238: The 3 Situations When Couples Therapy Won’t Work with Shane Birkel
Welcome back to The Couples Therapist Couch! This podcast is about the practice of Couples Therapy. Each week, Shane Birkel interviews an expert in the field of Couples Therapy to explore all about the world of relationships and how to be an amazing therapist.
In this solo episode, Shane explores the 3 situations when couples therapy won’t work: addiction, serious mental health issues, and acting-out behaviors. Listen to the episode on Apple Podcasts, Spotify, and your other favorite podcast spots, and watch it on YouTube – follow and leave a 5-star review.
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The Couples Therapist Couch 238: The 3 Situations When Couples Therapy Won’t Work with Shane Birkel
This episode is brought to you by Alma. Visit HelloAlma.com/ATPP to learn more
Get the Couples Therapy 101 course: https://www.couplestherapistcouch.com/
Join the Couples Therapist Inner Circle: https://www.couplestherapistcouch.com/inner-circle-new
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In this solo episode, Shane explores the 3 situations when couples therapy won’t work: addiction, serious mental health issues, and acting-out behaviors. Hear why couples therapy is not always helpful, the different types of addiction, why you might be a client’s last chance, the one case where you truly can’t do couples therapy, and the difference in abuse in adults and children. Here’s a small sample of what you will hear in this episode:
- Differentiating between an addiction issue and a relationship issue
- The one case where Shane is certain couples therapy won't help
- Why Shane is careful about what he calls emotional abuse
- How Shane creates safety in situation where physical abuse has arisen
- How abuse is defined differently when children are involved
Check out the episode, show notes, and transcript below:
Show Notes
- 238: The 3 Situations When Couples Therapy Won’t Work with Shane Birkel
- This episode is brought to you by Alma. Visit HelloAlma.com/ATPP to learn more
- [0:59] Welcome to The Couples Therapist Couch
- [2:13] How addiction impacts intimacy and the value they can get from couples therapy
- [5:03] Is it an addiction issue or a relationship issue?
- [7:42] There are times when serious mental health issues impact a relationship
- [11:53] We can't make individual changes without the support of the environment
- [12:51] Once the client starts taking steps, Shane is willing to work with them to work even deeper
- [15:45] Visit helloalma.com/atpp to spend less time on admin work and more time offering great care to your clients
- [16:33] Acting-out behaviors: ongoing lies & physical abuse
- [19:52] How Shane would interact with physical abuse within the relationship
- [23:38] Why Shane is careful about what he calls emotional abuse
- [26:48] How emotional abuse is defined differently when children are involved
- [29:35] Recapping 3 situations that make couples therapy counterproductive
- [31:29] This episode is brought to you by Alma. Visit HelloAlma.com/ATPP to learn more
What is The Couples Therapist Couch?
This podcast is about the practice of Couples Therapy. Many of the episodes are interviews with leaders in the field of Relationships. The show is meant to help Therapists and Coaches learn how to help people to deepen their connection, but in the process it explores what is most needed for each of us to love, heal, and grow. Each week, Shane Birkel interviews an expert in the field of Couples Therapy to explore all about the world of relationships and how to be an amazing therapist.
Learn more about the Couples Therapy 101 course: https://www.couplestherapistcouch.com/
Find out more about the Couples Therapist Inner Circle: https://www.couplestherapistcouch.com/inner-circle-new
Transcript
Please note: This transcript is not 100% accurate.
00:00
This is an extremely serious issue. The physical violence can never happen again.
00:14
Welcome to The Couples Therapist Couch, the podcast for couples therapists, marriage counselors, and relationship coaches to explore the practice of couples therapy. And now, your host, Shane Birkel.
00:30
Hey everybody. Welcome back to The Couples Therapist Couch. This is Shane Birkel, and this is the podcast that's all about the practice of couples therapy. Thank you so much for tuning in. I'm a licensed marriage and family therapist, and the goal of this podcast is to help you learn how to more effectively work with couples and possibly even learn how to have a better relationship. The episode this week is brought to you by Alma. They make it easy to get credentialed with major insurance plans at enhanced reimbursement rates.
01:00
Alma handles all of the paperwork and guarantees payment within two weeks. Visit HelloAlma.com/ATPP or click on the link in the show notes to learn more. I get a lot of questions in the couples therapist inner circle about when couples therapy isn't recommended. And it's important for us as couples therapists to understand that there are times when no matter how
01:24
good of a couples therapist you are, when there are certain situations going on, the therapy just isn't going to be helpful. part of it is about safety, and part of it is about intimacy and trust. And so I've broken it down into three different categories. I'm going to go through those three different categories that if these things exist, it's going to be really hard to build safety and trust in the situation. Now,
01:51
There are times where it's not that clear cut, where one of these or more of these things could be going on. I would be willing to work with people and help people, but I'll talk about what makes that possible and what I think makes it so that you probably shouldn't be doing couples therapy. The first category is addiction. And addiction, there's the obvious, alcohol and drugs, obviously.
02:20
And then there's also process addictions like gambling, video games, shopping. And so as I said in the beginning, like it depends what level of addiction we're talking about or, or, you know, we could talk about substance abuse versus addiction, you know, there are people who abuse alcohol, who might not be considered addicted to alcohol, but
02:46
The reality is that if there is a couple, if both partners are coming home every night and having 10 drinks or something like that, it's just going to be very hard for them to build intimacy with each other. It's going to be hard if that's going on in the background while you're trying to do work in the couple's therapy and that's not being acknowledged or addressed. I think sometimes it's hard
03:16
to, you know, and I've done episodes on addiction itself. I know I've talked a lot about it in the couples, therapists, inner circle about how to work with addiction, how to work with it when one partner comes in and says, hey, my partner has an addiction and the other person says, no, I don't. I'm not going to get into that fully in this episode. I had some episodes. I think I've done two episodes with Bob Navarra.
03:44
And he does a really good job talking about addiction and working with couples. For the sake of this episode, I just want to point out that if somebody has a serious addiction, I would be willing to work with them in couples therapy if they were getting treatment for it. You know, if they come in and the person is willing to acknowledge that there's an addiction or a problem, if they're willing to start going to meetings or
04:13
know, go to a treatment program or go to a 30-day program or longer, you know, then I'd be willing to work with the couple and help them through that. But there has to be an acknowledgement that the problem exists and an understanding of how it's causing damage to the relationship. I think that one of the things too, to realize that oftentimes people do think that their partner has an addiction, whether it's video games or social media.
04:43
or something like that. Dr. Gabor Mate has done a lot of writing about how people use the addiction in order to fulfill something that should be fulfilled by the relationship. So again, if I'm coming home every day and zoning out on playing video games for 10 hours, what is the consequence of that to my relationship?
05:09
And where is the line between this is addiction versus not? so oftentimes when we're talking about something that you're not sure if it's clearly an addiction, maybe it's more like one partner just wants to play video games for a couple hours every day and the other partner finds it to be a waste of time or something like that. You know, those are to me is not really an addiction issue. It's more of a relationship issue.
05:37
or even if you have someone who comes home and drinks every day or something like that and the partner is having a hard time with it and complaining about it, again, is it really an addiction issue or is it just a relationship issue? Meaning, if the partner is complaining about the other person's drinking, how well is the other person doing at listening to the partner's concerns? How well are they doing in making
06:06
compromises? How well are they doing in being understanding of the impact that it has on their partner? So these would be things that would be very helpful in couples therapy. So I wouldn't want to hear that one partner thinks that there's an addiction and then all of sudden as a couple of therapists say, well, I guess I can't work with you until you deal with that addiction. I think that we can be extremely helpful as couples therapists.
06:37
Even if the person does need to go to like a inpatient 30-day treatment program or something like that, we can help them navigate those conversations where we can help their partner to sort of say, here's what I need, right? Here's my boundary. Here's the consequence of what's going to happen if things don't change. And I think that we can serve a really important part of that.
07:03
for the couples we work with. And I'm going to talk a little bit more about that towards the end, just thinking about how we as the couples therapist can run point. And we can think about what leverage we have to help move people in the direction that's going to lead to them having a healthier life and a healthier relationship. But I'm not going to get into that quite yet. In a few minutes, I'll go a lot deeper into that. But I want to go through these
07:33
The next category, alright, so there's the addiction category. The next category is serious mental health issues. Now my perspective is that everybody has mental health issues. If you're human, you know, you have some level of mental health issues, but there are times where those are really impacting a relationship or someone's ability just to function.
08:03
on a day-to-day basis. if someone has serious depression, for example, and they can't get out of bed and they can't provide their partner with much of a contribution to their relationship, whether it's emotionally, financially, it's going to be very hard for the relationship to succeed. So we need to make sure that
08:33
we're sort of assessing for this when couples come to meet with us. If one partner has a lot of complaints, is it connected to a serious mental health issue? I've actually worked with people where they had a lot of relationship issues. And then during the couples therapy, we found out that there was some sort of serious mental health issue. It could be the depression. It could be anxiety. It could be ADHD.
09:01
and we were able to help that person get appropriate treatment, which in this case, it could be therapy, it could be medication. There are a lot of different ways to approach this. But once that person begins to get the treatment that they need, oftentimes it opens up the possibility for the couple's therapy work and the relationship work to flow much better.
09:28
So again, I wouldn't want to rush too quickly to, oh, you know, I can't work with you until you deal with your depression. As a therapist, I want to be part of helping them to, you know, possibly help motivate them to actually get the service that they need. mean, if you have somebody who's dealing with either addiction or with a serious mental health issue and they actually came to your office,
09:58
you might be the only opportunity they have to make a change or to actually have a healthy life or a healthy relationship. And I would hate to throw that away by saying, oh no, you need to deal with your mental health issue before I can help you. And you send them away and they never do anything about it. And then it was a missed opportunity. Like that was the chance. So I'm much more likely to be patient.
10:29
If somebody comes in, they have a serious mental health issue, I can do a little bit of individual therapy. If you're a therapist, you know how to work with individuals. You know how to work with anxiety, depression, all of these things. So do a little bit of good therapy. At least give them some compassion and validation and understanding about how hard this is. And then talk about
10:55
the impact on their relationship. Talk about the impact on their family and their kids if they have kids. Create some sort of leverage or motivation for them to have a desire to take the next step for change. How can I encourage them to make an appointment for themselves as an individual, to make an appointment with a medical doctor if it seems like medication could be helpful? How do we get them to move toward that? And so part of that to me is
11:25
the work of couples therapy. Because I want to help their partner communicate how important this is or how much they're struggling or suffering. Because that could be what helps motivate them to actually make change. I am a marriage and family therapist. I'm licensed as a marriage and family therapist. And so part of my training and my background is all systemic therapy. Systemic therapy meaning that we are
11:52
influenced by our environment. are part of our environment. can't make individual changes without it impacting the environment and without possibly without help from the environment. And so I think that the best way for people to make progress and to make change in their life is through couples therapy or family therapy or at least even if you're doing individual therapy, at least you're considering the environment and the system.
12:21
in which the person is living and experiencing. So anyway, if there is the addiction or the serious mental health issue, we want to use the experience in couples therapy, first of all, to help the partner to say how important this is to them and to create the motivation for the partner to seek treatment. Now, if in either of these two cases,
12:51
Let's say it's the addiction example. Let's say they start going to AA, right? They start going to meetings every day, or they start going to therapy for addiction, or they're taking steps, or they haven't had a drink for several weeks. I'm more than happy to work with them in couples therapy if they're getting a treat. Or same thing with the serious mental health issue. Let's say someone has serious depression.
13:21
And let's say in the first couple of meetings in the couples therapy, we're able to encourage them to go get help and they start going to individual therapy for depression and taking medication. I am more than willing to continue meeting with them as a couples therapist, knowing that they're getting the treatment for the depression. I think that the couples therapist can really be the person who knows more about what's going on than anyone else.
13:52
We hear the perspective of their partner. We hear the truth from their partner. We are the ones who are making a plan for them within the context of their relationship, within the context of their family. Obviously, if they're going to individual therapy, that person's focusing on the depression or focusing on the individual. But the amount of information that the couples therapists have to share with any other external providers is going to be more
14:22
beneficial than anything they can share with us. And I don't mean that to say that in a cocky way or something like that. What I mean to say is we get a fuller picture of what's going on and we should really take responsibility for helping them make the overall plan for what's happening in their treatment plan with their partner helping to make the plan.
14:51
I think we have a special responsibility and position as the couples therapist where we can do that in a way that any of the other providers will probably have a harder time. they can also be part of that and there's a lot of really good providers out there who can help us with that. But I'm just saying that again, I think there are too many situations where the couples therapist says, well,
15:19
you need to go deal with your addiction or well, you need to go to individual therapy and deal with this trauma before I can help you. And I tend to think that the couples therapy along with these other things is the quickest way to get people the benefits they're looking for. Building a private practice can be challenging. Filing all of the right paperwork is time consuming and tedious. And even after you're done, it can take months to get credentialed and start seeing clients.
15:49
That's why Alma makes it easy and financially rewarding to accept insurance. When you join Alma, you can get credentialed within 45 days and access enhanced reimbursement rates with major payers. They also handle all of the paperwork from eligibility checks to claim submissions and guarantee payment within two weeks of each appointment. Plus, when you join Alma, you'll get access to time-saving tools for intakes, scheduling, treatment plans, progress notes, and more in their included platform.
16:19
Alma helps you spend less time on administrative work and more time offering great care to your clients. Visit helloalma.com backslash A-T-P-P or click the link in the show notes to learn more. The third precondition for couples therapy is acting out behaviors. And I've broken this up into two categories.
16:44
Acting out behavior, I mean, we could probably talk about a lot of different categories, but the two primary categories of acting out behaviors are something like an ongoing affair or like an ongoing lies of any kind. You know, where you're working with the couple, you're doing things in couples therapy, you're trying to create safety, you're trying to create trust, and these affairs or other
17:14
betrayals are happening again and again and again. It's just going to be counterproductive to the work that you're doing in the couples therapy, right? Like no matter how good of a therapist you are, no matter how much you're doing the right thing for them in couples therapy, if there continue to be affairs and lies and betrayals, you're just not going to get anywhere. And, you know, I would say that out loud to the couple. I would say that to the person. I would say that
17:44
I would try to amplify how destructive their behaviors are. I would try to be very clear about that. I would do almost a discernment counseling type of intervention where I would make them commit to not acting out, to coming to therapy, to following through on the therapy and the relationship.
18:13
make it clear to them that nothing is going to change. They have to choose. They can have the affair lifestyle or they can have a good relationship with their partner. They can't have both. And it's not for me as a therapist to decide, but I can just give them an honest assessment based on other situations I've seen how it's going to be impossible to do both.
18:43
The other acting out behavior is physical abuse. And again, you will hear therapists who say if there's physical abuse going on, you can't do couples therapy. And this is the one case where I would say that is true. Now, if I'm meeting with a couple,
19:10
They come in for couples therapy. It comes out that there's been recent physical abuse. I would still be more than happy to continue meeting with them. I would still be more than in that session, I should say. And perhaps one or two follow-up sessions. here's the way that that conversation, there's only one way that conversation goes.
19:41
This would be me talking to the couple. This is an extremely serious issue. The physical violence can never happen again.
19:56
You have no right to harm another human being.
20:05
you know, we need to make a plan so that there's safety in the situation. And safety means that neither one of you are in danger of being harmed. So part of that plan would be if this ever happened again, the two of you are moving apart from each other. Part of the meeting, if I'm the therapist and we're on meeting with this couple, part of the meeting would be
20:32
Let's make a plan. Where are you going to go? Where are you going to go? Where are you going to be living? And where are the kids going to be? And making sure that they understand like. What the plan is if this were to ever happen again?
20:49
Part of that plan could be like, as soon as there's anything physical, the next step is calling the police, getting them involved. It varies from situation to situation, but I would spend some time really emphasizing how inappropriate this is, how abusive this is, how violating this is. I would probably talk about the importance of safety in relationships. Like there's no...
21:19
there's never going to be the relationship that either one of you really want if there's not the safety that is required for that. part of what would make the safety possible is like somebody not fearing that physical abuse could happen. And it's hard because once physical abuse has happened,
21:45
it takes a very long time for the person to begin to trust. Let's say it happened once five years ago, but let's say there's a lot of emotional overreaction or something like that from the same person. So they were physical ones, and then every time they come home, they're yelling and screaming and stomping around or whatever. There's still that residual fear of everybody else in the house.
22:14
that the physical abuse could happen again. They've seen it before and they know it's possible. And so there's a huge impact. That's why if physical abuse has happened, there has to be a commitment to change and there has to be a commitment to it never happening again. And, you know, we could talk more about the emotionally abusive stuff, but
22:40
That's most of what I would say about setting up the plan for the physically abusive stuff. So that's how I would work with that. Again, I would be willing to continue meeting with them until, you know, if we found out that it happened again, if it was reported that it happened again, then, you know, my next move, again, I would meet with them again. Personally, I would. I understand if some people wouldn't.
23:08
But I would say, right, you guys are moving apart. That's it. You can work on your relationship while you're not living in the same place together, but this isn't working. And if they weren't willing to have that type of conversation with me, then that would sort of organically end the couples therapy. I mean, that would be their choice. But that would be what I would say is necessary for us to continue meeting in couples therapy.
23:36
I did want to mention emotional abuse. think emotional abuse is different. It's not the same thing as physical abuse. I think there's a lot of videos on social media these days about emotional abuse. Some of them are helpful and accurate. Some of them are not, in my opinion. I think we have to be careful talking about emotional abuse.
24:03
I could do a whole episode on it. I have before and I probably will again. If you have specific questions, let me know. But what I'll say about emotional abuse is that I am very careful about how I use the word abuse, especially when it pertains to two adults. If we're talking about physical abuse, I mean, that is what it is. If we're talking about emotional abuse, I think it's more complicated.
24:33
because abuse is hurting someone else. And so in some ways, I would say all of us are abusive at times. There are times when I've snapped at my wife or been sarcastic or something like that, and that was hurtful to her. So that's emotionally abusive to her. That doesn't mean that we have an abusive relationship or a serious problem. It means that I need to be accountable.
25:03
I don't want to live with the idea that that's okay. I don't want to make excuses. A lot of times the emotional stuff comes up when we're triggered, when we're in a state of protection, when we're feeling hurt ourselves. So when two people are hurt and they're both attacking from the victim position and they're both in a state of stress and they're both not in their prefrontal cortex, not in their rational mind.
25:33
know, people say and do things that are hurtful to each other. Now, we could talk more, you know, I talk a lot about how to create safety, how to make a plan, how to take timeouts, how to have the speaker and listener framework in the way you're communicating with each other. There's all kinds of strategies and stuff we can set up. But if I'm a couples therapist, a couple is coming in to work on their relationship. I'm not looking at
26:03
emotional abuse as a precondition, something that would make the therapy counterproductive. I think that's what much of couples therapy is about, is determining what are the things that are hurtful to partner A, and is partner B willing to make adjustments to help them feel better? What are the things that are hurtful to partner B, and is partner A willing to make adjustments?
26:30
I think that is understanding the couple dynamic, understanding the attachment wounds, understanding the dance that happens between the couple. I think that's all part of what couples therapy should be. When I think of the word abuse, I think mostly how it applies to children because there's a big difference if a parent is being emotionally abusive to a child.
26:58
they're creating an unsafe environment emotionally that the child can't get away from, right? If that child is dependent on the parent for their survival, for their basic needs, and there are ways that the parent or caregiver is being emotionally abusive, the child can't get away from it. If I am an adult who's choosing to be in a relationship,
27:27
and my partner is continuously emotionally abusive, I'm empowered. I have all kinds of options. I can explain to them what my boundaries are. I can tell them how it feels for me. I can leave the situation either temporarily or permanently. I have all kinds of options. So I don't like the idea of just accusing the other person of being emotionally abusive when it's between two adults.
27:57
It's sort of like, well, what are you doing to set boundaries for yourself? How are we moving you into empowerment? How are you standing up to the person who's doing this to you? and it's not, I'm not, I'm certainly not blaming the victim in these situations, but I'm just saying, I just think there's a big difference. And I think people use that language way too much, you know, where they call each other emotionally abusive when it would be much more helpful.
28:27
for two adults who are in a relationship with each other, who are choosing to be in that relationship because apparently there's enough love and consideration for each other. would much prefer that they use language like, what you're doing feels hurtful to me or what you're doing isn't working for me. This needs to change. Listen, I'm going to go for a walk and I'm hoping when we come back, we can have this conversation in a different way.
28:56
I'm not going to stay around while you're talking to me like that. Things like that. Again, that's part of normal relationship work that I think needs to happen in any relationship. I'm not giving permission for people to be over the line, but I'm just saying, think there's a lot better language for emotional abuse than the word abuse. anyway.
29:23
With the physical abuse, I hope that was clear. So just to go over the three things that make couples therapy counterproductive. One is the addiction. Two is the serious mental health issues. So with the addiction and the serious mental health issue, it's important to remember that if these things are being treated, that I'm totally fine with working with the couples in couples therapy. If there's either a denial or refusal to get the treatment, then we'd have to have a different sort of conversation.
29:52
because you're just not gonna make any progress in the couples there.
29:58
And then the third one is the acting out behaviors, is about ongoing affairs, lies, betrayal, or about physical abuse. I hope that was helpful. I wanted to go over that. I hope that I covered all of the relevant points. If you have any questions for me, I'm always willing to connect with people. can go to my website CouplesTherapistCouch.com.
30:27
You can also go into the Facebook group, the couples therapist couch Facebook group, where people continue the conversation. a lot of people just besides just me are talking about these types of things and can weigh in on their perspective on how they work with things. You know, I want to be transparent about with everyone about how I work, but I'm also not, you know, there are also a lot of really good therapists out there who might work differently than I do.
30:55
Obviously, you can always join the couples therapist inner circle. That's a paid membership, but we have these kinds of conversations all the time and people can ask me questions and you know, I show up live all the time in that group. It's basically like a consultation group, but definitely reach out to me. Let me know if you have any questions about this topic or any other topics and I look forward to continuing to connect with everybody.
31:25
The episode this week is brought to you by Alma. They make it easy to get credentialed with major insurance plans at enhanced reimbursement rates. Alma handles all of the paperwork and guarantees payment within two weeks. Visit HelloAlma.com/ATPP or click on the link in the show notes to learn more. And thank you again, everybody. This is Shane Birkel and this is the couples therapist couch podcast. It's all about the practice of couples therapy. I hope you have a great week and we'll see you next time.
31:54
Bye everybody.