What Makes Couples Therapy Work? (Part 1)

To answer that question, we need to understand what makes couples fall apart.

One of the first things I tell people when we start working together is that therapy can leave you feeling worse before you feel better. If you have thoughts, feelings, or memories you've put out of your awareness so you could cope and keep living your life, and then you start the work of bringing those back into awareness, that process is going to disturb you. You put those things away in the first place because they were disturbing and you didn't know how to deal with them any other way. Couples work has a way of surfacing things you don't want to know but, at some level, already do.

Couples work is fundamentally about attachment

To understand attachment, we have to talk about the first two years of life. This window is critical for social and emotional development. The experience we have with our caretakers, how they understand us, interact with us, support us, and see us, gets recorded in our brains long before we have words to describe it.

Our brains can't evaluate every relational moment for safety in real time. That would be too slow and too costly. So instead, the brain builds a model from a set of data, and those first two years are the data. From that model, the brain generates predictions: when I feel this way, or find myself in this kind of situation, it will go well, or it will go poorly, or it will hurt. Based on those predictions, we develop strategies for staying safe socially and emotionally.

• If our data suggests things will generally go well enough, we tend to move through relationships as ourselves: feeling our feelings, expressing our needs, and taking in the needs of others without becoming overwhelmed. (Researchers like Mary Main called this a secure attachment style)

• If we predict things might go well but can't be sure when that will change, we tend to become anxious and try to control our social environment through pleasing, appeasing, criticism, vigilance, or codependency. (This is called an anxious/preoccupied attachment style)

• If we predict things simply won't go well, we stop engaging vulnerably. We don't show our own emotional needs, and we struggle to feel the emotional needs of others, even if we get skilled at solving their practical problems. (This is called an avoidant/dismissive attachment style)

• If we experienced trauma at the hands of caregivers, we predict a more painful pattern: things may go well until they don't, and then we get hurt. This often shows up as "come here, get away" behavior, since the brain has learned that the same source of love is also a source of pain and works to manage that impossible bind. (This is called a disorganized or fearful/avoidant attachment style)

That disorganized attachment style lines up with what attachment researchers Mary Main and Erik Hesse called "fright without solution": when a caregiver is both the source of comfort and the source of fear, the child's instinct to approach and the instinct to flee both fail at once, and no consistent strategy can resolve it.

When the data we're carrying is marked by pain, it tends to leave us insecure, about ourselves, about others, about the world in general. And because this data comes from before we could talk, it isn't stored as words or conscious thoughts. It's stored as feeling and as procedural, body-level knowledge of how relationships go. Attachment researcher Beatrice Beebe's work backs this up directly. Her lab's frame by frame analysis of four-month-old infants interacting with their mothers could predict, with real accuracy, which infants would be classified as insecurely or disorganized-attached at twelve months, based entirely on split-second patterns of gaze, facial expression, vocal rhythm, and touch, long before any child could put a sentence together. That's a strong argument for treating attachment convictions as automatic and unconscious rather than something people reasoned their way into.

What this has to do with couples

When we fall in love and couple up as adults, we bring those same unconscious predictions into the relationship, the ones we first built with our caregivers. We also tend to be drawn to partners who feel emotionally familiar. In my experience, people who grew up with attachment insecurities are often drawn to partners who carry some flavor of what they've known, but who also signal the hope of being a better version of it.

Then comes the honeymoon period. In those first months, we're flooded with enough feel-good hormones and emotion that we underweight red flags. That flooding is part of what allows us to attach in the first place, which means our real attachment patterns don't fully show themselves until after we've already committed. By then, we've usually invested enough that it's harder to take in the red flags that do start to appear.

Over time, couples shape their relationship into something that complements each partner's patterns. One partner may feel insecure in response to a moment that isn't actually threatening. The other partner, reacting to that insecurity, may soothe them the same way they once soothed a parent, or pull away emotionally the way they learned to with a caregiver early on. All of it runs automatically and unconsciously, each partner's pattern completing the other's.

These complementary patterns can be sustainable without being satisfying. They tend to hold together until something demanding happens: having children, a move, a job change, a loss, a tragedy. That's usually when the fragility of the relationship starts to show. As we get older, we often gain more ways to avoid seeing that fragility, and our own unhappiness along with it. We may have more money to spend, more focus we can put into our kids or our work, or we may look for something outside the marriage, an affair, over involvement at church, anything that keeps us from looking directly at what isn't working. It's not uncommon for a couple to spend years inside a relationship built around the unconscious insecurities both people brought into it as children.

Jane and Josh

Jane grew up in a middle-class home. Her parents loved her and did their best, but Jane always felt a subtle pressure to be a good girl: to look a certain way, get certain grades, be a certain way socially and religiously. That pressure conditioned her to stay out of touch with her own desires in certain parts of her life, a pattern that traced back to caretakers who didn't want to be disturbed or bothered outside of what they could handle.

Josh grew up in a lower-middle-class home. His parents loved him and did their best too, but Josh carried a subtle, constant sense that he was on his own, that if life was going to go well, he was the one who'd have to make it happen.

When Jane and Josh met in college, both there on partial scholarship, they were drawn to each other physically and in every other way, but they also felt understood. Josh felt Jane gave him a kind of emotional attention he'd never really had. He didn't have to put his needs into words; she figured them out for him. Jane felt that Josh was stable, undemanding, and genuinely interested in her. They got married.

What started as Jane offering emotional support that felt good slowly turned into her wanting more from Josh emotionally than he knew how to give. That made him feel small. And while Josh's stability and low emotional demand felt secure to Jane at first, she eventually started to feel lonely without more vulnerability from him. Kids didn't help. The division of labor somehow fell mostly on Jane, and Josh grew more distant as he felt the weight of financial pressure. Sex became less frequent, which hit Josh hard, since that had always been a primary way he felt emotionally connected. By the time they were around 35, they knew, consciously, that they were unhappy. What they didn't know was why, or how to fix it.

Part two will look at what couples therapy actually focuses on and how it works.

Notes and references

A few sources that back up the claims above, in case you want to go deeper or cite them yourself:

• Bowlby, J. (1969). Attachment and Loss, Vol. 1: Attachment. New York: Basic Books. Foundational work on internal working models, the mental templates built from early caregiving experience.

• Ainsworth, M. D. S., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of Attachment. Hillsdale, NJ: Erlbaum. Source of the original secure, anxious, and avoidant attachment classifications from the Strange Situation.

• Main, M., & Hesse, E. (1990). "Parents' unresolved traumatic experiences are related to infant disorganized attachment status." In M. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the Preschool Years. Chicago: University of Chicago Press. Source of the "fright without solution" concept behind the come-here-get-away pattern.

• Beebe, B., Jaffe, J., Markese, S., Buck, K., Chen, H., Cohen, P., Bahrick, L., Andrews, H., & Feldstein, S. (2010). "The origins of 12-month attachment: A microanalysis of 4-month mother-infant interaction." Attachment & Human Development, 12(1-2), 3-141. The study showing that split-second, nonverbal patterns of interaction at four months predict attachment classification at one year.

• Beebe, B., & Lachmann, F. (2014). The Origins of Attachment: Infant Research and Adult Treatment. New York: Routledge. Connects the infant research directly to adult treatment, including couples and individual work with adults carrying insecure or disorganized patterns.

• Jaffe, J., Beebe, B., Feldstein, S., Crown, C., & Jasnow, M. (2001). "Rhythms of dialogue in infancy." Monographs of the Society for Research in Child Development, 66(2), Serial No. 264. The earlier vocal-coordination research that set up the 2010 study above.

Stages of attachment

The following is a summary of the “Stages of Attachment Cheatsheet” from the Attachment Project. I liked their PDF and thought the info would be helpful. A link to the original PDF is at the bottom.

Understanding the Stages of Attachment*

Attachment plays a crucial role in human development, influencing how we form relationships throughout our lives. In counseling, understanding these stages can be beneficial in helping clients explore their relational patterns. Here’s a brief overview of the stages of attachment:

1. Pre-Attachment Stage (0-2 months): During this stage, infants are biologically predisposed to form attachments. They begin to recognize their caregivers, but there is no strong attachment bond yet.

2. Attachment in the Making (2-6 months): Infants start responding differently to familiar caregivers compared to strangers. Although the bond is still developing, they are more likely to smile or coo at their primary caregivers.

3. Clear-Cut Attachment (6 months-2 years): This is the critical phase where strong attachment bonds form. Babies often exhibit separation anxiety when away from their primary caregivers and are noticeably distressed when separated.

4. Formation of Reciprocal Relationships (2 years and beyond): As children grow, their language and cognitive skills improve, allowing them to understand why caregivers may come and go. This marks the development of a more reciprocal relationship with caregivers, and the child begins to balance attachment needs with independence.

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Understanding these stages can provide insight into adult attachment styles, which are often formed based on early experiences. If clients struggle with relationships, revisiting these foundational stages can help illuminate underlying patterns and promote healing.

Below are the key references to support the summary of the stages of attachment based on psychological theory:

1. John Bowlby's Attachment Theory: Bowlby, a British psychologist, is the pioneer of attachment theory. His work describes the critical role of early bonds between infants and their caregivers in shaping future relational patterns and emotional development​(stages-of-attachment-ch…).

2. Ainsworth's "Strange Situation" Study: Mary Ainsworth expanded on Bowlby’s work by identifying distinct attachment styles through her "Strange Situation" study, which provided empirical evidence for the stages of attachment and the importance of caregiver responsiveness during infancy​(stages-of-attachment-ch…).

3. Developmental Psychology: Attachment theory is widely discussed in developmental psychology, emphasizing how early attachment experiences influence later relationships. These ideas are elaborated in many academic texts on child development​(stages-of-attachment-ch…).

If you're looking for a deeper dive into these stages or have specific client needs in mind, consider discussing attachment theory in therapy sessions. It's a foundational concept that can offer valuable insights into personal relationships and emotional health.

*Summarized from the Attachment Project’s “Stages of Attachment Cheatsheet”