Do We Need Couples Therapy? How to Know It’s Time to Get Extra Support
Relationships Need Check-Ups Too
I think there’s a common misperception that shit has to be hitting the fan to go to couples’ therapy. And while that’s certainly an indicator it’s probably time to get help, there’s no need to wait until something has gone terribly wrong to get support. I frequently use physical health as an analogy in my practice, because I find most folks seem to take physical health a bit more seriously than mental heath.
Let’s say you wake up one day feeling sick. Bummer, but you have things to do right? Working, taking care of the kids, doing laundry, making dinner, grocery shopping - everyday life things. And chances are you’ll probably be fine. But then you start to feel worse. A lot worse. You have body aches, a fever, a cough, and pain in your chest every time you cough. But you continue to push through - you have commitments and you don’t have time to deal with this . Until you have to. You get to a point where you’re so exhausted you can’t eat, and that pain in your chest feels like someone is stabbing you. You finally go to urgent care or an emergency room, and turns out you have pneumonia. Because it’s been left unattended so long, things are a lot more serious than they were a week or two ago. You have to get admitted to the hospital, go on IV antibiotics, and it takes you months to recover.
Well, relationships and our mental health can be a bit like our physical health. Conflict and verbal arguments with a partner are normal, and doesn’t necessarily mean you “need” couples therapy. The most healthy relationships go through rupture and repair. But when those fights have gotten to a point where they’re no longer healthy, that’s when you might need some extra help.
Signs It’s Time to Get Professional Help
Even if you aren’t in the therapy world, you may have heard of the Gottmans. Dr. John and Dr. Julie Gottman are two therapists who have published a lot of research and are experts in romantic relationships. Through numerous studies over 30 years of research, the Gottmans have identified predictors of separation/divorce [1]:
More Negativity than Positivity: Even when conflict is happening, in healthy relationships there are more positive interactions than negative ones. Typically positive interactions to outweigh the negative 5:1. For relationships on the brink of failure, we see this ratio being closer to 0.8:1. It’s important to remember that conflict isn’t just the big arguments - it’s also smaller things. Your partner and you have different preferences on how to load the dishwasher. Is this lighthearted banter? Or does it turn into someone blowing up or shutting down? During those big arguments, are you and your partner still able to see each other as a human that has good intentions and that you love and care about? Or is your partner someone you don’t recognize?
Presence of the Four Horsemen: The Gottmans have coined criticism, defensiveness, contempt, and stonewalling as the four horsemen of the relationship apocalypse [1, 2].
In this framework, criticism is a personal attack on the core of someone’s character [4]. Not just, “I’m really upset that you didn’t tell me you would be late”, but “I can’t believe you’re late again. You never think of how your actions impact anyone else. You’re so selfish.”
Defensiveness is when someone plays victim and gives excuses, frequently a response to criticism. Sometimes this can also include reversing blame to instead try to make it the other partner’s fault. Using our previous example, this might look like, “You know how much pressure I’m under at work, and I can’t just leave because it’s 5pm. I can’t believe you would schedule something on a workday when you know how stressed I am. Now that’s selfish!”.
Contempt assumes a moral superiority over overs. In relationships, this can show up as a partner being really mean. They might be disrespectful, mock their partner or respond sarcastically, call them names, or roll their eyes when their partner speak. For example, let’s say a partner was feeling hurt, and spoke to their therapist before bringing up the issue with their contemptuous partner. This might look like, “I can’t believe you’re getting advice from some idiot with a psychology diploma. You truly are stupid if you think I’m going to feel sorry about what I did”. Contempt is the biggest predictor of separation/divorce.
Stonewalling is commonly a response to contempt. This is when one partner shuts down, stops listening, and generally avoids any further conflict.
Emotional Withdrawal/Disengagement: Withdrawal or disengagement in the relationship and in conflict is a cause for concern [1]. Lack of affection, shared humor, question-asking, active interest, excitement, joy, support, and empathy are all examples of where we can see this withdrawal/disengagement.
Failure of Repair Attempts: A repair attempt is any statement or action (even a silly one) that tries to prevent negativity from spiralling out of control [3]. It can be things like, apologizing, taking accountability for your part, expressing feelings in “I” statements, or asking to take a break. When conflict escalates to the point of being out of control (one or both partners goes into fight/flight/freeze) despite these repair attempts, this is cause for concern [1].
Seeing the Relationship Through a Negative Lens: Sometimes partners will begin to misinterpret neutral/positive actions or words as negative [1]. Now, miscommunications can happen, but unhappy couples will misinterpret their partner’s positive words or actions 50% of the time. For example: you decided to get up early to clean the kitchen to ensure your partner has one less thing on their plate, but they perceive it as you got up to clean the kitchen purposely to make noise and disturb their sleep.
How You Remember the Beginning: When partners look back at the early days of the relationship and remember things negatively instead of fondly, this can let us know that the relationship has soured [2]. Even when describing the hard times, healthy couples will talk about how they conquered their struggles or how those times made them stronger.
Bodily Symptoms of Distress: When some couples encounter conflict, they might have physiological symptoms that indicate they have gone into fight/flight/freeze [1, 2]. Things like a pounding heart rate (100-165 beats per minute), increased sympathetic activation and decreased parasympathetic activation, amygdala activation (our danger smoke detector), etc. When our fight/flight/freeze is activated, our prefrontal cortex (our reasoning and critical thinking centre) is no longer online, which can make it nearly impossible to have a productive conversation.
How the Relationship Starts: While enemies to lovers novels can make for a great read, in reality relationships that begin with criticism and sarcasm can predict the ending of that relationship [2]. These issues have a way of re-emerging later in the relationship.
If We Go to Therapy, How Long Will It Take for Things to Get Better?
I completely understand wanting to know how long things will be like this for, and unfortunately I, nor any other therapist, can give you a definite answer. Each couple is different. But what I can share is averages based on research.
I primarily use Emotionally Focused Couples’ Therapy (EFCT) and the Gottman method. For EFCT, 70 - 73% of couples will no longer be distressed after 8 - 20 therapy sessions [5]. We also see that couples that make it to this point make lasting and meaningful changes in their relationships. Using the Gottman method, we typically anticipate meaningful change and a reduction in distress after approximately 10 - 12 sessions [6, 7]
But sometimes more complexities come into play, like infidelity, that can take longer to heal. For example, the Gottman method has been shown to provide significant improvement over 32 sessions for couples navigating infidelity [8].
How Do I Know if Therapy is Right for Us?
While the signs discussed in this post can be helpful indicatorsess it might be time to get help, your gut is also an important indicator. If something feels off in your relationship, whether you’re starting to feel resentful, feeling unloved or unappreciated, struggling to communicate, or feeling hurt, it’s probably time to reach out for support.
And even if none of these things are happening, relationship therapy can be helpful for healthy couples too. Sometimes therapy is looked at as just a tool to repair the relationship, but it can also be used to strengthen an already healthy relationship.
How I Might be Able to Help?
If you live in British Columbia, I invite you to book in for a free 20-minute online consultation where we can explore what’s going on and how I might be able to support you and your partner. And if I’m not the right fit? I’m always more than happy to make a referral to my trusted network of clinicians. Book in by clicking here.
References
[1] Gottman, J., & Gottman, J. Level 1 clinical training: Gottman couples' therapy.
[2] The Gottman Institute. (2014).The 6 things that predict divorce. https://www.gottman.com/blog/the-6-things-that-predict-divorce/
[3] The Gottman Institute. (2024). The four horsemen: criticism, contempt, defensiveness, and stonewalling. https://www.gottman.com/blog/the-four-horsemen-recognizing-criticism-contempt-defensiveness-and-stonewalling/
[4] The Gottman Institute. (2014). R is for repair. https://www.gottman.com/blog/r-is-for-repair/
[5] Johnson, S., M. (2019). Attachment theory in practice: emotionally focused therapy (EFT) with individuals, couples, and families, Guilford Publications, http://ebookcentral.proquest.com/lib/adler/detail.action?docID=5604908
[6] Garanzini, S., Yee, A., Gottman, J., Gottman, J., Cole, C., Preciado, M., & Jasculca, C. (2017). Results of Gottman method couples therapy with gay and lesbian couples. Journal of Marital and Family Therapy, 43(4), 674–684. https://doi.org/10.1111/jmft.12276
[7] Davoodvandi, M., Navabi Nejad, S., & Farzad, V. (2018). Examining the effectiveness of Gottman couple therapy on improving marital adjustment and couples' intimacy. Iranian Journal of Psychiatry, 13(2), 135–141.
[8] Irvine, T. J., Peluso, P. R., Benson, K., Cole, C., Cole, D., Gottman, J. M., & Schwartz Gottman, J. (2023). A pilot study examining the effectiveness of Gottman method couples therapy over treatment-as-usual approaches for treating couples dealing with infidelity. The Family Journal, 32(1), 81-94. https://doi.org/10.1177/10664807231210123
*I do my best to ensure my posts are accurate and to cite reputable sources, however if you notice something that needs a correction please reach out to me at monica@beginagaintoday.ca.
