Why Couples’ Therapy Fails

A psychologist recently wrote asking for a referral for a troubled couple who seemed to be failing in therapy. My colleague, Jill Levitt, PhD and I both sent him some information about referrals in our group, but also pointed out some of the pitfalls in working with troubled couples.

Here are some of the comments I shared with him.

Here are some comments I wrote to a therapist who is experiencing failure in couples’ therapy. Judy wrote to him as well expressing similar ideas. Thought some of you in the group might find it a useful followup to our interpersonal therapy sessions in January and February. Transcript follows:

I meet with both separately for one or two hours to see if each is suitable for couples therapy. I don’t just jump in and try to help the two, as this is a ship heading for the rocks. Usually, it turns out that at least one cannot accepted into treatment.

During the pre-therapy individual sesssions, I ask each partner questions like these:

1. How strong is your motivation to develop a more loving relationship? How strong is your motivation to leave or try a trial separation?

2. Who, in your opinion, is more to blame?

3. Who, in your opinion, should do most of the changing?

4. If I agreed to accept you into treatment, would you be willing to accept 100% of the responsibility for the problem, and would you be willing, with my help, to pinpoint your own role in the problem? (I point out that this will be painful in all likelihood, and that if he or she does not want to experience that time of pain of self-examination, I would understand completely.)

5. If I accepted you into treatment, would you be willing to focus entirely on changing yourself, rather than trying to change, blame or punish your partner?

6. If I accepted you into treatment, would you be willing to do psychotherapy homework, 5 days a week consistently, whether or not your partner does homework?

7. And finally, would you be willing to read Feeling Good Together and do all of the written exercises in the book?

If one of the partners cannot give good answers to these questions, then I cannot accept that person into treatment, but I would still be willing to accept the spouse for therapy. Usually, at least one of the two is excluded from treatment. This would typically be someone who is unwilling to give up the blame/victim mindset. Then the prognosis for successful work brightens up considerably. I have had much greater success treating troubled couples when one of the two refuses to come to treatment or is excluded from the treatment by the screening above.

Just my approach! Many or most couples therapists would probably strongly disagree–but then again, as you’ve seen, couples’ therapy usually fails. This email reflects the importance of effective Agenda Setting prior to jumping into therapy. Agenda Setting, or the failure to do effective Agenda Setting, is the single cause of nearly all therapeutic failure.

Yet, few therapists can grasp this, much less know how to set effective agendas. This is often due to therapist narcissism and codependency, among other causes, as well as ineffective clinical training.