Co-Therapy: Expanding Couple Therapy from Triangle to Square; Structural and Dynamic Advantages

For the past decade, we have enjoyed a unique experience – working clinically with couples, as a couple; a therapeutic team.

We have each enjoyed significant success and personal satisfaction working individually with couples. Still, since deciding to work together in the four-person format, we have concluded without question, that our co-therapy model offers consistently superior clinical outcomes.

We have identified a number of structural and dynamic elements present in our model, which, we believe, offer compelling support for this conclusion. Through our experience, we have determined that these elements serve a more broadly-based, more expansive therapeutic structure, and generate more possibilities for clinical intervention than the conventional single therapist model can achieve. We believe this to be the case, no matter how skilled or energetic a given single therapist may be.

Our model operates as follows:

Sessions are alternated between the four-person format (clinical "square") one week and two parallel individual sessions the following week. Periodically, this schedule is modified to allow two (or on rare occasions three) consecutive couple or individual sessions, should clinical issues warrant such an approach. These occasions may result from therapist direction or suggestion, or from client request. Consensus for such modification is always sought, and, to date, always achieved. This alternating and overlapping structure ensures that each individual, and the couple, benefit from direct and informed clinical attention – separately and together.

"Overlapping" and "informed" in this context refers to the fact that each individual therapist carries clinical knowledge and awareness of his/her in dividual client to the couple sessions, and clinical insight regarding couple dynamics and issues to the individual sessions. At the same time, each individual client has their "own" therapist, not a "shared" one. The couple also has their "own" therapist – the clinical team, collectively and individually, within the four-person format.

Broadly stated, individual sessions are reflective of universal therapeutic structures and goals such as: confidentiality, trusting therapeutic alliances, individual sovereignty, accountability, authenticity, and self-reliance. These one-to-one therapeutic relationships manifest in the couple sessions as caring support and challenge in advancing individual concerns in a couple context.

Other foundational structures and goals of the couple sessions include: honesty, open communication, assertiveness, effective confrontation, vulnerability, and risk taking and...

A third therapeutic alliance.

We have determined that these mutually reinforcing and over-lapping alliances offer profound structural integrity and safety for the clients. Indeed, this structural integrity is such that we consistently experience dramatic and substantial therapeutic growth from within this framework.

The following is a summary of the advantages of our model which explain why there is a higher level of success using co-therapy than using the traditional single-therapist model of couple therapy:

Advantages of Co-Therapy for Couples

Co-Therapy provides enhanced structural equality and dynamic energy to any couple therapy regime, specifically:

  1. Any given interaction in co-therapy consists of two participants and two observers, eliminating feelings of isolation and marginalization – "triangling" – an on-going possibility in the traditional single therapist format. Also, both genders are equally represented in the 4-person constellation – eliminating a possible sense of triangling based on gender.
  2. A functioning couple is present in the therapeutic team – providing on-going modeling of individual and relational health to the clients. In terms of conceptual therapeutic models that incorporate "re-parenting" as an essential element, which includes our model, both "parents" are also fully and immediately present.
  3. Four individuals – two clients, two therapists generate exponentially more dynamic energy than the traditional three-person format. The structure of the therapeutic "square" frames and mobilizes this energy from within a more inherently equitable formation than the traditional "triangle".
  4. One therapist is actively directing/managing the session at any given time; the other is thus an active clinical observer with the advantages of immediate proximity... and subsequent active engagement founded on these observations. Therapist roles alternating in this way maintain and enhance sessional continuity, focus, and momentum. This advantage becomes especially obvious within a clinical intervention dynamic such as "heightening". A related advantage is the on-going capacity of the observing therapist to attend to shifts in body language, facial expression, etc. – in both clients – that would be more difficult for a single therapist to attend to.
  5. Two therapists are available to manage sessional crises that may arise. We have experienced such crises rarely. When they do occur, the presence of the second clinician, in silent support, has been enough to diffuse them. More active support is, of course, available.
  6. The potential for therapist burn-out/compassion fatigue is dramatically reduced.
  7. Individual sessions, whereby the team of four breaks into two teams of two, ensure that all three entities inherent in the couple relationship – he as individual, she as individual, they as partners – receive direct and informed clinical attention, separately and together.

Originally, individual sessions were structured exclusively based on gender – he with he/she with she. We soon determined that this was too restrictive. Any number of other considerations – clinical, intuitive, client preference etc., are now incorporated into the decision-making process.

Bob West and Lorraine Jaksic are both practicing psychotherapists with Abundant Living Counselling, a group of seasoned counsellors, psychotherapists, social workers and other mental health allied professionals in Ottawa, Canada.