Ethics and Competency in Couples Therapy

I like to believe that when I go to get my oil change, I know something about my truck.

Not a ton, just enough so that I don't feel like an idiot when I'm walking out the door $100 lighter after paying for something I could have done myself. 

In the spirit of being informed, I'm writing this blog for anyone who wants to feel empowered when they go see someone for their relationship. 

It's an absurd notion, really. The idea that you are going to walk into an office and talk to someone about your deepest and darkest secrets...and then expect things to get better? 

In my training, we talked about how couples generally wait too long to get help. But honestly, I'm amazed at the courage it takes to believe you can be helped. 

Believe it or not, there is both a science and an art to this process. In just a few weeks, I'm going to give a presentation on what it means to do ethical couples therapy. This blog is intended to be a warm-up for that presentation.

What is good couples therapy?

When more than one person is in therapy, I’m no longer dealing with individuals, but relationships. Within couple therapy, the individuals are not my clients; the relationship is my client. 

When I remove a person from the room, I remove the relationship from the room. When I have private conversations with one partner, I privately collude with their stories and exclude the relationship.

Sometimes collusion is necessary, and that’s okay. When there's violence, for example, I need to have some private conversations.

However, too many therapists see individual partners for couple problems because their clients’ chaos is overwhelming.

Ethical couple therapy is a relationship-driven process. Partners don’t just want to develop and grow. They want to develop and grow in their relationship. They want intimacy.

If I try individual therapy as a method for treating couple problems, it usually means I’m scared to see a couple. Unless there’s some threat to either partner, couple therapy should not be done with one person. 

I don’t keep secrets between partners. 

Secrets triangulate therapists and increase unhealthy collusion. Secrets turn therapists into affair partners.

Ethical couple therapists don’t have affairs with their clients.

Competent couple therapists respect their clients’ stories, but are also not afraid to show a little irreverence toward them. Not because its rude, or because I know better, but because if couples come to therapy, it usually means that their meaning-making systems have become rigid, calloused, and mutually exclusive.

One way to confirm this statement is to ask partners how they know the other wants to have sex.

I ask this question as often as I can because I’m secretly collecting responses for a book I’m going to write about all the bizarre and hilarious ways humans try to stay emotionally clothed and physically naked at the same time.

Couples will go years without having sex because Hollywood has created the destructive myth that you never have to ask to be desired, that you might have to vulnerable for good sex. 

We do come up with all kinds of creative hints that we hope will cue our partners’ sex response system.

Slap on rear. -> Cue sex response.

Snuggle in bed. -> Cue sex response.

Do dishes.-> Cue sex response.

“Honey, I’m home!” -> Cue sex response.

“Good morning.” -> Cue sex response.

“Are the kids in bed?” -> Cue sex response.

I wonder if she wants sex. -> Cue sex response.

Inhale. Exhale. -> Cue sex response.

I once asked a client how he knew his partner wanted to have sex. He responded that he knew she wanted to have sex when she was grumpy.

Another client once told me she knew her husband wanted to have sex when he ran into the room naked and swung his genitals in a circle exclaiming, “Want to take a ride on this helicopter?!”

I would fail my couples if I became lost in the abrasive and defensive humor that is the helicopter, a functional way that a man veiled emotional vulnerability behind brash nudity and coarse jokes.

He wants to have sex, but doesn’t want to ask. He wants to make love, yet does not want to risk crushing rejection, so he comes up with a drama for laughing it off when his partner rejects his…advances.

So he walks away again, his familiar smile hiding desire and rejection, he builds up resentment because his partner doesn’t want sex, all the while missing her similarly profound longing to be romanced by something other than a helicopter penis.

These meaning-making dramas can’t usually be interrupted by educational talk therapy. The husband knows he could ask for sex. A therapist could tell him he should ask for sex.

But the helicopter penis is an intelligently-designed system to avoid vulnerability. Telling a client to ask for sex doesn’t deal with the problem of fear or desire.

Change must be experienced, and new experiences aren’t always safe or easy.

 I hear too many of my supervisees talking about therapy as a “safe place.” That’s absurd. That’s a therapist’s way of making sense of the environment they idealize for people.

Safety does not promote change. Safety promotes stagnation. It’s a therapist’s job to create anxiety and hold that anxiety enough so that people will change, which is risky.

Safe therapy is ineffective therapy.

If I’m not willing to put myself at emotional or professional risk, I should probably not do couples therapy.

When I show empathy for one partner, I will inevitably anger the other. When I’m so worried about my Yelp reviews, or the fact that this client came from an important referral source that I withhold meaningful care, I’ve crossed into the realm of unethical treatment.

Different stories create different expectations for therapy.

Partners enter therapy with different levels of belief about whether therapy will work. Some think it’s a waste of time.

They might be right.

But don’t mistake this cynicism for a lack of desire to change. Many partners just have no other idea what to do. Some have believed their whole adult lives that therapy is a sham.

They might be right.

But nonetheless, they end up in my office because they’ve run out of options.

Distressed couples usually have one-dimensional perspectives on their problems – and you’ve been hired to collude with that perspective by whipping their spouses into shape.

Of course, as an ethical couple therapist, you understand that colluding with one partner’s narrative, no matter how strongly that narrative seems to make sense given your own family of origin rules (If you would just stop criticizing so damn much, maybe he wouldn’t shut down so often), will ultimately exclude the other.

This is not safe or boring work. If I’m bored, I’m just collecting a paycheck. If I’m just collecting a paycheck then my therapy is lukewarm, and lukewarm therapy is as good as lukewarm bath water in December. Couples wait far too long to come to therapy, so always be prepared for a crisis.

It’s winter outside and clients need hot water in their baths…figuratively speaking of course.

Dr. Mathis Kennington