Dr Joanne Stuart
CBT for Couples
Updated: Aug 30, 2022
Cognitive behavioural therapy is known to be effective for a wide range of psychological problems. Studies into the use of CBT for couples have shown its use for improving communication, reducing distress and conflict for couples in romantic relationships.
What is the idea behind CBT for couples?
It is based on the idea that most people have particular expectations about how their partner should be or behave. This influences the behaviour or characteristics which each partner attends to, which affects their appreciation of their partner and their relationship. So, for each person, thoughts, behaviours and emotional are all interrelated, and each member of the couple can impact on the other.
What would happen if I come for CBT as a couple?
Firstly, the couple will be seen for an assessment. This will cover a wide range of issues such as what the nature of the difficulties are, how long they have lasted, and what attempts have been made already to try and improve the relationship.
Why do couples come for therapy?
There are often a wide range of reasons why a couple come for therapy, including to look at issues of conflict they cannot resolve or issues which are in one member of the couple but having an impact on the relationship such as anxiety, depression, alcohol and sleep problems. They may also have some parenting issues, or problems with infertility or infidelity.
Regardless of the main concern, it is important for the therapist to have a clear picture of how this impacts on the couple relationship. To do this, each individual member will need to be willing to look at their own thoughts, behaviour and emotions, as well as thinking about how this impacts on the other, by keeping diaries to help track this information at the start of the therapeutic process. They will also need to be willing to carry out tasks at home to help therapy progress.
Will the therapist take sides?
The therapist will be equally aligned to both parties, and indeed if anyone is coming to therapy for couple work in order to show how bad the other person is, and hope that the therapist will take their side, then the therapy is not likely to be effective.
What are the main techniques used in CBT?
After the initial assessment phase, when it has been possible to gain a clear picture of how each partner is having an impact on the other, then it will be helpful to think of some goals for the couple. These could be individual, or joint goals for the relationship. Therapy can then focus on how to help people to reach their goals, using one of the following strategies.
Communication skills training
The couple will learn some basic strategies which aid communication, both in helping them to talk to each other clearly and without blame, and also to listen openly and without judgement. They can then practice these skills in the session, and also for homework between sessions. The purpose of this is not to solve problems, but to be able to really listen to each other and appreciate each other’s feelings.
The couple will learn some strategies to think through specific problems they are experiencing, and then practice this during the session and again for homework. For instance, Rachel was getting increasingly frustrated with Simon’s snoring at night, and had started to sleep in another room. Simon was upset about this, and felt it was having a detrimental effect on their relationship. They talked this though in therapy and brainstormed different possible ways forward, until they found a solution which worked for both of them.
Each partner will keep a diary throughout the work to help identify and then challenge the thoughts and beliefs which are impacting on the relationship. These can be explored and challenged, in a way to help improve the communication and understanding between the couple. For instance, Ellie was feeling that Richard didn’t care about her because he had started coming home late from work and then focusing on his phone. Ellie feared, ‘He doesn’t love me’ and started to feel, ‘I’m not important.’ Talking this through, Richard was able to help Ellie challenge her beliefs, by showing that he was concerned to help them move out of their home and had been working longer hours, and was still working on his phone when he got home. He in turn, felt that everything was his responsibility, and that Ellie was being, ‘insensitive and thoughtless’. Being more open about the thoughts each of them had helped them to challenge each other and find a better way forward.
It is sometimes helpful in couple work to identify emotions which might be hidden, such as fear, anxiety, or anger. These can be explored and discussed in a safe way. Sometimes emotions can be heightened, and techniques might be needed in order to help people manage these strong feelings. It is important to do this to help reduce conflict and help with problem solving, as when there are intense emotions, it is difficult for people to think logically.
A couple may come to therapy to help improve their sexual relationship, and deal with any problems. If there is significant sexual dysfunction, this is better dealt with by a specialist in this area. However, many issues in the sexual relationship can be addressed in couples CBT work, such as addressing any emotional concerns which are getting in the way of intimacy, and using communication training to help increase affection and connection between a couple. It can also be helpful to look at any thoughts or beliefs which are getting in the way of sexual pleasure, for instance addressing any unrealistic or negative expectations.
A few closing points
Couple work needs to be entered into with openness and trust. If there is violence in the relationship and there are issues of safety, then therapy is not the best way forward, and it would be better to have some space and individual work before coming as a couple, if that becomes appropriate.
It might be that the goals of the therapy are to help a couple separate. If that is the case, and it is agreed on, then the therapy can help think through how to manage this difficult time in an amicable way.
Sometimes, just to think things through with someone outside of the couple can be helpful. You do not have to be at the end of a relationship or with serious problems for couples therapy to help.