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An Integrative Approach to Couples Therapy

» Mental Health Library » Disorders & Conditions » Relational Problems » Featured Article

By Gwen Gruber, LCSW

Gwen Gruber, LCSWRelationships are continual growing processes that need to be nurtured. A difficulty in relationships can be the result of not letting go of past issues. Many people tend to take things for granted; for instance, they believe that their marriage is invincible. We live in a society in which sustaining a long term marriage is becoming less and less common.
 
In Arizona, the divorce rate is higher than the national average. One of the reasons, I believe, is that some people tend to move to Arizona as a last resort, assuming that the relocation itself will strengthen the marriage. However, this "geographical cure" rarely if ever works. If it does work, there is usually some therapeutic intervention, leading to an authentic willingness between both partners to work and move beyond where they are and to develop and utilize new communication skills.
 
Frequently, couples will have the variation of the same argument throughout their marriage. Common themes revolve around family, money and religion. Many times, when people have young children this becomes the cement to hold together a union that has a "fractured foundation."
 
In my practice I see couples ranging from their 20's to their 70's. More recently, I have been incorporating some of the techniques of "Emotionally Focused Therapy for Couples." In general, I use various techniques depending on which ones work best with a specific couple. I realize that couples therapy can be both frightening and intimidating. I strive to create a therapeutic environment where it is safe for both partners to ascertain and express their needs.
 
Quite often, I see couples choosing treatment early in their relationships. This includes people who are engaged or considering becoming engaged as well as newlyweds, who want to limit a potential conflict.
 
I frequently hear people talking about how "good" their relationship was in the beginning. Let's face it, if a relationship wasn't good in the beginning the chances of it prospering into a marriage would not have happened.
 
I think that, at least in the first six months of a relationship, people are in what is commonly termed "the honeymoon stage." During that time many true characteristics or faults of the partner are totally overlooked. This happens both consciously and unconsciously.
 
During the early stages of a relationship people are frequently infatuated with each other. The brain is creating certain chemicals such as serotonin and dopamine, chemicals that are in antidepressants and are also created with the use of opiates. There is a propensity for people to feel a sense of euphoria. In this euphoric state, it is very difficult for one partner to make a true assessment of the other.
 
This same sense of euphoria can also dominate when people begin affairs outside of their marriage. They sometimes delude themselves into believing that this new partner is going to be different than their married partner, who has become mundane over time. However, they fail to see that it is the newness and excitement of the new relationship is what they are drawn to. That too will often become boring over time.
 
People tend to withdraw into their own worlds in which they have separate interests and separate needs. I see people feeling disconnected from their partners. This can happen at any stage of a marriage/relationship. Sometimes it happens when couples are in their 20's, 30's or 40's and their children are still young, somewhere between toddlerhood and latency age. At this point people will speak of the mundane elements of everyday life setting in.
 
There is a lack of excitement that was there at least at some earlier point during the courtship or earlier in the marriage. Quite often, this will happen when the couple's energy is focused on work, getting things done in the household and tending to the needs of the children. It can be especially challenging when the adults in the family do not feel that their needs are being met. This imbalance of needs can create a wedge between the couple.
 
I strongly believe in the concept of identifying one's needs; when one's needs are not met over a long period of time fractures in the foundation of the relationship are created, which can lead to an end to the relationship. I often refer to the book "His Needs, Her Needs" by Willard Harley. The book takes a strong stance regarding structure in the marital relationship. However, one tool I find extremely helpful when working with couples is Harley's needs assessment. He presents a number of needs such as, affection, honesty, and trust to mention a few. He then asks the couple to rate their needs on a scale of one to ten. One being the lowest need and ten being the highest.
 
In one case, I was working with a couple in their mid twenties. A traumatic event in the man's life had caused them to postpone their wedding day indefinitely. The man had read Harley's book and downloaded two copies of the needs assessment one for himself and one for his fiancée. He took a lot of time examining and processing his needs. His fiancée on the other hand, made very little effort. She actually waited until the session to look at the majority of the needs assessment.
 
In this case, one of the most poignant issues that emerged was that the man had needs for sex and affection ranging from a nine to ten. The woman on the other hand, had very low needs in this area ranging from a zero to one.
 
Outwardly, however, they were both bright and attractive and made a lovely couple. Inwardly, their needs were not being met for a considerable amount of time within their courtship. I believe that the courtship is a reflection of what will come in the marriage. When there is a lack of connection in one's needs it is often a foreshadowing of what could become a serious problem in the marriage.

Another issue that is commonly presented in couple's treatment is the issue of sex, or more poignantly, the lack of it. Affection, sensuality and sexuality are significant needs. I note that when these needs go unmet there is a propensity for one of the partners to have an affair.
 
People frequently ask me if the lack of sex in a marriage is a red flag. In one scenario I see a man who has gone eight years without having sex. It took numerous months of individual therapy for him to finally broach this issue with his wife. In this case, only the husband was willing to come to therapy. Although that is unfortunate, it does happen from time to time. When this does happen I work with the one spouse and help them to create new communicative pathways. Although this is certainly not optimal treatment for the couple, I have seen people make progress in their marriage when one partner truly initiates communication.
 
Many times, people remain in marriages for the sake of the marriage, or the sake of the children, or the fear of becoming independent. These issues are also important to explore; as staying together for the sake of the marriage is not always the healthiest decision.
 
A major issue in all relationships is the willingness and capacity of individuals to grow. In relationships, it is important that a person has a degree of "emotional elasticity," a concept closely related to resiliency.
It is most rewarding to witness a couple recreating emotional intimacy and to reconnect.

About the Author...

Gwen Gruber is a Licensed Clinical Social Worker with over 20 years experience. She is presently in private practice in the Phoenix area in Arizona. Some of her primary specialties are working with adolescents, alcohol and substance abusers and those suffering from eating disorders.

Last Update: 2/3/2011



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