Individual Or Couples Therapy: Which Is Right For You?

Today on the blog, Yechiel Benedikt, an NYC therapist and member of the MyWellbeing community helps us answer one of the most common questions about therapy: should I go alone, or with my partner?  

Your partner is strongly suggesting, or even demanding, that you talk to a therapist to work through your mental health or addiction challenges. Should you go for individual counseling or couples counseling?

This is a quite common scenario that I have in my office. While it may be presented as a client struggling with a mental health issue or addiction who is being alerted by their partner, I find that treating the client individually is usually not optimal, and may end up being counterproductive.

When therapists treat individuals, we are collaborating with the individual on their goals and working at their level of readiness. As a result, what often ends up happening is that the individual will work on an issue from their perspective, which will differ vastly from their partner’s perspective. Consequently, the client will be satisfied but their partner may be disappointed.

If the partner is the driving force behind the therapy, they may convince their partner to terminate their work with their therapist despite the fact that the partner believes they are making progress and premature termination while cause them to not be able to reach their desired goals.

It is also important to evaluate the conscious and unconscious motives of the partner who is asking their significant other to go to therapy.

While, on the surface, it may seem like the partner is coming from a place of care and concern for their partner, concern is often not the only reason. Consciously or unconsciously, the partner is feeling disturbed with their partner’s behavior and trying to resolve their own disturbance by suggesting individual treatment. The partner may not be aware that their impact is partially related to their own unresolved issues as well as the interpersonal dynamic between the two of them.

From my perspective, based on systems theory and the EFT model for couples, the main challenge is not the individual’s mental health condition per se, but rather the lack of understanding between the partners around it. Once both partners are in sync with each other, the significance of the issue is minimized or it can be dealt with much better because both partners are in alignment.

Systems theory refers to the fact that people within a family system are not acting independently but rather through dynamic interactions with other people within the family system. From a systems theory perspective when mental illness is present in one individual, it would need to be viewed in the context of how reciprocal interactions in the family revolve around the mental illness and not merely as a problem with the individual. When the issue is addressed in the context of the family, the individual’s issue may not be significant. For example, if there is a couple with one partner with ADHD, once the family members learn to support the ADHD member and their limitations, the issue may become manageable for both the individual with the diagnosis and the family system. Therefore, from a family systems perspective, we would need to see the person’s mental health condition as an imbalance to the system, which needs to be treated in context of the system and not just as a problem in and of itself. This is especially important when the presenting issue is the impact of mental health on the system as a whole  i.e. the marital relationship.

EFT suggests that when there is conflict, it is a result of an ongoing negative cycle between partners. Thus, when a partner is focusing on another partner’s mental health challenge, it may very well just be that they are playing out their part of the negative cycle and the challenge may not be as significant had they not been in their negative cycle and constantly hyper-focusing on their partner’s limitations. Therefore, when a partner is suggesting that their partner seek treatment it may just be a misrepresentation of the negative cycle which would require treatment through marital therapy. Although there is no proof one way or the other, from my experience such a misrepresentation is common in clinical practice.

Based on the above, my default approach is to recommend marital therapy as an initial plan. Couples therapy provides an opportunity for the partner suggesting the therapy to be involved and eliminates the issue of one partner being singled out. Additionally, it provides accountability for both partners to focus on their issues not only from their perspective but from the perspective of their partner.

Emotional focused therapy (EFT), my model of choice, is highly effective in creating individual growth by healing attachment injuries, increasing self-awareness, and developing emotional attunement. Consequently, when using this model, it is highly likely that individual issues will be resolved during the process of couples therapy. These results come from the fact that EFT’s theoretical foundations are rooted in attachment theory, and a strong focus on emotional awareness.

Although in some cases individual issues may still need to be addressed at some point during or after the marriage therapy, I often find that the marriage work covers all other grounds to a satisfactory level.

One of my clients with a history of attachment trauma and social anxiety reported a significant decrease in social anxiety and increase in a sense of safety in social environments after a few months of EFT. Another couple with ADHD reported improvement in the impacts of the ADHD on the marriage because of EFT.

Considering both my experience and theoretical understanding of the subject, I would generally recommend marriage therapy as first line of defense when people recommend individual therapy for their partner. I also recommend the EFT model which emphasizes the negative dynamic between the partners as the underlying issue instead of focusing on just the limitations of the individual. I also acknowledge that this may not be true in all cases and is ultimately up to the clinician to assess each case individually. Additionally, some clients may not be ready for marital therapy, and individual therapy may be the only option at first.