When couples seek professional help, they usually have been living with their difficulties for a long time and feel discouraged about solving them. Some are locked in conflict, which gradually erodes their feelings for each other. Others have avoided conflict but feel they have drifted apart. No matter what the problem, it is hard for a couple to step outside the pattern of behaviour that has developed and to find new ways to work together to tackle their problems.

Couples often say that their most significant problem is communication, or conflict, or both. Disagreements and problems are normal in a relationship. When a couple doesn’t have ways to tackle these constructively, the relationship is in trouble. Difficulties grow and conflicts escalate. This can lead to a cycle of negative interactions that damage the love that is needed for a relationship to last.

Couples get locked into negative patterns, which encourage emotional distance, anger, blame, sarcasm, withdrawal, negative interpretations, put-downs, jealousy, sexual problems, and a search for caring and understanding in other relationships. Depression, extra-marital affairs  violence, and physical health problems are serious, potential consequences of chronically dysfunctional relationships. General unhappiness is common in a relationship that is not functioning well.

As an example of the potential health consequences, a study in the Journal of the American Medical Association reported that women with prior heart problems were almost three times as likely to have to have further coronary problems if they reported high levels of marital stress. After an affair, couples often seek help in order to try to save their relationship, or, sometimes, to decide whether they can save it. Therapy can provide a safe, confidential, and balanced environment, in which all work together to rebuild the relationship.

If there has been an affair, it is top priority when the couple arrives in the psychologist’s office. But successful therapy must also eventually address problems that predate the infidelity and may have contributed to the risk. This work is hard. I have found, though, that some couples not only survive this crisis, but in working through it, they achieve a level of harmony, satisfaction, and honesty in their relationship that they never had before.

Couples differ in the problems that bring them to counselling and so the approach to their problems must be sensitive to the uniqueness of each partnership. Because counselling differs in each case, it is difficult to describe exactly how it will proceed. In most cases, however, it focuses on two things, the problems that the couple are experiencing and the process of resolving them.

The partners need to take joint ownership of the couple’s difficulties, and both need to focus on their own efforts, rather than on blaming the other.

The process is usually the most important focus because the aim is to give couples the means to solve their own problems. Initial sessions typically involve having the couple talk with each other about some current (but not the most difficult) issue, while assisting with constructive, non-blaming dialogue and non-defensive listening. The aim is to avoid escalation of conflict and ensure that the one who is speaking is understood and feels understood. This simple-sounding step is often most difficult part of therapy. It is crucial, however, and very often couples find that the first three or four sessions open new dimensions to their relationship.

Sometimes, couples are impatient with the idea of learning how to solve problems, and instead, they repeatedly attempt to focus on the problems themselves. There are not very many problems that can be quickly solved in a therapy session, and couples usually have already made many unsuccessful attempts at solutions before deciding to get help. For this reason, work on developing effective communication is important before taking on the most difficult problems.

Each couple’s communication problems are different. Common difficulties include feeling that one’s concerns are ignored or too readily dismissed; having anger interfere with both speaking and listening; having the sense that one goes around and around the same discussion without progress; feeling overwhelmed by the emotional intensity of the partner; feeling that the partner is disengaged and uninterested; and having one topic lead to another and another in an escalating sequence of conflict.

Both parties need to focus on their own communication styles, their own feelings, and their own problems in conflict situations. Both need to take joint ownership of the couple’s difficulties, and both need to focus on their own efforts, rather than on blaming, instructing, and giving direction to their partner. Often, an obstacle to progress is the initial view of one or both partners that only the other has to change, to do what he or she believes is right.

Therapist and couple work together, they are enabled to begin tackling the bigger issues, which sometimes involves exploration of earlier parts of the relationship, and sometimes also earlier relationships and other unresolved issues. Although the focus is on here and now, the past may need to be examined sufficiently to understand and alter what is happening in the present. For many couples, understanding earlier problems and feeling understood is important in order to progress to forgiveness of the partner and of oneself, and it is crucial for them to go forward. With some couples who like to work in this manner, readings may assist in the therapeutic work between counselling sessions. “Homework” may enable practice and further progress with what has been accomplished.

Some couples find that two or three sessions are sufficient to get them on track or deal with specific problems they are having. More typically, therapy lasts 10 or 12 sessions, or longer.