Working With Relationship Problems In Individual Therapy

A few weeks ago, I asked my readers to answer this question: “What is your single biggest challenge when working with clients with sex issues?”

I’m so grateful for all the thoughtful, nuanced answers I received. I’m still sorting through them (and they’re still rolling in; bring it on!). Over the next few months, I’ll be answering as many of those questions as I can, beginning today. 

A few people wrote to me about the challenge of working with an individual client whose partner has problems that they are unwilling or unable to work on in therapy, and which are negatively affecting the relationship dynamic. This can manifest in a huge variety of ways. Perhaps the partner has a medical problem that is affecting both their lives, but they are unwilling to seek treatment. Perhaps they have difficulty self-soothing and managing emotions, and that’s contributing to unnecessary stress and tension in the household. 

In any case, it can be a tremendously frustrating position to be in as a therapist. What do you do when you know that you have interventions at your fingertips that could help your client and your client’s partner, but you’re unable to directly reach the person who needs them the most? 

• Consider bringing them in for a joint session. This hinges on your client’s partner being willing and able to access therapy. But if it’s an option in your case, it’s a great idea. You can get a fuller, more accurate picture of the dynamic at play, and speak directly to the partner. I often provide a bunch of psychoeducation about sex in this manner, so one partner isn’t in the position of carrying information home to their partner from me, some of which might be a little challenging to hear, and some of which might lose something important in translation. In particular, if sexual satisfaction, desire, orgasm, or consent/willingness are part of the issue, I always prefer to see both partners together if possible. 
• Consider collaborating with a relationship therapist. Again, this hinges on your client’s partner being willing and able to access therapy. 
• Get some inspiration. I often suggest the book It Takes One to Tango to clients in this situation. It’s written by a Developmental Model therapist, Winifred Reilly, and is about how she used the Developmental Model to transform her relationship–all without her husband’s participation. If you want to help your client feel empowered to make a change in their relationship single-handedly, in ways that are compatible with the Developmental Model, this is a great place to start. 
• Focus on your client’s part. Part of the challenge of being an individual therapist is that, when you’re talking about relationship dynamics, you only get one part of the story. Everything you hear is coming through the filter of your client, and they are almost certainly missing important aspects of their partner’s perspective. It is incredibly tempting in individual therapy to focus on the many annoying things their partner does. Don’t do it! Instead help your client identify their own meaningful goals for change…within themselves. If their primary distress is relational, ideally the things they decide they want to change will have something to do with improving how they show up in their relationship. At the end of the day, all any of us can change are things that lie squarely within us. 
• Help your client show up as the partner they aspire to be in their relationship. If your client lacks insight into what they might be able to change that will make a difference in their relationship, here are some very common areas of potential focus:
  • Does your client self-soothe well? 
  • Are they able to figure out what they want, feel, and think? 
  • Are they able to communicate those things to their partner in non-dramatic ways?
  • Can they tell the difference between things that are about them, and things that are about their partner? 
  • Can they hold steady when their partner is telling them something they find difficult to hear? 
  • Can they take action on their own? 
  • Can they recognize a desire to set a boundary, and then set one? 
  • Can they hold that boundary warmly if pushed by their partner?
  • Does your client listen well, and then are they able to get curious about what their partner’s experience is?
  • Can they express empathy, even if they don’t agree?
  • Can they show love even when they are annoyed or disappointed? 
  • Can they feel their partner’s love even when they are annoyed or disappointed?