Online Therapy with Couples 1/5: A Clinical Quarantine

The focus of this blog series will be on doing remote couples therapy while Covid 19-based social-distancing recommendations remain in place. I am hopeful that these posts will be instructive not only when it comes to managing the specific challenges of online therapy with couples who are often forced to be at home together during a global health crisis, but also when it comes to addressing the general challenges of working with intimate partnerships. Adversity always illuminates indelible aspects of the human condition – and human relatedness – in unique and unmistakable ways. 

So while I believe that the Covid 19-crisis will eventually resolve as medical research  progresses towards better therapeutics and an effective vaccine, I also believe that it remains  valuable to examine what is revealed during this anxious, fearsome and exasperating time. There will surely be other communal crises that exert their influence locally and/or globally, and there is always something for us to learn when it comes to encountering the mysteries of intimacy and love.

Agreeing on a goal

One of our main priorities when treating couples is to suspend our eagerness for a particular outcome and maintain residency in the state of open-mindedness. When it comes to psychological treatment with adults, I am of the belief that it is the patient, not the therapist, who should determine what the goal is and whether it has been achieved.

Of course, one of the most formidable aspects of couples work is that there are two patients, not one, and the very dilemma that may have brought them into treatment is that they can’t agree on what the ‘goal’ is.

One may want to stay, the other may want to leave.
One may want more sex, the other may want less sex.
One may see relational justice as a well-balanced quid pro quo, the other may see relational justice as a series of sacrifices that require relinquishing the very concept of ongoing equity.

Whether or not there is a pandemic, and whether we are meeting our patients in person or virtually, it is still advisable for us to take our cues from our patients when it comes to how we can be of value.

Establishing for the couple at the outset of treatment the variety of roles that the therapist can play – such that responsibility is placed squarely on the two of them to determine how therapy is going to be useful – emphasises this ethos. So I usually start by laying out a quartet of options:

• I can help you dismantle your relationship so that you can disentangle from each other with civility and dignity.
• I can help you to stabilise your relationship so that you can stay together without chronic hostility and hurtfulness.
• I can help you to improve your relationship so that it becomes richer and more fulfilling.
• I can help you to clarify the nature of your relationship so that you can better determine which of the previous three functions you would like me to fulfill.

Quarantine and clinical captivity

During quarantine conditions, partners are stuck with each other, and, for better or worse, there is much less room for escape. Likewise, during therapeutic conditions, the partners and their therapist are now stuck with each other, as well, with much less room for escape (that is, if the therapist is doing his/her job). 

So we might say that couples therapy mimics a quarantine – and our job as the new, third person in the system is to leverage the confinement such that the inescapable physical closeness yields a more satisfying emotional closeness. The act of clarifying the four aforementioned pathways creates ground rules for the clinical captivity that is about to commence, and raises the odds that it will be a productive one. 

In my second blog I will explore the challenges of creating a constructive clinical crucible through online therapy.