After many years of being a psychotherapist, specializing primarily in sexuality and relationships, it has become more and more clear that some of the most powerful changes I’ve observed have occurred in the context of couples therapy. Certainly many forms of therapy are helpful, but I think there are a few specific reasons why couples (or any kind of relationship) therapy seems most powerful.

First and foremost, being in a healthy relationship forces people to change. Psychologist David Schnarch called relationships a “crucible” for this very reason– they act as an intense pressure cooker on individuals within the system. Because of this, couples therapy has certain advantages over individual therapy. Individuals that want to make a relationship work must learn to empathize, collaborate, and compromise with others, something that does not come easily for many. These flaws are more readily disguised in individual therapy since I may only see the person one time a week for 45 min and these kinds of situations obviously do not as commonly arise as they do in relationships where people see each other all the time. Couples therapy imposes a demand on individuals to change in order to have a more successful relationship, or else choose to move on and terminate the relationship. Such demands for change are not as evident in individual therapy.

Along these lines, within the context of couples therapy, I can receive more than one input of information. In individual therapy, people often present their single perspective, which is often biased (why wouldn’t it be), so as a therapist, I am working with limited information. I have no idea how other people relate to this person, how they experience them, or how much they may or may not agree with the individual’s perspective. I can only go by the intersubjective feelings that come up in the room between us to try to formulate a conception of how this person interacts with others. In couple’s treatment, all of these issues are presented out in the open for everyone to see. I can readily see the cognitive distortions, over-reactivity, and toxic misunderstandings front and center, which allows me to make more informed and precise interventions.

Despite couples therapy being such a potentially rich experience, I know that a lot of therapists shy away from this kind of work. It’s a lot more explosive so it requires a different kind of skill set. A Rogerian approach of kindly asking questions and demonstrating genuine interest won’t fly in a couple’s setting when people’s emotions are ramping up and they are about to blow up right in front of you. It’s much more directive and requires a far more assertive approach. At the same time, no other therapy is as rewarding as it allows me to see specific, concrete behavioral changes in real time, which is immensely rewarding.

I’m often asked if there’s a difference between sex therapy and relationship therapy, and the truth is that I don’t really believe someone can be a skilled sex therapist without also extensive training in couples therapy. I have written more about this here. That’s because sexuality usually occurs within the context of relationships and most intimate relationships involve the experience of sex, so how can the two be separated. Indeed, people who are single often have slower progress because they don’t have a practice partner. And there are some aspects of sexuality that can only be resolved within the context of a relationship. Likewise, there are some relationships which will never improve unless the sex gets better, especially if resentment has set in because one or both partners has felt sexually rejected. Open relationships are certainly an option, but they don’t work for everyone, and in some cases opening up the relationship may definitely provide more variety and an outlet, but it doesn’t resolve underlying feelings of abandonment and rejection.

I follow a couples therapy model developed by Ellen Bader and Pete Pearson called the couples developmental model. What’s especially fascinating about this approach is that it envisions the evolution of a relationship in similar ways as the growth and development of a child. Initially, in the honeymoon stage of the relationship, individuals are symbiotic, they are attached at the hip and feel united as one, much like a young child and its mother. Eventually, though, individuals begin to assert their differences, which brings up a kind of alienation, mirroring the move towards independence of the child. This is a very crucial stage and is predictive of how the rest of the relationship will unfold. In this stage, people must not only learn to accept each other’s differences but also give up their attachment to the perfect partner, the “mythical mate” which they have constructed in their own mind. Many relationships are stuck in this stage, they are clinging to symbiosis and cannot accept differentiation. Sometimes individuals jump a stage and go right to a stage called “practicing,” where they are no longer even trying to get their partner to accept differences but have just decided to do their own thing. I’ve written much more extensively on this topic here and here.

The point is that evolving within one’s relationship also allows for self-improvement and self-development. By being more differentiated within a relationship, we also become more differentiated people. Psychologist Harville Hendrix developed a theory called Imago in which he postulated that individuals pick out their partners based on an unconscious attempt to resolve childhood wounds. I’m not sure there is any way to prove this in a laboratory setting, but my experiences certainly show me that some of the most powerful growth occurs within relationships and within couples therapy.

To this effect, I have several programs I offer for interested couples. Besides regular weekly or biweekly couples therapy, I offer intensives, particularly for those who are coming from out of town or those who want to jump-start progress in a compressed time frame. These are more structured day or weekend-long events that involve both individual and couples therapy, homework and role play. Sometimes I have couples mix and match and do both. In the end, I have found this type of work to be some of the most gratifying work I do.