Psychotherapy Office Hours: Monday -morning/early aft.
Tuesday, Thursday, Friday - days/eves.
Phone for appointment: 415-362-8262
For more information on couples and marital therapy, please feel free to read more about my approach below.
To go to my main page, click here. For Frequently Asked Questions, click here.
To make an appointment, or request a consultation, please phone my office.
Read my article online: "Why Couples Fight and What to Do About It"
To make an appointment for an initial consultation, click here.
INTRODUCTION: Relationships are central to our lives. When people seek out therapy, usually they are concerned with the primary relationships in their lives -- with lovers, spouses, siblings, parents, children, and friends. But our world is densely woven with relationships with many, many people, including co-workers, grocery clerks, salespeople, consultants, therapists, babysitters, hair stylists, and so many more. In therapy, we work to better understand our relationships. Usually, we are concerned with what is going wrong in a given relationship; hence most couples therapy concerns problems in a couple's relationship. Given that both members of a relationship are individuals, with different backgrounds, expectations, fears, and characters, it's almost a miracle, given all the other social and economic stressors, that we can have a decent relationship with any one at all!
Of course, my goal, and that of most couples therapists, is to help both members of the couple succeed, where in the past, or without therapy and counseling, the relationships have failed, or seem doomed to fail. My method of treatment is informed by the work of Sue Johnson, Daniel Wile, John Gottman, and other therapists and theoreticians of couples life and attachments, in addition to my nearly 20 years working with couples.
There are a few essential issues that will make couples or relationship counseling work for you.
First, both members in the relationship must wish to at least try therapy. It's natural for one (or both) of you to be wary or suspicious of the process. There are a lot of charlatans out there, so you must be careful about who you choose. The therapist, and the mode of treatment they use, must be fair, impartial, non-judgmental, and respectful of both parties. The therapist must be there for the couple, and not for one member more than the other. The couple brings to therapy only a commitment to try it out.
Second, both members of the couple must be open to learning more about themselves, and realize that however frightening, change is both normal and good. Relationship therapy has helped many people. It can be a profound developmental experience for one or both members of a couple. But, there should be no expectations that any relationship will be "fixed" because of going to therapy -- only a realization that without therapy, there will continue to be suffering and lack of understanding in the relationship. The couple must be willing to forego violent solutions or abusive behavior, as this poisons the therapy, just as it damages the relationship itself.
I have worked with many different kinds of couples: straight and gay, married and unmarried, immigrant, biracial, old and young, etc. The challenge of intimacy makes for a consistency in my approach to all types of couples. Every couple presents a unique situational problem or relational dilemma. Nevertheless, because many patterns occur over and over, what follows are a few thoughts about typical couples' problems. It is not meant as a substitute for a therapist's evaluation, and a course of individualized couples therapy. Some of the issues below are common to those presented by clients seeking therapy. They are not inclusive, and some important ones, such as infidelity, are not addressed here.
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I have not yet known a couple or any relationship that did not experience arguments. The complete absence of arguments can indicate a serious breakdown in communication or spontaneity in the relationship. However, arguments are probably the number one problem I have heard from couples seeking treatment. This is not surprising since arguments can be damaging and hurtful, repetitive and unfair.
The wider problem is rooted in both human nature and in the conditions of existence. For instance, inordinate stress upon any social grouping will likely result in more aggressive behaviors or conflict. But I think the main issue is two-fold:
1) arguments occur because the significant needs of one person come into conflict with the significant needs of the other person. Because the need, whatever it is (to be heard, to be comforted, to feel safe, to have quiet, to be stimulated, to share, etc.), is valid for the person who feels it, it makes it difficult to hear or appreciate the other person's condition. Arguments occur because the need state of both individuals is at an acute state, and interacting in a maladaptive fashion.
2) arguments occur because significant anxieties or concerns by one partner are not communicated effectively to the other partner, or rather, are communicated in such a fashion that the other partner's own anxieties or concerns are heightened. One reasons these fears or anxieties are not communicated is because we are usually well-defended against such anxieties, and while this is usually a good thing, in couples life, such defenses become barriers to communication. To make matters more complicated, if we try and put aside our defenses so we can communicate something difficult to a partner (some shame, fear, worry, feeling of dependency, or even a desire!), our own anxiety can worsen, again making communication difficult.
Therefore, the kernel of every argument usually contains something of importance. The problem is that usually the important aspects have been poorly or incompletely communicated. Once an argument begins, both partners usually stop listening and start getting defensive. This is logical, because usually they are being attacked, just they are are usually also doing some attacking.
In an argument, what is being expressed are various feelings, resentments, past grievances, usually anything but what is most difficult to express in the moment of the fight. That is why fighting partners feel so frustrated, even after the fight. The trick is to stop the argument and shift to a non-judgmental, understanding and listening mode. This is very hard, and sometimes will take the intervention of a trained therapist to help you learn how to do this quickly, before blame and anger leave wounds that prevent or delay the reestablishment of loving and trusting bonds that facilitate communication, understanding and intimacy.
It may be helpful to realize that arguments often perpetuate themselves because of conscious, and unconscious, expectations and assumptions about our partner. These assumptions are carried over from past hurts and lingering wishes from previous relationships, including the relationships we had with our parents and siblings. When the assumptions and/or needs of one partner touches off negative expectations (fears) or disappointments in the other partner, you have a recipe for the kind of repetitive argument pattern that plagues so many couples. Therapy is especially helpful in working through such dilemmas.
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The second most common problem I see in couples who come to therapy is a difference in level of commitment between the partners. As well-known couples expert, Daniel Wile, has put it, there will always be a difference between the general level of commitment or desire of one partner for another. Such differences can be fluid, though most are fairly consistent. "Do you want me as much as I want you?" "Are you willing to get married?" Behind the feelings around commitments are usually unexamined fears around being abandoned or rejected, or being commandeered or controlled by the other in a relationship. (See The Myth of Perfect Togetherness & the Need to Control below.)
Issues around commitment demand the utmost in honesty between both members of a relationship. It is expected that there are anxieties and fantasies by both partners around what it means to be dependent upon another, to be united as a couple, different expectations about what the future will bring, and on the conflict between individual careers and goals and the overarching needs of the relationship and/or future family.
Even more, our feelings about relationships -- being in one, committing to one, leaving one -- will have a lot to do with our own individual experiences in our family, with past losses of those close to us, with tragedies around betrayal, and dreams of reconciliation. One common conflict is that between the commitment we have to our family of origin (to our parents and siblings) and the new commitment to the man or woman we have chosen as central in our lives. There often are likely to be problems around conflict between the old family and the spouse. But there are always problems in every relationship, and we cannot escape the problems of our own. We have to find a way to live with them. If we are try, we will surmount some of them, though not without some bumpy moments, and not without a dedication to open, non-blaming communication.
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Therapists (including myself) talk enough about communication that you'd think we were born incapable of expressing ourselves. Actually, most of us can express ourselves pretty well. But do we do it effectively enough? When there is an argument, it's the rare member of the couple who does not know the other is mad or upset. But does their partner know why, really?
The main problem in couples communication comes, remarkably enough, from the almost universal assumption that our partner knows what we are thinking and feeling, without our having to explicitly express it.
The point of communication as an issue in couples therapy is to establish a new, different mode of communication that becomes only one of a number of ways of relating and expressing oneself. An argument may be the only way to let feelings out... initially. What makes communication-savvy partners more effective in their relationship is their ability to communicate after the argument phase is over... their feelings of vulnerability, their hurt, their expectations and hopes -- in essence, everything that didn't get expressed during the argument.
Some feelings are particularly difficult or embarrassing to report to our partners, for reasons of upbringing, culture, or natural inclination. Examples include issues around sex, around money, around the expression of anger, children's upbringing, and feelings of loneliness or discomfort around times of separation.
There are lots of "rules" for good communication. For instance, report your feelings or anger rather than express it in action or harsh words. Avoid name-calling or blaming. A corollary rule is: use "I" statements instead of "You" statements. An example might be... rather than say, "You are always coming home late. You don't care about me or the kids," one could say, "I feel bad when you come home late all the time, or what seems like all the time to me. I worry about the effect it will have on our relationship, or your relationship with the kids." (Tip: Say the above variants out loud to yourself to really get the difference.) -- No matter how many rules for good communication there are, they all start with being a good listener. This is very hard for most of us, and takes practice.
When in doubt, I've learned to remember these simple rules:
- Don't assume (you know what your partner is saying or that they understand what you're trying to communicate)
- Be concrete (in what you say). Say what you want, what you need. But remember not to blame or label the other. This allows for communication of difficult feelings.
- Example -- Not "You never listen to me. You're impossible, terrible, etc." But [Being concrete] "I need to feel more heard." [Not assuming] "Something is blocking us from hearing each other."
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Sex is both an exciting and (sometimes) taboo subject. Sexual problems in relationships happen to couples of all sexual orientations and preferences. From a therapist's standpoint, sexual behavior is both an instinctual need and a way of relating to others. Some couples come to counseling because of sexual difficulties, others are embarrassed to bring up such problems, or there are cultural prohibitions about discussing them. I advocate thorough sexual education, together with a healthy sex-positive attitude. Sexual problems in a relationship range from a lack of desire, to performance anxieties and impairments, to the inability to have an orgasm, and other issues often very specific but felt to be crucial (STDs, HIV, fetishes, etc.).
Sexual inhibitions and performance problems can usually be treated by concentrating on the major themes of couples counseling, as discussed on this webpage (in an introductory fashion). Additionally, sometimes couples will benefit by being taught sensate focus techniques to make lovemaking feel less angst-ridden and more natural and comfortable. The need for this type of treatment can be discussed with your couples therapist. (I have helped a number of couples using this combined treatment: relationship therapy and sensate focus therapy.)
The main things to remember when there are sexual problems are:
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The myth is that, as adults, we should know what to do in relationships. It doesn't take a flood of self-help books and couples manuals to prove that, in fact, we are often at sea about what is happening to us, or what to do, or what has happened to us in our relationships. It is almost always humbling to feel one has to seek out another to help, when the issues concern the basic ability to live together in a relationship. But it is a sign of strength and fortitude of character to realize that problems with relationships are endemic, are expressed in the art and literature of the centuries, and that sometimes, we need assistance in order to live a more satisfying life.
The powerful wish for togetherness is probably allied to the wish (and often the fear) of mutual merger. This wish is also expressed in our sexual lives. Much misery in couples or married life comes from the belief that one should be perfectly attuned with one's partner (or them with you!), and especially when together in bed. But couples and sexual therapists all agree that communication is never more important than around one's sexual life and behaviors. For some people, the failure to achieve or maintain a feeling of fusion or merger in their relationship can be experienced as profound rejection or abandonment. They may feel desperate, and even pursue their partners relentlessly for reassurance. Such individuals would benefit by working through these anxieties in either individual or couples therapy.
Sometimes, the issues around togetherness discussed above get turned on their head. Instead of a frustrated wish for perfect attunement, fears surrounding merger, as noted above above, become the primary problem. At such times, our partner feels as if they are smothering us, or a spouse may feel as if they are being controlled by their partner. It doesn't help if the other partner is trying to control his or her spouse, often because of their own insecurities and needs surrounding their own fantasies about fusion. The whole situation can quickly become intolerable, and the ambivalences, unconscious fears and wishes, etc. can only be worked out through careful analysis in couples therapy. However, it is a good bet if there are issues around Control in a relationship, then somewhere fantasies and needs associated with desires to be close or distant, to either lose oneself in another or validate one's individuality from another, are prominent in the couple's functioning.
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It is notoriously difficult to get two people to agree on certain things. This is especially true if they have been arguing, and have come to see their partner as an adversary. Relationship counseling can help restore a way of dialogue and mutual empathic understanding that can help heal wounded relationships. But often, and understandably, one or the other partner doesn't want to come to couples therapy, or feels threatened by it. What if the therapist is a quack? Won't the therapist take the woman (or man's) side?
Relationships are about trust, so it won't come as a surprise that therapeutic enterprises to help relationships also involve the establishment of trust. In couples therapy, I will try (or if you are seeing a different therapist or are in an area outside of where I practice, then your therapist will try) to get an understanding of both sides of the problem, from both partners. As in individual therapy, the goal is not to "fix" the problem, but to build or re-establish those aspects of the relationship that helps both partners talk about, understand, even commiserate, about their problems. If there is a way to "fix" it, great. But the goal of treatment is to talk, learn how to express oneself in a non-blaming way (and that includes not blaming oneself, in addition to not blaming one's partner). -- No gimmicks are needed in relationship counseling, no games, no psychodramas. In first coming to treatment, the more reluctant partner should know that the first one or two meetings are for assessment only. They are consultations, and no one should feel coerced into treatment.
If you've been in couples therapy before, you may find that your next experience with a different therapist is anything from overly similar to wildly divergent from your previous experience. As with individual therapy, go with your internal judgment in deciding whether couples therapy works for you. You should give it a fair chance, and if it's working, you will find that your domestic life will be more civil, feel more hopeful, and even more loving. Problems, whatever they are, will feel more solvable and less onerous. -- One caveat: some problems in life are truly difficult and affect relationships harshly. These can range from a partner's physical or mental illness, to the death of a child, to the loss of job and home. These problems usually cannot be "fixed", at least easily, and the couple's job then is to learn to live with a problem or set of problems, rather than hope for their amelioration through therapy.
Online help? I know there are sites on the Internet that allow for e-therapy, email exchanges, live chat with a therapist, etc. I do not have enough experience with these sites, directly or second-hand, to recommend them or not. However, I know of no site or source that recommends couples therapy over the Internet. It still seems best and most effective to work in person in therapy with an experienced couples therapist for relationship problems. But, if you've found something helpful you'd like to pass on for possible posting, please send the link or suggestion to me at sfpsych at gmail dot com.
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Please note that Gay, Lesbian, and Transsexual clients are welcome in both individual and couples counseling.
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Last modified: December 07, 2011
Copyright © 1999-2005 Jeffrey Kaye, Ph.D.
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