Editor’s note: One of our readers asked about how to find a good couple therapist/counselor, so we contacted our colleague Dr. David A. Sbarra. In Part 1 of this article he discussed the process of choosing a therapist.
You’ve found someone (a therapist) who might be good, but what treatments will they provide? There are many different forms of couple treatment, but only a handful have good scientific support. In my opinion, you want a therapist who is up-to-date on the best scientific treatments available to you. Here’s a brief description of three basic forms of therapy:
- Behavioral (or cognitive-behavioral) couple therapy (BCT). This treatment is based on the idea that couples with relationship problems have developed behavioral patterns that erode relationship quality. The essential elements of treatment are altering interaction patterns through, for example, things like how to communicate in less destructive ways, how to interrupt and alter negative thoughts about a partner, or how to express and experience emotion in a more positive way.
- Integrative behavioral couples therapy (IBCT). IBCT is a direct extension of BCT and focuses on teaching couples ways to manage and accept irreconcilable differences in their relationship. IBCT provides couples skills for decreasing dysfunctional relationship patterns, and it also focuses teaching couples to accept and better understand their partner’s actions. For instance, when a husband learns to be accepting of his wife’s lack of affection in certain situations, he may no longer react with negativity or withdrawal, which, in turn, results in a positive (rather than vitriolic) outcome. I note that some therapists may simply say they are “integrative” when describing their practice; this does not mean they practice IBCT per se, and you should ask directly: “What do you mean by integrative?” IBCT is the most well-established form of integrative couple treatment, and simply drawing from multiple, unsupported treatments in an “integrative way” is not necessarily meaningful. It’s equivalent to saying, “I have no real theory of what’s wrong with couples, so I pull from everything and hope something will work.”
- Emotionally focused couple therapy (EFT). EFT is fairly different from the two therapies I described above. As its core, EFT is based on the idea that distressed couples have developed a problem using each other for emotional support (technically, EFT says that distressed couples “fail to use each other as a secure base”), and the treatment is based on teaching couples to identify with and connect to each other’s emotional needs. An EFT therapist does this work by helping couples explain their emotional needs to each other and to respond in new ways that deepen their emotional connect. In this way, EFT is not focused on, say, communication skills directly but is pluralistic and uses many approaches to teach couples how to deepen their emotional connections to each other, as well as how to recognize and validate their partner’s emotional/attachment needs.
These three treatments constitute some of the main “empirically supported” therapies for couples. When you speak with a potential therapist, you should ask him/her directly about what types of interventions he/she uses. If you’re going to spend months working with a therapist, you want to know, to the best of your ability, if they are going to deliver a treatment that is known to work well for couples. Don’t be afraid to ask what treatment your therapist will provide when he/she works with you.
Where to go from here? You feel like you have decent answers to the questions above and that your therapist is well-versed in one of the treatments I’ve mentioned. What’s next? My suggestion is for you to think about the first few sessions as an evaluation of sorts. To be sure, you should invest as much energy as you can in the treatment and your therapist’s recommendations, but you also want to ask yourself if this therapist, in practice, is the best match for you and for what you think your relationship needs. These are general issues about fit, but you can consider the following questions:
- Does my therapist understand my perspective on our relationship problems?
- Do I feel connected and as if I have a good alliance with this person?
- Does my therapist seem to take sides, perhaps suggesting that one of us is right/wrong about the majority of our issues?
- Most simply, with the help of this therapist, is our relationship going to be better off now than before we started treatment with this person?
Time and again, research shows us that feeling understood by and connected to your therapist is important for a good outcome, and this is no less important in couples treatment than in individual therapy. You have the right to evaluate your therapist and make sure he/she is a good fit for you. You want to find someone you connect with and who does not take sides in your relationship disagreements. Making sure this is the case is the last step in choosing a good couples therapist.
I wish you the best of luck and hope you find this advice helpful.
Dr. David A. Sbarra is an Associate Professor of Psychology at the University of Arizona. His research focuses on self-regulation and recovery following social disruptions, normative attachment processes in adult relationships, and treatment outcome research related to family transitions. You can read more from Dr. Sbarra on his blog at youbeauty.com.
image source: buzzle.com