Couple’s Therapy: Deconstructing the Myths

Relationships can be extremely rewarding and fulfilling, however, sometimes they present challenges we don’t feel prepared to overcome. In these occasions, many people don’t seek help from a therapist because they have wrong preconceived notions about couple’s therapy.

We thought that gathering the most common misconceptions we have come across through years of experience in this field and deconstructing them would help you make an informed decision about couple’s therapy.

My Partner’s Problem, Not Mine

Relationship and couple’s therapy works with the relationship.

— The focus is on the dynamics —

Though partners in the relationship may gain individual insight about themselves, the focus is on the dynamics that create the problematic situations.  In order to work on these issues in the relationship, it’s important that all partners have an opportunity to express how they feel, their wants and needs.  Partners entering relationship and couple’s therapy come to therapy for the mutual purpose of exploring the relationship dynamics which they are part of.

It’s Too Late

Relationship and couple’s therapy helps you decide where you are in terms of your willingness to work on, or continue, the relationship.

— In some cases, partners find that with therapeutic support they are able to develop skills that allow them to continue in the relationship in a healthier way. For others, they are ready to leave the relationship —

Therapy can provide a safe space to express the need to move on, and can provide a supportive way to create a more positive ending.  It can also be used to help couples discuss and communicate issues arising around practical issues involved in a separation or ending of relationship.

My partner won’t change OR  My partner will realize what they are doing and will change.

Just like people, relationships can change. Partners in the relationship have the option to make individual changes that are healthier for themselves, as well as options for individual change that benefit the relationship.

— Therapy provides an option for each person to examine their role in the relationship and decide what they would like to change —

Partners may be tired of their role and would like a more balanced relationship.  Therapy facilitates this discussion, as well as the option for how to enact these changes.

My partner won’t listen to a therapist.

Couple’s therapists support you and your partner(s) to express how you are feeling, what you want and to help you find the language and actions to get there.  The therapist helps create a healthy and constructive discussion by introducing skills and techniques to aid the relationship goals.

— It is not the role of our therapists to tell a person what to do to change —

Rather, the therapist facilitates the opening up of the person’s experience so they can explore themselves.  In situations where one person in the relationship is not willing to engage in therapy, it is difficult to help resolve the issues in the relationship.  The therapist will address this with you and decide whether this type of therapy is productive and what other options exist for support for the individuals involved.

The therapist won’t really see what my partner is doing.

In a professional setting, therapists get to know your relationship and you.

— Safe place —

The therapy rook becomes a safe place for each partner to express their perception and feelings of what is going on.

The therapist will help us get back to the way we were.

You may recall happier days earlier in the relationship and have a strong desire to get back to those positive feelings.  If you and your partner(s) are working to develop a healthier relationship, then what you reflect, explore, and practice in couple’s therapy may improve the relationship dynamic and how you feel about each other.

— Going forward —

We like to think of going ‘forward’ with new skills in a more developed, rich relationship, than ‘backwards’ to a time when you might have had fewer coping strategies.

More information can be found here: Couple’s Therapy at Dr Thaddeus Birchard & Associates for Psychological Therapies

For further questions or assistance, please contact us on 020 7224 3532 or send us an e-mail at 


Sex Addiction, the Twelve Steps, and Therapy

Timothy D. Stein, MA and Patrick Carnes, PhD. present us with their summary of the chapter 4.4 Sex Addiction, the Twelve Steps, and Therapy of the Routledge International Handbook of Sex Addiction.

Rex had consistently avoided 12 step meetings.

When he reluctantly walked into the room for the first time, he found a room of men who shared his struggle. He listened to readings, hearing numerous phrases that described his pain, his fear, and his situation. He heard men share their experiences while others nodded their heads with understanding and support. He realized that no one at the meeting was interested in who he was outside of the room. No one was interested in “outing” him or his behaviours. Instead, they were focused on changing their lives and helping others do the same.

During the meeting, Rex mustered up the courage to share his struggle with pornography and masturbation. He talked about his desire for things to be different. He talked about how he had tried to “control” and “manage” his life unsuccessfully. And then, when he started to talk about his wife and kids and the impact his behaviour had on them, the walls came down. Tears streamed down his face. His voice cracked. His words came out in choppy and difficult to understand bursts. He dropped into the pain he had been avoiding for so long. The facade he had unconsciously created decades earlier, to show the world a strong, capable, successful, handsome, “got his shit together” image of a man, cracked.

The men in the room created a safe place and allowed Rex to be vulnerable. They became his community; the community that helped him stop isolating and open up to a solution larger than himself.

Rex’s therapist took advantage of the acceptance Rex began to feel in his new community by integrating the principles of the 12 steps as a way to create traction in Rex’s therapy. She supported Rex’s 12 step work and used it as a springboard into the deeper issues and patterns in his life. She was able to intertwine the work done in therapy sessions with the 12 step work Rex was doing in the recovery community, and this intermingled process of recovery became a gestalt, a process for change larger than the sum of its parts.

The steps do not focus on stopping the problematic behavior.

Instead, the message embodied in the 12 steps is that by focusing on something larger than yourself and trusting something larger than yourself, change and healing can happen. In fact, the only step that mentions the behavior is step one, and then only to admit powerlessness over it. Steps 2 through 12 do not mention the addictive behavior or even an attempt to stop or change the behavior. Instead, those steps focus on spirituality; they guide addicts into connecting with their Higher Power and allowing that Higher Power heal them.

Because of this, the 12 steps are often referred to as a spiritual solution to a behavioral problem. Carl Jung, the well-known psychiatrist, influenced this idea. In correspondence with one of the co-founders of AA, Bill W, he suggested that an alcoholic’s “craving for alcohol was the equivalent, on a low level, of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God” (Jung, 2001).

Critics sometimes cite a low percentage of consistent sobriety by members of 12 step groups as evidence that they are ineffective. However, research that culminated in the book Don’t Call It Love (Carnes, 1991) shows that the 12 step process is a significant piece of the long-term sobriety puzzle. According to this research, sex addicts who have the most success with sobriety have a number of factors in common, three of which are:

  • They worked with a primary therapist
  • They were involved in group therapy
  • They attended 12 step meetings.

More recent research also supports the 12 step model of treatment. Hartman et al. (2012) tell us those sex addicts in residential treatment who also participate in 12 step programs show improved sexual impulse control and self-reported quality of life at six months follow up. Plus, they are more likely to attend aftercare. While there currently is a paucity of research in this area, these studies show that incorporating the 12 steps as an adjunct to therapy can lead toward positive client outcomes.

In the 1970’s, problematic sexual behavior was hitting a saturation point, and 12 step organizations addressing this issue started to spring up. Currently, active “S” programs include Sex and Love Addicts Anonymous (SLAA), Sex Addicts Anonymous (SAA), Sexaholics Anonymous (SA), Sexual Compulsives Anonymous (SCA), and Sexual Recovery Anonymous (SRA). These programs have adapted the 12 steps of Alcoholics Anonymous so they can address problematic sexual behavior rather than alcoholism.

Step work and therapy are both powerful processes.

Rob Weiss, a noted sex addiction expert, has said, “The 12 steps are where I grew up. Therapy is where I went to school” (Weiss, 2012). With an understanding of the 12 steps, weaving 12 step ideas into therapy is only limited by the therapist’s willingness to discuss these concepts and their creativity.

In chapter 4.4 Sex Addiction, the Twelve Steps, and Therapy of the Routledge International Handbook of Sex Addiction we highlight a variety of ways step work can be integrated into therapy.  We also discuss significant milestones that sex addicts in recovery will face during their step work and explain how therapists’ awareness of these milestones can be beneficial to their clients’ recovery and work in therapy.

About the Authors: Timothy D. Stein and Dr Patrick Cranes

Timothy D. Stein, MA, is a well-known expert in the field of sex addiction. His work as a clinician, lecturer, consultant, supervisor and author keeps him on the cutting edge of sex addiction treatment.

Tim is a regular presenter at national and international conferences and is dedicated to offering information, providing clinical and recovery guidance, and advocating for the understanding and treatment of sex addicts and their partners.

Tim’s professional life is guided by his passion to heal the lives and relationships of individuals and families impacted by sex addiction. Through his writing, lecturing, and clinical work, Tim strives to help those impacted by sex addiction to find self-love, emotional resilience, integrity and joy in recovery whether this is through personal insight or information and tools Tim provides to other professionals.

Tim is a co-founder of Willow Tree Counseling in Santa Rosa, CA and was integral in the development and evolution of their treatment programs for sex addicts and partners of sex addicts.

More information can be found on his website

Patrick J. Carnes, PhD, is an internationally known authority and speaker on addiction and recovery issues. He has authored over twenty books including the bestselling titles Out of the Shadows: Understanding Addiction Recovery, Betrayal Bond, Don’t Call It Love, The Gentle Path Through the Twelve Steps and The Gentle Path through the Twelve Principles.

Dr. Carnes’ research provides the architecture for the “task model” of treating addictions that is used by thousands of therapists worldwide and many well-known treatment centres, residential facilities, and hospitals.

More information can be found on his website


The Role of Sexual Fantasies in Sexual Addiction

I take the view that the mind comes equipped with many profound and ingenious resources which are partly the endowment of evolution, whilst also referencing metaphysical realities that pass beyond our current understanding. These latter may always elude our primate cognitive capacities, and therefore I do not believe that what we cannot now understand must eventually succumb to the overweening methods of science. Epistemological modesty therefore allows me to make provisional judgements about what is real, and for me this includes the products of the imagination understood symbolically, and a superordinate Self that offers us the opportunity to experience an intimation of wholeness via individuation. For me, a dialectical, intrapsychic relationship between consciousness and the unconscious promotes the journey of individuation, but this rests on successful experiences of relationship in our developmental years. It is also effortful. Without the cooperation of consciousness in the form of reflective functioning – an achievement for many of us, the unconscious mind may simply offer us analgesic strategies for our dysphoria, enabling us to tolerate our arrested developmental teleology, to ‘tread water’ while the universe waits.

Sexual fantasies and even sexual acting-out may begin as analgesic, but compulsive recourse, and a developmental imperative, ultimately make them empty and painful activities. Those who question the concept of an endogenous developmental imperative may ask folk who have spent their whole lives disappointing themselves and others why they have been disappointed. Discarding the trivial social constructionist answer that there must be a failure to socially conform and thus gain the approval of convention, we are left with something more profound and yet inspiring. There is a direction of travel; Jung called it individuation.

Part of the thesis in my chapter The Role of Sexual Fantasies in Sexual Addiction is an exploration of what, developmentally, blocks the meta-cognitive level of functioning. The research of Dutra et al (Lyons-Ruth) 2009 on pathways to dissociation showed that ‘small t’ relational trauma, for example a lack of positive maternal emotional involvement and poor communication, without the abuse associated with disorganised attachment, is also associated with dissociative symptoms. Of course, some sex addicts may have experienced abuse, but the Lyons-Ruth research appears to describe the aetiology of fearful-avoidant attachment, a developmental disturbance suffered by the majority of sex addicts (Zapf et al 2008). So Bancroft’s (2008) observation that sexual addiction often seems to involve dissociative states may be corroborated through this connection.

The distinguished Jungian author Jean Knox follows a similar trajectory in her 2005 article on sexual fantasies. She erects a framework of levels of self-agency, with the highest levels representing meta-cognitive and meaning-making processing. For her, the role of sexual fantasies is to rescue the vulnerable and relationally wounded – perhaps shamed, conscious self from painful awareness of dependency and relationship needs. She speaks of this process as eliminating reflective functioning and as a ‘defensive attempt to become mindless and so to eliminate a separate identity and sense of self, with the accompanying need for a loving relationship’. Another effect is to inhibit the dialectical relationship between conscious and unconscious, the meaning-making function Jung called the ‘transcendent function’. For me this is dissociative, but rooted in developmental relational deficits and disturbances.

I further explore in my chapter the Winnicottian idea of the ‘mind object’, a false-self constellation that is used to displace mother’s care, or lack thereof. Corrigan & Gordon (1995) assert that the mind object ‘is an omnipotently created object always available for mastery and control of internal objects so that dependence and the feelings it generates – anxiety, frustration, anger and envy – can be obliterated’. Again, a dissociative manoeuvre. Winnicott saw the false self as a defensive process emerging from relational and other forms of early trauma, but all is constructed from internalisations of primary object relations. For Jung, and the brilliant Donald Kalsched, whose books bring Jung into our contemporary world, there is a mytho-poetic inner world ‘just as primary, just as foundational, as the infant-mother relational world through which it is (usually) transformed’ (Kalsched 2013, p. 269). I have personal experience of the truth of this. This opens up the transformative possibilities of our unconscious minds, that transpersonal realm. But for effective communion with this pre-existing part of ourselves we need a paradigm of successful relationship gained through external connection and love. Therapy beckons where early attachment has been disturbed. Otherwise, the resourceful mind will help us to dissociate from what we fear may not be available.


About Richard Newbury

Richard has considerable experience as a supervisor for Relate and more recently he has worked as Clinical Lead for a branch of Mind. His interest in Jung stems from a long Jungian analysis and the success of Jung’s ideas in his own life and work. His focus on sexual addiction arises from working with Thaddeus Birchard to treat sufferers, as well as an admiration for Thaddeus’s books.