Revising the Script: Making Changes in “Couples Therapy”

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By Christopher Skeaff, LCSW, PhD

Real therapy doesn’t work like it does on TV, a patient once told me during a couples therapy session. But what if it’s real therapy on TV rather than a fictionalized version seen in shows like “In Treatment” or “The Sopranos”? How does it work then? That’s the question the Showtime docuseries “Couples Therapy” explores as it follows various couples in their breakdowns and breakthroughs during a course of treatment with NYC-based psychoanalyst Dr. Orna Guralnik.

Granted, the fact that such treatment is in its own way made for television affects the participants’ experience of it – Guralnik notes in an interview, for example, that the couples may have been more circumspect about issues they don’t want broadcast publicly, such as details about their sex lives or their children. It’s clear, nonetheless, that the hidden cameras don’t ultimately get in the way of the couples’ and Guralnik’s ability to undertake meaningful therapeutic work dealing with issues of attraction, intimacy, sobriety, control, and more.

As the show reveals, in real therapy, although patients aren’t given a script, they always arrive with one. And healing, we might say, resides in a couple’s ability to revise their story.

Couples Therapy Act I: Beginning

In the beginning is … ambivalence about change. “Do you want some help in changing things?” Guralnik asks one of her patients several sessions into treatment. At first blush, it may seem an odd question – aren’t all the couples there because they want help making changes? – but it’s not easily answered, especially at the beginning of therapy. Often, people start treatment with the belief, explicit or implicit, that the main problem in the relationship comes from their partner, whom they’re going to enlist the therapist to change. And so they balk at the prospect of changing their own behavior and perspective.

In couples therapy, people can get “very dug into their view of the other person,” Guralnik observes, “and sometimes it does require a real push to confront them with the reality that, as convinced as they are about their story, it’s not working.”

What’s “not working” in the relationship goes beyond the specific viewpoint or conduct of either partner taken in isolation; the problem consists in the way they interact. Focusing on a couple’s interpersonal process – how things typically go and how they go astray – offers not only a more accurate picture of the relationship but also a useful starting point for the work. As Dr. Arthur Nielsen details in his book A Roadmap for Couple Therapy, adopting a process focus accomplishes three things: first, it normalizes a couple’s difficulties as “a systems problem” (e.g., a cycle of mutual avoidance); second, it externalizes the problem as an adversary that can be identified and combated together; and third, it reduces blaming by countering victim/villain narratives while encouraging reflection on the maladaptive pattern.

In the second season of “Couples Therapy,” one of Dr. Guralnik’s couples, Michal and Michael, make some initial headway by constructing and discussing a diagram of their typical negative cycle. They identify and name six steps in the process (1. Lull; 2. Driven; 3. The Slide Back to Laziness; 4. The Silent Resentment; 5. The Explosion; 6. The Return) and unpack what happens throughout. For Michael, the cycle starts with Michal “being driven” and needing something to happen. In response, Michael enters into what he calls a “lull period” where his motivation diminishes and he just rests. Michael’s “lull” provokes more anxiety in Michal, which prompts Michael, in turn, to retreat further into laziness. They then experience a mutual withdrawal and a period of “silent resentment” between them, soon followed by an explosive fight. Finally, they mount a comeback, engaging each other in discussion and trying to make sense of what happened.

As viewers peering in on their therapy, we see Michal and Michael addressing this negative cycle as a systems problem and brainstorming with Guralnik how they might interrupt and divert it toward a healthier mode of interacting.

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Couples Therapy Act II: Middle

The next portion of the treatment for Michal and Michael, as for most couples, requires a shift in focus from examining how their interpersonal process unfolds to exploring the underlying hopes, fears, and desires that are fueling it. Guralnik encourages Michal and Michael to adopt a posture of curiosity regarding their personal histories and emotional styles so as to consider how they came to occupy their respective roles in the relationship as given to states of “lull” (Michael) and as anxiously “driven” (Michal).

“When you really understand deeply what happened to you and what dynamics shaped you,” Guralnik explains, “it’s the actual only way that you can have any sense of choice in the matter” of how to live and love in the present.

In session, Michael traces his passivity back to his schooling, which, he realizes, gradually sapped him of his passion for learning and argument until he eventually gave up altogether and entered into a kind of “lull.”

“But,” he says, “what am I going to do about it? It already happened. Like, at this point, all I can do is live.” Guralnik’s response underlines the potential for expanded freedom and choice: “At this point, you can look at how you’ve generalized from that realm into other areas of your life and see that you’re losing out on the possibility of engaging more in the world and for it to be rewarding – that your relationship with whatever you could be doing could actually bring some satisfaction.”

Michal, for her part, begins to examine how her anxiety “about nothing ever happening” precedes her relationship with Michael and has its roots in her upbringing. In some of the most interesting sequences of the show’s second season, Guralnik invites Michal to view her anxiety not only as a concrete reality but also as a “memory” or “errand” handed down to her by her family, particularly her mother.

Guralnik: Why don’t we try to understand this some more? If you had to imagine, in addition to her love, what else was her investment in your success?

Michal: I think that being an immigrant in this country, and moving to this country, there was this fear in her that she really didn’t want her kids to have to go through anything remotely close to what she went through. She didn’t want me to fail. She didn’t want me to have an unhappy life.

Guralnik: But what is this specter of failure? How does she feel like a failure?

Michal: She talks a lot about her failings…a lot about regret. She told me more than once that she regrets she wasn’t able to give us more. But mostly she regrets, I think, maybe parts of how her life turned out.

Guralnik: So what you’re witnessing [as a child] is a tremendous sense of failure, regret, and a lot of investment in you to make up for that.

Michal: I guess, yeah.

Guralnik: So maybe that’s one way for you to start understanding this anxiety. You’re also fixing something for her.

Michal: I guess. I never saw it that way because my mom relates to her kids as extensions of herself.

Guralnik: It’s such a lack of differentiation between her and her kids that you can’t even say in language, “I need you to do this so I will feel better.”

Michal: Mm-hmm.

Guralnik: And you keep going back to the language of, “She wants what’s best for me so I can’t be angry.” But it kind of puts you under a certain spell where you can’t utter other words like, “She’s very anxious and she needs me to fix it for her,” which makes you anxious because it’s an impossible job…

Michal: Yeah, I mean, I hear what you’re saying, but I’m not that selfless. I don’t spend my time thinking about her anxieties…I think she just gave me, like, a guideline for life. It’s like, she built the blueprints, right? She drew up the blueprints and now they’re there. And…I don’t refer back to the blueprint and go, “Well, is this gonna upset the architect?” I don’t think about that.

Guralnik: Well, it’s built into the blueprint. The anxiety about the architect is built into the blueprint.

Michal: But I’m never thinking that.

Guralnik: If you were thinking that, you’d be cured.

Michal and Michael [both laugh]

Guralnik: That’s how the unconscious works. Once you’re aware, you will not be anxious anymore.

Michal: I don’t know about that. Everybody, their blueprints of their mind get built by their parents. Everyone’s like that! And then they can stray from that to some degree.

Guralnik: There are particular blueprints that take on – I mean, when you’re so anxious, it gives a hint that maybe the blueprint was not simply a blueprint (“this is the good life”). But anxiety tells you something about your parents’ unhappiness. And you’re being recruited to do something about it.  

As treatment proceeds, Michal comes to recognize “remnants of the blueprint” at work in moments when she feels too anxious to enjoy life yet hopeful her kids might enjoy theirs. With that awareness and more help from Guralnik, she begins to allow herself to fantasize about unplugging from anxiety and to envision what that might do for herself and her relationship with Michael and the children.

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Couples Therapy Act III: Ending 

A key pathway for success in couples therapy, which we can also see play out in “Couples Therapy,” lies in the therapist helping each member of the couple reclaim disavowed aspects of themselves (thoughts, feelings, behaviors). Consider Michael and Michal. From a highly polarized status quo – with Michal over-functioning, holding all the anxiety for the couple and Michael passive and apathetic – they start to take ownership over their specific contributions to the dynamic. Michal begins to address her anxieties as hers and no longer simply as Michael’s doing; Michael begins to take more initiative within the family, finding his own way to completing household tasks and parenting their children. As a result, we see them each re-establish a connection with their own desire, with Michal allowing herself some rest and frivolity and Michael embracing a newfound sense of responsibility at home and at work.

As their treatment wraps up with Guralnik, though, it’s clear that the ending we’re seeing is no simple “cure.” For one thing, Michal and Michael have only begun acclimating to the positional shifts in their relationship. Michael shares that he’s been feeling uncharacteristically anxious lately about some professional feedback. Michal, feeling her own stress level rise in response, says, “Just don’t tell me those things. I don’t wanna know!”

In session, Guralnik helps them examine how their changed dynamic, in which Michael shoulders more anxiety and Michal less, might feel if it is not to devolve into another polarized cycle. A good template, Guralnik suggests, is “when there’s anxiety, for it to be passed back and forth for the two of you so that each of you can take a look at it and give some kind of constructive opinion…You know, when things pass back and forth, they get more and more rational, manageable, and the anxiety ideally then subsides.”

Ending treatment, then, if we watch “Couples Therapy” for insight into couples therapy, seems to involve something more like a couple’s release from the sole grip of their original script. Michal and Michael leave Guralnik’s office for the last time having seen and felt how “overburdened wife with lazy husband” needn’t remain the dominant narrative for their life together.

As viewers, we don’t yet know what their revised script will be, though we catch glimpses of it perhaps in the more equitable and pleasurable connection they begin to establish with each other. In real therapy, a couple like Michael and Michal may have stayed in treatment longer (beyond the show’s allotted 20 weeks) so as to consolidate their gains and work on some of the emotional co-regulation outlined by Guralnik. We know how it ends for them on TV, at least.

Ready to rewrite your script together?

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