Your partner is strongly suggesting or demanding that you talk to a therapist to work through your mental health or addiction challenges. Should you go for individual counseling or couples counseling?

This is a quite common scenario that I have in my office. While it may be presented as a client struggling with a mental health issue or addiction and is being alerted by their partner, I find that initiating treatment by treating the client individually is usually not optimal and may end up being counterproductive.

When we treat an individual client, we are collaborating with the client on his or her goals and objectives and working with the client at their level of readiness. What will often end up happening is that the individual client will work on an issue from his or her perspective, which will differ vastly from the perspective of his or her partner. Consequently, the client will be satisfied but the partner will be extremely disappointed. Being that the partner is the driving force behind the therapy, and it would be somewhat fair to assume that they are in the dominating position, they may convince their partner to terminate with the therapist. While this may not always be the case, it is something worth considering.

Furthermore, it is important to evaluate the conscious and unconscious motive of the partner demanding the therapy for their significant other. While on the surface it may seem like the partner is coming from a place of care and concern for their partner, it is often not the only reason. Consciously or unconsciously, the partner is feeling disturbed with their partner’s behavior and trying to resolve their own disturbance by suggesting individual treatment. The partner is oblivious of the fact that his or her impact is partially related to his or her own unresolved issues and the interpersonal dynamic between the two of them.

From my perspective, the main issue is not the mental illness of the individual per se, but rather the lack of understanding between the partners around it. Once both partners are in sync with each other and the individual challenges are not creating a gap between them, the significance of the issue is minimized or it can be dealt with much better because both partners are in alignment regarding the issue.

As a result of the above, my default approach is to recommend marital therapy as an initial plan. This provides an opportunity for the partner suggesting the therapy to be involved and make sure it serves their interests. Additionally, it also provides accountability for both partners to work through their impact on the relationship. While individual issues may need to be addressed at some later point, I find that often the marriage work covers all other grounds to a satisfactory level. Emotional Focused Therapy (EFT), my model of choice, is highly effective in creating individual growth by healing attachment injuries, increasing self-awareness, and developing emotional attunement. This is based on the theoretical foundations of EFT being rooted in attachment theory, and a strong focus on emotional awareness.

One of my clients with a history of attachment trauma and social anxiety reported a significant decrease in social anxiety and increase in a sense of safety in social environments after a few months of EFT. Another couple with ADHD reported improvement in the impacts of the ADHD on the marriage because of EFT.

Systems theory is another foundation that EFT is built on. In simple terms it refers to the fact that people within a family system are not acting independently but rather through dynamic interactions with other people within the family system. EFT suggests that when there is conflict, it is a result of an ongoing negative cycle between partners. Thus, when a partner is focusing on another partner’s mental illness, it may very well just be that they are playing out their part of the negative cycle. Although there is no proof one way or the other, from my experience, it is commonplace in the clinical environment. In any event, from a family systems perspective, we need to see the person’s mental illness as an imbalance to the system which needs to be treated in context of the system and not just as a problem in and of itself.