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  • Writer's pictureMaire Daugharty, MD MS

Find me for Couples Counseling

Updated: May 1

Couple arm in arm

Situations triggering a call for assistance with couples counseling are generally described as a need for improved communication, chronic conflict, lack of physical or emotional intimacy, or a desire to better understand impacts of past trauma. Therapeutic work can evolve into tackling more specific long-standing disappointments in emotional and physical intimacy with each other. Disconnection is often exacerbated incrementally by increased responsibility with children, aging parents, and cultural differences among other things. Learning how to disagree effectively, understanding emotional boundaries, and a refocus on prioritizing the relationship is some of the work engaged towards re-discovering or deepening intimacy. An ability and willingness to hear one's partner is a crucial skill often embroiled in a tacit view which must first be understood and then explored. While it is easy to talk about what this means cognitively, couples therapy is at its heart an experiential process. Being in the therapy room together (sometimes virtually) tackling your differences in real time with a thoughtful observing therapist is essential. And taking your process actively out into the week between sessions together helps movement towards durable change. Rekindling friendship, love, a sense of team work together, and intimacy and passion can be infinitely rewarding.

Some popular or well known approaches include Gottman therapy, a prescriptive approach where the therapist instructs the couple after an initial assessment, often giving homework between sessions. Emotionally focused therapy (EFT) is a highly focused approach really digging into a single aspect of your relationship. There are discernment counselors specifically engaged to help a couple decide if there is room for repair versus deciding to divorce. Additionally, eye movement desensitization and reprocessing (EMDR) has been accommodated to address couples counseling, particularly where there is trauma. And there are therapists who take a holistic view of the relationship, prizing agency, while serving as a guide in helping you to better understand each other. In this approach, unique points of conflict are explored for integration of relationship skills while harvesting authentic moments of intimacy which arise. A psychodynamic therapist seeks to deeply understand each partner's unique perspective in order to better elucidate points of volatility and unpack these road blocks to intimacy.

So, a psychodynamic approach looks comprehensively at what's happening and begins the work of deducing where misunderstanding, anger, and disappointment consistently arise. This is partly captured in EFT's concept of the maladaptive cycle in which our pattern-recognizing brain favors internal subjective assessment over external objective reality. But while EFT stays focused on emotion, a psychodynamic approach seeks to understand origins of the misunderstanding and the deeper meaning held in these intense feelings. This is rooted in the development of our central nervous system within the first few years of life and depends largely on our primary care givers, be they mother, father, uncle, grandparent, or other interested party. From them we learn what feelings are because we are not born knowing this. We learn to understand first the visceral signals of frustration, anger, then more nuanced wistfulness, longing, anguish, peace, tranquility, joy. We learn whether those we love tend towards trustworthiness, whether we are inherently lovable. We are tender and so vulnerable in our babyhood without the ability to recall specific events or interactions. And we carry these internal beliefs forged in preverbal experience applying them indiscriminately as the unwritten rules of relationship.

The tricky thing is, we are often not consciously aware of our own rules, it is like the air we breathe, which we rarely have occasion to mindfully consider. Referred to as our attachment system this acts like a reflex arc. And so when our pattern recognizing limbic brain is activated by a perceived threat or challenge, underlying rules of engagement are launched. This can leave our partner stunned and bewildered because they are not privy to the same set of rules. This looks like feeling righteous fury or indignation with no understanding for our partner's dismayed confusion. It is hard work halting in the middle of this to parse out what's actually happening (see below for a worksheet to test your own ability to do this). For one thing, anger wants out, and both parties want validation in their often diametrically opposed positions. How do such disparities arise?

We become attached to our initial caregivers, a biological process necessary for our survival. Whether we in general trust people or not, rely on others for help, caring and empathy, or not, is largely determined by this early relationship. When we cried in hunger as an infant did our caregiver show up to comfort us most of the time, or were we consistently ignored? Outcome of these interactions repeated over time forges an attachment that is described as secure or insecure. And if insecure it is further delineated as anxious, avoidant or disorganized. We recognize in couples therapy what role attachment styles play in drawing the individuals closer to each other or driving them further apart. Some goals include recognizing this, digging deeper into the associated feelings, and then exploring how feelings can be leveraged for connection rather than disappointment and hostility.

A psychodynamic approach teases out and examines these implicit expectations. Cognitive insight understands intellectually what is happening, and this is a first step. For example, when one partner asks why the dogs are in the yard, the other partner's brain might interpret an entirely different message (my father yelling at me for not walking the dog) based on early repeated interactions, and feel sudden overwhelming shame. Though it is actually an innocent question, the brain interprets far more than what is being communicated adding it's own nuanced layers of underlying emotion. An ability to make the connection between how I feel and why I feel that way versus what my partner meant can be a healing experience in and of itself.

Emotional insight develops in experiencing these moments differently after developing the skills to actually recognize when it's happening. This occurs both in the therapy room and between sessions in real time with your partner, and it has to be emotionally felt to transform expectation. It is precisely why arguing in the therapy room can be so helpful. It is one thing to understand that an expectation of disappointment or feelings of shame are stirred in stereotypical moments. It is another to begin to feel differently when such moments arise. This is when the brain begins to really sense that the person in front of you doesn't in fact follow patterns learned early. This is the emotional undertow that ultimately transforms into a smoother current. This is the artful blending of family of origin dynamics into an entirely new system, unique between partners, often an experience of tremendous intimacy as it evolves.

Attachment styles and implicitly determined expectations are not static. Because the brain is always evaluating and changing in the face of input, expectations are dynamic, and we take advantage of that in a therapeutic relationship, both for individuals and for couples. Because this is an experiential process it typically involves moments of intense emotion. While contemporary experience with feelings impacts our implicit expectation over time, it isn't the same as the brain in a pre-verbal developmental state. This is a unique period in which information is soaked in like a sponge with no ability to discern. This is what can make conflict in intimate relationships so confusing, and is also the nadir for growth and change.

There are additional challenges related to intimate relationships. Navigating the impact of addictions (see my next post), for example, or the impacts of ADHD in one or both partners, a discovered infidelity, all can tear relationships apart. But this isn't inevitable. All of these things can be overcome if each partner is committed to the relationship. Lastly, unanticipated life circumstances can derail even the strongest of relationships. Sometimes unexpected pregnancy, pregnancy loss, a sick child, job loss, illness or death in the family can tear at the foundation of a close relationship.

Couples' therapy prioritizes one of our most important and durable relationships. Whether it is identifying whether a relationship is salvageable or focusing on improving intimacy among the committed, counseling can help to mitigate and change ongoing destructive patterns. Learning relational skills and a deeper understanding for and connection with one's partner can be a gratifying investment in personal growth. Sometimes this work can alleviate conflict headed for divorce. I work with couples to assist in transforming relationships with an overarching goal of increased emotional and physical intimacy. If a couple determines divorce is inevitable then we can discuss referrals for assistance with this including navigating the process and effective co-parenting.

Curious about your own ability to repair your relationship after an argument? Take a look at this outlining some first steps:

Download PDF • 134KB

Determined that your relationship is over and need help navigating the challenges of divorce, mediation, and co-parenting?

Just need a jump start back into desire? Check out the widely popular (with good reason) Esther Perel

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