Setting Realistic Expectations

Columbus Couples Counseling

I was recently in a car accident and hit by a semi that luckily didn’t do way more damage than it did. I am primarily okay after several months of treatment and was lucky in the grand scheme of things. The first visit to the Chiropractor was a little frustrating. I paid around $200+ for x-rays that took just a few minutes”. My initial thoughts were along the lines of “wait, I am paying this much, and I am not at all better.” Then I learned I would need massages twice a week and adjustments three times a week for the foreseeable future in the hopes of feeling better after several months or a year. Couples counseling has some similarities (but usually works faster than that).

The average couple waits six years after the sign of serious problems to seek help. Those problems do not go away overnight. Counseling is usually not a quick fix. You wouldn’t want to go to a chiropractor after an accident and have them start twisting your spine without a plan and an understanding of what was going on. You hopefully wouldn’t want a counselor to sit down in your first session and just tell you what to do with arguably the most crucial aspect of your life (I avoid giving advice as a general rule (unless it’s evidence-based education), but instead help clients understand what they need for themselves to meet their personal goals).

That said, people are naturally impatient and understandably want to see that they are getting value for their time and money. The goal of Cardinal Point Counseling is to balance the need for assessment with some interventions to provide at least some short-term help. Even with assessment, there are built-in interventions that may not stick out. Of course, you don’t want to be tested for months and asked endless questions about your childhood, but a healthy balance is necessary. I colleague of mine tells clients that they might not know it, but every single thing he does in a session is to help his clients. There is a lot of truth to that statement.

Treating Individual Issues Related to Stress, Anxiety, and Depression is Typically a Faster Process

While every situation is different, if choosing to work on anxiety, depression, or stress, there is usually less assessment, fewer sessions needed, and faster outcomes than when working with a couple.

Striking a Balance Between Assessment and Treatment

Evidence-based methods for couples therapy guide almost every step taken by Cardinal Point Counseling. The Gottman Method is backed up by about 45 years worth of extensive research. Emotionally Focused Couples Therapy (EFCT) is backed by extensive research and statistically shows the lowest relapse rate. You get to have the two approaches combined and used with other theories to help you improve your relationship. This is a restatement of the information above (because it’s important), but no one wants to answer questions and go through a lengthy discovery process without knowing if they will see results. But some discovery is necessary to create a plan that best addresses your needs. If you went to a doctor for pain in your arm, they would want to rule out a broken bone or tear before giving you a cortisone shot to numb the pain or recommending surgery.

What to Expect

“Studies show that, in the hands of a good counselor, marriage counseling is successful 70-80% of the time”
William Doherty, PhD, LCSWAuthor Name

If you schedule your first appointment, you will get a link to complete intake paperwork. Most of the paperwork is required legal stuff like understanding privacy policies, confidentiality, and practice policies (fees, cancellation policy, etc.). However, one crucial form is about your relationship itself or your background if doing individual therapy. The extent to which this is completed accurately, thoroughly, and honestly can make a big difference in how your first appointment goes. All forms completed at least 24 hours in advance are read word-for-word, and any questions are highlighted for additional review.

Intake paperwork is essential but is not a substitute for conversation. The first appointment involves an oral history review of your relationship or situation, and a review of your goals and reasons for therapy. While part of the assessment and understanding your relationship, evidence shows that reviewing your relationship from its start to where you are today helps couples who haven’t reflected on why they fell in love in a while. It helps them remember all the great times they have had together and their strengths. You’ll have a chance to learn a little about the Gottman Method and others, and I like to end the first appointment with a positive activity that usually helps strengthen the relationship and end on a good note.

The Gottman Relationship Assessment

The next step is an optional but highly recommended comprehensive relationship assessment. One may think, “I already completed a written questionnaire, talked about my relationship for an hour, and now I need to take a long and time-consuming test?” This test also costs $39, going to The Gottman Institute. I have yet to have a couple take this assessment that didn’t learn something from it. Experience shows that it reduces the duration of therapy by eliminating interventions that you don’t need. It is also based on 45 years of evidence in the questions that help support counseling and identify your needs.

Individual Sessions

The final assessment phase involves an individual session with each of you. Depending on the extent of the issues, sometimes this can be accomplished by meeting with each of you for half a session. This session invariably reveals things that didn’t come up through other methods. The goal is not to have secrets, but couples are generally more comfortable saying some things in private. While secrets are discouraged, we talk about ways to bring up sensitive topics when the time is right. This session also allows each client to have uninterrupted time, as it’s not unusual for one person to dominate the conversation when the couple is together. The individual session also lets you learn more about the Gottman Method and Emotionally Focus Therapy and some behaviors that may help the relationship.

Customized Interventions

After completing the individual session, the real work and targeted interventions can begin. These are based on the extensive evidence that has been gathered to this point. The quote above about couples therapy working 70-80% of the time is accurate at Cardinal Point Counseling, but it does take time. The quote doesn’t say that it typically takes 8-12 sessions to achieve the maximum benefits. Some couples may need counseling every week or two for a year. For 20-30% of couples, counseling will not be as effective as they like. It is a team effort and most of the work has to be done by you outside of counseling (and the goal is for you to learn to fish so you can do it on your own).

There Can Be Some Benefits in “Failure”

Some couples see that perhaps they have an unhealthy relationship that is unlikely to get much better. This realization can be a success in and of itself (although it may not seem like one at the moment). Some couples realize that their relationship isn’t improving at the rate they would like, and something needs to change. Some learn communication skills to help with any current or future relationship. Some people learn more about themselves in ways that will help them throughout life.

Healing is not Always Linear

Ideally, each session would bring you and your partner closer together. However, realistically, that is not always the case. Something may surface in one appointment, leading to more arguments before the next appointment (although it is generally recommended to save these for therapy if possible). Sometimes issues come to the surface that have been buried for years or even decades, and that can be like a painful cortisone shot that soon reduces the pain.

Feedback is Welcome

Perhaps you need a session where we don’t work on Gottman Interventions, and you want to process something that happened that week. Cardinal Point Counseling believes in individualizing therapy toward what makes sense for you and your goals. While constructive feedback is preferred, letting your therapist know if you aren’t getting the results you want fast enough can open the lines of communication.

You Are the Key Players in the Process

While finding the right counselor who uses scientifically based methods to help you is essential, you and your partner play the most critical role. It is normal not to jump for joy over starting couples counseling or individual counseling. It is typical to have some hesitancy or concerns. At the end of the day, though, your role is paramount. It is like going to a personal trainer or physical therapist. Do you do the recommended exercises? Do you avoid what is difficult? Do you push yourself? Do you put in the necessary work? And not everyone needs a personal trainer. Some people do fine working out independently (but most clients have already tried and failed this for several years first). Cardinal Point Counseling will give you a highly dedicated resource, but counseling is unlikely to be successful if we want your success more than you want it for yourself. Your attitude is also key to how successful you will be. If you tend to see the silver lining, you probably will. If you tend to see the glass as half-empty rather than half-full, it probably will be. Therapy outcomes can be predicted somewhat accurately by how couples complete their intake paperwork; whether they take it seriously and get it done in time, or whether they don’t do it, need reminders, or answer full-sentence questions with a couple of vague words. At the same time, not everyone is comfortable being completely upfront right away, which is fine. Sometimes the discovery process is like peeling off layers of an onion. You learn some things from the written questionnaire, then you ask questions and learn perhaps the way something was written wasn’t what was intended, or it was written when the client was in a bad mood. The assessment really goes deep, but it’s typically not enough to answer the questions without explaining the answers later. More often than not, clients will withhold things until they feel comfortable, which is also nothing to be ashamed of (but also causes therapy to take longer).

Gottman Recommendations on When to End Therapy

  1. Primary markers of divorce, such as negative sentiment override (essentially discounting the positives and focusing on the negatives) and the Four Horsemen (criticism, contempt, stonewalling, defensiveness) have been significantly reduced
  2. Partners show strong fondness and admiration toward one another
  3. Partners understand what is happening in each other’s world and talk about it daily
  4. Each person accepts influence from their partner and includes them in decision making
  5. Partners turn towards bids for connection as opposed to turning away
  6. The couple can effectively repair negative interactions
  7. The couple can de-escalate problems
  8. Each person can psychologically and physiologically self-soothe themselves and their partner
  9. The couple can make each conversation better than the last, without the help of a therapist
  10. The couple attacks problems sooner than when they started therapy and doesn’t let issues fester

– From the Gottman Level 2 Clinical Training Manual

Good and Bad News

The good news is that couples therapy generally works. The bad news is that it takes work, time, and money. It is usually not a quick process and sometimes can be difficult. I think the personal trainer analogy makes sense and applies. The personal trainer can guide you and push you, but you probably won’t get stronger if you hate exercise and don’t want to do it. You can start working with a personal trainer if you aren’t feeling motivated, but if you don’t become motivated, it is time to find a new personal trainer or decide to give up on the cause and try a different route.