If you’re currently in individual therapy, let me start off by saying – good on you! It’s not always easy to recognize when additional support is needed and to do something about it. But if you’re here today, you may be questioning whether you need something more… or different.
If you’re currently in individual therapy but notice that you keep coming back to things connected to your relationship, then it’s time to consider couples therapy. Let’s explore more about the difference and whether it’s the right move for you.
Individual therapy vs. couples therapy
The American Psychological Association (APA) defines individual therapy as: “treatment of psychological problems that is conducted on a one-to-one basis. One therapist sees one client at a time, tailoring the process to their unique needs in the exploration of contributory factors and alleviation of symptoms.”
The APA then defines couples therapy as: “therapy in which both partners in a committed relationship are treated at the same time by the same therapist or therapists. Couples therapy is concerned with problems within and between the individuals that affect the relationship. For example, one partner may have undiagnosed depression that is affecting the relationship, or both partners may have trouble communicating effectively with one another. Individual sessions may be provided separately to each partner, particularly at the beginning of therapy; most of the course of therapy, however, is provided to both partners together. Couples therapy for married couples is known as marital therapy.”
Many people believe that you have to choose one or the other when, in actuality, a person can be in individual and couples therapy simultaneously. In many cases, this is an ideal situation – your couples therapist focuses on you and your partner as a unit, and your individual therapist is for you and you alone. Sometimes, in the process of couples’ work, a person needs a safe space to process or focus on personal goals that are only somewhat connected to the relationship.
When is individual therapy not enough?
This question is more complex than it appears. The answer varies based on your situation, personality, partner, and therapy goals. But let’s get you started and explore a few key indicators:
Misaligned goals. What are your goals for individual therapy? Are they focused on managing personal stressors or addressing issues in or strongly connected to your relationship? If your therapy goals predominately revolve around improving things with your partner or stress that can only be resolved if things improve with your partner, individual therapy probably won’t cut it.
One side note: I recommend always being clear on your goals for any therapy you engage in, whether individual or couples work. Your therapist should be clear and able to share what you both are working towards at any time in your professional relationship. If the goals are not transparent or you (as an individual or a couple) are not aligned with your therapist’s goals, that’s a red flag.
Assess progress. Think back on the progress you’ve made in individual therapy. Do you know what triggers or stresses you out? Have you developed coping strategies? Do you understand yourself and your worldviews better? If you’ve noticed that individual therapy has helped equip you with valuable insights and coping strategies but still haven’t made progress in the way you’ve hoped… it may be because it is the wrong approach. If you notice that you’re not making as much progress as you or your therapist would expect, explore whether you need to change the approach.
Let’s talk through an example. James sought out individual therapy to manage work-related stress and anxiety. He’s made progress in identifying triggers and using coping strategies, but he’s noticed that his stress and anxiety haven’t decreased as much as he would have thought. Exploring further, he realizes that while stress and anxiety at work have diminished, his overall stress and anxiety levels haven’t because the main issue isn’t work – it’s tension within this relationship.
In such cases, the difference between your individual therapy goals and ongoing relationship challenges is a compelling indicator that individual therapy alone isn’t going to cut it. Please realize – this doesn’t mean that individual therapy was a waste of time! In James’ case, he may never have realized what his stress was really tied to if he hadn’t gone through individual therapy.
What happens in couples therapy?
Now that you know individual therapy isn’t enough, what can you expect in couples or marital therapy? The highlights are:
- Both partners are expected to attend sessions
- Identify problems that affect the relationship
- Identify what is maintaining or exacerbating your problems
- Share your feelings and thoughts
- Practice active listening
- Identify strategies to improve communication
- Practice various strategies
The details of a session will depend on your goals, your preferred style, your therapist’s working style, and your working modality. But let’s walk through an example of a couples therapy session to help you imagine the process.
An example of how a couples therapy session might go
John and Sarah have been married for a few years and are struggling with deciding when to start a family. They’ve decided to take the advice of a close friend and see a couples therapist. They’ve explored various providers – different degrees (MFT, PsyD, PhD), different modalities (e.g., relational, CBT, ACT, Gottman method), by their insurance, and private pay.
They do a few calls and decide, together, on a psychologist who practices Acceptance and Commitment Therapy (ACT) for couples. Their first two sessions will be a comprehensive assessment.
When they arrive at their session:
- Fill out forms sharing information about their social, mental, and physical health history
- Sign informed consent forms
- Complete any payment or provide insurance information
In session:
- Learn about the limits of confidentiality.
- The therapist introduces herself, her general role, and how she approaches therapy. She’ll also share the confidentiality limit and ensure that Sarah and John understand.
- The therapist starts with an open-ended question like “What brings you here today?” To which John and Sarah are allowed to answer organically together or separately. As needed, the therapist will ask more specific questions. For example, she notices that John is quieter, so she specifically asks for his thoughts to create space.
- The therapist will stop the conversation if it becomes heated or if Sarah and John start raising their voices.
- The three will review John and Sarah’s history forms. The therapist will ask for more details as needed to better understand the couples’ core beliefs and how each copes with and avoids emotionally painful situations.
- The therapist asks questions to learn more. Questions like, “How does that impact you?” and “How does that make you feel?” and “What do you usually do in response?”
- The therapist asks a few questions about a recent fight John and Sarah had. She asks, “John, what was your understanding?” and “Sarah, can you tell me how that same conversation felt for you?” to better understand how their perspectives align or differ.
- The therapist doesn’t speak too much because she’s intent on listening and observing John and Sarah. She jots down a few notes but shares that it’s to help her summarize at the end of the session.
At the end of the second session (a.k.a., the end of the assessment period)
- The therapist shares her recommendations regarding a treatment plan. A treatment plan includes goals, a general timeline, and a frequency of sessions. For Sarah and John, the therapist shares that she’d like to focus on:
- Identifying each of their core values.
- Identify each of their schemas (or core beliefs) that are causing difficulties in the relationship.
- Identify and practice interventions such as accepting emotional pain instead of avoiding it.
- Mindfully noticing when it comes up and identifying and doing an alternative, value-based behavior.
- The therapist asks if Sarah or John has any questions or concerns. They’ll take some time to discuss it.
- John and Sarah feel like this therapist is a good fit—they are warm and validating but also confident and don’t seem to take BS. So, they schedule their next session.
- The therapist gives them some “homework.” She asks them to identify their top three values from a list.
Red flags in therapy
Couples therapy is a big investment, and, unfortunately, there have been instances where it’s done more harm than good. To help avoid that, here are a few red flags to be aware of:
Overlapping roles. Your couples therapist should not double as your (or your partner’s) individual therapist. While it’s okay for a couples therapist to occasionally meet with you or your partner individually, it should always be for the greater purpose of achieving your goals as a couple. And these sessions should always be made aware to the other partner, and brought back into the joint sessions. It should never be a consistent arrangement; if your therapist says they can fulfill both roles simultaneously, it’s a clear red flag.
Clear bias. Does your couples therapist favor one partner over the other? Do they clearly allow for one partner to speak more or only ask them questions? If these things are occurring, it may be that your therapist has a bias and that can be harmful in couples work. Bring up your concerns in session; a competent therapist will be able to explain or apologize and set clear steps to remediate.
Lack of progress. Despite the time and effort invested, if you’re in couples therapy and you find that you and your partner are not making progress (or having the same discussion over and over again), it may be a sign that your current therapeutic approach isn’t working. So, tell your therapist. Don’t ghost them – tell them you don’t think this is working and be open to a conversation with them about the next steps. Maybe it’s a readjustment of the goals or approach in session, or maybe it’s looking into different therapy modalities or even a different therapist whose approach works better for you both as a couple.
Feedback. If your therapist is unable to receive or be open to feedback, consider a better fit. If the feedback you’re providing is respectful and constructive, your therapist should be open to hearing your concerns and having an open dialogue.
Unrealistic expectations. Assess what is doable for you and your partner right now, both mentally and financially. It’s not an easy ask – syncing up your and your partner’s schedule with a couple of therapists alone can take a lot of work. While continuing with individual and couples therapy at the same time can offer benefits, it’s also not always doable. Avoid feeling pressured or guilty if you’re unable or unwilling to pursue both at the same time. A competent therapist will work with you to develop a plan that aligns with your current needs and capacity.
Final thoughts
Individual therapy is a valuable tool to address personal challenges and build personal insight, while couples therapy truly focuses on the couple and ways to improve or solve relationship-based issues. Both avenues of therapy are beneficial and can be utilized at the same time, but it is helpful to be clear on the goals for each.
Recognizing when individual therapy may not be enough or the right path is powerful for your relationship. It isn’t easy to recognize and accept that additional support may be useful. While there is no shame in engaging in couples therapy there can be a sense of sadness that arises, but moving forward can help you foster a healthier, more fulfilling relationship.
By asking these critical questions and assessing your current therapy experience, you can make a more informed decision about the next, best step. As you explore your options or enter couples therapy, be aware of the red flags to ensure therapy remains a beneficial experience and not one that puts you in a worse place.
Frequently Asked Questions (FAQs) about couples therapy
We know you might still have questions so we added in some of the most frequently asked questions from you all below.
Q: Can I be in individual therapy and couples therapy at the same time?
A: Yes! If you have the capacity and financial ability, it often can be the ideal set-up. I would recommend letting your individual therapist and couples therapist know about each other. If you feel comfortable, you can also let them speak to each other; by law, you would have to sign a form giving them permission to speak to one another (often called a Consent for Release of Information form).
Q: What should I do if I encounter red flags in my therapist?
A: My first recommendation is always to talk to your therapist. Be clear, open, and honest about your concerns, and be open to their response. If they respond in an empathetic and knowledgeable manner, then there is a path to move forward (with clear steps set out to remediate the concerns). If the therapist responds with anger, blaming, and no openness to make changes, I would suggest looking for another therapist.
Q: What does your average couples therapy session consist of?
A: This depends! The best therapist won’t use the same structure for all couples – they use approaches that fit the couple and their current concerns. But, on a super high level, an average session will involve both partners sharing their current difficulties, focusing on their own emotions and thoughts, practicing a new way to listen/respond/act, and identifying what to work on until the next session.
Q: What is the most effective form of couples therapy?
A: So this is a little tricky – the most effective form of couples therapy depends on the couple and the fit. However, there are forms of couples therapy that are “evidence-based.” As the APA notes, evidence-based practices have integrated the best available research with “clinical expertise in the context of patient characteristics, culture, and preferences.” These include behavioral couples therapy, cognitive behavioral couples therapy, emotionally focused therapy, and integrative behavioral couples therapy.
Dr. Vivian Oberling is the Founding Psychologist at Pace Groups. She is also a licensed clinical psychologist who has dedicated her career to improving the lives of clients across the lifespan. Background-wise, she’s been trained and worked in academic centers and hospitals (Stanford, Harvard, UCLA, Kaiser and Rady Children’s), and utilizes evidence-based treatments and research to enhance non-clinical, supportive services.
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