On the couch: What happens in couples counselling

IT’S GOOD TO TALK: Rosamund Pike and Chris O’Dowd who star as a couple undergoing relationship counselling in State of the Union. Picture: SundanceTV

CHRIS O'Dowd and Rosamund Pike star as a time-crunched couple who are undergoing relationship therapy in a new mini-series, State of the Union. They meet up every week in a London pub, have a drink, and then hurry to the office of their counsellor. Although we never see what happens when they meet their therapist, the sessions have a deep impact on their relationship.

And, indeed, therapy has been shown to help a troubled relationship according to research published in the Journal of Marital and Family Therapy in 2011 - it found that that couple therapy positively impacts 70% of couples receiving treatment.

After nearly two decades of experience as a relationships counsellor and psycho-sexual therapist, Eithne Bacuzzi has found that couples seeking support tend to be between the ages of 20 and 60. However, she says, within this is a sub-category of time-poor, under-pressure couples in their late 30s with busy careers and up to three young children she says. 

“The relationship can be neglected as a result of time constraints and family pressures - the relationship goes to the end of the pile and gets neglected because they literally do not have the time for each other. It’s a case of time-famine - a routine of running and racing,” she observes.

Although he believes there’s no ‘typical’ issue or any specific age at which couples decide to seek help, Dr Fergal Rooney, principal psychologist at John of Gods Hospital, has found that people are generally about 10 years into a relationship by the time they seek therapeutic support. However, this is not a strict rule - he has worked with troubled couples whose relationship is just a few years old.

Reasons for seeking therapy cover all of life’s dilemmas, he says, from infidelity and the pressures of child rearing to infertility and addiction.

Relationship therapist Bernadette Ryan has found some older couples can struggle with the difficulties posed by adult children - sometimes in their late 20s or older - remaining at, or returning, home. This is something which crop ups, particularly for urban residents, she says.

Communication difficulties are “at the foundation of everything” in couple therapy, believes Bacuzzi, who has also found that porn has become an increasing issue for modern couples. She believes this can stem from over-exposure during teenage years, leading to pornography becoming “a template” for a young man’s perception of sexual relationships.

However, she warns, problems can be exacerbated by the fact that many couples don’t seek therapy until their relationship is at “shut-down” point. 

Lisa O’Hara, a counselling therapist specialising in relationship difficulties. O’Hara points to the finding by relationships guru Dr John Gottman, that couple generally don’t seek therapy for six years after they first start experiencing problems:

“They will have been unhappy for a long time,” she says adding that for younger couples, there can be steadily increasing difficulty with issues such as commitment, parenting, work stresses or money. 

Such difficulties can also crop up for partners in their 40s and 50s, adds O’Hara, along with other problems such as empty nest syndrome, caring for ageing parents or the decision by one partner to do something unexpected later in life, like returning to college.

The overarching thing is that a disconnect appears. Defences are high and they cannot see each other.

There may be criticisms, contempt, stonewalling and defensiveness - these are the four key issues behind a problem, and a couple’s inability to be close.

Expectations - often shaped by the way things were done in one partner’s family of origin - can cause problems when they come up against the other partner’s expectations, says Bacuzzi.

Given its complexity, she says, couple therapy is “one of the most difficult kinds of therapy". This is an area which warrants significant further training, believes Bacuzzi, who underwent four years of training in the speciality in Britain. 

Rooney believes couples seeking relationship therapy would be advised to ensure their therapist has specific training around working with couples

“There is no standardised legislative training level but it would be reasonable to expect a therapist to have additional training,” he says. 

So what happens when a couple find themselves sitting in front of a therapist for the first time?  Bacuzzi explains there will be an initial ‘getting to know you session’ in which the therapist gathers information about the couple and gains insight into the dynamics of the relationship in terms of what’s working or not working.

From there, she says, the trio tease out the issues. Once there is “acceptance and understanding on both sides, we look for change,” she says.  

“The outcome of the therapy is dependent on a couple engaging in the process and each partner’s willingness to own their part in the difficulties they are experiencing together.” 

One of the most important issues at the start of the therapeutic process, says Rooney, is establishing with a couple exactly what they want from therapy - because they may not actually know.

Do they want to re-establish a more committed relationship, do they want to negotiate a separation, or simply learn how to exist together for the sake of their child?

Realistic expectations are critical for the couple and the therapist, he says. 

“It’s very much about what the couple needs and it can take time to establish what the couple want to achieve - because they may not know what they want.

“They may just know they’re in trouble,” he says.

At first, Rooney meets the couple together. Then he meets them on an individual basis before agreeing on a programme of therapy to work through whatever the goals are.

“It’s about supporting the couple to communicate more effectively and hear what each other is saying, and rekindling empathetic responses to each other. Without that, I don’t think the relationship can progress.

“It’s a major problem when people stop listening to each other and become entrenched in their own perspective and lose empathy for one another in the process.

“Very often a critical piece is about listening effectively to each other and developing fundamental communication skills so that can move beyond their entrenched positions.” 

Success, however, may not always be about a happy couple walking hand-in-hand into the sunset.

“Sometimes it’s about realising that a relationship is over and the couple can reach an amicable way forward with an understand of what has happened," says Bacuzzi.

Failure, she adds, can come about from something as simple as one partner's refusal to become involved in the therapeutic process.

It’s also about how you perceive or measure success, says Ryan.

“If a relationship is irretrievably broken down, counselling can help a couple break up in the best way possible.” 

She has encountered situations where one partner firmly wants to save the relationship and one wants to leave. 

“One participant might only come to the counselling to ensure the relationship can be broken up in a safe way.”

 However, she says, couples often get caught in a "negative downward spiral" which can be reversed if both of them want to change.

“Therapy is about helping a couple to come together to make the decisions and choices they need to make for both of them, for their relationship and their family,” she says. However, she has seen couples who have come through very difficult times in their lives and found a way to work together. 

"That is what gives me hope,” she says. A sense of goodwill is crucial to the success of therapy, says O’Hara.

“A couple’s ability to resolve their differences depends on their ability to talk about it, to forgive and to have compassion for each other,” she says. “It’s very important because it gives you something to work on.” 

If couples can respond positively to the question ‘what’s working in the relationship?’, it’s a sign, she adds, “that there’s gas in the tank. The outcome is largely dependent on how willing people are to engage.

Couples who do better are those who tend to take responsibility for their part and are willing to engage in the whole process and to listen to what their partner says without shooting them down.

“Therapy is only effective if each partner is willing to engage in the work and to change as appropriate.” 

The outcome of therapy is not guaranteed. It can fail if “the couple is not in a position to mutually engage with each other," says Rooney. 

Other factors that can contribute to the breakdown of therapy range from the honesty of the couple to their fit with the therapist and external pressures, says Rooney.

It’s worth putting real work into it, because the cost of couple therapy can be expensive, depending on where you find it. Sessions cost from about €25 to €150. In Accord, which offers marriage preparation courses and counselling, sessions the cost is €25 for couples outside Dublin (Accord charges €35 a session in the capital) but some private urban-based therapists will charge up to €150.

None of the therapists interviewed expect any great changes in the area of relationship breakdown to result from a ‘yes’ vote outcome of the May 24 referendum on divorce, which if passed would mean the Constitution would no longer require a person applying for a divorce to have lived apart from his or her spouse for at least four years.

While it would make it easier to get a divorce following separation, the process of relationship breakdown and separation, says O’Hara, usually takes much longer than people think. 

“The reality is that a lot of people think about separating," she says. "But it can take a lot longer than you think in terms of the emotions, the logistics - and children.” 

  • 10 tips for conflict resolution

  • 1. Stop blaming, advises therapist Bernadette Ryan. Take responsibility for your part in the relationship difficulties you and your partner are experiencing.
  • 2. Be clear about what your needs are. Your partner is not a mind reader.
  • 3. Be respectful.
  • 4. Ban sulking, advises psychologist Fergal Rooney.
  • 4. Be able to say ‘sorry’. It’s important.
  • 5. Always remember the other person has feelings too.
  • 6. Be aware of your personal blocks to listening, such as disagreeing with what the other person is saying, says couples counsellor Lisa O’Hara.
  • 7. Watch your language. Are you hypercritical? What about your body language? Are you eye rolling?
  • 8. Take responsibility for your behaviour.
  • 9. Talk about your feeling, says relationship counsellor Eithne Bacuzzi.
  • 10. Don’t wait until breaking point before seeing a therapist.

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