When couples therapy is doomed to fail

When we talk about couples therapy, we usually assume people go to improve whatever needs improving and so avoid a break-up. And yes, that’s true, but not always, and certainly not at any price. In recent weeks I’ve had a couple of cases in which doing couples therapy would have been, from my point of view, a nosedive, as well as what I would have considered unethical practice on my part, given my firm conviction that it wasn’t going to achieve anything. And at this point you may be thinking: “Come on, Sara, how do you know the therapy wouldn’t have worked? How can you be so sure? That’s your opinion, but you could be wrong”. True, I could be, but I can’t carry out a therapy I don’t believe in; it would be sabotaging it from the start. Any patient has the right to disagree with the professional and, if so, to try someone else. That wasn’t the case with these patients.

When is couples therapy guaranteed not to work?

When one member of the couple is willing to come to therapy only to please the other, because they think the other person is responsible for everything that isn’t working. Basically: “I’m here so you can help my partner fix their problems”. It’s rare for a couple to come to therapy with only one of them being solely responsible for the conflicts. When one of the two comes in blaming the other for everything, in the first sessions we try to show the factors that cause and maintain the problems and how both of them play a part in them (after the sessions devoted to an initial assessment of the situation). If the person in question still won’t accept their share of responsibility, or at least be open to considering it, there’s little more to be done… if we carry on with therapy, all we’ll achieve is more conflict and frustration. The first step towards having a chance is acknowledging my share of responsibility for the situation.

Sometimes only one of them even comes to the first appointment and asks for couples therapy, “but my boyfriend/girlfriend/husband/wife won’t come even if I drag them, because they think I’m the one who needs it”. Asking for couples therapy in these cases is like wanting to fix a vase broken in two when you only have one of the pieces. It can’t be done. We need both pieces of the vase to have a chance. And then we’ll see whether we can eventually put it back together. In these cases I always reply that we can work in individual therapy, but not couples therapy, which means setting individual goals that depend solely on the patient, without expecting that success in them will guarantee changes in their partner.

Another situation in which couples therapy becomes unworkable is when the two people are at different stages. That is, when one of them has already moved on and is waiting, either for a moment of courage to say they don’t want to continue, or simply letting time pass until circumstances arise that they consider more favourable for taking the step (the children being older, the other person falling out of love, a big fight that serves as an excuse… as many situations as there are people in this world).

This time we have the broken vase and, yes, we have all the pieces, but we don’t have the right glue to try to restore it.

The worst thing isn’t having moved on and not saying so, but going to couples therapy in those circumstances. In these cases the therapist is put in quite a compromising position if they know (personally, I’ve come across few situations like this, but there have been one or two). How do you start couples therapy knowing that one of them is waiting for the break-up while the other has no idea and has genuinely come to fix things? The situation is complicated because, if the psychologist says something, they betray one of them, and if they start therapy, it would be like deceiving the other, who has come ready to commit 100%. One option is to tell them they don’t seem ready to start therapy and that it would be advisable for them to talk about certain issues in private before deciding to take the step (which is tricky because the one who doesn’t know the truth will, naturally, ask). It’s a different matter if the person who has moved on does want to say so but doesn’t know how, and wants to use the session so the professional can act as an intermediary. I have to admit I don’t like these situations at all; I can assure you it’s not at all pleasant to watch the other person receive the news unexpectedly when they came hoping to start therapy and save their marriage. As a therapist, keeping emotional distance in certain situations can be quite hard.

When can couples therapy succeed?

When there is sincere motivation on both sides to give it a try, and that motivation translates into real commitment to the therapy. Starting with each of them taking responsibility for their part in the situation, and continuing by working as much as possible, and consistently, so that the desired changes happen. The vase is broken, but we have all the pieces, good-quality glue and the hands that will restore it: we have a chance.