This is the final installment in this three part series on the most common interventions that I use in couples therapy. In this blog post I present four final interventions: Attend to the Relationship Ecology, Nonviolent Communication, Forgiving Injuries, and Sensate Focus.

Attend to the Relationship Ecology

Especially given that I see couples in Silicon Valley, I often see an imbalance in the environment needed to help a relationship function. Based on my experience as a therapist, I have found that the following environmental factors are very important for a relationship to be healthy: time for individual development, time alone together, community support, and resources (e.g., money). Given that work schedules in this area can break above 80 hours per week with ease and the instability caused by start-up technology culture, I have found that though money is often abundant, time for individual development (like play, “downtime”, or relaxation) and time for the couple alone together are often lacking in the couples that I see. By making sure that a couple is preserving time for emotional rest individually and making time for each other together, many relationship problems resolve themselves. The “communication problems” are often just a symptom of the deeper message, “I don’t feel connected to you when I don’t see you very much.”

I also find that the time for individual development must come before the time for the couple development. Whether you recharge by reading a book or playing racket ball, you need to bring your best and brightest energy to your relationship endeavor. I emphasize this point because in more than one couple I have seen the conversation about relationship ecology misapplied. One member of the couple will come home and say, “Okay, I’m all yours!” but flop onto the couch and shift into a brain-dead stupor because the person just got off of a 12-hour day at work. Give your relationship the cream on top, not the dregs at the bottom.

Nonviolent Communication

Like many therapists, I might teach my couples Non-Violent Communication (NVC). Aside from NVC, I rarely teach couples formulas for communication because I don’t find them effective. I’ve seen “I-statements” used with vitriol and contempt enough times to know that fill-in-the-blank sentences aren’t the secret to generating a positive communication between a couple. But in NVC, the communication requires the person providing the communication to be aware of their feelings and needs. This is a very important skill to develop and so I find NVC to be a helpful stepping stone towards communication effectiveness. NVC also follows the principle that we change our communication for ourselves, not to become better manipulators of our partners. I like that because it fits with the principles of differentiation that I use throughout my practice. In brief, NVC invites a person to communicate in 4 steps:

• “When you ______________” Filled in with specific concrete behavioral observations that anyone who watched a video would recognize. No blame, judgments, or labels.
• “I feel _______________” Use a specific feeling. When people say, “I feel that. . .” or “I feel like. . .” it usually leads to an interpretation, judgment, label, or perception but does not actually convey a feeling.
• “Because my need for __________________ is/is not met.” NVC provides a Needs Inventory list for suggestions.
• “In the future I would like to request that you _____________________.” Filled in with specific concrete behavioral request.

Forgiving Injuries

This tool comes from Emotionally Focused Couples therapy primarily created and developed by Sue Johnson. The communication outline is very helpful for helping couples get over past hurts. Many times I hear one partner lament, “I have already apologized a lot. What more can I do?” Because of reading Sue John’s work with EFCT, I now understand that most likely what was missing from the apology was the sense in the hurt partner that the pain of the transgression was shared and felt by both partners. The Forgiving Injuries process helps couples make sure that the emotional connection takes place before the apology and that solutions and problem solving come afterward. The steps to Forgiving Injuries are:

1. Hurt partner describes the hurt and other related emotions.
2. Other partner does active listening and active empathy
3. Other partner describes how they feel knowing their actions generated these feelings in the hurt partner.
4. Other partner expresses apology or sadness that this pain happened.
5. Both ask, “How did we get here? How did this happen?”
6. Both ask, “What will I do differently to make sure this doesn’t happen again?”
7. What is our new story about this bad experience and how it makes us stronger?

I often emphasize that steps 1-3 above need to be repeated as many times as necessary until the hurt partner feels that the emotional connection between the two of them is strong. Only then should step 4 take place. If steps 1-3 were completed thoroughly, then step 4 will come as a relief to both and the apology will be accepted. Then steps 5-7 flow naturally. If you find this step-by-step process compelling, you may be interested in Sue Johnson’s book, “Hold Me Tight: Seven Conversations for a Lifetime of Love” which I often recommend to my couples.

Sensate Focus

A fairly common presenting issue in couples therapy is the loss of sex in the relationship. Sensate Focus is an step-by-step process developed by Master and Johnson to increase sexual functioning. I have used it to help couples resolve sexual pain, increase sex frequency, end a sexless state, and to treat erectile dysfunction. Throughout the process, Sensate Focus asks the couple to refrain from other partnered sexual activity while they are doing the Sensate Focus process. I have found that this helps create motivation. When actually practicing Sensate Focus the couple identifies a giver and a receiver. The receiver gives feedback and guidance to help the giver know what the receiver finds pleasurable. They spend 15-20 minutes in each role and then debrief about it afterwards. Sensate focus divides the practice into 3 parts, nonsexual, including erogenous zones, and including whatever final sexual behavior the couple hopes to incorporate into their sex life. I often customize the process of Sensate Focus for each couple and their unique presenting issue.

Conclusion

These are only the most common tools that I use, not the only tools that I use. I share all of these tools here so that you can better know what you might expect from working with me. I also share them with a certain hope. On the one hand, if you are just beginning to experience a relationship challenge, maybe the description of these tools will be of use to you. On the other hand, I believe that couples therapy is not just a mechanical process or a set of tools and skills that you can pick up from a blog or a book. I believe that couples therapy is a way of transmitting an experience of comfort and safety in yourself and in your relationship. The tools can help but what I provide as a couples therapist isn’t just a set of tools, it comes through in delivering these tools with a blend of compassion and challenge that will work for you. I have faith that you can come closer to the partner you want to be and that I have some ideas about how to help you get there.

Other posts in this series:

How Does Relationship Therapy Work? (Part 1 of 3)
How Does Relationship Therapy Work? (Part 2 of 3)