The situation is a common one. A client comes for individual counselling or psychotherapy but either at the start or as the therapy progresses their partner also appears to be part of the struggle. Perhaps the client’s presenting problem appears closely intertwined with their significant other; for example, feeling depressed as a result of constant fighting at home. Maybe the client makes progress in their individual therapy but their partner struggles to accommodate their changing loved one. As a result the therapist may be left wondering if it would be helpful to include the partner in the therapy. However, most trainings – because they tend to concentrate on either individual or couple therapy – provide little guidance on how to manage these situations; either introducing the partner into the therapy dyad and thus changing to couple therapy, or adding a simultaneous individual or couple therapy to the original format. Without guidance it is likely the therapist will then either continue with what is familiar, hoping that it is adequate, or be faced with unknown territory if altering the therapy format is deemed necessary. This article explores that unknown territory in order to put together some best practice guidelines for managing these scenarios.
Changing the format of the therapy is a complex task and carries many considerations. For example, can the significant other be integrated into a psychotherapy format that is already established with their partner? How should confidential information that was obtained during the individual therapy be treated now the partner is also included in the therapy? Should a referral be made to a different therapist so that they can begin with an equal allegiance to both partners?
In order to address these types of questions I conducted a systematic literature review. While the literature contains few empirical studies or trials, it does have several case studies and expert opinion pieces. These have been read critically, the insights pooled and analysed, and several guidelines and clinical considerations have been extracted. The findings have been assembled into three chapters and are outlined as follows:
Chapter 1 covers what the literature tells us about why psychotherapists might consider changing from a traditional individual psychotherapy to one that also includes – or at least considers – the partner. Topics in this chapter include consideration of an individual therapy bias, situations where individual therapy may lead to new problems emerging that include the partner, times when significant others may resist or even sabotage their partners therapy, and ethical reasons for considering the impact that individual psychotherapy has on significant others.
Chapter 2 explores how the psychotherapy format can be changed when including the partner in the treatment. It looks at how the therapy format should be decided and includes some general indications for choosing between individual or couple psychotherapy. It considers the usefulness of meeting the partner at the beginning of therapy and raises some considerations around getting the partner to attend. The chapter then explores converting an individual therapy into a couple therapy. Finally, it looks at options for mixing the therapy format; these options include simultaneous individual therapy for both partners as well as simultaneous individual and couple therapies.
Chapter 3 addresses the issues that may arise around having one therapist versus two when working with these varying formats. It considers the main hurdles that face each, such as how confidentiality will be managed by one therapist when two partners are seen separately, or alternatively, the challenges that face two therapists when trying to work collaboratively.
The article concludes with a summary of findings and makes recommendations for further research.
Continue reading —> Chapter 1. Should therapists consider the client’s partner in individual counselling and psychotherapy?