradually. In some relationships one stage may merge with another, while in others, certain stages may be skipped altogether. In specic circumstances, such as second marriages where there may be children from previous relationships, the stages may be markedly altered. Each of these stages gives rise to a range of pressures and potential difculties. All of this is complicated by the fact that each of the partners is also likely to be going through his or her own complex stages of psychological and emotional

Couple Therapy

An Information Guide

to focus on their own relationship or may be distracted from doing so. In addition, the arrival of children sometimes brings up differences around child-rearing, or the kind of family life each of the partners desires. Often, the couple were unaware of these differences earlier in the relationship. This stage is obviously different for childless couples, who will focus their relationship differently and who face an array of different issues as a result of not having children, including those issues arising from their difference from the norm.

Finally, people often look forward to their retirement years. For some couples retirement is satisfying, but for others this period can be difcult nancially and emotionally. Illness and the prospect of losing a life-long partner are among the most difcult issues that arise in this period. Some couples are also unprepared for the loss of structure and meaning that work provided in their lives. This is particularly true when retirement is not voluntary, and comes earlier than planned.

Specic inuences
Why two people are attracted to each other is often a mystery to others,

Middle age may be difcult for couples. At this stage of life people often take stock of what they have accomplished and re-evaluate their goals. They may or may not be happy and satised with what they have achieved. There are additional issues if the couple have children who enter the teenage years at this point. Couples cope with their teenagers struggle for independence and may fear that their children are vulnerable to such dangers as alcohol or drug abuse, risky sexual activity or harmful companions. The current trend of children staying longer in the home prolongs the sense of parental responsibility. Once children leave home, many couples have to readjust to relating primarily to each other. Some partners may experience a serious sense of loss without children to care for, though others may channel their interests and energies into new careers, activities and relationships. Middle age is also a time when couples may nd their elderly parents need care. This can create additional pressures, and a sense of frustration, as it occurs at a time when the couple are just beginning to feel that their children no longer rely on them so fully.

and sometimes to the couple themselves. People may be attracted to those similar to themselves or prefer those who have opposite or dissimilar characteristics. People may admire different qualities in their partners at different stages in their lives. As a relationship develops over time, an initial attraction based on chemistry yields to a more complex relationship inuenced by such factors as the personality of each partner and the t between them their values, interests, life experiences, and cultural, religious, educational or family backgrounds and preferences. Each partners experience in his or her own family of origin inuences the current relationship in complex ways. Each partners expectation of what the relationship should be, and the roles each should play within it, is a signicant inuence. The partners may be unaware of some of their expectations until they are disappointed or a conict surfaces in the relationship. Often this occurs at a time of change: when the couple begin to live together, marry, have children or one or both face signicant life stress. The partners may be astounded to discover that some of their expectations of life as a couple are so far apart.

Couple Therapy

An Information Guide

Stress in life is inevitable. The number of stressful situations, their length and severity and a partners individual capacity to cope, are all factors that will affect a relationship. It is normal for couples to experience difculties during periods of change until they can nd their own ways of adapting to the situation. A couple may be less able to adapt if they face signicant stresses in several areas of their lives at the same time. A major physical or emotional illness in the family can have great impact. Financial difculties and loss of employment are other common stresses facing couples. In such times, family support (or lack of it) and the involvement of friends will play an important role in improving or worsening the situation.

The aim of couple therapy is not only to help the couple deal appropriately with immediate problems, but also to achieve better ways of relating in general. Often people have questions or misconceptions about couple therapy what it is, whether it is benecial, what form of therapy is most helpful, and whether seeking this kind of help implies some weakness or failure in the partners. The following chapters will address many of these issues.

Improving a relationship
There is no universal, ideal model against which a relationship can be evaluated. A good relationship is one that works for both partners and effectively supports them in achieving their goals. If this is not working at some point, it does not necessarily mean that the couple requires therapy. All relationships tend to encounter problems during stressful periods and at different stages, and many couples are able to resolve their difculties without professional help. Some couples nd that they are able to do so at one stage but not at another. Others may nd that they are continually unhappy with their relationship. Sometimes one partner feels frustrated and misunderstood while his or her mate is totally unaware of the situation. If the couple are unable to resolve issues in a manner that is acceptable to both partners, professional help should be considered. Many couples only consider therapy as a last resort. It may however, be helpful at any time, and sometimes seeking therapy soon after things get stuck prevents a buildup of frustration and disappointment.

Couple Therapy

An Information Guide

WHAT IS COUPLE THERAPY?

What is the difference between couple therapy and sex therapy?

Couple therapy focuses on the total relationship while sex therapy deals

Couple therapy is a means of resolving problems and conicts that couples have not been able to handle effectively on their own. It involves both partners sitting down with a trained professional to discuss their thoughts and feelings. (see Section 5, questions 1 & 2, for information on how to nd a therapist.) The aim is to help them gain a better understanding of themselves and their partner, to decide if they need and want to make changes, and if so, to help them to do so.

more specically with sexual dysfunction. Other problems within a relationship often affect the sexual relationship, and the quality of their sexual relationship is important to many couples, so this may be discussed in couple therapy. However, a couple may experience sexual problems in an otherwise sound relationship. If this is the case, sex therapy may be benecial. This treatment recommendation would be based on the therapists initial assessment of the problem.

Are children involved in couple therapy?

No. Couple therapy involves only the couple. Children may be affected either directly or indirectly by problems in their parents relationship, and to varying degrees, depending on factors such as their ages and the nature and severity of their parents problems. They may, as a result, become anxious and begin to exhibit their own problems, although not all of their difculties necessarily stem from those of their parents. The childrens difculties may improve as the couples relationship improves or the couple may become more condent in their own ability to help the children. Therapy that involves both the couple and their children is a different process called family therapy, which usually focuses on the relationships among family members rather than solely on the couples relationship. During the course of this therapy, however, the focus may shift to the parental couple for a period of time. If this occurs, children would no longer be involved in treatment. If parents are wondering whether their children should be involved in the sessions, they should discuss this with the therapist.

What kinds of problems do people usually bring to couple therapy?

People seek therapy for a range of problems and every couple is different. Some of the most common complaints include lack of communication, frequent or constant arguments, unfullled emotional needs, nancial concerns and conicts about children. You may be wondering why these problems sound like common issues that many couples resolve without professional help. Couples often seek help not because their problems are different from those of other couples, but because they are unable to resolve them. Sometimes, this is because of a buildup of frustration and disappointment over time, sometimes because there is some other issue or meaning underlying the conict. Other couples seek help as a result of a crisis in the relationship, such as an affair or apparent loss of affection and caring, or a traumatic event, such as an illness or loss in the family. (See the Appendix for examples of the kinds of situations for which couples seek help.)

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What will the therapist do?

The therapist is a professionally trained, objective third party who will listen to both partners as they express their thoughts and feelings and help them identify and clarify problem areas. Most therapists start with an assessment. In an assessment, the therapist asks about the problems and how both people see them, the history of the relationship, and the individual histories of the partners. This enables the therapist to develop a deeper understanding. Most therapists will discuss their impression of the situation with the couple at the conclusion of the assessment. The couple then can decide whether to accept the therapists recommendations about whether or not to enter therapy and what kind of therapy to pursue. Once the couple enters therapy, the therapists interpretation of issues may offer the couple a new perspective, which permits a change in feelings and behaviour. The therapist may act as a mediator, attempting to clear up misunderstandings in communication. This is often difcult for people to do themselves because they are emotionally caught up in the situation. The therapist may also help the partners consider alternative ways of handling problematic situations.

DO WE NEED THERAPY?

Are our problems serious enough to seek help?

For a number of reasons, couples tend to underestimate the severity of their problems. An intimate relationship is usually very important to a person and the thought that something might be seriously wrong with it can be quite threatening. The couple may mistake the problems for a normal stage in the relationship. Some people feel that the need to seek help is a personal failure and this view is unfortunately reinforced by the sometimes negative social attitudes that linger towards people seeking this type of help. Finally, some people have difculty or feel embarrassed about asking for help, question whether they deserve it, or whether their problems are really serious enough. If you think you might need help, it is worth investigating.

We are involved in a relationship that is just becoming serious. Is there anything we can do to prevent problems?
Some members of the clergy and couple therapists offer pre-marital counselling for couples who are beginning their relationship and want to take a preventive approach to problems. The better programs of this nature can help a couple anticipate and deal with some of the issues they will face before they become problems.

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Is this just a phase were going through or do we really need help?

At one time or another all couples go through difcult changes and stages and experience stress. How much stress each person can, and is willing to, tolerate at any particular time varies. If you feel your stress level is intolerable or that you have reached an impasse, you should seek help. Some people ignore problems and hope they will go away. Other people nd they are unable to solve their difculties despite repeated attempts to do so. If problems in your relationship persist, or if you cant solve them in a way that is acceptable to both of you, do not wait to go for help. Problems are easier to resolve before they become larger and when there are still positive feelings in the relationship.

unconscious to begin with. These issues can become further obscured as both partners begin to resent each others anger, coldness, dissatisfaction, distance, etc. The aim of couple therapy is to clarify the important issues in your relationship. Although you and your partner may not agree on all of them, therapy may enable you to identify the most signicant problem areas, consider possible solutions and start implementing those that t your situation.

Weve been this way for years. What good will couple therapy do?
People develop patterns for handling difculties. Some of these patterns fail to solve the problems; they increase tension instead. If both of you recognize a need for change and are prepared to do something about it, couple therapy can provide the extra support you may need during this difcult process. The therapist may also be able to offer a perspective that is not obvious to you and your partner.

Were intelligent people. Why cant we sort out our own problems?
Feelings are in a different realm from logic and cannot always be resolved on an intellectual level. Sometimes an objective third party is needed to mediate conict, or to help clarify what the issue means to each of the partners.

Were ghting a lot and cant agree on anything.

People who ght often feel as though they are going around in circles. Unresolved issues that continue to bother a person can begin to colour everything, and to obscure the original causes of feelings of anger or outrage. There may be aspects of the original problem that were fully or partly

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COMMON CONCERNS ABOUT THERAPY

they feel that agreeing to go to therapy is agreeing that youre right, Im to blame. This resistance can be increased if the suggestion of couple therapy is made angrily. If you stress your concern about the relationship, your partner may be encouraged to consider ways of improving it. Usually, if one partner feels the problem is serious enough to warrant getting help, there probably is a need for assistance.

I think my personal problems are creating tension in our relationship. Should I go for help by myself or should we both go?
Personal problems undoubtedly affect your partner and your relationship. Examples of these might be low self-esteem, illness or work-related stress. For some people, being in a committed relationship may itself be a problem. Same-sex relationships can be affected by other personal problems, such as one partners discomfort with a same-sex lifestyle. Initially, it is probably best for both of you to seek help. This may, in fact, help your partner to better understand your difculties. It may also be helpful for the therapist to hear your partners perception of the problems. After an initial assessment of your situation, the therapist will be able to recommend either individual or couple therapy.

Does it mean our relationship is over if we need couple therapy?

No. Some people fear that seeking help is a sign of failure. This is unfortunate because it is best to go for help early before the problems become too great. The outcome depends on many factors. Two of the most important are how much you and your partner want to work on your problems, and how important the relationship is to both of you.

Is couple therapy always successful?

The answer to this question depends on how you define success and

If I need help does that mean Im crazy?

Seeking help for your personal or relationship problems does not mean that you have a mental illness. Instead, seeking help is an appropriate and mature means of dealing with issues that, if left unresolved, could lead to considerable distress and possibly the breakdown of the relationship.

your reasons for engaging in therapy. The decision to either separate or stay together may be seen as a successful outcome depending on the couple and the situation. In couple therapy you may come to understand yourself and your partner better and decide whether or not you are able to make changes to better your relationship. In many cases, your understanding of yourself and your partner may change the way you feel about the issues that led you to seek therapy. This understanding may lead to greater acceptance of the relationship as it is. Generally speaking, motivation to change is required on the part of both partners to improve a relationship. If a relationship cannot be changed to meet the needs of both partners, couple therapy might still

What can I do if my partner refuses to seek help?

Discuss the issue with your partner even if he or she has refused to participate in couple therapy in the past. People are sometimes reluctant because

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help the couple end the relationship in a way that is not destructive to them or their children.

Everyone has some feelings that are deeply personal and many people have experienced events or circumstances in their lives that they are not comfortable in discussing. Successful couple therapy, and a successful relationship itself, does not necessarily require that you surrender your privacy. Some things about you may not affect the relationship signicantly. However, other factors, which you may consider very private, may block progress in therapy if they are not discussed. Again, you need to exercise discretion and carefully evaluate the signicance of the issue for the relationship, the reasons you are reluctant to talk about it, and your reasons for feeling it should be discussed.

Will the therapist understand my values?

Therapists are trained to respect the values of others and not to impose their own values or to be judgmental in their work. However, the issues that arise in couple therapy are complex ones, and it is possible that the therapist might at some point not understand what a certain issue means to you. It is also possible that certain values or issues might require working out between yourselves and your therapist, as is true of all relationships. Finally, you might experience a therapists comment as judgmental when that is not the therapists intent at all. Any of these situations should be addressed with the therapist as they arise.

What if the therapist thinks our relationship is over?

A therapist cannot make this decision. It is up to you and your partner to

Do I have to disclose everything about myself? If I dont, will therapy be benecial?

One of the most important ways in which couple therapy helps people is by enhancing their understanding of themselves and their partner. For this reason it is important to be honest about your feelings and the issues that are signicant to you. Nevertheless, there can be risks involved in revealing what has not been expressed before. It may be very difcult to decide how to handle information that you believe may hurt your partner or the relationship but that you think is important to discuss. Your own discretion and comfort may help you decide when and how to introduce certain topics. The therapists involvement may also help alleviate any misunderstanding that might occur and support you and your partner in continuing to talk together despite the difculty.

decide whether or not you want to continue the relationship. However, it is part of the therapists job to identify an impasse when one exists. Again, this does not necessarily mean that therapy cannot proceed or that there is no hope for further change. Some impasses can be resolved, and this may lead to considerable gains.

Will the therapist think Im to blame or make me feel guilty?

No one person is entirely responsible for the problems in a relationship. You may feel guilty or singled out at some point in therapy. However, you might be surprised to nd that your partner feels the same way. This kind of experience can be part of the process and should be discussed with the therapist as it arises.

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FINDING A THERAPIST

associations for marriage and family therapy, such as The Ontario Association for Marriage and Family Therapy social work or outpatient psychiatric departments of most major hospitals family physicians religious or faith organizations or leaders employee assistance programs or employee health services community information centres.

Who does couple therapy?

Many social workers, psychiatrists and psychologists have professional training and specic expertise in couple therapy. Some members of the clergy, rabbis and family physicians are also trained in this area. Feel free to ask about the therapists qualications and experience. Associations such as the Ontario College of Certied Social Workers and the Ontario Association of Marriage and Family Therapists can conrm the professional qualications of the practitioner.

How do we know what type of therapist is best for us?

Trained and experienced therapists are able to understand and help peo-

There are many people who offer to help people with relationship problems but who have no special training to do so. It is best to see someone who has been specifically trained and is experienced in couple therapy.

ple regardless of whether they hold differing moral values, religious beliefs, or ideas about what makes a relationship good. If you have very strong preferences regarding the type of therapist you want to see, you should pursue those preferences. However, not all communities will necessarily have a therapist who is both a skilled couple therapist and meets your criteria.

How do we nd a therapist?
You may nd a couple therapist in the same manner that you might nd a doctor or a lawyer, namely through family and friends. If they cannot help or if you do not wish to conde in them, you can contact any of the following individuals or agencies either for couple therapy or for a referral to someone who does couple therapy: social service agencies such as family service associations, mental health associations and in some communities, the Childrens Aid Society

Can we try different therapists until we nd one we like?

While it is helpful to feel some degree of t with a therapist, it is also important to give the therapist a reasonable opportunity to help.The process itself may be painful; it is important to distinguish between discomfort with the therapist and discomfort generated by the issues being discussed, or the process of seeking help itself. If you are not comfortable with a therapist you are seeing, it is best to discuss this with the therapist.

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Weve had a bad experience with a couple therapist. How do we know if another one would be any good?
There are a number of possible reasons for a bad therapeutic experience. The timing may not have been right for you or your partner to tackle your problems. Alternatively, you, your partner or both of you may not have been comfortable with the therapist or his or her approach. It is useful to be as clear as possible about what the problem was with your former therapist and to discuss this with a new therapist at the outset. It is well worth thinking about this carefully and discussing it with your partner, if possible, before seeking a new therapist.

SOME PRACTICAL QUESTIONS

How long does couple therapy take?

The length of time varies depending on the way the therapist works and the nature of the problem. Couple therapy may take from one or two sessions to months or even years. This can be discussed with the therapist.

Will my partner and I be seen separately or together?

Some therapists prefer to see each person separately as part of the initial assessment and then see the couple together on future occasions. Others prefer to see the couple together from the beginning. Still others use a combination of these formats during the therapy.

Can the information that I reveal in therapy be used against me in legal proceedings?
Like most other helping professionals, couple therapists can be subpoenaed to give evidence in court under certain circumstances. However, this rarely happens. Generally speaking, information disclosed in therapy is condential, but there are exceptions. If you have any questions or concerns about this, discuss them with your therapist

How much will it cost?

Costs vary depending on whether your therapist is in private practice or works for a social agency or hospital. Sometimes couple therapy is covered

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in whole or in part by the provincial or medical health insurance plans, employee assistance programs or private insurance programs. While some social service agencies have a sliding fee scale based on nancial circumstances, professionals in private practice set their own fees. Costs should be discussed at the outset.

ABOUT SEPARATION

Should we stay together for the sake of the children?

There is no easy answer to this difcult question. Each couple must make

Is therapy always during business hours?

Not always. Some agencies and therapists schedule appointments outside normal business hours. a decision that is right for them and their children. Even if problems are not discussed with or in front of them, children know when their parents are not happy with each other, and they may suffer as a result. Separation also greatly affects children. Couples must weigh the emotional costs of staying together against those of separation.

What if I want us to stay together and my partner wants to leave?

If you can resolve some of your problems, your partner may not feel as hopeless about the relationship and may decide to stay and work at it. However, you cannot keep someone in a relationship who is determined to leave.

Weve already decided to separate. Can couple therapy help us?

If you have made the decision to separate there may be some issues you still need to resolve and decisions you need to make. Therapy could help you come to terms with these decisions. Some common issues facing people who decide to separate include:

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 Who will have custody of the children? How will family react? What will happen with our friends? How will I/we manage nancially? How will we divide our possessions? What will it mean to be a single parent, to live on my own? How do I deal with my feelings of anger, loneliness, failure?

Where can we nd more information about marriage, common-law or same-sex relationships, and the different problems each may experience?
Popular magazines frequently publish articles on marriage and marital problems. The self-help and psychology sections of bookstores and libraries often have a variety of books on these topics. Many religious or community organizations have material as well. The quality of this material and its applicability to your specic relationship will vary. You should look for material that is relevant to you and your own situation. The best way to use these materials is to further understand yourself, your partner, and how the problems in your relationship developed; it is not helpful to use this information as a source of ammunition with which to blame your partner.

Will the therapist continue to see me if my partner and I separate?

If you separate it may be helpful for either or both of you to engage in individual therapy. Some therapists, after having seen a couple together, will not see either of them individually, but instead will refer them to other professionals for individual therapy. However, under certain circumstances, therapists may continue to see one or both partners on an individual basis.

What is mediation counselling?

This is a specic kind of counselling for couples who have decided to separate and require help in resolving issues such as custody of children, visitation rights, division of property and assets. The aim of mediation counselling is to avoid painful confrontation and to resolve conicts fairly, without bitter legal struggles. Mediation counselling may be available through the Family Court system. Some family agencies and private practitioners also offer this specialized service. Mediation counselling aids in solving problems and making decisions. Couple therapy will address these issues, but it will also help the couple look more deeply at the meanings and feelings underneath the conicts.

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APPENDIX
Examples of ve couples who sought couple therapy
Mr. and Mrs. A.
Mr. and Mrs. A came to couple therapy complaining of frequent arguments. They were both in their mid-20s and had been married two years. They met at their place of work, where she was a secretary and he was an accountant. They had hopes of one day buying a house and having a family. After a year of marriage they agreed that, to achieve these goals, Mr. A. would quit work to continue his education while Mrs. A. continued to work to support them.

was worried about not doing well in his courses. He was older than his classmates, who were unmarried and without family responsibilities. He often found himself torn between going out with classmates to relax and going home to be with his wife. Since being with his wife increasingly led to arguments, he began to go out with friends more often. When Mr. and Mrs. A. were seen in therapy sessions they were each given the chance to air their frustrations. It became clear that each was under pressure: Mrs. A. felt pressured being the sole breadwinner and handling the household responsibilities on her own; Mr. A. worried that he might not succeed at school, particularly since the couples future rested on his achievement there. Both were so emotionally caught up in their own feelings they had not realized their partner was also under stress. As they listened to each other they were more able to give each other emo-

When they came for therapy Mrs. A. was very resentful that her husband often went out for a couple of drinks with his friends after class and arrived home late for dinner. Mrs. A. was budgeting her salary carefully in order to pay all the bills. In fact, she had started taking her lunch to work to save money and was angry that her husband was spending money having fun while she was scrimping. It also annoyed her that on weekends her husband said he had to study while she was left to do the household chores on her own. She thought he was taking advantage of her. When she told him this, she found that it did not change the situation. Mr. A. felt that his wife was nagging him and said he often didnt feel like going home after his classes. He had worked ve years before returning to school, was used to being nancially independent, and resented having to ask his wife for pocket money or for her approval of how to spend it. Also, he was nding it hard to get into the habit of studying again and

tional support. It was pointed out that in reality they were experiencing many pressures but they could learn to handle them differently. They talked about their original attraction to each other and found that these positive feelings remained. They were encouraged to build on these feelings and to make some time to spend together regularly in some enjoyable activity. They found that in doing this they were able to have something to look forward to, which helped make the stressful times more tolerable.

Ms. G. and Mr. M.

Ms. G. And Mr. M. went to a therapist because they felt stuck trying to resolve a recurring problem in their relationship. Ms. G., 29, was doing well in an entry position in a professional career she had chosen and for which she had trained. Mr. M., 28, worked at a technical job, which he liked but did not regard as his ultimate career. They had known each other ve years

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and had been seriously involved for three years. They had similar interests, values, and ways of looking at the world. The time they spent together was fun and stimulating they enjoyed each others intelligence and sense of humour, and they could talk for hours about anything from personal thoughts, feelings and tastes to world affairs. Both felt they had a very loving relationship that they hoped would last. However, from time to time, Mr. M. would begin to feel crowded and irritable. The couple had lived together several times, and each time these feelings came up for Mr. M., he had temporarily moved back to his mothers house. This was devastating for Ms. G., as Mr. M.s change of feelings had no obvious cause in the moment. Mr. M. was aware that his changed feelings hurt Ms. G. and he felt very bad about this. Both felt helpless to address the problem because they did not know what caused it. The therapist explored what was going on at the times when Mr. M.s feelings changed. The couple said that the changes seemed to follow a period in which things were good between them and there were no problems. Despite this, Mr. M. would begin to wonder whether the relationship was right for him, and to think about having his own place and traveling on his own. He was also conscious of not having a career direction, and felt guilty that he had not been able to pull his weight nancially in the relationship. Ms. G. said that when Mr. M. backed off, she tended to push him to decide one way or the other. It made her sad when she pushed him, as she knew it hurt him. When they met, the couple had been instantly attracted to each other on many levels and had spent a lot of time together over a short period. At that time, Mr. M. was scheduled to leave very soon for an out-of-town job, which he had worked toward for some time. When he left, they parted

company, thinking that they might never see each other again. However, Mr. M. kept in touch with Ms. G., which surprised and pleased her. He then became ill, was unable to continue his job and returned to the city for treatment that continued on and off for several years. The couple quickly resumed their relationship. Mr. M. recovered, but he had lost his job opportunity, and this turned into a career setback for him. Mr. M. grew up as an only child. His mother had been ill throughout his childhood, but he felt she had done her best to raise him well as a single parent. Mr. M.s father was an alcoholic who had left the family when Mr. M. was very young and had never provided support. Mr. M. felt grateful toward his mother and also felt protective of her. While he knew that his childhood had not always been easy, he did not resent his mother. He was very clear in his praise for her hard work, caring, and the limits she had set for him. Ms. G. was an only child who became independent at an early age. By her mid teens, she had a full-time job, and lived on her own. Her father was a rigid, critical man with a severe temper. Her parents argued a lot, and nally separated when she was 10 years old. A few years after the separation, Ms. G. became angry and rebellious toward her mother. They argued a lot before Ms. G. moved out on her own. Ms. G. had felt at the time that her mother was intrusive and controlling. Their relationship improved considerably after she moved out, and her mother had helped her while Ms. G. educated herself. In couple therapy Ms. G. and Mr. M. began to understand the causes of their difculties. Mr. M., although he was a loving, considerate man who was mature for his age, had an unconscious anxiety about his capacity as a man, husband and father, because of his own fathers problems and

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abandonment of his family. Mr. M. had been protective of his mother as a child, but this meant that he missed out on some aspects of being a kid. Rather than express his negative feelings about what he missed out on as a child, Mr. M. had repressed his feelings. In his relationship with Ms. G., he repeated this pattern, being loving and protective towards her but unable to recognize and express certain needs of his own. Periodically, his repressed feelings would erupt into anxiety, irritability and an urge to leave. Ms. G. realized that, while she had always enjoyed being independent and strong, she had been unaware of a side of herself that was dependent and vulnerable. This hidden side came out during her relationship with Mr. M., because of the level of love and trust she felt for him. His turning away from her was devastating because she had opened herself to him so fully. Recognizing these dynamics helped the couple to pinpoint ways in which they could identify and talk about their hidden feelings, rather than act them out. After a short time in couple therapy they decided that they could work on this together without the therapist, and agreed that they would return if they found they were stuck again.

home town. Excited about their future, they settled in the suburbs of the new city. Mrs. B. was not interested in pursuing a career and stayed home to look after their child. Two more children followed quickly. Her husband, who held a junior position in a large corporation, was often away on business trips and courses. His hard work paid off and he was steadily promoted until he reached a management position. His job became a source of increased satisfaction to him. The demands of his career also increased. When Mr. and Mrs. B. were seen in therapy sessions, Mr. B. was frustrated that his wife was not able to understand the demands of his job. It was important to him that his wife entertain his business associates and accompany him to out-of-town conferences. She did accompany him to his business-related social functions, but it was clear that she did not enjoy doing so. Having stopped her formal education when she married, she felt uncomfortable with her husbands colleagues and their spouses. She felt that they were far more knowledgeable and articulate than she. Also, she was not interested in becoming more active in her husbands world. She was far more focused on raising their children and running their household. When Mr. and Mrs. B. were given the opportunity to express their own viewpoints, they saw that they had grown in different directions and now had distinct differences in their preferred lifestyles, interests and goals. They saw that they shared a common interest in their children. They agreed that their sexual relationship had been a strong point in their marriage from the start. Mr. and Mrs. B., however, faced a major dilemma: knowing the differences between them they each had to decide if they had enough in common for the marriage to be satisfying. While therapy helped them identify this dilemma, they struggled over time to reach a decision to continue their marriage accepting its limitations, but also recognizing its strong points.

Mr. and Mrs. B.

Mr. B. called requesting help for himself and his wife. He was 44; she was 39. They had been married 16 years and had three children. The couple met as adolescents in a small town where they both grew up. He was a friend of her older brother and so was around her house a lot. She was very pretty, wasnt particularly interested in school and looked up to her future husband. Though shy, he did extremely well in school. Soon after they married, Mrs. B. found she was pregnant. The couple were delighted. At this time, Mr. B. accepted a job in a city quite distant from their

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Mr. L. and Mr. A.

Mr. L. and Mr. A. made an appointment with their family doctor to discuss a crisis in their relationship. Mr. L. was in his 40s and was a successful businessman. Mr. A. was in his early 30s and had a successful sales job. Although Mr. A. enjoyed sales, he also had artistic interests, and was unsure of his long term career plans. They had been together 10 years and, apart from their current problem, felt that they had a good relationship. They shared an interest in arts and culture, a circle of friends, and an affectionate and considerate regard for each other. Although Mr. A.s family had been unsure of Mr. L. at rst, they had grown to like him, and the relationship was now accepted by both families. In the rst few years of the relationship, Mr. L. was, in some ways, a mentor to Mr. A., who respected his partners wisdom and stability. Mr. L. enjoyed Mr. A.s energetic, spontaneous, enthusiastic approach to life, and his outrageous and irreverent sense of humour. Over a period of months, things had gradually changed, as Mr. A. began to criticize and verbally reject Mr. L. Friends of the couple who saw these changes were both surprised and distressed, as Mr. A.s behaviour seemed both uncalled for and out of character. Mr. L. at rst tried to ignore his partners gibes, but they became more hurtful, more frequent and more intense over time. He tried to discuss this with Mr. A. Mr. A., however, felt justied in his anger. He thought that Mr. L. was trying to put him down or treat him as an inferior, even in situations that seemed quite neutral. Talking about it only seemed to make Mr. A. angrier, and Mr. L. could not make sense of Mr. A.s anger. They did agree there was a serious problem in their relationship, although each saw the others behaviour as the problem. It was at this point that they went to their doctor.

The doctor talked with the couple and it was clear to all of them that the problem needed further exploration. The doctor referred them to a therapist who was experienced in both couple and individual therapy. During the assessment the therapist learned that Mr. A., as an adolescent, had been comfortable as a heterosexual. Mr. A. ignored feelings toward other boys and men until he became involved with another man in his late teens. He had then decided that he was gay and entered into a gay lifestyle without exploring what it meant to him to give up the life he had been living before. When he met Mr. L. their relationship developed well, but unconsciously Mr. A. still had strong mixed feelings toward his rst homosexual partner. He associated his rst partner with the shift in his orientation and his change in lifestyle. His feelings of anger toward Mr. L. were, in fact, displaced feelings toward his rst homosexual partner. When the couple identied and discussed this dynamic, they were better able to deal with the problem in their relationship. Mr. A. was able to see that his anger had little to do with Mr. L., and to acknowledge distress he had caused his partner. Mr. L. felt relieved that the issue had been addressed and that the relationship no longer seemed in danger. The therapist recommended that Mr. A. seek therapy on his own to deal with his personal issues.

Mr. and Mrs. J.

Mr. and Mrs. J. sought help when they recognized that their arguments were getting out of control, affecting how much support they gave to each other and also affecting how they dealt with issues relating to Mr. J.s son from a previous marriage.

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Mr. and Mrs. J. were both 26 years old and had been married for eight months after an 18-month courtship. Mr. J. was drawn to his wife by her looks, intelligence and his belief that she was a very moral person. Mrs. J. found her husband to be both attractive and a good person, who was unusually concerned and thoughtful toward others. They also felt compatible with each others values, interests and activities. A major focus of conict between them was Mr. J.s young son. When the couple met, the sons mother was minimally involved and Mr. J. had sole custody. At rst, Mrs. J. was not comfortable with the little boy. She saw the boy as overly demanding and a rival for Mr. J.s affection and attention. Over time, Mrs. J. grew to love the little boy. The stability of the relationship was then greatly upset after the couple married, when the little boys mother sought joint custody. This led to a long and painful court proceeding, which Mrs. J. felt did not consider her own connection with the little boy. The joint custody arrangement was granted, throwing the couple into ongoing contact with the little boys mother. Both were very angry at this and felt that the childs mother had all the power. Mr. J. felt caught. His wifes angry demand was that he take a strong stand with the childs mother, but he did not want to make waves, which he felt could hurt his son. The couple were quite upset and, to an extent, blamed each other. However, they also had begun to talk together. They realized that the considerable stresses they had been through had caused them to turn anger and frustration stemming from other sources onto each other. Their relatively new relationship had been through constant stress. This stress made them unable to work out issues which are usually negotiated in the early phase of marriage. They were highly motivated to make their relationship work,

and despite all the contrary feelings, they did not doubt their basic caring for each other. The couple were seen together in couple therapy, where a pattern was identied in which Mrs. J. would get extremely angry and emotional, while her husband would remain silent, waiting for his wife to cool down. In actual fact, her feelings would intensify when he waited, because when he did not respond, she thought it was because of his lack of caring about the intense distress which lay beneath her furious front. The couple were helped to identify this pattern and the consequences it created in the relationship. This enabled them to begin to discuss even the most emotionally loaded topics without blowing up, and with acknowledgment of each others feelings. Although they sometimes fell back into the old pattern, they felt able to get back on track much sooner and with less damage to the relationship. They also felt more effective, both individually and as a couple, in negotiation with the childs mother and with respect to related child-rearing issues. When they were seen for a follow-up appointment they felt that these gains had been maintained. They also felt that they had beneted from the chance to work on these issues in therapy.

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SUGGESTED READINGS
Books for the public
Coleman, Paul. (1994). Getting to the Heart of the Matter: How to Resolve Ongoing Conict in Your Marriage Once and For All. Holbrook, Massachusetts: Bob Adams Inc. Wile, Daniel B. (1988). After the Honeymoon: How Conict Can Improve Your Relationship. New York: John Wiley & Sons.

Books and articles for professionals

Carter, Betty & McGoldrick, Monica (Eds.). (1988). The Changing Family Life Cycle: A Framework For Family Therapy. New York: Gardner Press. 2nd edition. Guttmann, H. (1982). Transference and countertransference in conjoint couple therapy: Therapeutic and theoretical implications. Canadian Journal of Psychiatry, 27.2, 92-97. Jacobson, N. S., Gurman, A. S. (Eds.). (1995). Clinical Handbook of Couple Therapy, Second Edition. New York-London: Guilford Press. Karpel, Mark A. (1994). Evaluating Couples: A Handbook for Practitioners. New York: W. W. Norton. Siegel, Judith. (1992). Repairing Intimacy: An Object Relations Approach to Couple Therapy. Northvale, New Jersey: Jason Aronson.

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A Pan American Health Organization / World Health Organization Collaborating Centre

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cOUPLE THERAPY
an Information Guide

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