When Couples Therapy Isn’t Working: Director of Supervision and Training Kelly Scott in The Cut

There are times in couples therapy when things just aren’t changing. Sessions cycle through the same arguments with the same dynamics. Even though a couples therapist may be making insights and connections, nothing is shifting. At this point, two questions have to be asked. First, why aren’t things changing? And secondly—a bigger question—does the couple have the conditions for a healthy relationship, as well as helpful couples therapy, in the first place? Our Director of Supervision and Training Kelly Scott recently contributed to an article in The Cut that explores when couples therapy just does not work.

In “5 Marriage Counselors on What Therapy Can’t Fix,” Kelly reveals that she has to end treatment with “about a quarter of couples.” While that number may seem significant, Kelly explains this decision boils down to an “ethical obligation” for the therapist. “As a therapist,” she describes, “there’s moments of clarity when you realize a couple doesn’t have the conditions of a safe and healthy relationship, and at that point, it’s your ethical obligation to ensure you’re not colluding with their unhealthiness by keeping them in sessions.”

What are some reasons why a couples therapist may have to end treatment? In The Cut, Kelly provides an example of a couple who refused to confront the problem of aggression in their relationship. To continue therapy in this instance would perpetuate this harmful dynamic. But, there are copious other scenarios in which couples who come to therapy may not, in fact, be ready, willing, or able to change or have effective treatment. 

While not in the article itself, one of the biggest indicators that things aren’t working for the couple or the therapist is feeling stuck and being unable to move out of a rut. In these situations, a couple should be feeling disrupted but they’re not, an experience Kelly describes as throwing a grenade into a marshmallow. This may be because the couple doesn’t want to be disrupted. Couples stay stuck in therapy for a number of reasons: they’re checking off the box that says they’re “doing something about their marriage,” they’re scared of being alone in their relationship, or they’re seeking a therapist’s stamp of approval on the relationship. In these cases, couples need to be asked a fundamental question: Do they want to change their dynamic?

Other indicators are related to the basic conditions of therapy: safety and good faith. First and foremost, there has to be a baseline level of safety that makes the risk each partner takes reasonable and contained. While there is always the risk of the unknown (and therapy is an exercise in not knowing while working to know), each partner requires some level of confidence that what they say in therapy isn’t going to be weaponized against them after leaving the office. They also have to agree to give the therapist the authority to provide directives, including not talking about a hot-button issue between sessions or needing to be physically separated, in order to maintain the safety necessary for them to explore together. If a couple repeatedly has to be told they don’t have the ability to discuss a topic on their own but keep trying and escalating into conflict, they likely need a conversation about the conditions of keeping therapy safe. And if they can’t do that, treatment may not be able to continue.

Good faith is also a requirement for therapy, meaning honesty, respect, and having good intentions. Take, for instance, a couple who comes to therapy to address the impact of infidelity on the relationship, but one partner continues to have an affair in secret. That’s operating in bad faith by keeping secrets and being unkind to the partner who is presumably showing up in good faith without having all the relevant information. Similarly, if one partner wants to break up but is, instead, participating in therapy under the guise of trying to repair the relationship, that’s also bad faith. Sometimes couples seek therapy because they want to learn to hurt each other more (weaponizing vulnerability), because they get off on fighting with an audience, or because they want to have space to be mean to one another. All of this is bad faith and means the conditions are not there to explore, uncover, and learn about the relationship.

There can be real harm when couples therapists observe these situations that are problematic, harmful, and not okay but keep quiet and don’t reflect it back to the couple. Therapists can easily get sucked into the relational dynamics of the system on their couch (a lot of times it’s because therapists are scared of what will happen when they reflect back the truth and take a position). But, as Kelly says in The Cut, “I’m honest with patients. Therapists keeping things to themselves is a detriment to treatment.” It’s essential to name what isn’t working and, in many cases, assert a value along with that observation. The necessary next question, though, must be: “And do you want to do something about that?” Because if the answer is no, the couple doesn’t have the conditions for treatment.