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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Couples Therapy Can Help When Mental Health Issues Arise

Jan Sutherland, MSc, RMFT

Reprinted from the "Couples" issue of Visions Journal, 2015, 10 (4), p. 33

Life is most satisfying when we live in harmonious relationships. Often, when we enter into a committed relationship, we believe we’ve found a near-perfect friend, lover and support.

Life doesn’t always work out as planned, however, and sometimes partners are left wondering what happened. Losing the harmony in a relationship is difficult in itself, but especially so if some of the relationship changes are brought about by one or both of the partners developing mental health issues.

I believe people try to fix things the best they know how, but sometimes their personal resources aren’t enough to resolve complicated issues. Knowing what help is needed, where to turn and when to take necessary action is important. Finding a qualified couples therapist is definitely a valuable option to explore.

Marriage and family therapy—the ‘big picture’ is important

Many couples therapists fall under the professional banner of marriage and family therapy (MFT). Marriage and family therapists (MFTs) treat a wide range of clinical problems, including depression, anxiety, individual psychological problems, parent-child issues, and of course, relationship distress.

Marriage and family therapy is based on the idea that mental health issues and family problems are best treated in a relationship context. Everyone is part of a larger system of relationships that includes partners, other family members, friends and even people in the broader community. Life is a web of relationships.

As a marriage and family therapist, I’m very aware of how important it is to try to understand some of the bigger picture of people’s lives. Often, an individual who comes into my office with a mental health issue has had difficult things happen in his or her life that remain unresolved. These things could be a troubled childhood, a history of low self-esteem, feelings of rejection, loss of loved ones, or a trauma of one kind or another. Or, more simply, the unresolved issues may stem from expectations or other feelings that have not been recognized or expressed. Although many of these things occurred in the past, they get carried forward in some manner and often contribute to current-day relationship problems. When we develop a committed relationship we often don’t know about all the hurts and events in our partner’s life before we entered the scene. Sometimes we mistakenly think that love and a fresh start will fix it all. It is not that easy.

Individual issues frequently get triggered and spill over into the relationship. Such issues may seem to be individual burdens, but they did not form in isolation. They likely formed over time and involved other people. That’s why it’s so important to work not only with the individual showing mental health issues, but also with that person’s partner. And sometimes, when it’s possible, to work with other family members.

It’s the work of therapists to bringing healing to relationships. Therapy, in a non-blaming way, can help sort out feelings, identify patterns of destructive behaviour and help couples find better ways to relate. Therapists can lead couples to trust again and find support in their relationship.

Approaches to couples therapy

Many couples therapists have specific training in relationship dynamics. A knowledgeable couples therapist knows how to listen to both sides of the story and to support each partner, how to diffuse difficult emotions or handle painful emotions that arise in the session, how to help the couple describe what they want more or less of, and how to help them achieve these things. And, along the way, the couples therapist may meet individually with partners as issues come up that require this.

Couples therapists may employ particular approaches that shape how they guide and structure the conversation with clients and what they focus on. An experienced therapist will have knowledge of a number of approaches. They will select strategies according to the nature of the couple’s problem and the couple’s receptivity to the style of an approach.

Two approaches commonly used by therapists today are Emotionally Focused Therapy (EFT) and the Gottman Method. These approaches have been researched and tested in ways that other approaches haven’t been and they’ve been found to have good results.1

Emotionally Focused Therapy

Emotionally Focused Therapy (EFT) was developed by Dr. Sue Johnson from the University of Ottawa and Dr. Les Greenberg from York University in Toronto. EFT emphasizes that working with emotions is central to doing therapy with couples. Emotionally Focused Therapists (EFTs) help couples restructure their patterns of interacting, increase emotional intimacy and strengthen their bonds of connection.

For example, EFTs often focus on a partner who is angry or distancing and work to draw out their underlying feelings of fear and sadness. The therapist will guide this person to turn to his partner and will encourage them both to take small emotional risks with each other, so the talk can change from hostile to soft and tender. This is called “softening,” which is an important shift away from blaming or angry stances. It helps the couple build secure attachment, so they can share their vulnerabilities and ask for their needs to be met, rather than attack or withdraw.

EFT can be especially useful when there’s been an injury to the emotional bond between the couple. This injury could be an infidelity or failure to be there for one or the other during a time of loss or crisis. When using EFT, I’ve witnessed many couples open up to each other and heal hurts that have been a stumbling block between them for a long time.

Gottman Method

Dr. John Gottman, from Washington State, developed his approach from spending time observing and studying communication differences between couples who stayed together and ones who divorced. He observed many couples in his “love lab,” which was basically an apartment where couples volunteered to spend some time discussing issues, particularly ones they struggled with and had conflict around.

From Gottman’s observations of how couples related and talked with each other, he was able to predict with impressive accuracy which couples were headed for divorce. These were the couples that consistently and relentlessly used criticism, defensiveness, contempt and stonewalling (when the listener simply withdraws, either physically or mentally). He found that the use of contempt was the single biggest predictor of divorce.

Many stable couples who don’t divorce also criticize, defend and stonewall to a certain extent. But overall, Gottman noticed that when more stable couples were engaged in conflict, they were kinder, took time to still listen to the other, and offered more positive comments about their partner and relationship even while working through a contentious issue.

Therapists who work with the Gottman Method ask couples to complete a detailed survey of their relationship. The therapists then help the couple notice what behaviours are hindering or helping the relationship. The therapist acts as a relationship coach, empowering couples to take ownership of their relationship, while teaching them strategies to deepen friendship, successfully manage conflict, build back a sense of intimacy and purpose, and have a more successful marriage overall.

Many couples seek therapy because they believe they don’t communicate very well. I’ve noticed that what most couples typically mean by this is that they have trouble working through conflict. I’ve found John Gottman’s research very helpful in working with couples who want more productive ways of handling disagreements.

When there are mental health issues

We all come to our primary adult relationships consciously and unconsciously preloaded with information on how to be in relationships. We also come with our own stories and feelings around mental health issues. For instance, we may have a mother or brother with such issues, or we may come from a family where mental health issues garner little compassion. These contexts may influence us one way or another in how we feel in the present toward our partner’s mental health struggle.

In many ways, couples coping with some mental health issues are not much different than other couples when it comes to couples therapy. Just like others, they fall into patterns of poor communication, increased conflict and little intimacy. They, too, have likely developed protective strategies that keep them stuck in negative cycles, leaving them feeling overwhelmed, resentful, helpless and sad.

Each mental health issue presents its own unique challenges, however, and thus requires some special attention in couples therapy. A skilled couple’s therapist will fairly quickly be able to assess the situation. He or she will usually consult with the primary care physician or psychiatrist, so that everyone can be informed, have input and work together to bring about some desired change.

Give therapy a try

People from all walks of life seek professional help. Sometimes there comes a time when one feels tested beyond their normal coping resources. Struggling with a mental health issue may be one of those times. Seeking a therapist during difficult times can be a very productive step to take.

Getting your partner to come along with you to therapy is the best strategy. But even if your partner won’t go for therapy, a couple’s therapist can still provide some clarity and direction for the partner who does go. I’ve initially met with many individuals who’ve come alone, and they have found it helpful to talk to a couple’s therapist about the challenges of their relationship. Many eventually found a way to encourage their partner to attend. While couples therapy won’t necessarily erase the mental health issue, it can introduce much-needed hopefulness and movement toward positive change.

About the author
Jan is a marriage and family therapist in private practice in Kelowna, BC. She is a Clinical Fellow and Approved Supervisor with both the American and the Canadian Association for Marriage and Family Therapy. See
  1. For research studies and articles on the effectiveness of the Gottman Method, see For more on the effectiveness of Emotionally Focused Therapy for couples see

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