A Thoughtful Approach to Couples Counseling:
A Conversation with Melinda Rezman, LCPC, CDA
BR: How did you get interested in couples
MR: When I worked in community
mental health a lot of referrals were for couples and only a few of us at
the center were really trained in couples counseling. I advocated for outside
consultation, which was helpful. I also started to attend different
conferences, workshops and classes, including two semesters at Chicago Center
for Family Health. At some point I participated in my own couples counseling. This was immensely helpful, and it sparked my interest even
more. I was able to observe, first
hand, the difference between dealing with a dyad and dealing with
BR: What did you notice about the
difference between therapy with the dyad and the individual?
MR: The couples therapist was far more
interactive and not afraid of being assertive or even confrontational. She was able to maintain a level of
neutrality but, at the same time, confronted us about each of our issues--as
individuals within the couple.
also saw a different approach to the psychotherapeutic process in terms of
structure. First, there was a more explicit discussion about what was being worked towards. Second, a time frame may be set with
couples, such as meeting for five sessions and then reevaluating. I also see the sessions as a great
opportunity for a couple to learn how to really talk with each other, to experience
what it is like to actually sit down and focus on the relationship itself. It's
often really a shock to people that a relationship is a lot of work, that it requires
I don't believe that people are
prepared in life for what it takes to have a solid relationship. It is usually
not until a problem arises that a couple will notice that they have drifted
from each other and can't find a positive way to reconnect.
BR: Are there any special issues with
various types of couples?
MR: I think it is very tough to work with
couples where there is a high level of chaos. When working with couples where
both members have multiple problems, sometimes it is helpful for each member to
have concurrent individual treatment and for the therapists to collaborate. For same-sex couples,
if the couple is requesting treatment around general issues, any good couples
therapist is fine. If a same sex
couple is struggling with issues related specifically to roles/identity, it may be more helpful
to refer to a therapist with extensive experience with same- sex couples.
BR: But isn't any couple going to be
struggling with role or identity issues?
MR: Yes, but for same sex couples it can be
a little more confusing because of cultural "norms." There can be a wider
range of issues, such as dealing with an extended family. I think it's very
important for same-sex couples to make sure that their therapist has both the
sensitivity and experience to address these specific issues with them.
BR: What is your experience of how clients
use couples therapy?
MR: On the one hand, people come into
couple's therapy when problems have already become unmanageable. This can make
it harder for the therapist because the focus has to then be on managing the
symptoms instead of addressing the underlying issues. Paradoxically, though, because the couple is in such
distress, this may increase their motivation and ability to work quickly and
effectively with the therapist.
BR: What about people who are "out the
MR: I tell couples all the time even if
you're coming in because you're getting a divorce or separating, I recommend
counseling because whatever mistakes you're making in this relationship, you
will repeat in every relationship after unless you understand your role in a
relationship. If children are involved, learning how to parent when you're no
longer married is going to be vital.
Sometimes part of the treatment is
helping the couple decide if they are going to stay together or not. A therapist needs to be very proactive
with this topic, because couples may not have a clue as to what they really are
trying to do in therapy. There can
be a lot of confusion about what they really want. Frequently there is a hidden agenda. For example, one partner may want
out of the relationship but is not ready to address that. Sometimes one person is bringing
the other into therapy with the belief that the partner needs treatment or that the therapist
can actually change the partner. At times a couple is there because they want the therapist to see just
how "wrong" the other person
is. I strongly acknowledge how dangerous
that type of projection can be and acknowledge that it's a wish to have a
witness in how you have been "wronged." This "witnessing" by the therapist can be
an effective way to engage as well.
BR: Can the 'witnessing' contribute to
MR: Splitting is always a tough issue with
couples. It is one of the
strongest tactics to defend oneself! If a couple has been operating with all types of destructive dynamics for
a long time, it is incumbent on the therapist to explain how this has to
change for the relationship to continue in a different way, along with acknowledging
how frightening this change can feel. It
can be unnerving not to know if the relationship can survive in a different way
of being. It can also be helpful for the therapist to communicate that it's no "quick fix" and that the longer couples are willing to commit to being in a treatment, the better chance they have of working
BR: What kinds of issues do couples ask for
MR: The biggest issues people come in with
are related to sex and intimacy. One thing I
say to couples around issues of intimacy is that sex is not about sex. What I'm
trying to say to them is that there's something important to understand about
why they're not able to connect.
And it's important to have sex in the relationship, for without the sex
you don't have a real relationship. Other issues
are money, extended family, substance abuse, pornography, and affairs. Most important
is that you need two willing participants.