Robert Winer, M.D.

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Couple Therapy

Couples usually come for help when they’ve reached a crisis point in their relationship. Often the problems have been long-standing, but now matters have taken a turn for the worse. If both members of the couple want to try to work things out, treatment helps. It’s usually possible to restore the relationship to the level at which it was functioning before the crisis (the affair, the loss of the job, the death of a parent, and so forth) in reasonably short order, a few weeks to a few months. To create a shift in the couple’s underlying long-term dynamics is much harder, and may take months or even years of work. But if both partners are motivated to change the relationship, there are prospects that therapy will improve things.

But some couples come for treatment with one partner dragging the other in tow. Sometimes the reluctant partner can be successfully engaged, and the treatment moves forward. At other times, that person has simply come in an act of angry compliance, and having paid his or her dues by doing so, doesn’t return. And occasionally one partner is towing in a spouse just to shame the person, and neither party really wants a stranger’s help. Rarely, one partner has actually signed off on the relationship; I’ve never seen such a person change course. It doesn’t necessarily mean that the marriage is over – some people need to be in a relationship with a person they can despise. But on the rare occasions when I’ve encountered this (perhaps a half-dozen times in the five hundred or so couples I’ve seen over the years), being in couple therapy is pointless – and I’ve said this.

For the well-intentioned couple who I think I can help, my goal is to help each person understand why the partner thinks and feels the way he or she does, based on the partner’s own life experience. A few years ago, I presented my thinking about what makes marriage work to an audience, and this is what I said:

Here’s a modest proposal. When you find your spouse taking a truly outrageous position, try to imagine, using all that you know about him, how he got there. You don’t need to agree with your spouse’s point of view, you can even continue to think that it’s ridiculous. But if you can understand that, for example, his upbringing gave him good reason to be totally paranoid when confronted with the request you just made, you make him human in your mind.

And that goes a long way. Because in our fights we regularly dehumanize each other, make each other into a cardboard enemy, a stereotype. The most common complaint I hear from couples is “We don’t communicate.” But typically that isn’t true – they’ve been quite emphatic with each other. What the person actually means is: my partner doesn’t see it my way. I have met people who are deeply convinced that if their partner doesn’t agree with them, the partner just doesn’t understand the situation and needs to have it more clearly explained. And relentless explaining ensues. Actually, I don’t think that agreeing is all that important for having a workable marriage; it’s generally quite sufficient just to understand what the other is thinking and how he or she got there, even if how he or she got there involves major league distortions.

I discovered that the word “empathy” has two definitions in the dictionary. And they’re opposites. The first definition is “the imaginative projection of a subjective state into an object so that the object appears to be infused with it.” Put more simply, I imagine that you feel the way I would feel if I were in your shoes. I think that this is unfortunately what, in practice, people usually mean when they say in a situation, “I was very empathetic.” The other person, of course, doesn’t feel understood at all.

The second definition is “…vicariously experiencing the feelings, thoughts, and experience of another [without having it directly communicated].” In this definition I actually try to put myself in your shoes and imagine your experience. It’s the heart of what we do as therapists. And the mutual ability to be empathic in this sense is the single best criterion for a workable marriage. Being empathic doesn’t mean having the same point of view. Partners can disagree absolutely. What it means is having respect, taking the other seriously.

Couple therapy can also be quite useful in two other situations. Occasionally I’ve seen a couple who are contemplating either marriage or moving in to live together, who want to take stock of their situation before making a commitment. Meeting for a few sessions or a few months, they may be able to sort this out in a helpful way. And I’ve also seen couples who have decided to separate who want to find a way to work together to make the parting less acrimonious, or to help with planning for their children’s futures. Couple work can be vitally helpful in this regard.

In any event, a couple therapy is always a trial intervention. Some of the time individual work will be the best course for one or both partners to pursue, sometimes in concert with joint work and sometimes not. In the initial evaluation we try to sort out the question of which course of action offers the best prospects.

Most often couple therapy proceeds on a once-a-week basis, but some couples have found it useful to meet regularly for double sessions to have time enough to really have a chance to open up to each other. And I’ve occasionally seen couples more frequently, on one occasion actually meeting usefully three times a week for several years.