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At the April, 2006 conference of the New Jersey Psychological Association, Milton Spett presented his approach to couple therapy. This article is an adaptation of his presentation.

                                       The Three Levels of Couple Therapy

By Milton Spett

(Throughout this article, l use the generic names “Martha” and “George” to describe typical interactions that occur in couple therapy. Martha and George are not a real couple.)

 In couple therapy, there are three levels of couple problems and interventions:

I  Couple Conflict and Communication Problems. George says something or behaves in a way that upsets Martha. This is a couple problem, and there are two ways to resolve the problem: George can change his behavior, or Martha can stop being upset by George’s behavior.

II  Misperceptions. Part of Martha’s upset is usually due to her misperception of George’s behavior. I use the term “misperception” because the way Martha experiences George’s behavior is not just a cognitive misinterpretation, but also an inappropriate emotional reaction as well as a tendency toward a counterproductive behavioral response. Couple patients’ most common misperceptions are that their partner’s behavior means that their partner doesn’t love them, thinks they are stupid (or incompetent), or is trying to control them.

Couple patients also misperceive their own behavior. George fails to perceive his behavior toward Martha as critical, controlling or unloving. If we had a videotape of George’s behavior, the objective reality would almost always be more negative than George’s perception of his behavior, but less negative than Martha’s perception.

III  Low Self-Esteem. Low self-esteem is the most important cause of couple patients’ misperceptions of their partners. Feeling unlovable causes couple patients to misperceive their partners as not loving them, feeling inadequate causes couple patients to misperceive their partners as criticizing them, and feeling controlled causes couple patients to misperceive their partners as trying to control them. Alleviating these components of low self-esteem will correct couple patients’ misperceptions of their partners. Low self-esteem also causes couple patients to be critical, controlling, or unloving toward their partners.

 Level I Interventions: Communication Skills

            1. Withholding negative feelings is a very important cause of couple discord. Many couple therapy patients do not communicate negative feelings toward their partners because they fear conflict. This creates two problems. First of all, when Martha inhibits her negative feelings, these feelings build up and manifest themselves later as annoyance, withdrawal, sarcasm, an angry explosion, or withholding affection. Secondly, George remains unaware that his behavior is upsetting Martha, and so he continues his upsetting behavior.

            2. Discuss tone before content. No conflict resolution techniques will work if one partner addresses the other in an annoyed, nasty, critical, or sarcastic tone. If Martha speaks rudely to George, George should not respond in kind, but rather ask Martha to “Please say that again without the negative tone.” If Martha refuses to stop, George can leave the room. If Martha follows him into the next room, George can leave the house.

            3. It takes two to have an argument. If George asks Martha to change her negative tone, but Martha continues to argue or speak in an angry, nasty, critical, or sarcastic tone, George can prevent an argument by refusing to respond in kind or just refusing to respond at all. George can say, “Let’s postpone this discussion until we both are calmer and can discuss it more rationally. It takes two to have an argument, but it only takes one to prevent an argument.

            4. You can’t reason with an unreasonable person. If either partner cannot calmly discuss an issue or conflict, the couple should postpone their discussion until they are both feeling calm. If one partner insists on continuing an angry conversation, the other partner should leave the room or, if necessary, leave the house.

            5. Don’t discuss generalizations. It is impossible to resolve a conflict over whether one partner does too much of this or not enough of that. It is only possible to resolve conflicts over specific behaviors in specific situations.

6. Empathy training. Sometimes couple therapy patients cannot resolve conflicts because they cannot understand and empathize with their partner’s beliefs and feelings. Frequently ask these patients to express their partner’s beliefs and emotions. If they do not get it right, make sure they keep trying until they do.

Level I Interventions: Conflict Resolution Concepts

            1. The partners are on the same team. Couples often get into arguments with each partner trying to win the argument rather than trying to find the solution that is best for them as a couple. If they agree on a solution that is in their best interest as a couple, they both win. If they don’t, they both lose. If one partner “wins” and the other “loses,” the winner will have to live with the loser, and it is not pleasant to live with an annoyed or angry loser. So even the partner that “wins” will be a loser. Point out to couples that if either does something that pleases the other, both partners will benefit.

            2. The partners are not adversaries and the therapist is not a judge. Couple therapy often deteriorates into each partner trying to convince the therapist that they are right and their partners as wrong. Point out that you are not a judge. You will not decide who is right and who is wrong. You will try to help the couple find a resolution that is acceptable to both partners.

2. Communicate without trying to convince. When couple patients try to convince each other they are right, they are attempting to win the argument rather than searching for the best solution. This immediately converts the partners from teammates to adversaries.

            3. Many conflicts do not have to be resolved. For example, Martha and George can agree to disagree on how they view their in-laws.

            4. If the partners can’t agree on how to resolve a conflict, they can agree on who will resolve the conflict. For example, if Martha and George disagree on how to put their children to bed, they can agree that Martha should decide because Martha puts the children to bed more often. Or they can decide that each partner will put the children to bed in his or her own way.

Level I Interventions: Conflict Resolution Techniques

            1. Ideal conflict resolution asks “What is best for us?” No negotiation, no compromise. In conflicts, each partner should decide which resolution is best for the couple. Is it more important to George to do it his way or is it more important to Martha to do it her way? If both partners are being objective (a big if), they will come to the same resolution.

            2. No Quid Pro Quo. Quid pro quo is a standard behavioral technique that asks the partners to make a contract: George will do something for Martha, and in exchange, Martha will do something for George. I do not recommend this technique because it puts the partners into an adversarial relationship. In a love relationship, each partner should want to give to the other to make the other happy. If George is giving to Martha only because he expects to get something in return, their relationship is no longer a love relationship.

            3. Four steps to in-session conflict resolution:

                A. Ask each partner to make a specific, behavioral request, explain why he or she wants it, and indicate the importance of the request to him or her. Instruct both partners to refrain from criticizing each other, and, if they do, ask them to restate their request without criticism.

                 B. Ask each partner to paraphrase the other partner’s statement.

                 C. Ask the requesting partner if he or she has any additions or corrections.

                 D. Ask the couple to find a resolution that is in their best interest as a couple.

            4. Do not let the partners express too much anger. It is useful for couples to understand each other’s feelings, including their angry feelings. But anger usually begets more anger, and a point is quickly reached where the expression of more anger becomes counterproductive. If you cannot stop couple patients from angrily attacking each other and defending themselves, separate them and talk to each partner alone.

            5. Use shuttle diplomacy to resolve important conflicts the couple cannot resolve. Speak to each partner alone and determine exactly what range of solutions is acceptable to that partner. Couple patients are usually more reasonable and flexible when their partner is not present. When you find a solution that each partner has accepted in private, call the partners in together and tell them the solution they have both agreed to in private. This technique can help the partners resolve a conflict that must be resolved, and it may provide a framework that the partners can use to resolve future conflicts without your shuttle diplomacy.

            These Level I behavioral interventions may accomplish some temporary improvement in the relationship. But unfortunately, Level II problems and Level III problems almost always prevent these Level I interventions from permanently resolving couple discord.  

Level II Interventions: Correcting Misperceptions

            Inadequate communication and conflict resolution skills are one cause of conflict and communication problems. But couple conflict is also caused by Level II problems -- couple patients’ tendencies to misperceive their partner’s behavior and motives, and to react to their misperceptions rather than to what their partner actually said or did. The three most important Level II misperceptions are “you don’t love me,” “you think I’m stupid (or incompetent),” and “you’re trying to control me.”

            It is tempting to assume that these perceptions are sometimes accurate, but in fact they are always misperceptions. Couple therapy patients sometimes act unloving, disrespectful, or controlling toward each other, but this does not mean that they want to control, or don’t love and respect each other. If any of these were true, the couple would not, or should not, be in couple therapy. They would be in divorce mediation.

            Couple patients’ tendencies to misperceive each other’s behavior and motives are difficult to correct. If Martha tends to misperceive George as not loving her, she will often misperceive his behavior as evidence that he doesn’t love her. The tendency to misperceive causes misperceptions, and misperceptions strengthen the tendency to misperceive. Over time, Martha’s tendency to misperceive George becomes a closed, self-perpetuating system.

Couple patients’ tendencies to misperceive each other must be gradually diminished over time, and through many experiences that contradict these tendencies. Here are some techniques for correcting Martha’s tendency to misperceive George:

1. In Vivo Evidence. When Martha complains about George’s behavior, ask her “What does George’s behavior means to you?” Martha will answer with some variant of “If he loved me he wouldn’t do (or say) that,” or “He thinks I’m stupid (or incompetent),” or “He’s trying to control me.” Then ask George if that was his motivation. George will always answer “no,” and describe what he believes is his real motivation. Martha may not believe him, but each time this conversation occurs, Martha’s tendency to misperceive George’s behavior will weaken slightly.

2. Hypothesis Testing. Ask Martha about incidents when she felt unloved, disrespected, or controlled by people other than George. Then suggest alternate explanations for the behavior that Martha perceived as unloving, disrespectful, or controlling. Couple patients almost always misperceive in many situations. Each time Martha recognizes that she erroneously perceived disrespect, lack of love, or controlling behavior in people other than George, her tendency to misperceive George, as well as others, will weaken slightly.

3. Homework. Between sessions, ask Martha to tell George immediately whenever she feels George is unloving, disrespectful, or controlling. Then ask Martha to question her perception and consider George’s explanation of his motivation. Each session ask Martha about incidents since the last session when she perceived George as being unloving, disrespectful, or controlling.

4. Early Learning. If Martha believes that one or both of her parents, or her teachers, or her childhood peers were disrespectful, unloving, or controlling toward her, suggest that these experiences cause her to misperceive George as if he were these other people. There is no way to prove that Martha’s parents, teachers, or peers were unloving, disrespectful, or controlling toward her. And even if they were, there is no way to prove that this is the cause of her current misperceptions of George. Nevertheless, for most couple therapy patients, early conditioning is a persuasive argument that they are misperceiving their partners’ motives. You need to use every possible argument to gradually diminish couple patients’ tendencies to misperceive each other. 

Level II Misperception 1: “You don’t love me”

            The case of Oscar and Louise (a real couple) illustrates how Level II techniques can be effective when level I techniques have failed. Louise’s presenting complaint was that Oscar spent too much time at his job and away from her. Level I conflict resolution training helped this couple to negotiate behavioral compromises. They agreed that Oscar would spend half an hour alone with Louise every evening.

            But the conflict resolution training did not address Oscar and Louise’s misperceptions of each other. Louise misperceived Oscar’s working long hours as meaning that he didn’t love her. So now they fought over which half hour Oscar would spend with Louise, and whether he was giving her his full attention during that half hour together. The conflict resolution training was ineffective because it did not correct Louise's tendency to misperceive Oscar’s behavior. As soon as Oscar and Louise negotiated a resolution to one conflict, her misperceptions created a new conflict.

            Each time Louise became angry at Oscar for working late, I asked her what it meant to her that he worked late. Each time she replied “If he really loved me and wanted to spend time with me, he would find a way to be home earlier.” Each time I asked Oscar if he loved Louise. Each time he replied “yes.” Each time I asked him why he worked late if he really loved her. Each time he explained that his job and his boss required him to work late, and his working late had nothing to do with his feelings for Louise. He insisted that he too would like them to have more time together.

            To strengthen Louise’s emerging new perceptions of Oscar’s lateness, I asked her how she thought others felt about her. She reported that she frequently perceived her boss as favoring others over her. This insight helped her to see that she tended to misperceive many people as having negative feelings toward her, and this insight further diminished her misperception that Oscar’s working late meant that he didn’t love her.

            Louise’s tendency to misperceive Oscar’s behavior gradually diminished. She slowly came to correctly perceive Oscar’s lateness as due to his obsessiveness about his job and his unassertiveness toward his boss. She still would have preferred that he come home earlier, but because she no longer misperceived his working late as meaning he didn’t love her, she no longer became angry. Instead, she started spending more time with her friends. 

Level II Misperception #2: “You think I’m stupid (or incompetent)”

            Martha misperceives George’s neutral comments as criticisms, misperceives his differing opinions as insults, and misperceives his suggestions as accusations of incompetence. In addition, Martha misperceives George’s criticisms, suggestions, and differing opinions as meaning that he thinks she is stupid and incompetent. So even when George really is criticizing or correcting Martha, she is misperceiving the meaning of those criticisms and corrections.

            When Martha feels criticized or believes that George views her as stupid, her usual reaction is to either fight back or say nothing. Fighting back increases the conflict and harms their relationship. But saying nothing is more harmful. When Martha says nothing, she adds this incident to her list of grievances, resentments, and perceived criticisms, strengthening her belief that George thinks she is stupid, and increasing the likelihood of future misperceptions. Instead, Martha should respond with some variant of “You’re talking to me as if I am stupid.” Voicing her misperception in this manner is a big step in the right direction -- it alerts George to Martha’s misperception and/or his own tendency to criticize, and it presents the opportunity for them to work on correcting these problems.

            As with other misperceptions, the treatment for this misperception is to continually marshal evidence that Martha is misperceiving George. When George is present, ask him if he thinks Martha is stupid or incompetent. He will surely say “no,” Next ask George to enumerate the qualities he admires in Martha. Hearing George’s compliments will further diminish Martha’s tendency to misperceive George as believing she is stupid or incompetent.

If Martha also perceives that other people view her as stupid or incompetent, you may be able to present evidence that Martha misperceives these other people as well. For example, if Martha has told you that friends sought her advice in the past, point out that these friends could not possibly think she is stupid.

            Finally, if Martha believes that her teachers, her childhood peers, or one or both of her parents treated her as if she were stupid, you can assert that she is perceiving George as if he were these people. This is a powerful technique for convincing most couple therapy patients that they are misperceiving their partners. 

Level II Misperception #3: “You’re trying to control me”

            This misperception is difficult to treat. Patients who misperceive their partners as trying to control them are resistant to therapy because they tend to view therapy as another attempt to control them.

             When treating these patients, I like to begin by clarifying the differences among an opinion, a request, and a demand. Then I review interactions where these patients may have misperceived their partners’ opinions as requests, or misperceived their partners’ requests as demands. The partners of these patients usually assert that they were not trying to control the patient, and, if we observed the interaction, we may be able to confirm this assertion. Patients who feel controlled find it very difficult to recognize that this is a misperception -- they are certain that their partners really are trying to control them. Here are two common examples of control misperceptions: 

            Martha: How soon will you be ready to leave?

            George: Don’t rush me.

            In this example, George misperceived Martha’s question as a demand.

            George: You’re always trying to control me.

            Martha: Like when?

            George: Just last week you insisted on seeing that romantic movie.

            Martha: No I didn’t. I just said that I wanted to see the movie.

            George: But if I objected you would have become angry and ruined the evening.

            This example includes two misperceptions. First George misperceives Martha’s request as a demand. Then George makes a questionable assumption about what Martha would have done if he hadn’t give in to [his misperception of] her demand.  

Oscar and Louise Again

            As discussed previously, Louise was able to recognize and change her misperception that Oscar’s coming home late meant he didn’t love her. Oscar's contribution to their problems was his misperception that Louise was trying to control him when she requested that he come home earlier and spend more time with her. He accused her of badgering him and of failing to understand the demands of his job. Oscar felt controlled whenever he misperceived Louise’s opinions as requests and whenever he misperceived her requests as demands.

            Oscar and Louise began one of their fights in my waiting room. He had been idly fiddling with an artificial plant next to his chair, and she had asked him to stop. He became enraged because he misperceived Louise as trying to control him. Louise insisted that she was not trying to control him, she was just pointing out that he might damage the plant.

            I asked Louise to repeat what she had said in the same tone she had said it previously. When she did, Oscar objected that her tone in the waiting room was much bossier than her tone in my office. Louise insisted that she had repeated her comment in exactly the same tone. We did not have a videotape of her original comment, but Louise’s original tone was probably more forceful than she realized, but less forceful than Oscar experienced it. (When couples disagree about a communication, the truth is usually somewhere in the middle.) Louise admitted that that she might sometimes misperceive her own tone of voice, and Oscar admitted that he might sometimes misperceive her tone. But Oscar never changed his belief that Louise wanted to control him. 

Control is in the Mind of the Controllee

            On a more profound level, the actual tone of Louise’s comments is irrelevant. Even if Louise were demanding that Oscar do what she wanted, her demand could not control him. Couple patients who feel controlled by their partners often do have controlling, or at least partners who express themselves forcefully. But even if Louise were trying to control Oscar, this would not mean that Oscar had to feel controlled by her. If Oscar feels controlled by Louise, it is he who creates that feeling in response to his perception or misperception of what Louise said or meant.

            Control is always in the mind of the partner who feels controlled. Regardless of Louise’s tone or her motive, Oscar always has the choice of complying or not complying with anything Louise prefers, requests, or demands. All couple therapy patients always have the choice of doing or not doing what their partners want. Couple patients must accept the consequences of their behavior, but it is still their choice to comply or not comply with their partners’ wishes. Unless she holds a gun to his head, Louise can never control Oscar. 

Why was Oscar Upset?

            So why was Oscar upset by his misperception that Louise was trying to control him? Louise can never control Oscar without his complicity. Patients like Oscar tend to feel controlled because they feel obligated to do what others want. Oscar felt that he should comply with Louise’s wishes, and he would have felt guilty, as if he were a bad husband, if he didn’t give her what he thought she wanted. Oscar also felt obligated to do what his boss wanted, or what he misperceived his boss as wanting, and this was one reason he worked late. Patients like Oscar feel guilty if they don’t accede to others’ wishes, so in fact they are being controlled -- but they are not being controlled by others. They are being controlled by their own feelings of obligation and guilt, and by their fear of offending others.

            These patients are so focused on being liked and obtaining the approval of others that they often become unaware of their own wishes and needs. Three critical therapeutic goals for patients who feel controlled are:

            1. Becoming more aware of their own wishes and needs;

            2. Becoming more assertive; and

            3. Becoming comfortable with disapproval.

            Patients who tend to feel controlled must first learn to distinguish their real wishes and needs from their need to please others. And they must learn to act on their real wishes and needs, not their need to please others. So the important issue is not what these patients do, but why they do it. Do these patients agree to do what others want because they fear the other’s disapproval and their own guilt? Or do they do what others want because they truly believe it is the appropriate thing to do? Often it is not so easy to distinguish between these two motives, but teaching patients to make this distinction is a critical step in overcoming the tendency to feel controlled. 

Level III: Low Self-Esteem

            And this brings us to low self-esteem. I will only say a few words about the treatment of low self-esteem because a full discussion of this problem appeared in the February, 2006 issue of this newsletter, and is available online at NJ-ACT.org/self.

            In order to temporarily feel good about themselves, patients who tend to feel controlled need approval and admiration from others. Disapproval evokes their feelings of worthlessness, and so they do what they believe others want in order to temporarily feel good about themselves. Low self-esteem causes these patients to seek approval and admiration; seeking approval and admiration causes them to do what they believe others want; doing what others want causes them to feel controlled.

            Low self-esteem is also an important cause of couple patients’ tendencies to misperceive their partners as not loving them, and thinking they are stupid or incompetent. These patients assume that others, especially significant others, feel toward them as they feel toward themselves. Because they have doubts that they are lovable or intelligent or competent, they misperceive others as not loving them or believing they are stupid or incompetent.

            Low self-esteem is also an important cause of couple patients’ critical, controlling, and/or rejecting behavior towards their partners. This type of behavior is partly a compensatory reaction to low self-esteem. Some couple patients with low self-esteem can temporarily feel better about themselves by acting superior – criticizing, controlling, or rejecting their partners. This has been called the “see-saw” effect -- patients attempting to boost their own self-esteem by putting their partners down.

            The therapeutic goal for low self-esteem patients should not be viewed as “good” or “high” self-esteem. Each of these goals would require patients to judge themselves positively, and no realistic person can always judge himself or herself positively. Everyone makes mistakes and half of us are always below average. The goal for low self-esteem patients should be “self-acceptance.” This means that patients recognize and enjoy their strengths and accomplishments, and they recognize but do not berate themselves for their weaknesses, mistakes, and failures. They accept themselves whether they receive approval or disapproval from others. They do not feel offended or controlled if their others criticize or disagree with them, and they do not misperceive criticism, control or rejection where it does not exist. They correctly perceive other’s comments and behavior. Even when they are criticized or rejected or have demands made on them, self-accepting individuals do not feel inadequate, unloved, disrespected, angry, hurt, or controlled. They simply agree or disagree, and they discuss their partner’s criticisms, demands, and rejecting behavior.

            Treatment for low self-esteem should help these patients to accept themselves, even when others don’t. Only when they accept themselves will they be free of their need for acceptance from others, their fear of disapproval, and their feeling obligated to comply with the [often misperceived] wishes of others. Only when they fully accept themselves will they perceive others accurately and be free of their tendency to misperceive others as criticizing, not loving, or trying to control them. 

Individual Therapy for Couple Patients

            Couple sessions enable the therapist to directly observe couple interactions, and couple sessions are invaluable for teaching and practicing communication and conflict resolution skills. Couple sessions also enable each partner to hear the guidance the therapist is giving to the other partner. If the couple discord is not too intense, each partner can remind the other partner of what the other partner should be working on between sessions. But couple sessions are not the most powerful tool for alleviating couple discord.

            Low self-esteem is the most important cause of couple discord. Low self-esteem causes critical, controlling, and unloving behavior, and low self-esteem causes couple patients to misperceive their partners’ behavior as critical, controlling, and unloving. Low self-esteem is also the major cause of the hurt and angry feelings that prevent couple patients from communicating effectively and amicably resolving their conflicts. Since low self-esteem is essentially an individual problem, individual treatment of couple patients is the most powerful tool for alleviating couple distress. Individual treatment of couple patients can be accomplished in full, individual sessions, and also by allocating parts of sessions to individual treatment of each partner.

            When treating couples, I highly recommend spending some time with the couple and some sessions and parts of sessions alone with each partner. For almost every couple therapy case, the advantages of one therapist treating both partners far outweigh the disadvantages.

            There are some potential problems when a therapist provides individual therapy to both partners. Each partner may fear that something they tell the therapist will be revealed to the other partner. The partners may become competitive with each other for the therapist’s approval, or may feel that the therapist is taking sides with their partner against them. But I have found that it is possible to avoid these problems by sympathizing with each partner’s feelings, while maintaining scrupulous neutrality. In the vast majority of cases providing individual treatment to both partners creates no problems, and the benefits are substantial. Each patient will report information about their partner that the partner has failed to reveal. And by knowing both partners, the therapist can give each partner expert guidance on how to deal with the other partner. 

Conclusion: Is it Possible to Remain Happily Married?

            It is true that many marriages and long-term relationships deteriorate into either divorce or a sexless, distant, slightly irritated co-existence. But this is not inevitable. The initial excitement or infatuation will always wear off, but hopefully it will be replaced by a deeper, more satisfying intimacy.

            Every relationship will encounter conflicts once the honeymoon is over -- and nowadays the honeymoon is usually over before the wedding begins. The key to maintaining a fulfilling long-term relationship is to recognize conflicts as they arise, and work to resolve them.

            Paradoxically, a very important cause of couple conflict is the attempt to avoid conflict. Ignoring or failing to discuss irritations does avoid short-term conflict, but leads inexorably to the deterioration of the relationship.

            The odds are against any couple maintaining a gratifying, intimate relationship over the long term. But with good communication and conflict resolution skills, with accurate perceptions of each other, with self-acceptance, and maybe with a little professional help, it can be done. 

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