Couples face challenges but long for love, security

Healthy marriages are good for everyone involved – the couple, of course, but also the rest of the family, the community, colleagues… everyone benefits. But, with a reported 50% of marriages ending in divorce, the on-going need for couples therapists seems like a niche that will never be fully filled.

Just in time for Valentine’s Day, New England Psychologist’s Catherine Robertson Souter had a chat with Robert L. Miller, Ph.D, a clinical psychologist with a practice in Cambridge and Stoneham, Massachusetts about his work with couples and how it has changed over the past several decades.

A supervisor in the Couple and Family Therapy Program at Harvard Medical School and co-instructor of the Couple and Family Therapy seminar for Psychiatry Residents, Miller is also a certified Gottman Method therapist, employing a research-based couples therapy approach that has been growing in popularity.

You have been providing couples therapy for more than 35 years. Are the concerns that couples bring to you any different now than when you first began?

Although couples’ stated concerns have changed some over the years, the underlying central issue has not; couples want a secure and loving relationship.

They argue about the nature of their relationship, about the process rather than the content. Can I trust you to be there for me emotionally and behaviorally when I’m in need? Will you be attuned and responsive? Will you not lie or cheat, dismiss my feelings or insult me?

I do see more couples concerned with emotional intimacy, growth, and fulfillment in their relationship. They’re more likely to say “I feel distant and lonely, I want a deeper and more meaningful connection.”

They are busier so they have less time and psychological and physical energy to devote to nurturing their relationship.

Has technology made it more difficult for people?

The presence of electronic devices and social media has made it harder for couples to carve out time together to be fully present without distraction in order to achieve this intimacy, so I also try to help them find practical ways to do this.

I’m also seeing more diversity in couples—differences in race, ethnicity, religion, preferences around monogamy, more same sex couples.

Although this diversity can be mutually enriching, it also brings challenges as it may be difficult for them to understand each other and negotiate their differing needs. But how they fight and the quality of their interaction is still far more important than the content of what they fight about.

One of my key goals is for them to learn to be more curious about each other’s concerns and inner lives, and to understand what is really at stake so that when they argue, their fights actually deepen the connection and intimacy.

What are the most important skills that a marriage counselor needs to provide good therapy?

The skills needed to be an effective couples therapist are in many ways different from those of the individual therapist.

Individual therapists who are good at empathizing and joining can run into problems when they empathize with one of the members of the couple and the other person feels that the therapist is siding with the enemy.

Therefore, a couples therapist needs to be empathetic but at the same time, carefully assess how that empathy may be perceived by the other person.

A couples therapist needs to be skilled at maintaining control of sessions and managing rapid escalations in the room.

The therapist also needs to be comfortable with intense emotion so that he or she can regulate it and use key emotional moments to help the couple engage with each other in a deeper and more positive way.

Like diplomats and mediators, the therapist needs to be good at helping couples to negotiate and find solutions to their problems.

A therapist who is too timid or passive will lose control of the session and the couple will destructively repeat the same dysfunctional dynamics they struggle with at home.

What advice do you have for counselors, tricks of the trade, so to speak?

I would suggest that therapists assign practical homework to couples using specific structures and handouts. An example is a “conflict blueprint” which helps develop skills to become more empathetic and attuned to each other.

They take turns talking about their own feelings and needs, the partner uses active listening to reflect back and validate what they hear, and they delay looking for solutions until they really understand each other.

Other advice pertains to the challenge in working with couples in which one person is emotionally attuning and their partner is more emotionally dismissing or action-oriented.

She says “I just want to express my feelings, I don’t want advice or problem solving.” He says, “You’re too emotional, I just want us to be rational and logical and find solutions.” If the therapist says, “you need to talk about and express your feelings,” the more action-oriented person can feel the therapist is siding with their partner. The therapist can honor both perspectives with both an emotion focus and an action focus in therapy.

How did you decide to follow this career path yourself?

I had some early disappointments in my own romantic relationships, so I got interested in relationship research and clinical work in part to figure out what I was doing wrong and how I could have better relationships.

What I was doing in individual therapy to help people improve their relationships often did not seem very effective, so I was drawn to the more active and directive role of the couples therapist.

I tended to be more the pursuer of connection in my own personal relationships—I was verbal, proactive and sometimes critical and defensive.

As a result, as a therapist, It was a challenge to empathize enough with the more silent, passive, and withdrawn partner. I had to work on this bias and counter-transference issue to empathize and help the more silent partners express themselves and make their case better. This has helped me to be a better partner in my own relationship.

Can you talk about the Gottman Method?

It is an evidence-based approach, based on 40 years of research on what makes relationships succeed or fail. The research transcends models and approaches, and points to the common factors in effective couples therapy, so I think it is very useful to anyone who works with couples.

How does it work?

The Gottman approach helps couples develop the skills of successful couples, particularly gentle ways to manage conflict, de-escalate arguments, and repair when they get off track.

The research finds that two-thirds of conflicts even in the most successful relationships do not get resolved. Successful couples effectively manage these unresolvable conflicts and get to the heart of the matter and actually use their fights to deepen their connection. Once they do, it becomes much easier to find solutions.

Couples also learn to deepen their friendship, honor each other’s life dreams and create a sense of shared meaning together.

Does it work with all clients?

The Gottman approach is practical with its balance of emotion focus and action focus which is appealing to many guys who are wary of therapy or exploring emotions.

It is particularly useful for high conflict couples when there are rapidly escalating arguments with lots of criticism, contempt, defensiveness and stonewalling (what Gottman calls “the Four Horsemen of the Apocalypse”).

Many couples need to explore deep attachment injuries and individual enduring vulnerabilities, so I integrate the Gottman method with other approaches such as Emotion Focused Therapy (EFT) and exploratory psychodynamic approaches.

Any other messages you think are important to impart to therapists about your work and about working with couples?

If you are doing good work, there will be a lot of emotion in the room, and sometimes the couple and you will feel overwhelmed.

Good self-care — both outside and in sessions—is crucial. We need to monitor our own feelings in sessions, slow down, notice what’s happening inside us, calm ourselves, sort through our own feelings and countertransference reactions and biases so we can be in control of sessions and appropriately empathetic, balanced, and helpful.