As of Thursday, March 28, 2013
DEAR DOCTOR K: My husband and I have been happily married, more or less, for 25 years. But lately we’re fighting more. A friend suggested couples therapy. Can you tell me more about it?
DEAR READER: I don’t feel as comfortable answering questions about relationships as more traditionally “medical” problems. I’m not Dr. Phil or Dr. Ruth. That said, here are my thoughts.
With age, things often become ripe, but they can also turn stale. That’s true of any long-standing relationship, starting with marriage. Challenges to one person’s life — such as a job crisis — can bring out that person’s worst, causing pain to the person’s partner. When either partner is facing challenges, that person needs more support and attention than usual and may become irritable if the support is not there. Also, when the needed support is not there from a spouse, sometimes other companions fill the void. Preserving a marriage can be hard work, and I think that’s true for most people.
When most people think about psychotherapy, they think about one-on-one therapy — one person with a psychotherapist. Such therapy can be very helpful; it can help you think about issues in new ways and suggest productive remedies. But couples therapy has the advantage of focusing directly on the relationship. With both partners present, a neutral therapist asks questions, teaches new skills, and provides reassurance, guidance and support.
When both you and your spouse work together with a therapist, it avoids the implication that only one person in the relationship has a “problem.” Equally important, it says that the problem you jointly have can be solved by the two of you working together.
A couples therapist can help you examine a current or ongoing issue and decide what changes you might need to make. She or he will help you eliminate misunderstandings, unreasonable expectations and mistaken assumptions.
A good couples therapist will take an active role. Let’s say you and your partner are getting sidetracked or your exchanges are turning into angry outbursts. The therapist will interrupt, comment, and help you find a more positive tone or focus. However, the therapist shouldn’t dictate what you should do, or act as a judge in disputes.
If you decide to try couples therapy, it’s important to see someone with expertise. Therapists who treat couples require specific skills and training. Whether a therapist is a psychiatrist, psychologist, social worker or licensed marriage and family therapist matters less than couple-specific training and experience. To find someone in your area, check the website of the American Association for Marriage and Family Therapy (aamft.org).
Before you commit to a therapist, request a trial session. This will give you a sense of whether the therapist’s working style is comfortable for both you and your partner.
Finally, don’t wait until your problems become severe to consider couples therapy. The sooner you take action, the easier it may be to work through your issues.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.