Couples Therapy

Encouraging couples to learn to appreciate and nourish their emotional connection with an impartial guide along the way.

Couples therapy is a step toward addressing problems and concerns that arise in a relationship, no matter what stage. This includes understanding conflicts and developing productive solutions for issues such as:

Communication
Intimacy Concerns
Conflicts about Child Rearing
Substance Abuse
Infidelity
Our therapists are trained to assist couples in finding successful ways to manage challenges and make productive decisions that lead to success.

In addition, couples therapists can help provide a neutral party to create insights into the relationship. This includes:


Exploring each individual’s needs
Discovering mutual strengths and weaknesses
Identifying toxic patterns
Recognizing new perspectives

Ultimately, couples therapy can enhance trust building, passion for one another, and communication skills, no matter the stage of the relationship.

Please note that ITS does NOT offer couples therapy in cases of domestic abuse. We refer these cases to Psychology Today – Domestic Abuse.
If violence has escalated to the point that you’re afraid, counseling alone isn’t adequate. Contact the police, a crisis line, or a local shelter or crisis center (City of Tacoma DV Resource List) for emergency support.

Gottman Method


The Gottman Method is designed for couples from all backgrounds.

It aims to increase:

  • Intimacy
  • Respect
  • Affection
  • Healthy communication
  • Empathy
  • Understanding

It aims to decrease:

  • Barriers causing feelings of stagnation
  • Armed verbal conflict

It targets issues including:

  • Conflicts/Arguments
  • Poor communication
  • Emotionally distanced couples
  • Couples verging on separation
  • Sexual difficulties
  • Infidelity
  • Conflicts regarding finances/money
  • Parenting

Dr. John Gottman states “We have found that all marital conflicts fall into two categories: Either they can be resolved, or they are perpetual, which means they will be part of your lives forever, in some form or another.” The Gottman Method aims to address the perpetual category.

Tenets of the Gottman Method are included in the figure below:

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Emotionally Focused Therapy (EFT)

The goal of EFT is to understand what drives emotional responses in a relationship, and understands emotions as “complex syntheses of all that is experienced.” Emotions are adaptive and can amplify thought processes, impact behavior, and can stem from both biological and social stimuli.

Couples in EFT aim to express their underlying emotions in order to build intimacy and connection and affirm safe attachment.

The process is collaborative, and can be beneficial for traditional and non-traditional couples.

Emotionally Focused Therapy (EFT) builds on the idea that humans instinctively seek relationships for safety and comfort, and they follow patterns of relationship behavior learned in childhood (John Bowlby’s attachment theory). EFT was developed in the 1980s, and has undergone rigorous clinical research since.

Simplified “Negative Cycle” Diagram which Sue Johnson states “keep couples away from the Heart of the Matter.”


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Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) for couples takes a similar approach as CBT for individuals, however it is complicated by needing to view three distinct components: each participant of the couple as distinct individuals, and the couple as a whole. This allows you, your partner, and your therapist to approach and view therapy from different angles. You or your partner may speak regarding your respective individuality, or who you and your partner are within the relationship.

CBT for couples helps to address both unproductive individual thoughts and behaviors, as well as those developed as a couple.

Unlike other forms of therapy, CBT focuses on the “right now,” rather than deep-diving into the cause of the problem. It helps clients to recognize their own unproductive thoughts and behaviors in the moment and provides methods to change them.

Core Principles

Psychological and relational problems are, at least in part, due to:

  1. Unhelpful ways of thinking
  2. Unhelpful learned behaviors
  3. Unfounded assumptions

Core Goals

  • Decrease individual and relational cognitive distortions
  • Decrease and replace negative/unproductive behaviors with positive/beneficial ones
  • Develop communication skills to minimize distortions via cognitive restructuring
    • Cognitive restructuring – Reframing negative/maladaptive thoughts and behaviors
  • Build trust
  • Resolve conflicts
  • And more…

Couples are often concerned about starting counseling due to the potential for revealing relationship damage, thus causing “couple distress.” Couple distress comes in many forms, but is typically indicative of one or both partners feeling insecure in the relationship.

Re-establishing security may require confronting unpleasant emotions or situations, however more often than not the problems stem from one partner “jumping to conclusions” about how the other feels.

CBT helps couples discover:
1. If each partner is jumping to conclusions about the other (even without realizing it)
2. How the couple communicates
3. How you and your partner’s behavior impacts the other
4. How prior experiences may influence negative thoughts
5. How those negative thoughts influence behavior
6. How the influenced behavior impacts the partner

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Cognitive Behavioral Therapy Plus (CBT+)

Cognitive Behavioral Therapy Plus (CBT+) is an integration of multiple therapeutic techniques, specifically:

Cognitive Behavioral Therapy (CBT)
Acceptance and Commitment Therapy (ACT)
Compassion Focused Therapy (CFT)
Dialectical Behavior Therapy (DBT)

All of these therapies are evidence-based and emphasize approaching problems from different perspectives.

CBT+ allows for a broader view of the presenting concern, and incorporates real-world problems into the framework. For example, CBT+ integrates concerns such as poverty, racism, and marginalization into the approach to treatment.

CBT+ also adds a stronger emphasis to relationships and dives further into the history of the client.

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Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based, modified form of CBT which specifically addresses coping with trauma as an individual and a couple.

Trauma may be caused by a wide variety of events including:

Sexual or physical abuse
Traumatic loss of a loved one
Exposure to violence – domestic, school, community
Exposure to disaster – weather, terrorist attacks, war
Serious accidents
Serious medical procedures, operations, or hospitalizations
And more…

Taking a trauma-informed approach to couples therapy can help each participant understand how past events in their respective lives impact their attitude, reactions, and perspective in the relationship. It allows a broad-view of concerns, and helps to build empathy and understanding.

It can help answer questions such as:

How has pain or trauma in the past impacted your reactions in/expectations of the relationship?
Why does _______ trigger you/your partner?
Why did the conflicts happen?
What are your coping and/or survival skills? What are your partners coping and/or survival skills? How do these blend in the relationship?

By evaluating past traumas and understanding the development of each individual in the relationship, TF-CBT allows couples to build compassion and understanding for each other, as well as develop mutual coping and communication skills to help strengthen the relationship moving forward.

TF-CBT also helps couples develop stress management, problem-solving, safety, and communication skills as well as build self-esteem and trust.


Stabilization

P – Psycho-Education
The therapist helps the couple learn about trauma, PTSD, common behavioral concerns associated with trauma, and validation of feelings.
R – Relaxation Skills
Learning relaxation skills helps reverse physiological effects caused by trauma, and includes a variety of techniques such as mindfulness, progressive muscle relaxation, and focused breathing.
A – Affective Regulation Skills
Affective regulation skills help each member of the couple to recognize upsetting states and learn to manage their feelings. This includes developing problem-solving, anger management, and positive distraction skills. It’s also a time for the couple to build trust, work toward emotional safety.
C – Cognitive Processing Skills
Cognitive processing skills help each individual connect thoughts, feelings, and behaviors and replace unhelpful thoughts and behaviors with beneficial ones (as in CBT). Cognitive processing poses two key questions: Is it accurate? Is it helpful?
This process allows each participant to create a “window of tolerance” for communicating about trauma and the relationship. Once both feeling and thinking are within a tolerable range, both partners are present and trying, then trauma can begin to be processed.

2. Trauma Narrative

T – Trauma Narration and Processing
Creating a trauma narrative is a key component to processing a traumatic event, and it includes the telling of the individual’s story – the who, what, when, where and associated emotions with each component. Creating a comprehensive narrative is often difficult and deeply emotional, but is a core step in understanding where you have been and how to move forward. Once the trauma narrative is complete, each partner can contribute their narrative and begin to understand how the trauma impacts their shared experience.

3. Integration and Consolidation

I – In Vivo Mastery of Trauma Reminders
In life trauma reminders often cause psychological and/or physiological responses. This step helps to recognize the stimuli that cause the trauma response, and learn how to overcome avoiding these reminders and cope with them as they emerge.
C – Conjoint Sessions
Sessions with your partner help to develop communication about the trauma and moving forward. This step is a time to address topics such as healthy sexuality, safety plans, and trauma responses with your partner.
E – Enhancing Safety
The final step is to apply the processing and coping skills and positive insights to current life and your life moving forward. It helps create a comprehensive toolbox of strategies and reminders to handle trauma, stress, and conflict moving forward including co-regulation of emotions and strategies for finding solutions based in emotional support and understanding.

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Solution-Focused Therapy (SFT)

Solution-Focused Therapy (SFT), also known as Solution-Focused Brief Therapy (SFBT), is a short-term, goal-oriented, evidence-based approach. The emphasis of SFT is the future and potential solutions, rather than on problems brought to the session.

SFT uses an interview-style collaboration, in which the therapist asks questions to help the client(s) create a specific goal and focus on different methods and techniques to help achieve that goal. Once a goal has been established, the therapist helps the clients develop solutions that are clear, concise, satisfying, and realistic.

Goal Development

The goal development stage includes framing, defining, and envisioning your goal. The following questions are often used to start the conversation:
Scaling Question
Both therapist and clients assess the situation, identify their current distance from the goal, and what it will take to progress forward.

  • Ex. On a scale of 1 to 10 with 10 being “our marriage will last forever, I have no doubt” and 1 being the opposite, where do you see your relationship?

Miracle 10/Miracle Question
Imagine a scale of 0-10 in which 10 represents that you have fully achieved your goal, and 0 represents the opposite. You wake up and you are suddenly at a 10, but since you were sleeping when it happened, you don’t realize it immediately. What will be the first thing that you or the people around you begin to notice?

  • This question can help clients envision small building blocks toward their goal behavior.

To further define the parameters of the goal, additional questions may be pursued including:

  1. What is your best hope for what will be different in your life as a result of coming to therapy?
  2. What needs to happen so when we are finished you still think it was a good idea to come and a good use of time?
  3. How will your life be different when your overall situation is improved to the point of satisfaction?
  4. What do you project your life will be like once your goal has been achieved?

Solution Development

Again, the therapist uses questions to help define solutions to help achieve the client goal.

  • What solution is both practical and sustainable?
  • When have some parts of the goal already been achieved in your life?
  • Have there been times when this has been less of a problem?
  • What did you or others do that was helpful?
  • When have you experienced some part of these building blocks in the past?
  • Can you replicate these experiences/behaviors in your every day life?
  • What past problem-solving experiences do you have? Can you implement those skills into the current situation?
  • What will you do in the next week that would indicate that you are continuing to make progress?

Additional Components

Coping Questions
These questions help you prepare for challenges and overcome hardships:

  • How have you managed to continue/carry on in the past?
  • What are previous examples of successfully coping with difficulties/challenges?
  • How have you prevented problems from getting worse?

Positive Reinforcement
Your therapist will provide you with positive reinforcement to help encourage progress. Additionally, they will validate your feelings, acknowledge your struggles, and connect with you based on your goal, an understanding of your situation, and empathy.

Consultation – Invitation for Further Information
Your therapist may check in with you to make sure all bases that you want to cover have been covered. They may ask:
“Is there anything I did not ask that you think it would be important for me to know?”

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Narrative Therapy


Narrative Therapy centers around the idea that each of us view our lives as complex, multi-layered, logically progressive stories. The stories we formulate helps us understand ourselves and our experiences. Narrative therapy helps to externalize elements of our stories that have been neglected, diminished, or hidden – these stories are often layered beneath problems such as blame, distrust, and disconnection.

In this perspective, problems in the relationship are viewed as distinct from the relationship itself. The problem is identified and named, which allows the problem to be viewed by each partner as it’s own entity, not an innate truth of the relationship that is unchangeable.

Examples of externalization:
“Anxiety” – How does “anxiety” impact the development of “trust?”
“Anger” – When does “anger” impair your ability to connect?
“Criticism” – Does “criticism” change how you view your shared goals?

This approach makes it easier to question conclusions that have been drawn by the couple about the relationship and the problem itself. It also allows each partner to question and change negative beliefs, allowing them to create new meanings.

Solutions may also be externalized, which allows elements such as “compassion,” “friendship,” and “reconnection,” to also be viewed as their own entities as well.

Narrative therapy was founded in the 1970s by David Epston and Michael White, and has since been assessed for effectiveness in individual, couples, and family therapy. This technique has been found to:

Individuals

Help control negative emotions
Decrease negative automatic thoughts
Promote positive emotions
Decrease depressive symptoms
Improve anxiety
Positively alter body image

Couples

Decrease conflicts
Increase cooperation
Increase forgiveness
Improve sexual relationships
Increase relationship satisfaction
Decrease separation and/or divorce

Family

Improve overall family function
Increase forgiveness

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Perinatal

Please see our Bloom – Perinatal and Family Planning Therapy page here.

Pride/LGBTQ+

Please see our Pride Program and Resilience Group page here.

Insurance

Please note that couples therapy is only covered by insurance IF there is a mental health concern impacting the relationship.

This means:

1. Couples therapy must be “medically necessary”
2. There must be a diagnosis code to submit to insurance (common diagnoses include generalized anxiety disorder, adjustment disorder, postpartum depression or anxiety, etc.)

Otherwise couples therapy will not be covered.

Couples therapy is billed to insurance under one of the partners – The partner with the diagnosis code will be the “Client” in ITS’ system. If each partner is on different insurances, we can only bill the insurance of the “client.”

Couples therapy which is NOT covered by insurance include:

  1. Co-Parenting Therapy – Even if court-ordered, co-parenting is always relational exclusively and therefore is not billable to insurance.
  2. Communication skills – If communication is the sole focus, it is not considered medically necessary, and will not be covered by insurance. If communication skills are part of therapy that is working on a bigger mental health concern, it will fall under that umbrella.
  3. Any couples therapy that is NOT medically-necessary (neither partner is diagnosable with a mental health concern that is impacting the relationship).

Meet our Providers

Our staff is trained to provide a broad range of therapies such as couples therapy, family therapy, and individual therapy for children, teens and adults.

our providers
call: 253.460.7248
email: hello@integratedtherapynw.com
fax: 253.564.4409
3560 Bridgeport Way W
Suite 2-C
University Place, WA 98466