Couples on the couch

If you're at each other's throats, will therapy make it better – or worse?

(GETTY)

It is a poignant fact that January is a peak month for marriage bust-ups, as the fallout from holiday tensions – or simply enforced proximity – settles over fragile households. But increasingly, there's another stop before things reach the lawyer's office: couples counselling.

Couples therapy is no longer something to be embarrassed about. Relate now helps around 150,000 couples each year – a four-fold increase in the past 20 years – and there are at least a dozen professional bodies offering specialised help to couples. It's even available, in certain cases, on the NHS. But how successful is it? "It works, but only if both of you really want it to," says a friend. "Six couples we knew had or were having therapy," says another friend, Emma, who went with her husband Dan over the course of a year when their son became anorexic and they couldn't cope. They're divided on the end result.

"Talking to him rather than to each other," says Dan, "was useful and he made you want to say sensible things. It made a difference later that these things were out on the table." When I speak to Emma, she gasps. "He said that? I thought the therapist put Dan in the role of the bad guy, which was validating for me but didn't really move things on. I wanted Dan to acknowledge that he was depressed but he didn't buy the idea that this was part of the problem. He stayed quiet and unavailable when the therapist brought it up. So there was really nowhere to go from there."

Nevertheless, after 28 years of marriage, they're still together and their son is healthy again. So was the therapy successful in spite of their different takes on it? It's difficult to quantify. Eighty per cent of couples who'd had Relate counselling said that it had strengthened their relationship. But as American writer Laurie Abraham says in her new book The Husbands and Wives Club: A Year in the Life of a Couples Therapy Group, such improvement "doesn't catapult couples into the realm of the genuinely happily married".

"My job isn't to decide things for people," says Judith Coché, the Philadelphia-based therapist featured in Abraham's book. "It's to help them figure out where they want to go, then help them to get there... Couples therapy is individual therapy for people who decide to stay together, because until you know yourself, it's very hard to convey how you feel to another person."

We're still far behind the therapy culture of the USA. "The holy grail is to have a couple sensible enough to come when they have a few problems but a lot of love is still there," says Sarah Litvinoff, author of Better Relationships: Practical Ways to Make Your Love Last.

"It's used as a last resort in this country," agrees Janet Reibstein, professor in the school of psychology at the University of Exeter, "while in the USA, people go when they're not in such severe circumstances." Behavioural couples therapy, which is all about symptom reduction, isn't just good for the relationship, says Dr Reibstein, it's shown to be as effective as individual cognitive behavioural therapy for moderate to severe depression.

On the other hand, the psychologist Oliver James, author of How Not to F*** Them Up, is less than impressed with the no-blame ethos of couples therapy and the doctrinaire-like "fixation with patterns of communication between partners". What's often far more significant, he says, is the fact that one partner may have a personality disorder or be severely depressed or abusing substances and in these cases, thrashing over compatibility issues isn't going to get them very far. "The great weakness is that it doesn't sit people down separately. Often it's not just a matter of poor communication. The problem would probably be there whoever they were with and if they split up, they'd end up with the same issues with a different person."

We establish different attachment styles and play different roles depending on whom we're with, says Dr Stacy Malin, a clinical psychologist in New York. She says that couples therapy "moves so much faster than individual therapy" and that it's often more exposing because you can't refuse to confront things or answer questions, because "your partner might spill the beans right there". Women often come with the hope that the therapist will tell the man, "You're a shmuck," Dr Malin, says. But there's no black and white, each is playing the role that the other has assigned.

And even if therapy doesn't save a relationship, it can help the next stage. "I'm very good friends with my ex-husband," says a friend. "We had as good a divorce as it's possible to have, we've brought up our two kids successfully and I credit the couples therapy."

"People can and do drive each other mad," says group analyst John Schlapobersky. He believes couples need to be seen together in order to untangle unacknowledged collusion that may have been present but buried for years. One woman became severely depressed after her mother died. "The husband never looked as if anything was wrong with him – it was his wife who was depressed. It wasn't until he was in the consulting room that it became clear that he carried hidden and unacknowledged issues to do with loss."

Both had fathers who'd been in the navy; the husband's father was killed in the Second World War while the wife didn't see hers till she was five and even when he did come home he never stayed around long. "They both had this communality of the absent or missing father and they needed to sit down and explore the impact of the losses."

Psychotherapist Kitty Hagenbach says that couples usually have the same issues even though they've adapted to life in different ways. "One person may become very outgoing because they feel isolated inside, while the partner may also be isolated inside but stands back from the world." People don't speak honestly to each other because they're frightened – it's much easier when a therapist "holds the space".

It takes on average seven years from the onset of a problem, according to Kate Figes, author of Couples: The Truth, for a couple to get themselves to therapy. And once they're there, who knows how long it will ta ke. In The Husbands and Wives Club it takes 12 years of therapy before Aaron and Leigh manage to get "decent sex" and 11 sessions before Michael and Rachael bring up the matter of his homosexual relationships. Therapy can be a long and expensive business – but, as Sarah Litvinoff points out, "it's much cheaper than divorce".

www.relate.org.uk