Couples Counseling is Hard Because We Ignore Level of Care.
Trouble in couples counseling part 2
I don’t actually remember her saying she wanted a divorce. I remember that I’d worked with them for about six months. I remember that I really liked them both. Like I really liked them. I remember working really hard to get her to talk about her pain. And I remember working really hard to get him to hear her. And I remember the really beautiful moments when he saw her. And some even more beautiful moments when she saw him, something he’d never had before.
I don’t actually remember her saying she wanted a divorce. I just remember how it felt. Like I’d gotten the wind knocked out of me. Somehow those words hurt like I’d been physically hit.
It completely blindsided me.
I want to keep going with this idea that couples counseling is hard. A few weeks ago we empathized with the fact that it is hard. But why? Why is it so hard? If we wanted to not only empathize but also fix the problem what would we change? What would we do differently?
I think we should see people at a higher level of care. Before I go into that, let’s get a good hard look at the problem.
Think about the amount of negativity your couples spew at each other. If they wake up at 7 am and leave by 8 am that means they’ve got an hour to fight or complain and pump negativity into their relationship. And let’s say they get home at 5:30 pm and go to bed by 10 pm. This means by the time they lay down and go to sleep, they've pumped 5.5 hours of negativity total going being pumped into the relationship. And this 5.5 hours of negativity is being pumped into their relationship 7 days a week. Which means every week the couple is dumping 38.5 hours of negativity into their relationship
But it gets worse.
It gets worse because therapy doesn’t start when the problems first start. Gottman says couples have issues for 6 years before they come to therapy. That’s years of negativity. This means the average couple comes in with 12,012 hours of negativity and adds 38.5 hours every week.
Jordan, you say, but that’s not right. Yes, couples wait on average six years to come to therapy, but they don’t fight for six years. The negativity probably starts off slow and adds up.
Ok, so pick your number. How much of the 12,012 hours did your couples spend fighting before they came to see you? 50%? 20%? 10%?
Let’s say it’s just 10%. That means the couple fought for 1,201 hours over a six year period, and by the time they see you they are adding in 38.5 hours a week.
But it gets worse.
Gottman also tells us that negativity is 5X stronger than positivity. So if the couple only fought 10% of the time, 1,201 hours of fighting did 6,005 hours of damage and if your couple fought all the time the 12,012 hours of fighting turns into 72,072 hours of negativity.
6,006 to 72072 hours.
And then they see you.
For 1 hour a week.
And you’re expected to fix them.
We’re simply treating them at the wrong level of care.
Addiction professionals are the ones really understands level of care. A simplified version of level of care, adapted from the addiction world and translated for couples, would look something like this:
Tier 1 is outpatient counseling.
Tier 2 is outpatient counseling plus extra help.
So outpatient counseling plus any other service. In the addiction world this might be counseling plus IOP or Med Management. In the couples therapy world this might be seeing a couple while they also do individual therapy.
Tier 3 is residential work.
Think 30 day treatment centers, but also couples retreats. Any area where you control the environment.
Tier 4 is medical intervention and safety housing.
For addicts this might be some sort of 72 hour hold in a hospital. For couples, you wouldn't actually work with both partners. However, this would be where you'd help an abused wife find safe housing for instance.
If you go through Gottman’s training he says most couples need to begin with some sort of 3 day intensive and then step down to lower levels of care. That means most couples should start out at level 3 and then step down to lower levels of care:
In most cases, we recommend a three-day marathon. A one-day marathon is appropriate for couples seeking preventative care, couples with a solid relationship that have some minor issues to work out, and couples interested in premarital preparation.
And where do most of us start our couples? At stage 1. That’s a problem. And that’s a huge part of why couples therapy is so hard. We’re fighting a 6006 to 1 battle. The that’s enough to make even the best couples counselor want to throw in the towel.
I remembered seeing him in target a month later. I turned the corner and there he was. And we almost fell into each others arms, but we didn’t. I imagine it’s what those who survive a tornado together feel when they see each other. No one else knows what we went through. No one else was there. Maybe it’s silly to say, but it felt that way.
See, couples therapy is hard on us clinicians too. That’s why I write this blog. We have a hard job. The chips often are stacked against us. And over time it can take a toll. So know that it’s not you. It’s not because you don’t know enough. It’s not because you don't try hard enough. It’s just hard because the deck is stacked against us.