3 Reasons Why Most Couples Therapy Fails
By Matthew McKay, Publisher and co-founder of New Harbinger Publications
Couples therapy is a big business. But it isn’t always effective. Only about 50% of partners view their couples work as effective two years into treatment, and 25% believe they are worse off than before. Perhaps more concerning, 43% of divorced partners sought couples therapy while still married, but the relationship ended anyway. This data suggest that we have work to do to improve treatment efficacy for distressed partners.
In my view, there are three main reasons why couples therapy can fail to deliver positive treatment outcomes:
1. Conflict resolution and communication skills are taught ineffectively.
With the exception of Emotionally Focused Couples Therapy, most couples therapists teach communication skills while the partners are NOT emotionally activated. Partners are shown how to use non-violent communication, active listening, “I” messages, and negotiation strategies during session via therapist modeling and rehearsal. But when partners are at home, emotionally triggered by hurt and conflict, they tend to forget everything they’ve learned. The theory of state-dependent learning explains this. Knowledge acquired in a relaxed, unthreatened state is difficult to retrieve and utilize during states of high emotion. If we want partners to have access to communication skills while they are emotionally activated, couples therapists must teach the skills in the same emotional state where they’ll be needed.
Effective couples therapy must deliberately bring affect into the room by letting conflict develop to the point where partners are triggered. Only then should communication skills be rehearsed; only then can we teach partners to respond effectively in the face of emotional pain.
2. Couples are taught new behaviors that are theory rather than values-based.
John Gottman tries to get partners to increase the ratio of positive to negative interactions (above 5:1). Sue Johnson, developer of Emotionally Focused Couples Therapy, encourages couples to express underlying fears and attachment needs (based on John Bowlby’s attachment theory). Psychologist Marshall Rosenberg advocates for non-violent and compassionate communication. But teaching new responses based on a theory of healthy couple behavior may not match what a particular couple actually needs or wants to do. Increasing positive interactions, the expression of attachment fears and needs, or non-violent communication can be useful new behaviors for some couples, but are not tailored to the unique relationship values of each partner who enters the therapy process.
Replacing dysfunctional relationship systems and processes with effective responses requires going beyond a one-size-fits-all approach. Instead, couples therapists need to assess and uncover each partner’s values—principles of who they want to be and how they want to act in an intimate relationship. These values, in turn, form the basis of new, more effective behavior. These new responses will be different for each partner because what they truly care about and value will be different. The therapist’s job is to help couples build new relationship patterns based on the unique, relationship values that each partner holds.
3. The formulation for the cause of couple conflict is wrong.
Every system of couples therapy has a theory for why partners get caught in conflict. Formulations to explain couple conflict include:
- Poor communication skills
- Attachment problems
- Aversive (win-lose) problem solving strategies
- Dysfunctional systems such as “pursuer-distancer”
- Cognitive distortions
- Unexpressed emotions and needs
While these formulations may, for some couples, be vulnerabilities that lead to conflict, they are not the cause of conflict. The prime cause of relational conflict is early maladaptive schemas and the avoidance strategies—schema coping behaviors—partners use to manage schema pain (McKay, Lev, and Skeen, 2012). Early maladaptive schemas are core beliefs, formed early in life, about who we are and the nature of our relationships to others. Among the schemas that cause relationship conflict are:
- Abandonment – the belief that important people will sooner or later abandon or reject you.
- Defectiveness – the belief that you have deeply shameful flaws.
- Deprivation – the belief that you will never get what you need in a relationship.
- Subjugation – the belief that a partner’s needs come first (which leads to engulfment).
- Abuse/distrust – the belief that others will hurt or take advantage of you.
- And five others.
Each schema, when activated by a relevant trigger, creates painful emotions such as fear, shame, hurt, hunger/yearning, despair, etc. To control this schema-generated pain, partners use schema coping behaviors such as aggression, withdrawal, surrender, clinging, and others. These toxic coping behaviors both cause and maintain couple conflict by keeping partners stuck in self-reinforcing loops. Partner A’s schema coping behavior triggers Partner B’s schema coping behavior, and visa-versa—endlessly. This is why conflicts often don’t resolve.
Successful couples therapy must (1) uncover and articulate each partner’s schemas and schema pain, (2) identify the destructive schema coping (avoidance) behaviors used to manage this pain, and (3) replace schema coping behaviors with new, values-based responses.
The above reasons why couples therapy often fails led us to develop and test (in a randomized controlled trial) a new approach to couples work: Acceptance & Commitment Therapy for Couples. This new treatment helps partners:
- Recognize which of the 10 relationship schemas most influence their attitudes and actions toward each other.
- Watch – in the moment – when schemas are triggered, and both observe and learn to tolerate (through exposure) schema-driven emotional pain.
- Observe – in the moment – the urge to use schema coping behaviors to avoid pain.
- Recognize the moment of choice to use schema coping behaviors vs. new, values-based behaviors when schemas are activated.
- Resolve conflicts using values-based problem solving.
- Deal with barriers to values-based behavior using classic acceptance and commitment processes such as mindful awareness, defusion, and exposure.
The promise of couples therapy is real but still emerging. Putting values, state-dependent skills training, and schema awareness into the process may significantly improve our treatment outcomes.
Matthew McKay, PhD, is a professor at the Wright Institute in Berkeley, CA. He has authored and coauthored numerous books, including The Relaxation and Stress Reduction Workbook, Self-Esteem, Thoughts and Feelings, When Anger Hurts, and ACT on Life Not on Anger. He lives and works in the San Francisco Bay Area.