Working with couples (with Marie Vakakis)

Introduction

[00:00:05] Bronwyn: Hey, mental workers, you're listening to the Mental Work Podcast, your companion to early career psychology. As always, I'm your host, Dr. Bronwyn Milkins, and today we are talking about working with couples. When you work with couples, you're really helping clients to build healthy relationships and you might be seeing couples at the start of their relationship or at the very end and everywhere in between.

[00:00:28] There can be lots of conflicts, but also lots of insights and it can be a very rewarding area to work in. I reckon it's an area that every psych should be aware of as clients frequently present with difficulties in their relationships, even in individual therapy, so it's good to be aware of what happens in couples.

[00:00:45] Here to help us unpack everything is our returned guest, Marie Vakakis. Hi, Marie.

[00:00:50] Marie: Hello. Thanks for having me back.

[00:00:51] Bronwyn: My pleasure. It's such a delight to have you back. And Marie, could you please remind listeners who you are? And today's question is, what famous person would you love to meet?

[00:01:02] Marie: I think very topical preparing for this, uh, this topic today, I would have to say as cliche as it is a bit of a draw between maybe Brene Brown and Esther Perel, um, thinking about two, really strong women who embody this sense of vulnerability and authenticity, maintain boundaries and a kind of forces to be reckoned with, but not in a, in a way that we might have expected someone to be so impactful.

[00:01:31] I really think I'd love to meet them and be around them. Uh, I remember seeing Esther Perel in her life, um, like his Q and a workshop or whatever you call it. And it's just such a captivating person. And I just think it'd be really cool.

[00:01:46] Bronwyn: No, that's a great suggestion. In my mind, I've just got, I wish we could sticky tape them both together and then I could just see them both and not have to choose between. And could you remind listeners who you are?

[00:01:57] Marie: Yes. So, uh, my name is Mareeva Karkis. I'm an accredited mental health social worker and couple and family therapist. And I like to work a lot with that intersection between mental health and relationships. So I started off very kind of clinical mental health, very medical model, diagnostic sort of treatment based. And as I moved into more family therapy and systemic work, I started to have a real appreciation for relationships and interpersonal skills and that connection. So, I still work a lot with individuals and I consider them within their system and then I do some kind of couple and family work as well.

[00:02:34] Bronwyn: I guess out of 100, what percentage would you say is couple work for you?

[00:02:40] Marie: Probably about 40%.

[00:02:42] Bronwyn: Oh, wow, cool. So let's get into it. So what's going to happen is I'm going to read out a case study and then we're going to unpack and just deep dive into that. Sound good?

[00:02:51] Marie: Sure, sounds great.

A case study couple

[00:02:52] Bronwyn: Awesome. So the case study today is with Mark and Emily. Mark is 40. Emily is 38. They've been married for 10 years and they have two children aged eight and six. Mark works as a financial analyst and Emily is a teacher at a local primary school.

[00:03:10] They've always considered their relationship to be strong and supportive, but recently they've been experiencing some challenges that have led them to seek couples therapy. Their relationship has undergone some changes over the past year. Mark's demanding job means that he's been working longer hours and travelling frequently. Meanwhile, Emily has been juggling her teaching responsibilities with caring for the kids.

[00:03:31] With Mark's increased workload and time away from home, tension has been building between him and Emily. They find themselves arguing more frequently, often over trivial matters, and Emily feels overwhelmed and unsupported, while Mark feels unappreciated and frustrated by Emily's perceived lack of understanding about the demands of his job.

[00:03:50] Another source of tension in their relationship is their sexual intimacy. Mark expresses a strong desire for physical closeness and sexual connection with Emily, but she often feels too tired or preoccupied with other responsibilities to want to engage. And this has led to feelings of rejection insecurity for Mark and guilt and pressure for Emily.

[00:04:08] They've come to therapy now because they recognize that their attempts to address these issues independently have been unsuccessful and they feel really stuck. From therapy, Mark and Emily really want to improve their communication and address sexual intimacy so that they can have mutually satisfying solutions there. And that's the case study.

[00:04:26] Marie: Wonderful. Where, where should we start? What are your questions?

[00:04:30] Bronwyn: Very Esther. Yeah. So Mark and Emily, they're experiencing increased conflict. So they're not communicating as well as they used to. And they're also got some discrepancy in their sexual desire. Mark really wants some intimacy. Emily doesn't feel like she's able to provide that. And I guess maybe the first thing I'm wondering is how common is this presentation?

[00:04:52] Marie: Very, and It's it's probably one of the big reasons that people seek out couples therapy is increased conflict and one of those areas of conflict tends to be sexual desire or sexual appetite within the relationship. But I think because of the, the listeners are people who maybe are interested themselves in attending couples therapy or might be referring to couples therapy. I might sprinkle in some of the sort of the stats and the research to kind of help people know a little bit more.

[00:05:24] One of the things with conflict is we know that, and through the Gottman research, um, so those who aren't familiar, the Gottman Institute has some really great resources and has a training modality called the Gottman method. Their research has shown that about. 69 percent of problems in a relationship are what we call perpetual problems. So there are things that might not, they might never go away and conflict in itself is inevitable, even if you lived with your identical twin, who is literally got the same DNA as you. You will have conflict. So just two people being together are going to have conflict.

[00:06:01] So that in itself is not a bad thing. It's how it's resolved, how it's handled, how it's repaired that are really big factors in, I guess, relationship satisfaction. And then there's also the absence of fun. So they've done some research where they looked at fondness and admiration and building kind of connection and conflict management skills or tools.

[00:06:25] And what they found is if you just focus on conflict, you'll get some improvement. If you focus on both conflict and Relationship building and that fun stuff, you'll get really good improvement as well, and the same amount of improvement of just focusing on the good stuff. So sometimes we don't need to just focus on conflict resolution. We also need to build in some of the fun stuff as well, that friendship.

[00:06:48] Bronwyn: I assume that's something that you might tell clients as well. So they've come in being like, okay, we just need to disagree with each other better and manage that conflict. But it sounds like something you'd be saying to them is like, but you also need to have more positive interactions with each other.

[00:07:04] Marie: Yeah, absolutely. And I, most of my training in couples work is using the Gottman method. So I would schedule in a session and I explain to them at the start, the first kind of four sessions is really an assessment. So just like if you went to the doctor and you said, my stomach hurts. And if the doctor didn't touch it, didn't look at it, didn't ask you anything else, like, you know, I know what's going to fix that. And just kind of jabbed you with a needle. You'd be like, what, what are they doing?

[00:07:29] And, and, and that's why I like the Gottman method. Those first few sessions really forms a really solid assessment process that you can really get into some of the areas of conflict for the family, for the couple. And they've got a framework, a kind of assessment framework that they use as well.

[00:07:46] So I would say the first four sessions we're unlikely to get change. I'm actually just trying to understand what's happening for you and being really directive around, um, I'm going to take note of that. I'm going to park that. Let's bring it back to what, what I need to do is really get to understand the problem where it started. What are your strengths?

[00:08:06] And I also want to know their history, uh, shapes, their ideas of a relationship, what it was like when they first met, what are some of the early challenges they face? So it's really kind of thorough assessment process.

[00:08:19] And then we would kind of bring that back and say, okay, what are your thoughts? What's been coming up for you? What are your areas of priority? This is why you said you first came. Here are some of the things I'm noticing. And then I would bring in those psycho ed bits if that's an area that it feels relevant to them.

[00:08:37] Bronwyn: I've heard that retention is really hard for couples therapy and I can understand this. My experience working with individuals, they might've seen a couples therapist and a frequent thing they'll report to me is like, "Oh, but my partner didn't like the therapist. So we're not going back to see them". I'm wondering, is it, is it true that retention is hard for couples? And if it is like, how might you address this? Like, do you tell them like, give me four sessions?

[00:09:05] Marie: I, I do. Um, like I had a, a, a session, um, prior to this recording where that was, that's the speil on like the first session is very structured that I meet with you each individually. I give you at home to fill out questionnaire, then we come back together. So really it's, it's setting up really clear expectations, which I think gives you better... better chance of those good therapeutic outcomes.

[00:09:28] So it's in that really clear communication. It's saying this is how I work and this is how I do it. And that starts for me personally, from before they've even come to see me, it starts with what's written in my bio on the website, what's written underneath couples therapy, what's in our intake paperwork, what admin talks about in the first sort of point of contact.

[00:09:48] And then I reinforce that. So really someone's not coming in thinking, what are we going to do? Are we going to have like rubber batons and be, you know, whacking each other, like in an old Simpsons movie episode? Uh, Oh, is it going to just say, let it rip and we yell? Um, is this person going to referee our arguments?

[00:10:06] So it's really containing and saying, look, This is what it might take and prescribing that and saying, you know, you've been having these problems for X amount of years. They're not going to just resolve straight away. This is what it's likely to, the change we're likely to need, um, or the frequency of sessions to get the change that you desire.

[00:10:27] And that can be quite confronting because I think some people hope that the therapist will tell their partner how wrong they are.

[00:10:34] Bronwyn: Yeah. That sounds like it would be a hope. Yeah. I mean, so that brings up for me, I'm like, what if one member of the couple feels ganged up upon and they're like, okay, therapist is siding with them. I don't like this. Is that something you address in the process or is that something you tell them explicitly?

[00:10:54] Marie: It's, it's both. It's like with any relationship with a client, you sort of, you're checking in and you're using what's happening between you as a therapeutic intervention. So I might be able to interrupt and I would ask permission. I would structure that from the start saying, look, this is quite a, um, engaged process. I might interrupt you at times. I need to keep us on track. And I might then say, look, I just need to interrupt you there. I might look at the other person and say, I feel like I'm losing you right now. What's, what's happening.

[00:11:24] And, and also being honest saying you both might not like me and that's okay. I can refer you to someone else, or if it's something I can adjust, we might have some sessions where we talk a bit more about what's happening for one while the others holding witness to it. So it's, it's whatever you do, having some clarity around that and averting that and talking about that with the couple. So if we go back to someone like Mark and Emily, there might already be preconceived notions of what they're coming into thinking based on maybe my, my gender or my age, or if I have kids or not have kids or who am I going to side with? So We can overt some of that stuff if it feels relevant and useful.

[00:12:05] Bronwyn: Yeah, cool. Is there anything else that you might do in an introductory session or in the first four sessions when you're assessing really deeply? So I've gotten that you'll see them together, then you'll see them separately, and then you'll come back together. You'll set the expectations from the start, even before they come to see you. Is there anything else that you think is important?

[00:12:24] Marie: Yeah, so, um, the Gottman method quite has quite a structured approach. So there is like an oral history interview. So we're looking for, uh, their story, how they met. And then even in the way they respond to things, we look, that's part of the assessment. So we're looking for, can we see fondness and admiration? Can we see perspective taking? How do they talk about their past? Do they have shared values?

[00:12:49] So some of those aren't explicit questions. It's through observation of how those other things are being spoken about or answered that you get to observe some of those patterns or interactions or kind of areas for intervention. And so I'd be looking for all of those things.

[00:13:08] And sometimes I just let things kind of unfold because if a fight comes out, if someone's like, no, but that's not what you said. And that's, and I might let that go for a little bit because. The benefit, one of the many benefits of, of couples work that I don't get an individual because I get to see what's happening live.

[00:13:26] Bronwyn: Yeah.

[00:13:27] Marie: Rather than just one person's perspective of it. So I can see that as, I guess, more, um, information. To kind of keep informing my, my work with them. So I might let that sort of play out for a few minutes and then sort of see what happens. Is one person flooded? Does one person withdraw? Do they go towards criticizing? Like I kind of let some things play out. And then I can check in and see, is this what happens at home? Is it a bigger response or smaller? It's like, it's really good live information.

[00:14:00] And I joke sometimes that I want to do Ikea therapy where I buy some flat pack furniture and I've set it up in the room and the couple walks in and I'm like, okay, today's assessment is put this Billy bookcase together. And I just, I really want to see how people, how do they do that? How do they resolve conflict? How do they cooperate? Does one put like, and I really think it would be quite a funny intervention.

[00:14:23] Bronwyn: I think it'd be a great assessment. Like, whenever I set up IKEA furniture or the like with my partner and we do it successfully, I'm like, we just like climbed a relationship mountain. Like, I do feel like it's a real test.

[00:14:35] Marie: Yep. So Ikea if you're listening and you want to sponsor some research into this method of therapy, hit me up.

[00:14:41] Bronwyn: Look, I'm surprised I haven't done it already. It's genius.

[00:14:46] Marie: You heard it here first.

[00:14:47] Bronwyn: Yeah. Patent pending. Marie with that, what if you see a live argument and then through that, I'm not sure if this is what you think, or if I'm projecting it, I'm probably projecting, but what if you're thinking, you're like, Emily's the problem. I can see this. She is calling him names. She's putting him down. She's not listening. She's not perspective taking. Mark is doing everything right here. And like, how do you, how do you deal with that when one partner is like, air quotes, the problem?

[00:15:17] Marie: I have, I've yet to find a, be the case where one person is solely kind of the problem, because even if, if that were always like that, then the other person still chose them. Okay. So they made an active decision there, but often it's, if that person is really heightened, or if we're working with someone who's got quite a, a mental illness, that's quite impactful, think something like borderline personality disorder that might require extra sensitivity and not alienating either of them.

[00:15:47] So it would be really, I would be able to be in a position to notice, whoa, there's a lot of pain behind what you're saying right now. And I want to just remind you, we're trying to say it in a way that doesn't come across as criticism. So could I get you to redo it, blah, blah, blah.

[00:16:05] So I might have a script, we would have a, maybe a role play, or I might paraphrase for them. So I get to role model. In front of them, how we do that. And so that can still be, I've yet to sort of work with a couple where I'm like a hundred percent this person's fault.

[00:16:21] Bronwyn: Okay, good. That's good to know. it's good to dispel that myth. I'm probably like bringing in Hollywood interpretations of couples or what you've seen, but it sounds like it's quite different when you get in the room. Like couples really want to work most of them towards a better relationship.

[00:16:35] Marie: So often I find that there's conflict for usually one of three reasons to be in control, to be correct or for communication, to feel kind of heard and connected. So most of the time people are, if they're trying to get control, then that's something you can work with if they're trying to be correct and that's something. Um, but often I'm finding those big misattunements it's around connection.

[00:17:04] Bronwyn: Um, could you elaborate on that one a bit more? What might be an example of an argument where one partner is trying to connect, but they're kind of going about it in a less helpful way?

[00:17:20] Marie: Bronwyn, you're always on your phone. No I'm not. Well you, yeah you are. You're always on your phone. Well, I'm not. Like, well you're always on your phone and then you start a fight about being on the phone. When really it could be I want some quality time with you. I want to connect. Can't you see I've had a tough day and I'm looking at you and you're scrolling through your phone, not, not seeing my, my, my suffering or my pain or my fatigue.

[00:17:47] Bronwyn: So in couples therapy, you might help the couple identify that what is actually happening here is wanting connection rather than like, it's not about the phone necessarily. It's about wanting attunement and connection with each other.

[00:18:04] Marie: Yeah. And if that's then the area of most need for the couple, I might bring in some more sort of emotionally focused therapy. So some EFT techniques. But it's, it's really trying to get people to start to realize, you know, how you ask for it also then creates a response in your partner. And if this has been happening for weeks and weeks and months and years, perhaps that can feel so loaded.

[00:18:27] Bronwyn: Are couples generally receptive to this kind of framework when you'll point out that, hey, what you're wanting is connection here. How can we go about that?

[00:18:35] Marie: Mixed. I think some still, if they're, if they're really quite entrenched in that conflict, they feel so hurt that until I can build enough empathy with them for them to feel that I've really understood them, they might not be ready to accept that because if you're constantly in conflict with your partner, it can be really hard to maybe soften and accept that they might still want to be around you or be with you or want your care, when you're maybe not feeling so fond about them.

[00:19:07] So it, it really depends on how, how dissatisfied they are in the relationship or how much we, you know, there's that, what we call a negative sentiment override, like how much of that vibe is in the relationship. It can really, it can really depend.

[00:19:23] Bronwyn: What kind of homework might you give for clients who are wanting to improve their communication and reduce their conflict?

[00:19:32] Marie: I use, um, a range of different things. So there's a really good free app that the Gottmans developed that used to be literally cards you had to hand out. So if people kind of Google the, I think it's called the love deck, or the card deck. Yeah, it's really great and then I might prescribe one of those so within that app there's, then essentially several decks of cards um and then there will be around ones like around like sex, around perspective taking, around dreams, there's all these different categories and I might pick a category and say, I want you to do X amount of cards before the next session, or I might even be more direct and say, we're seeing each other fortnightly in that middle week. I want you to put this same time slot in your diary and go through these things.

[00:20:17] So I don't want to set someone up to fail. And I really want to be aware of what other commitments and responsibilities they have during the week or the fortnight, because if they're wrangling children to activities and extracurricular things, and they might have aged parents or stressful periods at work or a house renovation, I don't want to set them up to fail by saying, can you please make sure you've done this by the next week? And then one partner's like, we haven't done our homework. And the other one's like, well, you never reminded me. It's like, well, I always remind, and then it becomes a fight. So whatever I do, I really want to try and simplify it, contain it, be specific, and then see what happens.

[00:20:56] Bronwyn: That sounds sensible. I'm just wondering for couples, I'm wondering if you also recommend that they increase fun time together, like they do activities?

[00:21:08] Marie: It depends on the assessment. So through that assessment process, I get a really comprehensive report and then I match that with, uh, like I've sort of got a case formulation tool. So I'll be looking at what the, the Gottmans used the sound relationship house as sort of a visual to represent what they're looking for.

[00:21:25] So we're looking at these two side pillars of trust and commitment. And then we've got, you know, fondness and admiration, turning towards positive perspective, managing conflict, making life dreams come true and creating shared meaning. So depending on where the couple's strengths are or areas for maybe growth, then it would kind of change what I'm recommending. So if they're already doing really great on that fun fondness, and if that bit's really strong, I might say, just keep doing it. That's working for you. Keep that up.

[00:21:55] Bronwyn: Yeah. So it's really important to have the case formulation and base the interventions and techniques that you use on that.

[00:22:04] Marie: Yeah, like any other therapy, you find the modality that you align with, that works for you. And then you have a kind of way of conceptualizing that person's presenting problem within that model or framework and you want whatever assessment process you use that then informs the treatment.

[00:22:22] Bronwyn: Yeah. That makes sense. Cause I guess like the specific situation I was thinking was like, let's say Mike and Emily, it's like, it's gotten so bad that they can barely get two sentences out to each other before it turns into an argument. I'm just wondering if like a recommendation might be to somehow just say, we're not going to argue or something like that.

[00:22:42] Like, how do we, how do we make a dent? How do we start with that? If, if everything turns into conflict.

[00:22:48] Marie: If it's in the session, I might be really directive and, and intervene and paraphrase. And then sometimes I find the action of coming to regular therapy and knowing when those sessions are, some people feel like they can kind of put their grievances on pause and bring them into the therapy space. So it might help some couple compartmentalize and be like, I don't need to keep bringing this up or actually, no matter how I bring it up, it does not come out the way that I want. I'm going to kind of mentally put that in the box to talk to Marie about.

[00:23:24] So it really, it really depends. Like I'm not taking the full responsibility of fixing a relationship that may have had, I mean, you know, this couple you're saying they've got an eight and six year old, so they might've been together over a decade. I'm not proposing or taking the responsibility that in one session, I'm going to fix that or several sessions. I'm going to be this wonderful therapist that fixes all their internal conflict and relationship issues and attachment styles and any mental health challenges and solves the systematic difficulties that couples face raising children.

[00:24:00] And like, it's not, I have to take some, take a step back and be like, it's not all on me. And they've been dealing with this fighting for months and months and months before they got to me a few more weeks or a few more months. They might, they can, they can suck it up because they have been, and we'll do what we can to shift things in the time that we have available.

[00:24:24] So really trying to take the pressure off. It's not my job to fix it all.

[00:24:27] Bronwyn: Hmm. That sounds really sensible, um, and like a great perspective to take. And expanding on that, let's say Mark and Emily come and from your assessment, it kind of seems like they're at the end of their relationship and maybe they might, maybe separation would be best for them. I wonder how you. How do you deal with this as a therapist? It's like maybe from your perspective, you can say that maybe separation would be good. They're not seeing it as themselves and maybe they are. Yeah. How do you take the pressure off yourself to be like, I know what's best for this relationship?

[00:25:07] Marie: I would say that for a couple that's talking about that, I would still, I would say, look, you've brought it up. You've mentioned it, so it's on the table. And you've got kids together. So either way, there are some areas of your relationship and how you interact that you would benefit from improving for the sake of co parenting.

[00:25:28] So I might come at it from that angle of you might decide to stay together or you might not. Either way, there are some bits that I think are really, really important or even crucial that you find a way to work through for the sake of co parenting and to role model for your children what a healthy relationship looks like.

[00:25:50] So I, I not particularly you know, invested in someone never getting divorced, or it's not like it goes against any sort of my, you know, value, religious values or beliefs in, in that sort of way. If that's what someone wants, that's fine. Uh, if there's a mismatch, then we talk about that. I do want to... share with them what I've noticed and how by improving those bits, then that might help.

[00:26:17] So maybe for this couple, if they're saying, look, separating's on the table, I'll be like, okay, so let's not worry about your sex life. Let's talk about how you handle conflict. How are you, how can you, how would this look if you lived over separate houses? Where are you getting stuck? So it can still be really, really valuable.

[00:26:36] Bronwyn: Yeah. That prompts me to think about counter transference and when couples concerns might be hitting close to home or touching on beliefs that you have. You mentioned like religious beliefs there. And there might, like we all have beliefs about relationships and what works and what doesn't, and we've all got experiences, most of us do, with relationships.

[00:26:59] And I'm wondering how you manage that because I think that would be fairly unique, counter transference.

[00:27:05] Marie: I think it can, it definitely can be, and I do have to work a little bit harder in protecting myself when I do more couples work. The, the benefit of the family therapy training in particular was most of the sessions that you run with families are with your reflective practice group watching you. So a large component of that course is actually spending time on looking at how you, what comes up for you, what gets, uh, triggered or activated in you. And you do a huge piece of work on your own family of origin, your own attachment style, how you handle conflict and really kind of understanding that.

[00:27:49] So I think that's a little bit more robust for me having had that experience and then adding the couples therapy modality on top of that, because I'm not just learning it from, I mean, the first two levels of the Gottman training were online. It wasn't, I didn't even get to do role plays or anything.

[00:28:04] Bronwyn: Yeah, same. Yeah. I've done the first two levels and yeah, entirely online and kind of really didactic as well, like talking at you.

[00:28:11] Marie: And the third one I've actually, I'm doing in a couple of weeks, which is really cool. So I think, those things I can overt as well. And I can sort of say, just like I might say, I'm not from that culture or I might not understand what it means to have, you know, polyamorous relationship from a lived experience. I can own some of those bits. If it does feel too much, you know, if it is a conflict of interest, then we have those conversations and provide the appropriate referrals. You know, I have my supervision, I have my own ways of debriefing. So I think it's, it's really just checking in with all of those things.

[00:28:51] And then sometimes I just want to, you know, come home and just, you know, just be, left alone for a little bit because observing conflict can be a little bit more taxing than when it's one person in the room and they're, they're venting. Um, they're, they're not getting activated and charged in the same way as when it's two people who are just really charged.

[00:29:12] But then I use that, that's also information that if they're making me, if I'm feeling that way, witnessing that, how must their children be feeling? What, what impact is that having on their nervous system, being around that day in and day out? Like if I'm feeling agitated after maybe 50 minutes and I've got all these tools and skills and resources and I'm not invested in the outcome of the fight in the same way they are, Whoa, what must it feel like for those around them? So that's also useful information.

[00:29:46] Bronwyn: It does sound really useful. It does sound like there might be some additional self care that's required , because I imagined that some therapists may have grown up in households that were angry or where there was conflict and that might be quite activating for them and that just might be other triggers in couples that remind people of their own parents. Um, and yeah, I don't know, would you agree with that? That there seems to be maybe more or different self care that's required for working with couples?

[00:30:17] Marie: Uh, self care definitely, but I also think there needs to be probably a little bit more ownership and responsibility on the therapist to recognize what they are capable of containing and making sure that they've got the things in place so they don't feel easily flustered.

[00:30:39] Um, you know, I've had terrible experiences as a person. As a, as a client in couples therapy, uh, I even had one who I reported to the health board. Like I've had some really terrible, terrible therapists and I was like, they could not hold their own self, they couldn't hold the space, they got too caught up in their own stuff. And I think that's really, it does a really big disservice to the community.

[00:31:04] And it's hard because it's not a, it's not a, uh, a strict registration, like it might be in the U S where you have a license, like an LMFT, uh, and you can lose your license here. You could have, you could not be registered with anybody and be a psychotherapist who works with family therapy or couples therapy and have no kind of formal body that you report to, or you might not be AHPRA registered or... so that it's really quite tricky to choose someone who's got the clinical skill and whether it's temperament or, you know, capacity to self reflect, you know, I think there's, there's a, an extra skill that's really required for people doing that kind of work.

[00:31:46] Bronwyn: I agree and I'm sorry to hear that you've had negative experiences, but it's interesting because it's something that through my own clinical work, so I see individuals and in the past, more than once, more than twice, I've had people come and see me and recount experiences of seeing couples therapists. And some of the things that they've recounted to me have been quite concerning, and then as an individual therapist, I've needed to soothe, reassure, uh, help them emotionally, restore hope in their relationship. It's been quite difficult and... yeah. I don't know what my question is, but it just does sound like, yeah, being able to know yourself and what you're capable of containing sounds very important for couples work.

Avoid the triangulation trap

[00:32:33] Marie: Yeah. But also what you're touching on is we've got to be careful you don't get triangulated into that dynamic.

[00:32:38] Bronwyn: Tell me about that.

[00:32:40] Marie: So if one person is sort of saying, um, you know, they have a sensitivity to something being said in a particular way, and I may be paraphrased something that their partner said and they took that as dismissive and then they go to their therapist and say, the couple's therapist is always taking his side. She's dismissive of everything I do. I just can't get a word in and then pulls you into a line with her or him. Then it's the two of you against me.

[00:33:12] And that might be the exact same pattern that is replicated elsewhere in that person's relationship. So we really want to make sure when we're working with someone who has another therapist, that we're not alienating the other therapist, that we're not falling into a triangle there.

[00:33:28] And if possible, having a brief kind of check in or handover or update so that people can kind of be aware of what's happening, what we're working on, provide some context and instruction to each person involved so that it, it can feel a little bit more containing.

[00:33:46] Bronwyn: Okay. So as an individual therapist, how can I not be pulled into that? Is it about maintaining a stance of neutrality? Like what are some specific things I can say to a client if they're like, "God, that couple's therapist is horrible. They said this to me. I cried."

[00:34:03] Marie: You could unpack it like you would with some other interactions, instead of trying to, Solve it or go straight to what the therapist is doing or not doing. Just saying, tell me a bit what happened, what was the impact of that? Okay. What made it hard to say what you really wanted to in that moment? So you could kind of break some of those things down based on whatever other work you already have been doing with that client.

[00:34:27] So if you know that that, that person has had difficulty, Maybe they appease a lot and so they just go along with it and they did this again in the session and they're really frustrated with themselves. Then you might be able to say, Hey, this is the work we've been doing and I wonder if you're actually finding it really tough to share your perspective. Is it worth us talking about how you might do that?

[00:34:49] You know, so then like you can help them. To work on that, if it's actually really bad therapy and it's, it's unsafe or it's just something like that, then you might say, look, that might not be okay, but we have to allow for some risk of rupture. You're working with two people with two different needs, two different agendas in a 50 minute session, maybe a week or many weeks apart. There's a lot that could go wrong.

[00:35:14] Uh, so allowing for, okay, you've, you've, you've gone to couples therapy to improve interpersonal skills or to resolve conflict. This might be a conflict that you have with the therapist. I can help you ground yourself, what to say, do a script. So then you can go back into that session and talk about what you need. So you, you might help them advocate for themselves. You might help them figure out what role they can play in if that was a rupture on how to repair it. Are they going to old coping strategies of just saying, saying, nah, that's, that's it. I'm pulling away. Like you can use what's happening as part of your assessment of what you've been already working on with them potentially.

[00:35:54] Bronwyn: This makes a lot of sense, and I think it's more helpful than what I've been doing, to be honest, which is, I think, empathizing with the client's perspective, and I think what I've been doing is also, I think I've been trying to... maybe over balance the client's autonomy and I'm like, okay, they don't like them, so they don't have to go back . You could find a different couples therapist, but I wonder if in doing that, I'm maybe perpetuating some dynamics that they're having in their relationship and maybe it would be more helpful to try and repair with the therapist.

[00:36:26] Marie: Maybe.

[00:36:27] Bronwyn: Maybe. Hmm. Yeah. Okay. No, this is good food for thought, Marie. I'm liking this. Hmm. Another question I have around that is, for individual therapists, I have heard that, if your client comes in with, say you're seeing an individual client and they come in with difficulties in their relationship and then you as the individual therapist are trying to resolve these, these issues, but with an individual rather than the couple, then you can unintentionally increase the client's negativity towards their partner. Um, have you heard of this?

[00:37:06] Marie: I haven't heard of it that way, but what I would say is what, what's hurt in relationship is healed in relationship.

[00:37:13] Bronwyn: Oh, that's good.

[00:37:15] Marie: So the, there's a part that requires the relationship there to heal it.

[00:37:20] Bronwyn: Okay. So is there a point in individual therapy where I would be like, look, I think this would be better healed in, in couples therapy.

[00:37:30] Marie: Potentially. Yeah. And, um, you know, there's a blog post on our, uh, on the therapy hub website. That's when to refer individuals for couples therapy. Might give you some pointers, but absolutely like just like you would be thinking if you're a medical practitioner Okay, now I need to send you off to get this piece done or to an ultrasound or to an x ray or maybe you need to see a gastroenterologist.

[00:37:51] We need to also accept that mental health is so broad and we might not be the right fit for everything or new things might come up. So you might Refer onto couples therapy. You might prescribe that saying, this would be really helpful if you did this. I suspect this type of therapy might be best for you. Or you know, uh, this workshop or this, uh, course on conflict. So consider all of those things in your recommendations for further resources or further development or treatment.

Sexual desire discrepancy

[00:38:23] Bronwyn: Awesome. I'll pop that in the show notes. Okay, moving along, I'm interested to talk about sexual desire discrepancy. Um, because I've read, I read an article that said that this is probably like top three presenting concern to couples therapy, but it's something that I haven't received any education about. I've literally read that one article and it was talking about using emotionally focused couples therapy to help people with sexual desire discrepancy. I'm just wondering, like, Do you have an approach for this? What have you seen as helpful?

[00:38:54] Marie: It's, it's really, really complicated. And sometimes it's not actually about the sex. It could be what that represents. It could be what role that serves. It could be understanding what that means and even going deeper and sort of saying, well, what actually constitutes sex? So cisgendered couple, they might have very, um, narrow views of that is penis in vagina. And so if I have erectile dysfunction, sex is off the table. Or if my vulva hurts because of childbirth, sex is off the table. And that might be, that's all they know.

[00:39:29] So some of it could be, I guess, a really good place to start is educating yourself, getting comfortable using the correct language, the words, not feeling uncomfortable, because if you're uncomfortable asking, they're going to be uncomfortable.

[00:39:44] There's some really good training. So Monash Health has a three day kind of sexual health workshop series. It's online now, so people can access it anywhere. So that's a really great one. Um, there's a ship psychology, which has some really great online stuff. Um, in terms of books, I would recommend, um, Emily Nagoski's Come As You Are.

[00:40:06] Bronwyn: Great book. There's a workbook for that as well.

[00:40:09] Marie: And there's the new one, Come Together.

[00:40:11] Bronwyn: Yes. Yeah.

[00:40:12] Marie: For more understanding around just the different role sex can play, Esther Perel's mating in captivity, um, and then for, for, for women sometimes I would recommend even the book Burnout, which just kind of looks at sort of the body's stress response system because you don't want pleasure when you're in stress, when your body is, is in that, in that stress response.

[00:40:35] And so I think starting with some of that and knowing where your limitations are as a therapist and overting that with them as well as saying, this is not my expertise and I don't want to give you wrong advice. I don't want to misinform you. You might want to go to a sex therapist or couples therapist or do some sensate focus therapy or start to refer that out. So start with just getting comfortable with that language yourself.

[00:41:00] Bronwyn: Yeah, no, absolutely. I think those are really good tips because having studied sexology myself, it's really important, I think, to recognize your own biases, your attitudes. Like, what do you consider to be sex? Like if your view is restricted to like penetrative sex, then you're not going to be able to explore the smorgasbord of sexual options with your clients.

[00:41:19] Marie: Yeah, absolutely.

[00:41:20] Bronwyn: Yeah, and I guess like with, with that, like sexual aspect, that can be a really big aspect in a lot of romantic relationships. Like, is it something that you feel comfortable, uh, discussing with clients, or do you feel like that's something that you refer out for?

[00:41:36] Marie: It's something I, I do talk about with clients and I really enjoy it. So I sometimes do think about going back to study, to study, um, sexual health. And I was like, no more, no more university. I don't, I don't need it. Surely this can be done through workshops and sort of training.

[00:41:51] So there are times where, especially with particular physical injuries or other sort of areas that might extend past what I can offer. But usually the couples that are coming to me based on my bio, based on the referral pathways I have, aren't coming for that sort of really detailed sex therapy resources. They're, they're really coming for overall relationship dissatisfaction. So there's a lot of work we can do and sex is one component of that.

[00:42:21] Bronwyn: Yeah, absolutely. Um, I don't think you necessarily need to study sexology to be good at this. I think that my, my recommendation to listeners would be to do a sexual attitude and reassessment webinar, like workshop, and that's where you. Have a look at all your attitudes towards sex. You get comfortable with looking at different types of sexual interactions. And so it pretty much is like exposure therapy for sex. It's really good, really helpful. Really make sure that you use the right words. You can't go into client sessions using like, Oh, and your hoo ha, like, and stuff like that. You can't use euphemisms. Yeah, it's, yeah, you have to use the accurate words.

[00:43:03] And then I would recommend Ship Psychology. I love ships. I think they do a great job. And those books that you recommended as well. Sometimes I've had really good responses with clients just by talking with them about brakes and accelerator, like from Emily Nagoski's work. And that's like a revelation to them.

[00:43:17] Marie: Yeah, I do have an episode that I'll air soon where I interview, um, Sarah from Ships and we talk about, uh, sex and that'll be really cool.

[00:43:25] Bronwyn: Oh, fantastic. I'll make sure I link that when this episode comes out.

Final advice

[00:43:29] Marie: Wonderful. Any one last, one last, have we fixed Mark and Emily? Probably not yet, but any one takeaway.

[00:43:37] Bronwyn: With Mark and Emily, we've worked out the expectations. We know that this is not a attend one session and you get fixed. Um, we understand that there are differences in conflict, but what we need to do is understand each other's emotional needs and what we're looking for with our communications. Practice different ways of actually getting the needs met in that relationship, uh, increasing fondness and admiration if that's absent in the relationship.

[00:44:04] Oh, I guess the only other thing I'm thinking is that with Mark and Emily, so Mark travels a lot for work and he has very long work hours and that might, let's just say Emily, like. Really needs that physical comfort and soothing. Like it's, you know, it's different. It's a phone call. It's, you know, video conference. It's different. How do we help couples with difficult, real situations where it's like, Mark can't give up his job? Um, maybe he could, I don't know.

[00:44:34] Marie: Look, I would probably do either the Dreams Within Conflict script of the Gottman's where we're looking at what's behind some of those big needs or desires, or I might even bring in some act based work and then use that for the couple. So I might look at where, what are your values like right now?

[00:44:53] And most of the time there's some overarching values in I want stability, security. I want my kids to be happy and healthy, worried about being, uh, irrelevant or redundant in a job if I change. So there's... we need to look at some of those big things before we can start looking at problem solving.

[00:45:13] And then we can start, once we've understood it, we've empathized with both positions, there might be a gridlock that both, it's not their preference and they accept this is what has to be done right now. He has to travel for work. If he doesn't, we don't have the quality of, of housing or education for our kids. And knowing that, here's what we can then problem solve. So then you figure out, do we set a budget for every second trip one might fly up and spend the trip there? Do they have one where they say no to their boss? Is it that one gets to extended family, like family holiday time and what's been a building up, um, you know, RDO hours or something like that.

[00:46:02] So you can't probably, if you go straight into problem solving, you really miss the validating, the empathizing, understanding the root cause of that. And you're missing teaching them that as well. So by being able to slow it down, understand what it's really about, asking questions in front of each, you know, each person being there. You're giving them through osmosis a language to be able to say those things. And hopefully that they get to, you know, a little light bulb goes off of, ah, it's not about just that. They're not trying to control me or restrict me or abandon me or piss me off or reject me. Not reducing it to a character flaw. We're really understanding the meaning behind that. And then you'll be surprised when people feel really heard and allow the space to maybe grieve what a preference might be or a dream scenario.

[00:46:55] They're pretty good at coming up with some practical solutions themselves. I might give some ideas, but if I can do all that other work around it, I find that they're pretty good at thinking of some really fun or creative things themselves.

[00:47:09] Bronwyn: No, that's really awesome. I really like that. And I really like your approach to couples as well. I, I think particularly from our conversation, what I found helpful is, your way of taking your pressure off yourself as a therapist to fix everything. And I think like, if I feel that probably listeners feel that as well, cause I think as early career therapists, we can just place a lot of pressure on ourselves to like have all the answers, have all the solutions, fix everything.

[00:47:33] Marie: Yeah.

[00:47:34] Bronwyn: Yeah. Hmm. Um, so Marie, what is the biggest takeaway you hope listeners learn from the conversation today?

[00:47:41] Marie: Don't be scared to broach further kind of work in, say, couples work. It is really, really rewarding. I think I liked what you were saying around that, like the sexual attitudes webinar. I think those sorts of things where you've got to really figure out your exposure to stuff. So we don't want your first reaction to be negative or kind of grimacing or pulling a funny face in front of someone who's already talking about something really, really vulnerable. That's more highly stigmatized often than individual therapy. So have a think about that.

[00:48:14] And I, I don't recommend resources without having. done them myself or read them myself or watch them. So you can start there. One of the books I absolutely love and I recommend, I reckon anybody in a relationship would do it is the Eight Dates book by the Gottmans.

[00:48:30] Bronwyn: Oh, I haven't read that one.

[00:48:32] Marie: It's fabulous. Yeah. It's really, really good foundational work of each chapter is one date. And so you read that chapter, it gives you prompt questions. You go on a date, you talk about that and it covers the things like intimacy, trust, fun, sex, relationships, got like it has broken it down into eight key areas.

[00:48:52] And so doing stuff like that, you know, parallel to your couple, you know, if you're doing couples work is really important. So being able to to know what it feels like to have those tough conversations with your partner, you know, to know what it's like to be vulnerable. I think some of this stuff, I don't know if I would trust a therapist who had never been to therapy, who doesn't know how uncomfortable it feels to be sitting on that other seat or to talk about their vulnerability.

[00:49:17] So I think couples work can be a bit like that. You don't have to have the exact same scenario, but I think to have a, um, a tolerance for sitting in that discomfort and in that unknown and get some really good supervision.

[00:49:30] Bronwyn: Oh yes. No, that's a must. Thanks Marie. Marie, if listeners want to learn more about you or get in touch, where can they find you?

[00:49:37] Marie: So I'm on, all the socials. So my private practice is the therapy hub. So you can find that on Facebook, LinkedIn, Instagram, and then, um, me under my name. So I also have the podcast This Complex Life. So in the next couple of weeks, or maybe even by the time this episode is aired, there'll be a new season of episodes where we're looking at substance use, sex, yoga to treat addictions, um, men's depression, eating habits, all sorts of really cool fun stuff. So yeah, some really good stuff coming out.

[00:50:09] Bronwyn: Nah, awesome. Thank you. And I'll make sure that I have those links in the show notes and thank you so much for coming on Marie. It's been really enlightening. Thanks for putting up with my like pointed questions where I'm just like. Oh, what if this, what if that, really appreciate it.

[00:50:24] Marie: It's like people get to hear almost like what a supervision session might kind of be like. Um, I think it can be really, you know, peak behind the scenes.

[00:50:33] Bronwyn: Yes. I'm this annoying and supervision as well.

[00:50:36] Marie: Not annoying.

[00:50:38] Bronwyn: So as always, listeners, thank you so much for listening . Listeners, if you really liked the show and you don't want to miss an episode, do press follow on your podcast listening app. That means that episodes will automatically go into your feed, so you don't have to search them anywhere. They're just in your nice and easy in your podcast app.

[00:50:54] That's a wrap. Thanks so much. This is Mental Work. Have a good one. Catch you next time. Bye.