Couples counseling is the second large segment of my clinical practice. I have seen close a to thousand couples over the past 30+ years. Most have been married couples. Some have been in long term dating relationships. Some have been engaged. Some have been gay or lesbian.
I begin couples counseling in a structured way. I see the couple together the first session. I want to get an overview of what is going on. What are the issues? What are the strengths? What are their goals? Is the relationship in crisis?
I then see each person one time individually. I ask about personal and family history. I ask for their view of the relationship. I often get a somewhat different slant on the relationship when I talk to each partner individually. If there are important secrets (such as an ongoing affair), there must be a willingness to disclose the secrets. Effective couples work requires a rigorous honesty and openness between the partners.
At the fourth session, I teach a structured format for difficult conversations. The structure is basic and straightforward. When followed, it keeps the conflict bounded and respectful. The structure can also be used to express appreciation and give positive feedback.
Subsequent sessions focus on the couple's issues. There are sometimes "homework" assignments" to practice between sessions. I emphasize what is good about the relationship and what progress they are making.
Sometimes, couples counseling is an avenue for dissolving a marriage or ending a key relationship. The goals in these instances are that both parties have a clear understanding of the reasons that the relationship is ending and that both parties have had multiple opportunities to say what they needed to say.