Fran Miller, Ph.D. ©
When couples seek therapy they usually have a number of problems that they haven’t been able to solve. The issues that come up the most frequently are: personality issues and differences, falling into an adversarial relationship, not bringing conflicting issues to a resolution, addictions, difficulties with communication, problems with self-esteem, differences in lifestyle preferences, values, and goals, neglecting to make time together, and intimacy.
Personality issues and differences: Relationship problems often concern personality patterns, issues, and conflicts. It is more complex to delve into and to address this type of problem. Personality patterns need to be defined and acknowledged which sometimes means that one or both partners will have issues to work on in individual therapy. Personality conflicts are best worked on in the therapy context where each person’s tendencies can be defined and worked with. The psychotherapy setting can enable you to work on these more difficult and sensitive problems in a fair and compassionate manner. Part of the therapy in this regard is coming to understand and accept each others character style. In addition to working on personality growth and changes, with regard to relationships, accepting each others character style can contribute to longterm understanding, meaning and effects. .
Falling into an adversarial relationship: One of the most detrimental situations is when the relationship become adversarial. The good news is that once this is named and in awareness, it sometimes can be resolved fairly readily. As other aspects of the relationship improve, its extremely important to make an effort to work together as a team rather than two people working against each other with opposite agendas.
Bringing issues to resolution: I recommend to couples to focus on negotiation, compromise, and resolution. That means when there is a disagreement its important to focus first on negotiating what the issues and differences are. Then compromises can be considered and agreed to. Often couples don’t come to a clear resolution so I recommend defining the resolution specifically and underscoring exactly what conclusion you have come to. Clarifying, defining and underscoring the resolution is key.
Addictions: There are many forms of addiction – alcohol, drug, gambling, shopping, co-dependency, and sometimes even what we call “healthy addictions”. If one or both partners in a relationship is suffering from an addiction then an AA or NA program, the SMART program, a community agency, or psychotherapy is necessary. It is very challenging to make your way through the process of giving up and resolving an addiction, and it is something that would need to be addressed both short and long term. It is not the case that some addictions are more severe or harmful than others. All addictions are serious physically, psychologically, and emotionally, and any addiction can cause irreparable harm in a relationship.
Communication: Difficulties in communication are pervasive in relationships. Howard Rosenberg has developed specific techniques, and describes them in his book, Non Violent Communication. He recommends that each person specifically express what they observe, feel, need, and request. This more detailed expression will help each partner to understand the other, and gives each one the chance to express all of their thoughts and feelings on a subject.
When couples come to therapy, I always include reflective and empathic listening guidelines. Rosenberg described speaking guidelines, and I have developed listening guidelines. I have had clients tell me that empathic listening has helped them more in their relationship than any other intervention they have ever pursued. We go over written guidelines for reflective and empathic listening techniques, and then practice them during therapy sessions.
I almost always recommend reflective/empathic listening instruction. Unlike in a usual conversation, with reflective and empathic listening, you define who is to speak and who will listen. The speaker describes all of his or her thoughts and feelings on a subject, and the listener listens according to specific guidelines. The guidelines include setting your own judgments, opinions, and advice aside, paraphrasing what the speaker is describing, reflecting the feelings they have expressed, and learning to respond empathically to their feelings. When the speaker feels completely understood, the roles are reversed and they trade the roles of speaker and listener. Both of these techniques, non violent communication and reflective/empathic listening help couples more than any other aspects of therapy. And developing these skills will help throughout your lives together.
Self esteem: Identity and self esteem issues are problems that often come up in relationship. Heinz Kohut, a self psychology theorist, describes what he calls a “clear and strong sense of self”. In both individual and relationship therapy, developing a clear sense of one’s identity and also a strong sense of self are important aspects of personal growth and improvement in relationship. The book, Self Esteem, by Fanning and McKay, and other self esteem books and workbooks, can be very helpful in this regard.
Lifestyle preferences, values, and goals: I have seen relationships end over differences concerning lifestyle preferences, values, and goals. All three are extremely important in evaluating the viability of a relationship. There is a theory in social psychology called the matching theory, which shows that the more items that a couple matches on, the more likely a relationship is to succeed. It is extremely important for couples to address these issues together, and when there are differences, to negotiate carefully how they can be resolved or tolerated. Love, intimacy, and chemistry are very powerful, but it is important not to ignore lifestyle preferences, values and goals.
Time together and intimacy: Inevitably couples get so involved with work, community, exercise, sports, and family that retaining some special time to be together becomes a problem. The solution appears simple, but it is frequently overlooked. It is necessary to rearrange priorities and schedules so that special time and date nights can be planned, and also maintained. Intimacy is what makes a marital or primary relationship unique. It takes intent and effort to make intimacy a priority and to make a commitment to regular, planned, and special time together.
Intimacy can take place on several levels: with general sharing in communication, with shared goals, at the intellectual and emotional levels, shared time and activities together, and sexually. One unique aspect of intimacy which makes it so powerful, is that intimacy requires honesty. When you have trust and complete honesty in a relationship that is what makes it profound and dynamic. All levels of intimacy are crucial to a healthy and successful relationship. Each one needs to be in awareness, worked on, and developed, and each one takes time and effort to be considered and maintained.
It is exciting and rewarding to see how much progress can be made. Your primary relationship is the most important aspect of your life. It requires time, and love, and effort.
October, 2025