World Mental Health Month: When to take therapy as a couple? Here’s what you need to know before you start

An individual's mental well-being is often affected by the state of their relationships with the people in their life. Whether they are family, friends or their partners of romantic interests, a rough patch or rooted problems can have an impact on the person's bond with their closed ones. For many people, it can mainly be about their relationships with their significant other or their partners, who are involved in their life and anything that triggers distress in their companionship can have the potential to greatly influence the mental health of both the persons.

While couples therapy is still not so common in India, there are couples who are taking a step forward to undergo therapy and counselling to improve their relationships. And this is not merely restricted to married or heterosexual relationships. While therapy must not be seen from a fire-fighting mode to just solve the problem, it certainly is an option to address the elephant in the room stirring conflicts and tackling it to better a bond and save it from dire consequences, if the couples are sure about staying together. Though, thinking about therapy can be easy, but the process can be confusing for many.

Mid-day Digital reached out to Priyanka P Siddheshwar, trauma-informed counselling psychologist and psychotherapist based in Bengaluru and Dr Sahir Jamati, consultant psychotherapist, specialisation in addiction and marriage therapy at Masina Hospital, Mumbai to understand the fundamentals of couples therapy and what are the essential points one must be mindful of before seeking professional help with their partners.

Please explain the difference between couples therapy and counselling.

Jamati: Many people have mistaken couple counselling and couple therapy as similar processes, but they actually are different. Couple counselling helps couples to handle the challenges faced in a relationship, while therapy is required to handle the root causes of issues in a relationship. Couple counselling focuses on the current issues faced frequently, whereas therapy traces the roots of previous fights and arguments to find out from where it all began. What makes couple therapy unique over couple counselling is that it can go a long way in addressing individual and personal issues to learn more about persons' behaviour in a relationship. In short, couple therapy is more inclined in finding out the ‘whys' and counselling is more about finding the ‘hows' of a challenge.

Siddheshwar: The difference between the two is the intensity of problem (higher in therapy when compared to counselling), the duration it takes to move towards achieving the goals set (long term in therapy vs short term in counselling), level of functional dependency of the client (functional clients coming for day to day challenges in counselling vs long pending repetitive patterns addressed in therapy and competitively more dependent functional clients come to seek therapy), immediate issues in counselling vs long term problems, telling is mostly seen in counselling vs asking/ checking is involved in therapy.

What are the different approaches to couple therapy depending on the needs of a couple?

Siddheshwar: People respond differently to varied traumatic events in their lifetime. Three approaches to trauma-informed therapy would vary depending not only on the needs, but also the capacity of each of the partners in a relationship towards path to recovery. These are:

Top-Down Processing: Traditional conversation-based psychotherapy and most cognitively-oriented trauma-focused therapies are viewed as top-down approaches to treatment. Most often this involves efforts to resolve trauma symptoms by working with the dorsolateral prefrontal cortex, the area of the brain most responsible for logic and reason.

Healing the Body from the Bottom-Up: Somatically-driven and body-based interventions adopt what has been characterized as a bottom-up approach to trauma therapy. These interventions focus to undo trauma's imprint on the body by directly accessing the limbic system - the part of the brain responsible for our behaviour and emotions--and by directly targeting sensory receptors located throughout the body.

Side Door Approaches to Healing from Complex Trauma: Contemporary mind and body interventions bring change by forging communication and restoring balance between the rational and emotional brain systems through a third pathway: the medial prefrontal cortex. Mind-body practices, such as meditation, biofeedback, trauma-sensitive yoga, and similar therapies focused on sensory motor regulation/integration, may expand interoceptive awareness through the body's ability to sense movement.

How does a couple prepare for undergoing therapy in terms of what they are looking for?

Jamati: If one feels that there are frequent fights, growing distance between the two partners and a realisation of changing dynamics, then seeing a couple therapist would definitely help before the issues start snowballing. It is very important for a couple to find a therapist that both are comfortable with. A mental health professional must make you feel at ease and provide a safe space for sharing all your intimate problems or open up at your own pace.

Siddheshwar and Jamati suggest the following points that couples must be mindful of before undergoing therapy:

a. As a relationship is a mutual affair, be prepared about what you both would want to achieve from therapy.

b. Go in with an open mind and make sure you are both 100% invested in attending therapy together.

c. Despite the difficulties faced, partners must be sure about whether they are prepared to be fully committed in the relationship. Ask yourself in advance if you're prepared to take risks.

c. Discuss shared goals for therapy with your partner with realistic expectations.

d. Start your search for a couple counsellor by prioritising comfort and fit. Discuss your privacy expectations.

e. Be prepared to work with the support of an unbiased professional to identify and resolve specific relationship issues.

d. Be prepared for developing a solution-oriented approach instead of a problem-oriented approach to rediscover your relationship well.

e. Get ready to share personal and family history. Know that it's okay to be nervous about your first session! Decide whether - and what - you want to tell your friends.

f. Aim to be as honest as possible to disclose about yourself.

e. The main goal should be to seek help for improvising the quality of your relationship, increase compatibility, enhance intimacy and navigate/resolve conflicts effectively.

f. Don't assume you need to be at the rock-bottom to attend therapy, this can help you have a healthy relationship with you and your partner.

What are the checklists one must tick while choosing the right therapist suitable to their needs?

Siddheshwar:

Step 1: Write down what needs you both have and what are your couple goals.

Step 2: Search for therapists with specialised training in couples therapy.

Step 3: Speak to the potential therapists during the first session or on the phone to find the right fit for you in terms of place, medium of session, type of problem, age, gender, pricing and frequency of sessions.

Step 4: Couples who stick with therapy, improve.

What is your take on online therapy platforms/apps?

Jamati: I have personally observed the benefits of online couple therapy and potential drawbacks both. Considering the benefits, few observations are listed below:

a. It becomes convenient as there is no commute to the therapist's clinic and it saves time to allow other plans.

b. It doesn't feel awkward to walk into a new place, meet a completely new person and discuss personal details of your relationship.

c. Long distance relationship counselling becomes a viable alternative if the couple cannot participate physically.

There are also a few drawbacks associated with online couple therapy as listed below:

a. Online sessions are taken casually with many disturbing factors around like children, pets and neighbours among others.

b. It is also noticed that one may face internet connectivity issues or audio/video breaks which can disturb the flow and importance of a session.

c. Sometimes the couple is more conscious and hesitant to speak openly if they live with others.

d. Couples might feel the session to be less intense or less personal while communicating through the screen.

e. Having a virtual session limits the understanding of body language and the therapist may miss out on some important cues.

Also read: #Couplegoals: What are the essentials of a happy and safe long-term relationship?