My fiancée and I recently started going to couples therapy. It wasn’t my idea, I will admit, but she’s a psychiatrist, so I expected it to happen at some point. She goes to her own therapist at least twice a week, independent of our session. Prior to this, I have never seen a therapist of any kind. Our relationship is good, and while we have the occasional spat, it’s nothing out of the ordinary. She feels we don’t communicate as well as we could, and I don’t disagree. Although therapy wasn’t my idea, I was open to the idea, and I happily get out of bed at the crack of dawn so we can see the doc before work. The benefit so far is that it generally makes her happy that we’re doing it. And therefore, I’m happier.
While I’m finding our sessions to be helpful, I think it’s proving something I’ve long suspected about therapy. That is, it’s a forum for a person (or couple) to just talk out loud. The feedback is minimal, and it comes off as pretty well rehearsed. I like our doctor, but I get the feeling his jokes, patter, and advice aren’t from coming from great insights into how I behave — or how we behave as a couple — and that it’s more or less canned answers and advice.
Am I off the mark? How do I know we’re dealing with someone who pays attention to what is said, and not just listening for key words that prompt him to interject a stock line?
— Need Clarity
Dear Need Clarity,
When I used to treat children and adolescents, I’d typically get a call from the parents explaining why they wanted their child to see me. The parents would describe what was going on with their kid — maybe she was anxious or had an eating disorder. Maybe she was too perfectionistic, or suddenly failing her classes. Maybe she was withdrawing or acting out. Whatever it was, the parents would be concerned, and would want to get their child help.
Sometimes, though, it wasn’t just the child who needed help — it was the family. The child had simply become what therapists call “the identified patient,” or IP — the person unconsciously assigned to be the keeper of the family’s troubles. The IP looks like the one with the problem, but really she’s the healthiest one in the household, because in her own way, through her symptoms, she’s acknowledging the family’s issues. Instead of denying them or scapegoating others, she’s calling them out.
While the IP in a family is often a child, IPs exist in couples, too. The IP might be the partner who’s depressed, or checked out, or gets upset “over every little thing.” The IP is the one who seems more sensitive or fragile or in need of therapy, while the other partner is “just trying to help.” (The supposedly helpful partner is hoping that the therapist can “fix” the partner who needs it.)
You take great pains, Need Clarity, to explain that going to therapy wasn’t your idea, and that you’ve never gone yourself. You share that your fiancée, on the other hand, is well versed in therapy, both professionally and personally. You explain that you expected to end up in couples therapy because she’s in the field, without considering that perhaps you two are in couples therapy because you have some problems to work out together. (If you were engaged to an oncologist, would you expect to get chemotherapy simply because of your partner’s specialty?) And you share that not only is she seeing her own therapist, but that she goes “at least twice a week,” suggesting, perhaps, that she’s the one who has the issues to be worked out. Finally, you say that the benefit of the couples therapy is that it helps her, and that except as a byproduct of her happiness, it offer no real value to you.
All of which sounds like your fiancée has become the IP.
In order for you to gain more clarity about your therapy experience, NC, it will help you to consider your feelings around being taken care of. How comfortable are you with dependency, vulnerability, and acknowledging the need for help? I wonder if it might be easier for you to assign these traits to someone else (like, say, your fiancée). You minimize your “spats” as “nothing out of the ordinary,” though they’re out-of-the-ordinary enough for your fiancée to notice a communication problem. Even when you agree with her, you do so from a place of remove. Instead of simply saying that you two have difficulty with communication, you tell me that she feels there’s a communication problem, and that you “don’t disagree” (which sounds different from the affirmative, “I think there’s a communication problem” or, simply, “I agree”).
It’s natural to want to feel in control, and it’s also true that some people have early experiences that make being in control not just desirable, but necessary for their very survival. A person who perceives himself to be cool, calm, and collected might protect himself from any underlying emotional stirrings by distancing himself from the need for help, while also devaluing those who see people at their most vulnerable: therapists.
Couples therapy is one of the most difficult types of therapy to practice, because it requires the therapist to understand each person as an individual, in addition to how these individuals affect each other in ways they can’t readily see. What makes one person do something to the other that makes her partner do exactly the opposite of what she wanted him to do? How is their communication problem less about money and more about the fact that one person starts off emotional, the other defends himself by getting hyperrational, the first person gets angry and feels unheard, the second protects himself by getting even more controlled and logical, the first person makes a crack about his mother, then he blows up (finally! he has emotions!), and the first person has brilliantly dumped all of her rage onto him.
In addition to unearthing patterns, couples therapy is about elucidating emotional Catch-22s: She wants his affection but also wants to be able to rage and yell for it. He wants to be respected but doesn’t want to show his partner any respect. She wants to be understood but refuses to tell him what’s wrong unless he asks. He wants to be heard but is afraid to speak up. A couples therapist will look not just at what people tell each other (I miss you, I’m angry, I need space) but how they tell it (changing the subject, bringing the iPad to bed, threatening to leave). A couples therapist will say things like, “You don’t get to interrupt just because you don’t like what your partner is saying.” A couples therapist will point out that the person who repeatedly complains “I’m not getting my needs met” may have very little interest in or awareness of the other person’s needs. A couples therapist might look at you and your fiancée, NC, and ask, what system are we trying to disrupt here? How does it serve both of you to make your fiancée the IP? Because if you’re going to therapy to appease your fiancée, you don’t have to examine yourself.
It’s possible, of course, that your therapist is a frustrated stand-up comedian, presenting you with “patter” and “jokes” that are “well-rehearsed.” It’s possible that he tosses out “canned answers” and “advice” like candy. I have no way of knowing, NC, if that’s what goes on in your sessions or if you’re distorting the experience by projecting your preexisting beliefs onto him. I do wonder, though, how you came to suspect, before experiencing therapy yourself, that therapy is “just a forum for people to talk out loud.” If that were so, wouldn’t a friend or a wall or a mirror do? And if you truly believed this prior to meeting your fiancée, why did you choose a partner whose work you have so little respect for?
If you’re going to therapy to improve communication, why not start now? Share your concerns with your fiancée and ask what her experience of your couples therapy has been like so far. But don’t do this at home. Do this in your next session, in front of the therapist, so that he, too, can hear about your questions and doubts. Tell both of them that you don’t feel paid attention to in these sessions; that you don’t feel truly heard or understood as deeply as you’d like. Share with both of them that you don’t see the value in the therapy you’re getting, other than as a means to make your fiancée happier. Share your impression that you’re getting patter and stock advice. Ask your fiancée to share with you why couples therapy is making her happier when you’re finding it so empty and superficial. And ask yourself why you wrote “I like our doctor” if you feel like an audience member in a bad comedy show for which you’re paying three figures an hour. Bring all of this into the therapy, and see how both your fiancée and your therapist respond.
One or both of them may say something that changes your perspective and helps you to see the experience differently — or one or both might confirm your instincts and prompt you to find another therapist. Whether or not you stay with this therapist is largely beside the point. It’s the act of showing up authentically that will teach you something important. It’s the experience of letting yourself be seen and getting curious about seeing others and what might be going on with them that will help you examine the many assumptions you’re carrying around. Figure out how much of your discomfort with this process is about you, your fiancée, this particular therapist, or some combination thereof. These are skills that you’re going to need not just to make couples therapy work, but to make your upcoming marriage work as well.
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