NP006 Couples Therapy: Today and Tomorrow

This blog focuses on discussion regarding the course, NP006 Couples Therapy: Today and Tomorrow

NP006, Couples, Session 1, William Doherty


Welcome to the relaunched series of New Perspectives on Practice: Couples Therapy Today and Tomorrow. This practical, nuts-and-bolts first session with William Doherty, a seasoned couples therapist, will explore the most common mistakes therapists make in treating couples, and will provide strategies for how to avoid making these errors. Doherty will go over the most common obstacles to effective couples therapy, how to best structure couples’ sessions, how not to undermine a couple’s commitment, and much more.

In the inaugural series, course participants used the Comment Boards as a way to share what they thought was most relevant or interesting from the sessions, and to ask questions of the presenters and of each other.  It often led to back-and-forth discussions between course participants and presenters. We invite you to use the Comment Boards in the same way, after each session and after completing the course.

What was most striking about this session with William Doherty? Did this session bring up any similar experiences? Any questions? We encourage everyone to use the Comment Boards as a forum for reflection, thoughts, and questions. Thanks so much for your participation, and welcome to this extremely relevant and lively series!

06.07.2011   Posted In: NP006 Couples Therapy: Today and Tomorrow   By Psychotherapy Networker
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  • 0.2 avatar Beth Haessig 06.09.2011 08:29
    this was a really good hour I spent listening to this session. Thank you.
  • 0 avatar Eileen Summers 06.09.2011 13:21
    Liked the specific intervention techniques. Interested in any specific intervention when couples are discussing committment to change and one says they don't need to change and the other decides they will do all the changing to keep the marriage together but doesn't really believe the other is "ok" the way they are.
  • 0 avatar Pamela Wood 06.09.2011 13:21
    Thank you so much. I love the clarity with which you outline the important things to accomplish in the initial meeting, and some specifics of how to do this!
  • -0.3 avatar Sandra Galgano 06.09.2011 13:32

    I really appreciated examples given regarding blocking mind reading etc. I have been working with a couple where both partners reflect on the past ruining the hope of what we are working on currently. I've pointed it out numerous times yet they continue to go there any advice?
    • Not available avatar Bill Doherty 06.11.2011 13:01
      Sandra, Thanks for your note. With couples who continue to talk about the past and creating hopelessness, I would try offering a ground rule that if they go to the past, you will interrupt and steer them back to the present. If they give you permission to do this as a way of working with them, then you can successfully block their self-sabotage. If either resists when you follow through, you can keep them in the here and now about what is going on right now that is making them not follow through on what they have agreed with best for their relationship. Either way, you will not let them go backwards. Hope this helps.
  • Not available avatar Megan Nervi 06.09.2011 13:36

    I found this presentation to be particularly helpful as I am in the process of trying to decide if this is a modality that I would like to offer in my private office after more training of course! I'ven often felt wary about the idea of doing couples therapy as I worry that I would become overwhelmed by couples such as those we saw in the video clip. I appreciated Bill's encouragement and guidance regarding limit setting, and taking a more directive and active role in creating and modeling boundaries in the session. I found that very helpful! My one question for others is this....Do you generally take a full session with each person initially to gather extended family history before having the couple meet together? I imagine this is a more family systems approach to couples therapy but was just curious how others have handled these first inital sessions. Thanks!
    • Not available avatar Bill Doherty 06.11.2011 13:03
      Megan, I encourage you to start with the couple and stay with the couple, using individual conversations only if you feel you are not getting the straight story from one of them, or if someone is undecided about whether to work on the relationship, or if you have DV concerns. Otherwise, stay at the couple level. I hope this is helpful advice.
  • Not available avatar amy olson, LCSW 06.10.2011 12:48
    A very good primer and/or refresher on the important points when doing couples work. Good take aways today include laser focus on agenda setting, eliciting commitment to the relationship and well as to the therapy, interruptions and mind reading. I like the frame that making interpretations about one's spouses FOO issues is a boundary violation. Good emphasis on channeling the negatives through me and encouraging them to send the positives to each other.
  • Not available avatar Carol O. 06.10.2011 15:51
    Helpful material in a useable format. Clear and concise. So much of training directs us to be more passive in therapy. It is refreshing to hear you say that the therapist needs to be active with questions and offer observations. Love the idea of filtering the conflict through the therapist so that it is better received. Do you believe a certain seating setup is advantageous to the filtering - should couples sit side by side, opposite each other, triangulated with the therapist?
    • Not available avatar Bill Doherty 06.11.2011 13:05
      Carol, I don't think the seating is very important as long as they can face you and turn to each other. I've used chairs and a sofa, and both work. Mostly it's who they look at while delivering the conflictual feelings. Bill
  • 0 avatar Kristen Renshaw 06.10.2011 22:51
    I loved this session! Unfortunately I think I've made all of those mistakes and although I knew they were wrong steps at the time, it helps to understand why those were counterproductive moves and what I could do better next time.
    Thanks for all the specific Do's and Don'ts.
  • Not available avatar Joanna Burton 06.11.2011 09:59
    Finally, an "expert" talks about the "basics" of couple interviewing. I've noticed for years how master therapists "assume" that listeners know the basics of managing a couple interview. The concrete list of "do's and don'ts (with Bill's elaboration) was very helpful. Thank you.
  • -0.1 avatar Barbara Wahler 06.11.2011 11:44
    This was awesome and extremely encouraging. I've worked with only a few couples in the past few years and I am happy to see that with my latest couple I've actually done much of what Bill says needs to be done! I was rather uncomfortable being more directive, but I think it's important to create a safe space for both spouses. I especially appreciated the exhortation to focus less on insight (which seems to lead to analyzing each other) and more on how they couple can change. This session really excites me that I can do good work with couples and encourages me to learn more. I definitely appreciated the "basics" approach - the nuts and bolts of working with couples.
    One question: Was the video not available for the rebroadcast? I couldn't find the 2nd window to view it.
    • 0 avatar Psychotherapy Networker 06.27.2011 12:11
      Hi Barbara,

      We're glad to hear that yuo enjoyed this session, and sorry that you weren't able to find the video. It was on the same screen that the presentation was on, available for viewing by scrolling down the screen. If you ever have any technology-related issues, please just contact support@psychotherapynetworker.org and they'll get back to you as soon as possible!


      Networker Support
  • Not available avatar Tracy Krause 06.11.2011 12:49
    This session was very helpful,especially the specific microtechniques. The blocking mind reading and pathologizing as a boundary crossing and how to handle interruptions were great. I really appreciate the suggestion, too, of pursuing microtechniques when consulting with colleagues. That is a life-long process that will undoubted add great richness to my practice. I absolutely love the video series that Psychotherapy Networker offers. A fabulous way to learn and stay inspired.
  • Not available avatar Renee Segal, MA, LAMFT 06.11.2011 17:23
    This is my second viewing of this webinar. And I still got new information out of it. I am wondering what to do about a couple in which one partner is a therapist. She constantly is "diagnosing" her partner and telling what "his issues are" and that "you get anxious...etc". I have tried often to say that she is invading his psychological boundaries. I have used the here and now about what happens for you when you feel that you have to tell him about himself but she is really tough. Any suggestions? Also, by the way, I live in Minneapolis...are you doing any speaking locally? I would love hear you.
    Thanks very much, Renee Segal
    • Not available avatar Bill Doherty 06.23.2011 09:42
      Renee, Therapists can be tough clients in couples therapy. I generally frame the pattern the same way you do--diagnosing and telling the other what they are feeling and why they are feeling it--as a boundary issue that keep genuine connection from happening. I say that even if it's accurate, it won't work because the other has to resist. I see if the therapist/client gets this at least cognitively and agrees with me. If so, I challenge the pattern every time, without fail. If he/she keeps doing it, I then turn up the heat by making their inability to stay on their side of the boundary change the focus of the session. In order not to come across one-up, I often say that it's an occupational hazard of our profession, but a dangerous one. Finally, I work to get the spouse to be the one to assert his/her boundaries without me having to do it for them.
      I hope this helps.
  • Not available avatar Megan 06.11.2011 19:43
    I really enjoyed listening to the presentation. I recently heard Dr. Doherty speak at the KAMFT conference in March. I loved hearing the information again! I just recently started seeing couples in graduate school a few months ago, and appreciate the advice to be an active therapist, and create structure. It is a challenge for me to be active and create this structure, and this is something I have been working on. At the beginning stages in my career, I have found myself feeling overwhelmed with not knowing how to to be helpful for the couple and what needs to be done intervention wise. One thing I would like to hear more about is how others begin the first session with couples, and how they begin subsequent sessions. Thanks for the encouragement and support, and this information has been very helpful for me!
    • Not available avatar Winifred Reilly 06.17.2011 01:01
      I always begin a first session by asking each partner what they want help with. My goal is to have each person articulate his or her reason for being there- and not in vague terms. It's my way of getting the clients to focus on themselves- what they want from the work. eg- I want to have fewer fights. I want to understand why I fly off the handle. I want to be able to ask for things and not be so afraid. Often this conversation can take 5-10 minutes or longer (per person0 as they add in pieces of back story and I help clarify and get person to look inward and not at whatever the partner is doing that is making trouble in the relationship. Sets the tone for the work of therapy being about looking at oneself, ones own part in things, encouraging self-inquiry, etc.

      Subsequent sessions begin with asking what they took away from the last session, what happened from there, what they've thought about, discovered.
      Helps therapist see how active or passive they are.
      Hope this helps.
    • Not available avatar Bill Doherty 06.23.2011 09:46
      Megan, I being all sessions after the first one with two questions they each respond to: how things have been in your relationship since we last met,and what would you like to put on the agenda for our session today. The rationale: I want to know how things are going, and I want them to each take responsibility for our work each time. Of course, I might have an agenda item myself that I will bring up. Many therapists have unstructured openings in which they just ask what's going on, and then the check in can take half the session. I like to keep this focused and make a joint decision about the work we will do, as opposed to not knowing the distinction between check in and working on issues.
      I hope this is helpful.
  • Not available avatar Diane 06.11.2011 20:26
    Thanks for your clarity, Dr. Doherty, and for your whole approach. As someone whose marriage has been the "victim" of an incompetent couples therapist, I can't begin to tell you how important everything you taught was. For someone who works with couples who don't necessarily have a commitment to the relationship, it was a powerfully good reminder of what to pay attention to. Thanks again.
  • Not available avatar Kathy Hardie-Williams 06.11.2011 21:31
    I was struck by what Dr. Doherty said about personal responsibility and commitment to do their own work as opposed to their partner's. Could you provide an example of how you would respond if one of the partners isn't willing to look at themselves and do their own work? In other words, it's always about the 'other' (their fault) and the client becomes agitated if it's pointed out by the therapist that they need to be willing to look at themselves and they part they may be playing in the 'dance' that they do.

    Thank you! Enjoyed the webinar!!!
    • Not available avatar Bill Doherty 06.23.2011 10:00
      Kathy, In situations where I am struggling to get one of the partners to sign up for their own responsibility for the problems and for change, I ask to speak to this person separately during a session (not a separate session, but a focused time during the session--although some therapists do this with separately scheduled sessions). I begin by asking how our work is going for the client. I move into talking about the therapeutic relationship--my sense that I have been pushing for something that the client may not be interested in taking on, namely, their own contributions to the problems and the changes they would have to make. I ask if they have felt this struggle between us. Sometimes this opens things up. If not, I say with a matter of fact tone (maybe with a bit of sadness in order not to go one up too much) that the way I work is only helpful to couples if both have an agenda for personal change in the relationship; otherwise, it gets onesided and the other partner gets resentful. I am gently but firmly letting the client know that something will have to shift in how we are working, with the client signing up for an agenda for change, or the therapy is doomed. I am upping the heat here, and it's best to do it one to one. What may come out is their hopeless, shame or fear of being critized, or their sense of being the victim in the relationsihp. Sometimes the client is just not psychologically minded, and I am content with an agreement they he or she will try to work on finding out their part and what they can change. I am looking for something this person wants me to help with other than changing the partner. In sum, I prioritize this issue as a lack of a therapeutic contract, and I work to see if we can get past our impasse. If we can't, after multiple tries, then I move to a conversation with the couple about ending the therapy. For that conversation, you can see my other Networker webinar on therapist-initiated closure.
      I hope this is helpful
  • 0 avatar Martha Smith 06.12.2011 13:12
    Very informative and helpful in giving me direction, particularly in those sessions as in the movie segment shown in The Ref with the couple and the therapist. I had one of those sessions yesterday and now realize how I could have created more structure and prevented the melt-down.
  • 0.1 avatar Elizabeth Grant 06.12.2011 16:46
    I've just started to work with couples and what I notice is that they want you to be deeply interested, ask questions and note when they seem to be going "into story" or some other unhelpful pattern. In this way of working, the therapist is loving or caring for their relationship...which is what it sometimes needs until they can re-create that dynamic in a new constructive way! Did Dr. Doherty say "Blame is just a way to discharge pain."...I love that!
  • Not available avatar Jay Schlechter 06.13.2011 01:43
    Thanks for the great presentation! Both the material and your clarity were first rate. Also, I really "enjoyed" the film clip. Good reminder.
  • Not available avatar jenny tozer 06.13.2011 16:42
    Hi, what a great opportunity to listen to what Bill had to say - clearly explained with clarity and expertise. I wondered though about the therapist as being seen as the 'total expert' with all the answers - having said that I imagine that Bill works very collaboratively with couples. It is true that couples come and hope that their relationship can be improved and in that sense they do come to see 'the expert' but I wondered how Bill might draw out the couple's expertise and help them to develop a sense of expertness within their own relationship. Thanks again,
    Jenny Tozer..
  • Not available avatar Monica Evans 06.13.2011 17:09
    From a person centred background, moving into systemic couples work, I have found Bill's specific guidance to not invite a further response as a closing frame,"so you were feeling angry" particularly useful in moving the conversation on. I have also found the use of NVC to be useful in helping clients address particularly entrenched blaming views/patterns of speech.
  • -0.2 avatar Cindy Noble 06.13.2011 18:39
    How I cringe to think of all the mistakes I have made in working with couples. But it is so rewarding and challenging and so necessary, and I learn so much from each couple. Your tip on connecting with each partner is so helpful. It allows us to move into the "work" of therapy, and makes it easier for them to focus on themselves instead of getting into blaming patterns which really inject more of a sense of hopelessness. Also, thanks for the reminder on agenda setting in the first session - so important!
  • Not available avatar Lola Fatas 06.14.2011 04:00
    What a helpful session. Thank you Bill and Rich. I found all the "microtechnics" especially interesting.
  • Not available avatar jody galardo 06.14.2011 19:00
    I found this conversation a grass root information session that allowed me to reflect on my own successes and stumbling screw ups that helped identify where i went off the rails. i have been doing individual and couple therapy for over 28 years and still found the structure of a somewhat teaching/ supervisory approach valuable for me. i look forward to the continued sessions coming down he pipe!
  • Not available avatar Poonam Sharma 06.15.2011 20:05
    Excellent presentation--very clear and pragmatic. I found the distinctions between a therapist's stance in individual therapy vs. couples therapy very useful. It was also very helpful to note the necessity of a structured and directive style with couples, something that was never articulated in the many therapy classes I took in grad school. Thanks Bill!
  • Not available avatar Tom Nolan 06.23.2011 20:49
    Refreshingly grounded and based in respect and fairness...I agree about the importance of getting a read on commitment to do the work....important to have a structure and be active in modeling and teaching effective relationship skills from the start...Always important and critical to make a connection with each person the first session. I like the idea of actively blocking any "analyzing" and interpreting "whys" of behavior. I also redirect the negatives through me...Thank you for sharing such a positive and down-to-earth approach....Tom
  • 0 avatar marla holt 06.28.2011 14:14
    This session was very helpful. It was helpful to hear that most of the techniques I've been using are validated, but more importantly I was able to learn new techniques that are practical and effective. Thanks
  • Not available avatar Peggy Grose 08.06.2011 10:59
    This was most enjoyable and informative and I learned much. One very minor point: As an old Dale Carnegie Course instructor, I was somewhat distracted by the constant "ah's', "um's and hesitations on the part of both speakers.
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