It makes sense to have a certain degree of worry or concern about going to couples therapy for the first time. It’s stepping into an unknown, taking a risk. There may be a concern that the therapist will take sides, acting as a judge. Some might worry about what happens if one of you thinks the therapist isn’t good, but the other thinks they’re terrific. You may have feelings about the gender of that therapist and wonder if they might side with the partner of their own gender. Others may worry about getting a ‘touchy-feely’ therapist that will want them to emote, whether they feel like it or not. Still, others might be skeptical about the whole thing, thinking that it won’t work.
All of these concerns are valid. Until you know who you’re in the room with, you can’t really know. You’re both trying something new. That said, a competent couples therapist will not take sides. A partial exception to this is in the case of an affair. It is imperative to acknowledge the wound of the hurt partner as a place to begin. In any case, there should be no blame or judgment. Instead, a good couple’s therapist will have a healthy respect for each of you and the difficulties that brought you there. You should feel respected for what you’re trying to do and the courage it takes to make this step. Often, each partner coming in is in their own world of distress -or pain. A trained couples therapist will see that distress and respond to it with empathy.
Some therapists may send you a questionnaire to fill out before you start, while others may not. In part, this may reflect the therapeutic modality, the type of therapy that the therapist tends to use. But don’t let the number of questions, or the lack of a written questionnaire, deter you.
Coming in, it may seem obvious to you what the problem is and what needs to change. But ask yourself: What causes me the most distress, the most anger, the most emotional pain in the relationship? What happens that causes me the most sadness or worry, to feel hopeless, to feel alone?
Each of you may have different answers. But whatever your answer is, it should at least be a part of the goal for therapy. You must and deserve to know that you are there to address what’s most important, front and center for you.
Does it get intense?
The answer to that is yes and no. Emotions will naturally come up in sessions. And the subject matter may be challenging to talk about. But in good hands, you should feel that what you are talking about is within the limits of what you are ready for at that moment. Raw feelings can happen. But nothing that happens in the room should feel unsafe. There has to be room for vulnerable feelings to bubble up and be received with care. There also must be room for anger to be expressed, but in a way that doesn’t lead down the path of destructive patterns, that a couple might know only all too well.
On the other hand, there may be a more cerebral examination of things. For example, when looking at and identifying patterns, it can help to see them from a’ 30,000-foot view’ that maps out the whole picture. Last but certainly not least, there may also be humor and laughter, which also help to shift perspective.
Ground rules that are stated upfront by the therapist will vary. However, some of the basic ones to expect are:
No monopolizing the conversation. Some therapists may spend part of a session focusing on one partner, then shift to the other. Others might have more of a flow between you, going back and forth. The therapist’s decision as to which would be more productive is also influenced by personal style and the type of training they received. In any case, one partner should not be allowed to ‘overrun’ the other.
No interrupting. This may or may not be a hard and fast rule, but if it tends to happen a lot, most therapists will stop the interruptions, so each can be heard.
No escalation. Again, this may depend on the therapist’s training. But at no point are things allowed to get out of control. This includes shouting, name-calling, or verbal abuse. It should go without saying that physical aggression is never allowed. The therapy room is a controlled, safe environment.
No blindsiding, meaning bringing up a touchy subject that the other partner didn’t know was coming or not prepared to discuss.
Of course, you are being asked to reflect on what’s happening in a session. You’re also invited to talk about what happened between sessions. This can include good things- highlighting personal strengths and ways the relationship is working well for you both. Or it may be about how you handled things differently, as you build your own ‘natural immune system’ as a couple. You may also be asked about what didn’t go well- any points of tension, stress, or misunderstandings between you.
Both are ‘grist for the mill.’ A therapist may focus on what went well to highlight and reinforce it. Or the focus may be on the challenges that came up in order to help resolve them and facilitate understanding. And the focus could be on a balance of both.
Even if you don’t feel optimistic initially, it’s essential to give it a real shot. That means being open to hearing your partner, expressing yourself, thinking about the dynamics that get created together, and the willingness to do some things differently. There also may or may not be homework (again), depending on the model of therapy.
Feedback: your feedback should be encouraged. It helps your therapist stay focused on what’s most important to you. It helps with learning what approaches work best for you, what resonates for you. And it allows you to be even more active participants in the therapy. Overall, couples therapy should feel both relevant to what you need and effective at improving it.
Simply put, everything that happens in couples therapy is confidential and does not leave the room. That said, there are standard disclaimers that apply to any treatment: If one of you is a danger to self or others; and if there is a child involved with neglect or abuse. Insurance companies may also want to see notes, or a summary of treatment, in some situations.
A therapist may meet with one partner separately. The couples therapist may have a complete transparency policy about what can be shared with the other partner. Other therapists will allow for individual confidentiality if a partner is seen separately. Even then, however, the therapist will likely encourage the eventual disclosure of any secrets.
The kinds of questions your therapist will ask will depend mainly on their training. Some may ask about how you met and how your connection grew. Some may ask about your family of origin, for example, your perceptions of your parent’s relationship, the way feelings were expressed- or discouraged from expression in the family. You may be asked about your values, cultural background, and how you see each of your roles in the relationship. Some will start to ask more questions about the history of your relationship or your past relationships.
Most of all, each of you can expect to be asked what is happening that brings you to therapy. Each of you may have a different answer, or you may both agree on a central problem. Either way should be OK. It’s essential to be direct about what’s most important to you.
Most therapists will also ask you both, ‘why now?’ Was there some kind of precipitating event? Or was there a ‘final straw’? Some couples think about getting into therapy for a while before they actually do. For others, there may have been a crisis that needs a quick response.
Last, most will ask what you want to get out of coming. There are different ways of asking this. What is your fondest hope for therapy and the relationship? How would it feel? What would be better? You might talk about each of your goals, and you may have a conversation about your central goals as a couple. Once that happens, you have a target to focus on and work towards together that you both know will really help.
Some therapists will outline their approach in the first session to take away some of the ‘mystery’ of the therapy. It lets you know what to expect, which can be reassuring. Others may wait until they have all the information they need to discuss an approach specific to you. There is merit to both of these approaches.
Most therapists will refrain from offering you’ simple solutions’ right off the bat. A ‘simple solution’ may sound something like this: “OK, Mary, you should do X, and stop doing Y. And you, Harry, should do more of A, and less of B.’ People who come to couples therapy tend to be pretty intelligent. If it were that simple, they would have already figured it out.
To state the (hopefully) obvious, you should both feel respected, heard, and safe. You should think that you are in good hands and that there’s room for at least cautious optimism in going forward.
If you don’t connect:
If either of you feels that the therapist you just met with doesn’t feel right to you, you can always look for someone else. That said, you may want to give them one more try, with feedback from you about what you didn’t like or what didn’t work for you. That provides the therapist with a chance to course-correct in a way that might leave you feeling better by the end of that session. But if you don’t think that you’re working with the right person for you after 2 or more sessions, don’t be discouraged. There are trained, good therapists who can help and will be happy to.
Based (again) on training and orientation, your therapist may ask you to meet only with the two of you together. Others may want to have one session with each of you alone, to get more information about you and your background. Some might want the option of switching back and forth between individual and couples sessions, with each getting equal time. In any case, most of the time will be spent with both of you together. Most therapists will require or recommend weekly sessions. In the age of online sessions and Zoom, most therapists are comfortable with online sessions. Still, you would need to check with your therapist first.
You should expect that sessions are both focused on your goals and take into account whatever happened between sessions. Some therapists will give you ‘homework’- something specific to do or practice, while others won’t, using more of what happens between you organically.
Since there are multiple couples therapy models, the structure and flow of the session will vary, influenced by that model, what works for you as a couple, and the way your therapist works.
In any case, there should be progress in terms of your goals. There should be an overall lessening of tension and stress between you and an increase in understanding. Progress is never a straight, linear line. There will be ebbs and flows. Don’t let that discourage you, as long as you see a general trend in the direction you both want.
Broadly speaking, couples therapy can help build communication and listening skills, help with the presenting problem and goals, and help the relationship become more resilient. It can increase understanding and valuing of each other and increase the flow of mutual empathy and goodwill towards each other. On a practical level, it helps with discussing everyday issues, parenting, and day-to-day problem-solving. It can help couples deal with the inevitable challenges of life and make big decisions together when needed. It can and should deepen the emotional connection between you. And It can bring you closer in terms of knowing each other’s values, dreams, and aspirations. In the end, couples therapy should help you help each other in the specific ways you each want and wish to receive.
You may want to know how long to expect couples therapy to be, but there’s no standard answer. It depends on what’s happening between you as a couple, what you want to get out of therapy, and how long you want to stay and see positive changes holding up. Research using specific models of couples therapy may give a range of the number of visits, but that is not informed by who you are or what’s best for you. There is no cookie-cutter.
Getting ready to ‘graduate’:
When you both feel that you have successfully changed the relationship for the better in the ways that you want and need, it can be time to move on. You might discuss your goals, how you feel about where you are now, and your confidence level in the stability of those changes. Some therapists will recommend meeting less frequently, leading to ending therapy. You might be asked if there are any new goals, new directions, and ways you’d like to grow.
To sum up, the options are to stop therapy since things are better or come less frequently. Alternately, you might stop, but with a planned ‘check-in’ after a while. As before, there is no one way, no right or wrong answer. Therapy is there to make it what you want to be in the way that serves you best.