What Makes Couples Therapy Work: Top Ten Myths & Realities

“I really want our relationship to thrive but he’s so laidback. Can you change his personality?”

I’m so tempted to say I looked at my couples therapy coaching manual and Chapter 4 has all the details on how to change someone’s personality, but the truth is couples therapy is not some magic trick and neither am I a miracle worker. Most people I have come across have very little information and knowledge on how couples therapy works, and so I decided to write a primer on it here, based on my own clinical experiences.

Couples therapy is a big part of my clinical practice as a psychotherapist and coach. Couples who come to therapy want to make their relationship thrive, to be able to communicate and resolve conflicts better, to overcome the aftermath of a trauma such as domestic violence, betrayals & infidelity. Some report falling out of love and not knowing what to do, some talk about just having drifted apart, the friendship being lost and having developed irreparable cracks.

The need is real as is the problem.

All of these couples are in distress undoubtedly and are looking for resolutions. And their distress shows up in several ways as they sit across from me: Anger, tears, silence, disengagement, contempt, criticism, defensiveness, “I” vs. “You”, and hence, most despairingly, the need to engage in constant power struggles and one upmanship. They feel often tired and hopeless because they may have been to several therapists before and not found the salve and the treatment they were looking for.

“We went once or twice for therapy before and didn’t really find it beneficial,” said this couple as they came to see me.

“It’s too slow a process,” said another. “We didn’t feel any change after 2-3 sessions.”

I hear them out and ask them what were their perceptions of & expectations from therapy. And truth be told, not many know how couples therapy works. Which is why so many misperceptions abound about it. There is of course no one way of doing therapy with couples. It depends on the therapist’s training, the methods they use, and their overall approach towards what it takes to make couples rebuild their relationship from where it got damaged.

I have picked up the top 10 common misperceptions people have of couples therapy and my take on how to tackle them so therapy can actually be effective.

Here you go:

Myth # 1: The therapist sits like a judge/referee/principal and reprimands one partner and/or praise another; gives a judgment on who is right in an argument or whose position is the one to uphold.

Reality: As a couples therapist, I look for how the relationship is between two people, the strengths and challenges that co-exist in the relationship, without singling out a partner along with their misdeeds as presented by the other. The point of reference is the relationship and hence the focus is mostly on the dyadic interaction between the couple. As the therapist, I am a facilitator who observes, imparts skills and provides blueprints in three major domains of a relationship (based on the needs, of course): (1) Communication and conflict management; (2) Enhancing friendship, fondness, and positive affect; (3) Facilitating sharing of meaningful life goals, dreams, and aspirations. It is the couple who talks to each other in session, while learning new skills of looking at conflicts, deepening their understanding of each other, communicating better without contempt, derision, criticism, defensiveness, and  disengagement, and if significant trauma has rocked the relationship, then working their way through in re-establishing safety and trust.

 Myth # 2: There is a magic wand that will make their problems disappear without having them do much work. The therapist will talk to them and show them the way, and voila! everything will be fine. Therapy should start showing results within the first 1-2 sessions.

Reality: Imagine you went to the physician with symptoms of dizziness, and at the end of the 20 minute consultation, with no diagnostics such as scans done, they suggest a brain surgery, would you go for it? My guess is no. Because of course, there was no assessment done to see where the problem lies. I allocate the first three sessions usually just for the assessment of the relationship using conjoint interviews, individual interviews, and more recently a new set of standardized assessments, all of which bring out the strengths and challenges of the relationship in the three significant areas I mentioned in point #1. When you work with psychological aspects and that too of a tenuous relationship, you cannot dive into intervention without knowing the couple in depth. The intervention starts after, based on the plan that is elicited from the interviews and the assessments. A couple can feel a slight bit of relief after the first session, if they developed a good working relationship with the therapist, and feel heard, trusted, safe, and hopeful. But the interventions to actually build on the relationship start after a thorough assessment, in my practice at least.

Myth # 3 : The therapist will “change” the personality traits or temperament of either/both partners. “She’s so lacklustre, please change her personality,” “He’s so aggressive, you have GOT to change him.” Meanwhile, the couple sits back and expects me to work on the partner as if I’m giving them a mani/pedi. (You probably didn’t expect that analogy from me, did you? :) )

Reality: I will keep reiterating this, an effective therapist will work on the “relationship” and not single out one person, even if his or her behavior is the cause of distress. I would rather say “Looks like your conversations over a conflict start with a harsh start up, with swear words, hitting below the belt, and even more contempt. How about we learn to use a gentle start up and see how the conversation goes?” The responsibility of the therapy is with the couple as a unit, and of course where individual issues present (such as a mood or anxiety disorder with either/both partner(s), feeling uncomfortable with expressing emotions which leads to misunderstandings and frustrations, domestic violence & PTSD), they will be discussed in conjoint sessions and the relevant intervention may be taken to individual sessions. There is openness, transparency, trust, and even if distress is present while the couple works through issues, there is an inherent faith in the process. If that dwindles, that is also addressed in therapy.

Myth # 4 : Conflicts and triggers will go away with therapy. A couple even asked me for a “conflict-free” relationship and I said I would not like to disappoint them with not being able to meet that request. Not because I didn’t want to, but because it’s just not possible to have a conflict-free relationship.

Reality: Conflicts are an inherent part of any relationship, leave alone in a couple. But here’s a whopping statistic: More than 2/3rds of conflicts are “perpetual” problems, which means they never go away or get resolved. Some of these gridlocked conflicts are differences in personalities, feelings towards in-laws, how we spend money, how we want to raise our kids, and differences in individual needs. A couple can usually remain gridlocked, expecting one person to compromise or submit, which often leaves them both in a state of a painful impasse, or they can learn to communicate better and understand each other’s existential points of view on the subject and focus on addressing it based on mutual dialogue, understanding, and a workable solution rather than solely trying to change the other’s view on it.

Myth # 5: There is only one reality in a conflict situation and it belongs to obviously only one partner of the two. In other words, it’s “my way or the highway.”

Reality: In the face of an incident that causes significant damage, has been laced with regret and remorse, and yet continues to remain unresolved, it is important to point out that there are  always two valid subjective realities, and both appear to be right in their own way. What’s then left is to move through the situation and resolve the gridlocked position through better understanding and management. The process of working through fights such as these involves listening with empathy to each other, validating their point of view and seeing how their partner’s reality stood out, identifying triggers, and diving into them to understand where they are coming from (past trauma, dynamics of the family of origin?), and taking charge and action to come up with constructive plans so they do better next time. And to commit to it and not forget.

Myth # 6: Therapy sessions are freestyle fights and the therapist is the referee. The therapist listens on how the week went, allows the couple to express their anger and hurt, witnesses the couple attack each other, and tries to resolve the conflict situation. I often imagine couples looking at me and saying, “Milord, here is the proof of my partner’s misconduct. Please speak your sentence.” This is how most ineffective therapy sessions tend to be, because each partner is standing his/her ground, is engaging in a power struggle, is seeing things as “my” right vs. “your” wrong, “you” need to change, and yet they still want to make things better. Yes, I know, similar to Myth # 1 but who said reinforcement hurts?

Reality: This is the type of situation in which I teach couples how their aims and intent of therapy appear to be mismatched with their effort and behaviors. And how to course correct in case additional resistances are seen. At the risk of sounding redundant, it helps to restate the same point, at the outset of each session, that the needs of the couple are kept at the forefront. If conflict management is the biggest challenge which is affecting the basic foundation of their friendship and leading to emotional disconnect and distance, then that is the area where skills are imparted first. There is an organic deepening of the relationship as they learn to communicate better but again, one must work through with having the couple know each other’s internal worlds, build emotional connect through rituals of togetherness, address trauma, and work on a vision of their lives together where they both understand and support each partner’s life goals and aspirations.

Myth # 7: Reflections, readings, and “homework assignments” in between sessions are OK to be missed. Because “there’s never enough time,” (or other such excuses) are often presented as a resistance to therapy. For such couples, it’s also unfortunately OK to just attend 60 minutes of a therapy session, speak their heart out, prove their point, and go back into the loneliness, emotionally disengaged, conflicted, spaced out lives without gaining new insights, or learning new skills that would help with gridlocked problems.

Reality: Unfortunately, in scenarios like these the blame comes on the therapist that they were unhelpful and that therapy wasn’t working, despite the therapist knowing that he/she gave their best. At a recent training session where we were sharing our experiences as couple therapists, the trainer asked the audience, “At the end of the day, how many of you feel like quitting as a couples therapist or wished you had an alternative career?” The show of hands wasn’t surprising. We give our minds, our energies to be empathetic, to impart skills, to be there for the couple; we receive wrath and misplaced anger, and yet show compassion, even though a lot of it goes unnoticed, but we don’t raise that as an issue. Our job is to persist, till even we realize that the couple is presenting with different agendas in therapy, and it feels like breaking your head against a wall. There comes a time, when even that is addressed by me as my honest admission in therapy. That it seems that it is just my agenda to address the gridlocks and that they want to persist in them because they feel the other one needs to submit. My voice often gets lost in their screaming at each other, drowning out any efforts to help resurrect the relationship. Soon, the writing is on the wall.

Myth # 8: The pain and suffering of a trauma experienced in a relationship will never go away. Re-establishing trust may not be possible.

Reality: The wife sobbed inconsolably when the hurt she experienced was causing her significant panic attacks and she said, “I will have to live with this pain and suffering. It will never go away.” I have seen couples emerge from strong setbacks because they have somewhere had the faith in their relationship, even if it may have been dwindling in the present moment. This can happen because of a commitment that they can rebuild and reconnect in needed ways which would bring both of them joy and contentment, and not because it was “expected” of them to stay together. It takes immense courage and strength to work through trauma, especially when one partner has caused it to the other. But when the resentment, anger, hurt, regret, guilt, or anything else that is impeding the relationship is worked through, healing happens. It depends on what the couple is truly looking for and for both of them to work towards it.

Myth # 9: To be compatible, a couple needs to have similar likes and dislikes, preferences, temperaments, hobbies, and whatever else is important to be deemed “must be similar to be successful.”

Reality: “Opposites attract,” “We’re like two peas in a pod,” “we complete each other,” “We’re yin and yang.” These are all correct. A relationship is formed when two people come together, and decide to make something of it. And there is such beauty in seeing people make meaningful relationships, despite the differences, because they truly believe in the alchemy that coming together as a couple brings.

Myth # 10: Therapy suggestions and skills taught seem “unlike me/feels like I am pretending/put on and hence “won’t work.”

Reality: We are hard wired to react in set, impulsive ways if our conflicts have been deep-rooted and perpetual. We get used to the space, distance, and coldness that sets in when we are far removed from each other. When I ask a couple if they know their partner’s dreams and ambitions, they look at me perplexed, often saying but what’s the need! We take each other for granted, we get caught up in the everyday lives of work, taking care of home, and parenting if we have kids. Who has time for all these conversations? But more than time, do we want to make those changes in our regular patterns of being? Any new behavior will be a skill to learn and it will feel unfamiliar at first, “pretentious,” “not me,” but if the “you” was working initially, I tell the couple, you wouldn’t be sitting across from me in therapy. So yes, we learn, we love, we live. On replay :)


Why am I giving you this behind-the-scenes workings of how couples therapy works?

I have to admit, being a psychotherapist isn’t an easy job. And being a couples therapist is even more challenging. We learn from each couple as we go along, we stumble, we fall, and we pick ourselves again, because after all, it is the human mind and heart we are working with, which is replete with fickleness and unpredictability and refuses to be buoyed down at times. I don’t think our clients, the couples we work with ever see our struggles completely, because they are caught up in their own psychological suffering. And yet, we have to do everything in our might to keep ourselves together, to stay present with them, to show compassion and empathy when it may be the most difficult for us too along with them.

Some drop out of therapy prematurely, and unfortunately choose to live unhappy lives in an impasse, wishing for their problems to go away. Their reasons could range from the stigma attached to being divorced, to wanting to stay together for the kids’ sake, the fear of what lies ahead, to their own personal reasons. And some part ways, amicably, wanting to lead better lives, wanting to give better lives to their children as single parents than raise them in an abusive family. And some work hard on their relationships, rebuilding and repairing from the foundation up, because they truly believe they have something worthwhile between the two of them.

At the start of each session, I think how much rides on me as a therapist, how they have trusted me to help them through their difficult times. But then there comes a time when you would like to bring more clarity, and a better understanding of the psychotherapy process to my clients, so that they can align their expectations, work towards building a team with me, work towards addressing their relationship as “Us/Ours/We” vs. “You/Me,” and work towards truly addressing their lives to be meaningful, rich, and with a purpose. This blog post is an attempt to do just that.

To go back to what I started with, I really want our relationship to thrive. In this case, the “our relationship” refers to the one between the couple and me :)

This World Mental Health Day, Start with Self-Compassion

October 10th is World Mental Health Day and this year’s theme is increased investment in mental health. It took a pandemic to bring attention to this topic, when people the world over found disruptions in their daily lives, forced upon by Covid-19. And the disruptions have been varied and wide-ranging: increased conflicts within families, financial difficulties because of job losses, the isolation brought by the stringent lockdowns, work and education moving online. Boundaries between work and home have blurred, major life plans were shelved or disrupted, hugs and holding hands were shunned, couples disbanded, anxiety and depression rose, and those with pre-existing mental health conditions faced even greater challenges as the social isolation wreaked havoc. And those who lost loved ones in this pandemic went through crippling grief as they couldn’t spend time, or bid a last goodbye.

The fact that we have to talk about increasing investment in mental health shines a blinding light now on how we have often shunned seeking help for our mental health needs.

You’ll recognize these common reactions.

“What will people think?”

“Do I really need to talk to a professional about this issue? It seems so trivial.” 

“I’m sure I’m stronger than this. I will deal with this on my own.”

“Therapy is for the mentally ill. I’m not that bad.”

And the list of reasons to deny help to oneself and others increase.

I often wonder how many people continue to suffer because they or their colleagues, friends, and families see counseling and therapy through prejudicial, stigmatized eyes. How they may never find solace and comfort, joy and meaning, or even be able to reach their true potential which may lie buried under the suffering and angst. They talk about life going by in a blur, pointless, replete with drudgery & loneliness, feeling like no one cares. And resign themselves to being able to do very little about it.

Oh, how we get mired into our misery and make a compromise with life: Maybe this is how it is meant to be, we tell our weary heart.

In these past few months, I have worked with several people who brought a lot of things to the forefront: their sadness, worries, anger, anxieties, fear of the unknown and the accompanying uncertainties, pain, restlessness, interpersonal conflicts, separations, divorces, career paths dwindling. And whatever be the reason for why they sought therapy in the first place, I ended up talking about one aspect with every single one of them. The pathways and the time to get to the same first step in the therapeutic journey may be different but I would nudge and goad, and walk beside every one of them till they agreed to reach there, sooner or later.

Some would downright refuse, some would look at me pleadingly, some would acknowledge that it was time, some would break down because they couldn’t “allow” it, and some would gladly make space for healing to start with this one big step.

And that step is one of Self-Compassion.

To understand self-compassion better, let me start with telling you about Vidya (name changed).

Vidya, married for 24 years, has been silently suffering through her husband’s emotional abuse. She spent her years taking care of the children and him, giving up her dreams  of becoming a designer of heirloom clothes. Vidya spoke about her unhappiness to her siblings and her parents but they told her the same thing that most women have shared with me in session, “Itna toh bardaasht karna parhta hai.” (“One has to bear this much at least.”)

She finally decided to walk out of the marriage. She had suffered enough. But the guilt of bringing pain to her loved ones was causing her anguish and immense worry and sadness. Not only that, she was berating herself for not being able to stand up for herself through all these years.

“How could I just not say anything, Divya? Why did I waste so many precious years of my life?”

“I can never forgive myself for this. I was so stupid, so naïve.”  

What was adding to the mix of emotions was the fear of the unknown. A woman in her 50s, the “divorcee” tag, the vulnerabilities that come along with it, the lack of social status, and the much-heard line laced with condescension, “You’re in your 50s. Why not just go along with the marriage? You’ve come this far! What more do you want?” 

From having cared for others’ needs all along, Vidya was finding caring for her own self as being “selfish.” Which made her look at her decision of ending her marriage with skepticism and vacillation.

Vidya started talking about her best friend, who had been in a similar situation as hers years ago. They had known each other for a little over four decades, had been married roughly the same time, had kids roughly the same age, and who had built a kinship based on empathy and compassion. Vidya helped her through a difficult life situation, being a pillar of strength and support to her friend.

Vidya and I had a conversation around this:

“You really helped your friend in her time of need, Vidya. She was feeling bad, was struggling immensely, and you were there, right? How did you respond to your friend’s situation specifically? What did you do to help? What all did you say to her? I really want you to spell it out for me and I want you to write it down as you narrate it to me as well.”

Vidya played along with me. She said and wrote the following:

1. I would tell her she deserves better. She deserves to be happy. She had had enough.
2. I would encourage her to take care of herself: She loved to pray and go for her morning walks. I nudged her to resume them. I would often cook healthy meals for her.
3. I would always take her calls, and be there for her, even if she silently cried.
4. I told her to be kind to herself. She was so self-critical.
5. I would often tell her that I love her and I will always be there for her, like we had been for 43 years.
6. I made her seek professional help when she threatened to harm herself. I went with her for the first couple of sessions with her therapist.
7. I helped her set up her new home and was by her side when she was faced with transitional challenges. 

And so I went on. “Now, you are in a difficult and challenging situation yourself, and it’s been years of suffering. How do you typically respond to yourself in these situations? Again, if you can indulge me, please write down what you typically do or say, and note the tone in which you talk to yourself.”

She looked at me incredulously.

“I see what you are trying to do here, Divya, but you know it’s different when you are trying to be there for someone else. It comes easier.”

“Give it a go, Vidya. Take your time.”

1. I have stopped working out and have been emotionally eating. I have gained weight and I loathe myself even more.
2. I can’t sleep at night because I am constantly worrying, about others, about what my actions would do to them.
3. I call myself names: “Spineless,” “timid,” “passive,” “stupid,” “undeserving.” I tell myself that I deserve this misery for having kept quiet for so long.
4. I can’t forgive myself. I am to blame for all this. Even though I understand that I was young and wasn’t worldly wise and that I tried voicing my concerns to my parents but I couldn’t do more.
5. I feel selfish.
6. I feel stuck. Is the known devil better than the unknown?

“How’s the tone in which you speak to yourself?” I asked

“Oh, that’s always harsh, a pitch higher, condescending, blaming, unforgiving.”

“Did you notice a difference? In the way you treated your best friend and how you treat yourself?”

“Yes, she said.”

“What factors, fears, other emotions come into play that lead you to treat yourself and others differently? I went on…

“You noticed how your friend thrived under your care and compassion. You yourself said she credits you for taking her out of the deep, dark space. Would you please write down how you think things might change if you responded to yourself in the same way you typically respond to your loved ones, like your children, your best friend, your parents?” Why not try treating yourself with the same love and compassion that you would treat a friend and see what happens?”

This was an indirect way of teaching self-compassion to Vidya, and to several others who may show resistance to this concept, when they want to punish themselves for what happened in the past. When they feel that they don’t deserve their own love and kindness because they “messed up,” not seeing how the self-flagellation was causing them more anguish in the here and now.

It is easier to show compassion to others than to our own selves, and so indirectly I start with this lesson.

Compassion involves three key aspects:

1. Noticing another person’s suffering.

2. Feeling moved by the suffering and being able to empathize with their experiences. Your heart will respond to their pain and you will feel warmth, care, concern, and a desire to help the person who is suffering. Even if they have made mistakes, wronged you or others, failed, stumbled, messed up, you offer understanding and kindness rather than creating an emotional distance by judging them harshly or with deprecation.

3. You realize that imperfections, suffering, failures, mistakes are all part of what makes us human. We share lived experiences of yin and yang, suffering and joy, failures and successes. It is how we relate to these concepts that determine our outlook on life.

Vidya reflected on what we spoke that week in session and I also added a self-compassion meditation to her self-care toolkit.

In our next session, she reported a slightly heightened level of openness to discussing self-compassion. She reported that instead of all the name calling she was engaging in she softened up her inner critic’s voice and had become more aware of the harsh self-judgments and was beginning to be more compassionate towards herself.

“I started reframing what I would say to myself and it took a bit of an effort initially but I saw the effect it had on me. So for instance, instead of calling myself “stupid” and “undeserving of happiness” I would gently engage in supportive self-talk such as, “I feel worse when I beat myself up, so from today onwards I will focus on taking care of my needs and taking charge of my life bit by bit.”

Vidya had as a result, starting going for walks thrice a week to begin with, started cooking healthy meals for herself, and focused on taking charge of her emotional eating. She also spoke to her children about her decision and didn’t dwell on the guilt that used to torment her earlier. The kids were immensely supportive because they had seen her suffer enough.

She felt the self-compassion meditations and mindfulness moment to moment on being kind and gentle helped her in letting go of the strong hold she had on perfection, making no mistakes, and how she would beat herself up for the things she unknowingly and mistakenly held herself responsible for.

We still have a long way to go. But at least she had stopped mercilessly judging and berating herself, for holding herself responsible for inadequacies, mistakes, failings, shortcomings, not just of her own, but of others too. She was weighing herself down with too much baggage. She was taught to always be stoic, to keep herself together, and she learnt to let go of that too. There was comfort in shedding an occasional tear in session, of letting her vulnerabilities show up, of making room for them, and of learning from them, strength by strength.

She learnt that things don’t go as planned, that fears are a natural part of any major life transition, that we will experience pain and frustration, and losses, and grief even in walking out of a miserable marriage, that we will look wide eyed at our own limitations, that we may have a long way to go before we reach what we value for ourselves, but as long as we embrace and honor our own selves and our humanness, we will take everything that comes up in our stride.

Vidya invested in her mental health, and has stuck through with a dogged therapist like me who focuses on inner transformation if the clients agrees to trust me and engages with me. It isn’t always easy to show them this path, when we ideally would want to change the world around us to suit our own needs.

So, on this World Mental Health Day, I’d like to learn from Vidya and urge you to focus on:

1.  Seeing mental health services as a means to living a healthier, more meaningful life, and not just for the mentally ill. A huge part of my work involves working on personal development, reaching into your true potential, living a life based on you being guided by your own True North Star.

2. Showing compassion to self and others, on taking care of your own well-being and of those of your loved ones.

3. Supporting someone who needs mental health services. A client of mine told me that his friend had sponsored the session fees since he was going through a tough time financially. Truly, support in any form goes a long way: Being there for someone in need, showing compassion, encouraging them to seek professional help, and normalizing the experience of counseling and psychotherapy are some definitive ways.

Because mental health isn’t just the absence of illness. It’s the presence of wellness. It takes continuous and consistent awareness. And it can result in transformed, meaning-filled lives.

To corroborate this point, here is an insightful read by Rashi Bhargava, a client of mine who has been very vocal about her experiences in therapy without requesting for anonymity. She writes about “Why It’s Worth Investing in Your Mental Health.”

So, what would you do for yourself daily to take care of your mental health and overall well-being? What would it take for you to shower yourself with love, kindness, and care, like you would to someone you cherish?