What is cognitive behavioural couples therapy?

We tend to think about therapy as something that is helpful for individuals, but what about when you want to address problems which affect you and a partner or spouse? In this episode, Dr Lucy Maddox speaks to Dan Kolubinski about cognitive behavioural couples therapy, and hears from Liz and Richard about what the experience was like for them.

Show Notes and Transcript

Podcast episode produced by Dr Lucy Maddox for BABCP

Dan recommended the book Fighting For Your Marriage by Markman, Stanley & Blumberg

https://www.amazon.co.uk/Fighting-Your-Marriage-Best-seller-Preventing-dp-0470485914/dp/0470485914/ref=dp_ob_title_bk

Some journal articles on couples therapy are available free online here:

https://www.cambridge.org/core/journals/the-cognitive-behaviour-therapist/information/let-s-talk-about-cbt-podcast

The podcast survey is here and takes 5 minutes: https://www.surveymonkey.co.uk/r/podcastLTACBT

The BABCP website is at www.babcp.com

And the CBT Register of accredited CBT therapists is at https://www.cbtregisteruk.com

Photo by Nick Fewings on Unsplash

Transcript

Lucy: Hello, and welcome to Let's Talk About CBT. It's great to have you listening.

When we think about therapy, we often think of one-to-one conversations between one person and their therapist. But what about when the problems that we're going for help with are related to how we're getting on with a partner or a spouse? Cognitive behavioural couples therapy helps with these sorts of difficulties. To understand more about it I spoke to a married couple, Richard and Liz, and Dan Kolubinski, their therapist.

Richard and Liz did this therapy privately, but couples therapy is also available on the NHS to help with some specific difficulties. We hear more about that from Dan later on. For now though let's hear what Richard and Liz thought of their couples therapy in this interview which I recorded with them remotely.

Richard: My name's Richard. I'm 37 years old and I've been married to Liz for just over seven years now. I'm a postie at the moment, and kind of lived in Essex most of my life.

Liz: It's like a dating programme.

Richard: It is, isn't it? Yeah, a little bit. (laughs)

Liz: So I'm Liz and I make cakes for a living, and write about mental health. So that's us.

Lucy: That's great. So thanks so much for agreeing to speak with me about your experience of couples therapy, and specifically cognitive behavioural couples therapy. Would you mind telling me how you came across it and what made you think you might want to try it?

Liz: Yeah. So I think it's something that we've spoken about in the past. And we've both had therapy separately, and I think we've both had various different types of therapy. So Richard has had CBT before, I think we've both done psycho-dynamic counselling.

So when we decided we were going to do it, we realised that for us it was more beneficial to almost do a crash course, as it were, together. So to do a whole weekend, rather than a little bit once a week. And that was how we discovered Dan, and were able to book in with him.

Richard: Yeah, I think we both understand the value or had both experienced and understood the value of therapy individually. So it was kind of an easy step for us then to decide there could be a lot of value in doing this together.

Lucy: That makes total sense. So you already had a bit of an understanding of what it might be like, or what it's like on an individual level?

Liz: Yeah, definitely. And actually very early on in our marriage we had some couples counselling, which I don't think was actually as successful, and it was after that that we had separate counselling. And I think it was after we were both able to get ourselves into better positions, as it were, that that's when we were able to come back together and experience some therapy together.

Lucy: That's really interesting. Do you think that helped you access the conversations together in a different way?

Richard: Yes, I think it did. I think we both had an experience of therapy, of CBT and of other therapies, and the structure they would take or how they engaged you and enabled you to talk safely, and the prompts that might be used.

When we did it together, it did make the conversations a bit freer, a bit more open. And I think we both felt it was a safe environment, which when we first had it I don't think we did feel. And that made a big difference I think.

Liz: Yeah. And I think as with any relationship, until you've got a level of happiness with yourself, it's very difficult to have a relationship with somebody else that involves vulnerability or trust.

And I don't think we had that the first time we tried having counselling together. I think we were almost so reliant on our relationship to form who we were, that the first time around we put too much pressure on ourselves, on the relationship, and also on the counselling, and we expected some magic wand. Whereas now we've realised it actually does take a bit of work.

Richard: Yeah.

Liz: But obviously the pay-off is huge, so that's brilliant.

Lucy: That's so nice. Sometimes you see adverts for couples counselling, or couples conversations, when people are thinking of getting married. Was that something that was around for you?

Liz: (Laughs) Yeah, slightly ironically we started it and it was meant to be three sessions long, or four sessions long, and I think before the second or third session we had such a big argument that we never went back.

So yeah, again it's something that I think in hindsight there were warning bells that both of us were probably having our own inner struggles, as it were. And that we weren't really able to reap the benefits of that pre-marriage counselling. But I would definitely recommend it to any friends who were getting married.

Richard: Yeah, absolutely.

Liz: I'd definitely recommend it, even if it's just to get the conversation started.

Lucy: Yeah, it's interesting. So there are some conversations it feels like almost we don't quite have permission to have without somebody prompting it or some kind of structure around it.

Liz: Yeah, definitely. And I think it takes a certain amount of emotional maturity to have conversations like that, or the difficult conversations, and not to take something personally or get defensive. And I think that that's something as a society we don't necessarily encourage people to have those conversations, or to be able to freely explore things without there being some element of self-worth dependent on it.

Lucy: Liz and Richard went for therapy after experiencing a bit of a rocky patch in their relationship.

What was it like going for the weekend?

Richard: I think it was really beneficial. It's certainly something that – hopefully we'll never be in that similar circumstance again – but in a situation where we thought it was beneficial, doing it over… was it three nights?

Liz: Yeah, three nights.

Richard: Was really valuable, because it kept you in that space. So there were no distractions from, I don't know, going to work, having to get back, get to the session.

Then inevitably when you finish the session you get home and normal life kicks in straightaway. So whether it's cooking dinner or having to get ready for the next day, that's unavoidable. But in this situation we were really able to take ourselves away from normality and the routine, and really focus on it. And I think it had a great impact doing it that way.

Liz: Definitely. And also I think that having – because the sessions each day I think ran from 10:00 till 1:00, and then 2:00 till 4:00. So having those extended sessions meant you could really get down to what was happening and really attack that. As opposed to when it's say weekly, hour long sessions, having to almost get past the initial boundaries that you might have set up and break those down, and get into a place of being able to talk freely.

Lucy: And were there other people there as well? Were there other couples there or was it just you?

Liz: It was just us.

Richard: Yeah.

Lucy: And what was it like before you went? Was it frightening to think about going?

Richard: I suppose for me it was a sense of that nervous excitement. So I didn't quite know what was going to happen. I knew what I wanted from it. And it was the kind of knowledge that this was going to be good for us, at least for me.

Liz: Definitely. And I think one of the first things, on our first evening there, we had the initial introduction session together. And Dan did say it was quite unusual to be dealing with a couple who were in such a good place. And that was quite nice actually, and we definitely subscribe to the idea that therapy isn't just for when something goes wrong; it's actually really useful to keep things right, as it were.

And I think it was funny because the things we thought we were going to end up talking about over the weekend, actually it all came down largely to communication, which I think is often the case with couples. And learning how to communicate with each other.

Lucy: Before we hear more about Richard's and Liz's experience, here's Dan to give the bigger picture on this type of therapy.

Dan: My name is Dr Dan Kolubinski, and I am the clinical director of Reconnect UK, which is a CBCT based intensive retreat programme.

Lucy: And what's your professional background?

Dan: My master's degree is in counselling psychology, and a PhD in psychology as well. And I've been a CBT therapist for about 15 years now.

Lucy: Cognitive behavioural couples therapy might be something that people haven't heard of before. Could you explain what it is?

Dan: Well, as in CBT, in cognitive behavioural therapy, there are these two different aspects; there are cognitions and there are behaviours. The ideas are that if you change those two things you might change how a person feels. And with the couples aspect of it, it's built on the same principles, but trying to treat a relationship rather than an identified client. It's not just about one person, it's about how the two of them as a unit are.

So the primary focus is on the behaviour side of things. The idea is that if I can change what the couple are doing, that will change the way that they think about each other which will change the fundamental feelings of the relationship.

And so that breaks down into a couple of different components. There's on the one hand, 'do nice things'; trying to bring up some of those caring behaviours. That if I know what my partner likes and how they feel cared for, we have to guide the couple sometimes to actually doing those things.

And the other thing is around skill building. So we'll have things particularly around communication; really breaking it down to some of the fundamentals of how we talk to one another to make sure the message that's sent is the message that's received.

Lucy: Could you give some examples of the sorts of changes in the way that people talk to each other that you might encourage?

Dan: There are a couple of one-liners that I like to use in the work that I do. And one of the big ones I think that comes up in communication is that it's very important to listen in order to understand, rather than listen in order to respond.

So most of the time when couples get into a conversation, even the positive ones but especially the negative ones, rather than hearing what the other person is saying, what we have a tendency to do is already think about what we're going to say next. And so I'm not engaging with what my partner is saying, I'm already finding holes in their argument, I'm already stating my next case in my head.

And so we really have to stop that process so that people can slow things down and really make sure that what's coming across is what was meant to come across. So that idea of I need to button my lip, I need to put my world view on the shelf and I need to listen to what's being said, in order to understand it.

Lucy: That sounds super useful for all sorts of relationships actually.

Dan: Absolutely, yeah. These are generalisable principles, I think. It's when we're dealing with a couple, that's really the emphasis, but the same sorts of principles can be used for other family members, can be used for co-workers, can be used for neighbours. It's all about just two people interacting with each other.

Lucy: And so if a couple came to a therapist for cognitive behavioural couples therapy, what could they expect?

Dan: They can expect somebody who's there to try and understand their own point of view, but isn't going to take their side. So the role of the therapist really is to try and guide those conversations, and shift away from accusations and misunderstandings.

And to act almost as a bit of a mediator sometimes, in the very beginning. Eventually, like any good CBT therapist, our job is to try and make ourselves obsolete as quickly as possible. So it is about trying to skill them up to have those conversations. But in the beginning we can be there to try and translate; make sure that the message that's sent is the message that's received.

One thing that I meant to say, and I got a bit side-tracked, was one of the key principles is if I do something different then my partner might do something different. Usually what we're doing is we're waiting for our partner to do something different before I do something different.

And there are some interesting things with that. Number one is I have to take the lead; if I put 55% to 60% of the responsibility for my relationship on my shoulders, and just expect 40% to 45% from my partner, then if both people are doing that then they probably stand a good chance. So I'm not doing a tit for tat, trying to keep score; I'm actually taking a little bit more of the initiative, willingly. And then if I do that, chances are I'm going to inspire that good in my partner and they'll do that as well.

But the other thing that comes up I think in a lot of sessions is that people have a tendency to do something that seems like a good idea at the time, but can be really destructive to a relationship, and that is we have a tendency to follow the golden rule. Now what I mean by that is that the golden rule, treat other people the way you want to be treated – and it sounds good, and generally I'm very supportive of it – but it actually ends up being really bad relationship advice. It becomes so much more important to treat the other person the way that they want to be treated.

So if I'm doing all of the nice things for my partner that I would want her to do for me, they're not going to land well. And I'm not going to get the credit for them, because I'm not speaking in her language, I'm speaking in mine.

Lucy: So are the first few sessions trying to get that shared understanding with a couple, of what the problems are?

Dan: Typically. The first few sessions are usually assessment-based. So an assessment would take a little bit longer in CBCT than it would with CBT. Because typically – and again, this is something that couples can expect – the first session would usually be with the couple themselves. Coming in, getting a sense of the history, where they are now, current state of play, what might bring them to therapy. And getting their story; what brought them up to this particular point. We go right back to the very beginning.

And I think there it's necessary not just to hear what the couple is saying, but also how the couple are saying it. There's a fair amount of information in how people tell their own story. And then we can see if there still is some love there between the two of them; if they're warm and fuzzy. It's amazing when you ask a couple how did they meet, they both look at each other and they smile. That can be really quite telling, compared to those that just stare off into the distance as if they wished that day didn't happen.

But then we get into conversations with them as individuals. So there will be a couple of sessions where it is about tell me your story, tell me your side of things. We need to be able to understand both of them. And so that's a part of the assessment as well.

And then the final assessment session would be bringing it together. So as CBT therapists, we'll draw this out in what we call a formulation, which is just this diagram that links our thoughts, our emotions and our behaviours, and our view of the world, to one another, to each other.

Because I can see my partner's behaviour, what I can't see is what's underneath that. What are their thoughts? How are they feeling in these moments when they do what they do that drives me crazy, and then how do I react, and then how does my reaction then impact my partner? So we'll go through a session looking at that system, and the habits that have been formed.

And then from there we'll get into the communication side of things. I usually do. Starting off with the talking element of trying to understand each other. And at the same time, usually for homework between sessions, we would also expect a fair amount more of the positive behaviour, the caring behaviour. So that they're actually do something differently; hitting the ground running and trying to demonstrate that they care about one another, which they typically aren't doing by default.

Lucy: Are there any other concrete examples from therapy of things you encourage people to do differently, that have caused a change in thinking?

Dan: Yeah, I think generally speaking, there's a common thing that I see with a lot of couples. When we get into the formulation diagram – and so as I said, it has this connection between what we're thinking, what we're feeling and what we're doing. And it's informed by this higher idea of how we see the world.

And if I'm looking at my partner's behaviour for example – and I'm doing that through my lens, I'm doing that through the way that I see the world – well that's just going to be crazy town. It's not going to make any sense to me whatsoever; "I don't know why you're being so unreasonable. Can't you see that?"

And then we start to slow things down and start to highlight the other person's framework. And if I'm really open to that, that you see the world from a certain point of view, where we agree, we don't have problems. The problems come from where we might be on a different page. And we've done that because we've had different experiences.

And when couples start to really slow it down and listen to where those connections are being made, or how those experiences have shaped why they might see things the way that they might see things, it is amazing how the walls start to come down.

Lucy: I bet that's really rewarding.

Dan: Absolutely, absolutely. But frustrating in equal measure, because it's also one of those things that might be blatantly obvious to the therapist, but it's not obvious to the couple.

Lucy: Back to Richard and Liz. I wanted to know what practical techniques they'd learned that they could use day-to-day?

Richard: Yeah, so I think one of the early ones we did at the weekend was just about active listening. And like Liz says, a lot of it was about communication. And so we did some exercises talking about aspects of our relationship, and ensuring each of us was being listened to properly. And so we did an element of one person would talk about how they were feeling and the other person would almost paraphrase, and repeat it back to them to try and ensure that they had taken in what they were saying and understood it.

And the understanding bit was key, because initially there's that aspect of right, I need to remember this and say back to her, so to your other half. But if you do that, and I'll admit I did that initially, you get caught out so quickly because all you're trying to do is to remember it to repeat, instead of actually taking it in. And so that was a really valuable exercise that we've tried to continue using day-to-day as much as we can.

Liz: Yeah. And I think one thing that really stuck with me was we did an exercise about what's the best case scenario to come out of this, how does that look, what will happen if that doesn't happen? And so actually exploring possible consequences. And I found that really helpful. Because I think so often you can get caught up in the moment and being concerned with who's in the right, who's in the wrong, who hasn't washed up, whatever. And actually lose sight of what it means and what could that niggle lead to, and is it important in the run of things?

Yeah, it was very helpful to be able to step out and be given written exercises to help us step out of the now and consider what the future looks like together, and what we can do to make that happen.

Lucy: How nice to be asked what the best case scenario is as well.

Liz: Yes.

Lucy: I don't know about you, but I so often spend time worrying about the worst case scenario, so yeah.

Liz: For me it always sticks in my mind now, that if something happens, I think is bringing this up, is fussing over this going to get me closer to that best case scenario? If it's not, then can you let it go? And that's quite helpful. Like I say, I do that all the time, I let so much stuff go now. (Laughs)

Lucy: It's super hard though this stuff though, isn't it? It's really hard.

Liz: It is. And I think especially at the moment, I think that's the thing. The idea of being able to step out of things is very helpful at the moment because emotions are running high, and so it can be difficult sometimes to know if what you are feeling is actually a direct consequence of something that has happened with your partner, or just made up of general stress about everything.

Richard: The current situation.

Liz: Yes, absolutely.

Lucy: Are there other things that you think people should know, if they're thinking of embarking on cognitive behavioural couples therapy?

Liz: I'd say that it's definitely an investment. Because it's not the cheapest thing to do, especially if you're doing a weekend of it. But the pay-off has been incredible. And this is why we were so eager to speak to you, because we do still get so much from it.

So for example one thing we'd spoken about at the weekend was the idea of having time to check in with each other each week. And talk about how things are going and what our hopes are for the week ahead, and also hold each other accountable for things if we need to.

And so now once a week we have what we call an MM, our Marriage Meeting. And every week we come to the meeting with two things that we're grateful for, or that we've really appreciated that the other one has done in the week. And I love a spreadsheet, so we have a little form that we fill out that basically at the beginning says we will always come to these meetings positive and ready to engage.

And that has been really lovely, and that's something that I think has kind of become part of our week now, hasn't it?

Richard: It has. Very much so, yeah.

Liz: It's really lovely. And I mean I'd say physically things are much better as well. So obviously things… It seeps into other aspects of a relationship; when certain aspects are good other aspects are good.

Richard: Sometimes it may only be 20 minutes or something like that. So it's not something that will last for hours, but it's just a really good way to check in with each other.

Liz: Yeah. And initially we made sure we kind of sat down at a desk or on the sofas opposite each other. And now we have got to the stage, when the weather's been nice, we might sit outside in the sun with a G&T and have it. Or we've had a couple where one of us is sat in the bath and the other one is sat there chatting. So we are now integrating it into our everyday life, but it's a specific thing we make sure we do.

Lucy: It's interesting though the idea of the meeting, because it's such an important area of our lives, and yet we don't always put the same amount of effort into it that we might a job or other aspects of our life.

Liz: Yeah, it's funny you say about the job, because one thing that really struck me from that weekend, was when we spoke about relationships and roles in a relationship, and we said how essentially we have roles to play. So initially we audition for that role when we're getting to know each other. And then it's like okay, I've interviewed you for this job, you can be the role of my boyfriend or fiancé or husband, and we need to show up in those roles. And we need to give consideration to what we've agreed to be together in each other's lives.

And that I think was something that really hit home for me as well. And I think the meetings help us do that in a sense; we both show up to work each week.

Richard: We do indeed.

Liz: And it just resets that I think.

Lucy: As I mentioned earlier, Richard and Liz did their therapy sessions over the course of one intensive weekend, and it was a private arrangement rather than an NHS service.

Dan explained to me what other sorts of options are available.

Dan: There are these two different streams I guess that would be useful to see what might be accessible via the NHS. I should say that within the NHS, the real criteria there is mainly around depression; I think some services will offer it for substance misuse as well. So it would be good to know what might be available and what the criteria would be in order to be able to access that.

And so as a useful treatment for depression, usually you would have one, and then sometimes two people, who would meet the criteria for a mood disorder. And in couples therapy, the relationship and the depression can relate to each other; they can build on each other. And so by treating the relationship you can have a significant impact on depression.

In private practice, which is where I think most couple therapists reside, there it would be accessing online directories, looking at Google, typing in things like CBCT, cognitive behavioural couples therapy, or just behavioural couple therapy.

I should add that there are those therapists who actually don't look at the thoughts as much, it's more just the behaviours. And that is the fundamental core; it's about doing things differently. So behavioural couple therapy would usually be something people would have on a website, if that's what they're offering.

Lucy: Obviously it must be different for every couple, but roughly how long would a treatment take?

Dan: It would be similar to a lot of individual CBT. It can be for some really low level; we want to prepare things, we don't want to have the cracks form later, a little bit prevention. That can just be a few sessions; five, six or so of the actual treatment, once you get out of the assessment stage. That would be about three or four really, if they're just doing prevention stuff.

But typically a course of therapy would be about 10, 12, maybe upwards of about 15 sessions. Sometimes more, it could be upwards of 20, depending on how entrenched these old habits are.

Lucy: And is that something you do get; people coming early on in a relationship to try to head-off bad habits?

Dan: Absolutely. That's something that certain religious organisations have been doing for quite a while. The Catholic church has always expected couples to go through a marriage preparation course. And there are fewer people who are seeking that religious intervention now, so they come to us. We have the same principles, and a lot of the same material.

And so we see the divorce rate is 42%; that's a pretty staggering number when you think about all of the unhappy married couples, it's about a coin toss about whether or not any couple is going to make it and be happy. But there are things that we can do in order to make sure that we're in the right 50%.

Lucy: And what got you into doing this sort of therapy?

Dan: I've always been fascinated by relationships. I was first inspired by Albert Ellis, as a first year psych student, and I knew this was the area I was going to work in. But then as I was going through my studies, I just became really fascinated with relationships.

I'm one of the very fortunate ones, my parents are still together after 40 years – coming up on 50 years actually, very soon. And I just always appreciated their relationship, the way they interact with each other, the way they talk.

And in conversations I've had with clients over the years, I do recognise that very rarely is there the one person who's fully to blame. It's usually a system thing. And I think what the world needs more of is just slowing things down and trying to listen to understand, rather than listening to respond.

And so it's a very different type of work than if you're working with depression or anxiety, that's very much around distress and trying to reduce distress. There's distress in relationships, but it's the system that's the problem rather than there being an issue with mood or anxiety.

Lucy: Do you ever feel sort of caught in the middle as the therapist?

Dan: Sometimes. It's really odd when a couple has been particularly conflictual, and been fighting a fair amount, and they want to feel heard. And they're already under the impression that they're the reasonable one, and if you can just fix my partner then we'll be okay. Very rarely is that ever the case. But you do get dragged into that a little bit.

That's rare. Most couples, they come to see a couples therapist because they recognise that there's a problem with how they're interacting rather than, "Just try and fix my partner." But it does happen.

Lucy: It sounds like hard work, actually.

Dan: It's very much a game of mindfulness, I think, for a couples therapist. You always have to be on the ball and always in the moment. Especially with those couples who can trigger each other really quickly, and get caught in that vicious cycle of arguing, and they think they're the right one and their partner's the wrong one. And just blinking; you think you're having a productive conversation and it can just set off.

So we have to be far more active than we would do when treating individual clients, to make sure we're interrupting that pattern, because it's happening live. If I'm treating an individual, I might generate a panic attack, but one doesn't generally spontaneously happen in a session, but in couples therapy, the fights do.

Lucy: Do you think it has made you more able to listen in that kind of slowed down way that you talked about?

Dan: Well, there are skills there to try and understand some of the fundamental premise that someone might be saying. And I think I recognise that just about every topic under the sun tends to be a lot more complicated than what some people tend to think.

There are very few simple answers in this world, and I think that idea of being that mediator, from seeing a couple to diplomacy between nations, are all just aspects of the same spectrum. It's just people feeling unheard and misunderstood, and sometimes closing their ears to the other side.

Lucy: Couples therapy is in the NICE guidelines, which draw on different research studies to understand what the most effective therapies are for different sorts of problems. I asked Dan what the evidence base for this type of therapy is.

Dan: It's a bit of a tricky question to answer, for a couple of reasons. The short answer is, pretty good; not absolutely fantastic, there's no guarantee I think for any couple. But it is better than nothing, and it is one of those very few evidence-based treatments that we have. There is a lot of couple work out there that doesn't have the evidence base, that behavioural couples therapy would do.

And a lot of the time it really does depend on the couple. Again, one of the shocking statistics is that the average couple could very well wait around six years of having problems before they seek help. And as a result of that, it does linger and become and become a bit more complicated.

And it's the same thing with the relationship, and so those who are able to see the cracks beginning to form, they tend to fare a little bit better than the couple who have canyons that have come into their ways of communicating. But I think with an open mind, with an understanding, and with a willingness to be able to hear – which is usually the biggest obstacle – then a couple can do well with some good tools and the right direction.

Lucy: One really tricky thing about evaluating the effectiveness of cognitive behavioural couples therapy is that unlike individual CBT, the aim isn't always to make the relationship better. Pre and post scores on a relationship satisfaction measure aren't always the best indicators.

Sometimes couples use therapy to determine whether ending the relationship is the best option for them, which could still be a good outcome even if the scores don't improve.

I asked Richard and Liz what else had stayed with them since doing the therapy.

Richard: For me I suppose it's more the approach. So if people were interested in doing it, then the environment that you're going into is one of the safest that you'll have to talk about the really difficult stuff. So there's no reason not to be as open as you can. And don't hold back, because there's no point, you won't benefit from it. So I would just thoroughly recommend being as open and honest as you can, and you really will reap the benefits from it.

I think it's almost like that green light to be able to say maybe the things that you haven't said before, or the things that you've been scared of saying. Because it might be that those things in the past have been a catalyst for an argument or some difficulties. Whereas in this space you've got someone who, if it does go that way, can bring it back, and also is there to help balance the conversations.

And so once you've done it once in that environment, and realised the benefits, then just keep doing it, because it's very, very powerful.

Lucy: It sounds helpful for stepping out of patterns that we can all get into.

Liz: Yeah. And I think also it was having someone there who is trained, and they have this incredible toolbox of things that they can give to you.

And the range of things that we spoke about, I think there were some things that I think we didn't realise we would speak about, which actually in hindsight, of course they were going to come up. And we dealt with things across the spectrum of a relationship, didn't we?

Richard: Yeah, we did. Yeah.

Liz: And we were given tools not only to help us communicate there, at the time, but then also afterwards. And that has been really helpful for us as well. So we haven't just been left to get on with it, and hope that everything works out okay.

I think we've tried sometimes in the past to deal with things by Googling them and looking for articles. And you end up with all of these things that are suggestions as to how you can improve your relationship. But actually having a professional who takes the time to sit down to work out what's best for the two of you is invaluable.

Richard: I think it was almost like – and not to sound too cheesy – but we went there wanting to know how to dance, like how to do a Viennese waltz, and Dan was able to pull us back and say well, let's just make sure you can hold hands properly, first.

Liz: Yes. Yeah, exactly that. I still want to learn to Viennese waltz but…

Richard: Yeah.

Lucy: What was the hardest thing, do you think, about it?

Liz: There were elements where we were talking about physical things in our relationship, that you have the schoolgirl kind of – you get embarrassed talking about things like that.

But much like Rich said earlier, when he said just be honest about something, and when it doesn't go wrong you'll realise it's a safe place to keep being honest. And I think that's the thing. As soon as you start talking about something, and you realise the world hasn't stopped turning, it's then like that switch – again, as Rich said – that switch goes on and you actually realise this is okay, and this is normal.

Richard: Yeah.

Lucy: And what do you think the best thing has been to come out of it?

Richard: It's hard to answer that, because I just think it's the way we are. So the developments in our relationship, the way we communicate. The closeness, like Liz says, physically and mentally, is better than it has been, I think. So okay those butterflies may have gone, but like Liz says, it has been replaced by just a stronger bond.

Liz: A different type of butterflies.

Richard: A different type of butterflies.

Liz: Yeah, maybe.

Richard: Do you know what I think is important; it encourages you to want to continue to do that. So you don't go there have a session or a number of sessions, and once you're done, that's it, you're fixed. It doesn't work like that. But it encourages you to develop yourselves and keep going with, like Liz says, with the tools you've been given.

Lucy: But brave to be able to do that as well, because it's challenging too.

Liz: Yeah, absolutely. Because the path most trodden is the one you go back to, isn't it? But yeah, just recognising I think those old behaviours is a victory in itself.

Lucy: I asked Liz, Richard and Dan for their final thoughts for couples who are thinking about having this type of therapy.

Liz: If anyone's even thinking about it, take the leap, because the one thing you'll wish is that you'd done it sooner. And the good thing is if you're going to invest one day in it, you might as well invest sooner rather than later, because then you'll have longer with the benefits of it. And it's worth it.

Dan: I'd definitely encourage it. And there is an element of don't wait; don't wait until it's too late. There are those couples that I have seen where, in the session, five sessions in, one partner might say to another, "Look, had you offered to do this five months ago I would have been there, but I've lost it, and the fire's out now." And so this is a time limited situation sometimes. People do end up getting to a point where they've passed the point of no return and they just shut down.

So a relationship, it's a little bit like a fire. The flames tend to go out pretty quickly – the passion, the heat – and we have that in the first six months to two years, and then that starts to go. And that's the case for any relationship. But you would expect the embers to be glowing, you would expect some sort of heat to still be generated from what's left, from those coals.

But there is a time when that starts to extinguish. Sometimes it's as dramatic as a bucket of water being poured over it, sometimes it's just time, and it burns itself out. And so the sooner tends to be the better. And that would be the main advice.

Lucy: And just one last question, how do you know when to stop?

Dan: (Laughs) That's a great question. As I say, I think my job is to make myself obsolete as quickly as possible.

And in your typical therapy, there's a difference between treating relationship distress and treating substance misuse. With substance misuse there's very manualised – today is session two, therefore we're going to talk about this; this is session five, so therefore we're going to talk about… They're very rigid and strict in what they do, and it's a very dedicated programme.

For relationship distress, generally for the population where substances aren't involved, it's a little bit more open, shall we say. We deal with what's going on at the time. And I have a loose structure in my head, where I want to deal with things like caring, communication, and conflict management. Those are the three things that I want to make sure the couple has. So they have a lot of positive going in, they have little negative coming out, and they're able to use the tools to understand each other better. When they can do those three things then we start to wrap up.

And it would be very similar to how do you know you're done with depression. People feel a little bit more confident moving forward and don't really need you as much; we can phase things out a bit. They're managing their own conflicts.

Most problems won't go away; about two thirds of all conflict are what they refer to as unsolvable problems. When you pick a partner you pick a set of problems – that's kind of how relationships work. But they can manage them better; they're not sparking each other off. They're not becoming emotive conversations, they're becoming much more productive conversations around understanding and meaning. And then I'm not really required any more.

Lucy: Thank you to all of my guests, Richard, Liz and Dan. If you'd like more information on CBT for couples, have a look at the show notes.

For more on CBT in general and for our register of accredited therapists, check out BABCP.com. And have a listen to our other podcast episodes for more on different types of CBT, and the problems it can help with like clinical perfectionism and body dysmorphic disorder.

That's all for now. Thanks for listening and take good care.

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