We at Couples on the Brink began to define our couples counseling practice by questioning assumptions about the best way to work with partners on the verge of splitting up. We found that we needed a more intensive treatment model for couples who find themselves at The Brink. Rethinking our strategies started us on a journey into new and exciting therapeutic discoveries—and more comprehensive, efficient results for our clients.

One of the most often unstated, and therefore rarely challenged, assumptions in the couples therapy field is the 50-minute therapeutic hour. If couples have ordinary communication issues or relatively simple problem-solving challenges, we therapists typically see them for an hour once a week. A relatively happily-married couple, for example, may experience the situational stress of a job loss, raising adolescents, or caring for aging parents. If they work with a couples therapist because they don’t see eye-to-eye on some issues, therapy once a week for an hour is usually the one choice they’re given. And that should work fine.

For another relatively happily married couple, the wife goes back to work after many years of staying home to raise the children. They’re having some difficulties negotiating their new roles inside and outside the house. Again, their therapist will likely recommend sessions once a week for an hour until the problems are resolved.

Now let’s look at a couple who have been married for 15 years and in conflict for 12 of them. They are distant, antagonistic, frustrated, and hopeless. They have intense conflict around even simple issues. They have almost no intimate or sexual life. Neither likes who they have become in this relationship. Neither is getting their needs met. When asked, they say they have stayed together for a variety of reasons, including raising their two children who are now teenagers. At some point, one of them decides enough is enough. Maybe the idea of therapy has been discussed over the years but they could never get it together to go for marriage help. When she wanted to go, he refused. When it was his idea, she put it off. This couple is hanging on by a thread, and when they finally call a couples therapist, they’re offered, not surprisingly, once a week for an hour.

At Couples on The Brink, these two people are at our starting point.

We recognize the couples we see as distinct from the general population of clients in couples therapy. They need intensive, concentrated work beyond their comfort zones. They need what works for them, which our experience is an intensive, sustained-focus modality.

In the medical model, you might spend 15 minutes with your general doctor if you’ve got a cold or flu. But if you had cancer or another more serious condition, you would expect more time than that with your health care practitioner. Nowhere else in the helping fields do we prescribe the same exact treatment structure for all clients. Why should we do so in couples therapy for partners at the save-marriage point?

Some therapists have expanded the boundaries of marriage counseling a bit. Some do back-to-back sessions, some offer more than one hourly session per week. This is a step in the right direction but not nearly enough to make a difference in the lives of couples who are hanging on by a thread.

Keep coming back here, to View from the Brink, and we’ll discuss more what we can do for these clients.

- Paul Maione, Ph.D., and Melissa Bridges, M.S., family therapists

www.couplesonthebrink.com