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A broad theme in the research was that of what the participants

considered to be successful couple therapy. On further reflection and study of the

data it seemed clear that there were two interconnected themes here, one being

what the elements in successful therapy were perceived to be, and the other being

what the therapists took to be involved in the change process.

1) The elements of successful couple therapy

WCI5 found that openness and a safe environment were the elements of

successful couple therapy. In the role of the therapist, she would “facilitate the

couple being honest and open about their past and their hurt in order to establish a safe secure place for them to express their fears.” She went on to say that showing

appreciation of their openness and truly honouring it sets them on the road to

progress. She felt that their courage, sharing and opening up deserved the best

attention and led to the most effective outcome.

“I encourage them since it is very courageous of them to come and open

up. They share some deep things with me, intimate things. I am aware that it is quite hard to share some deep intimate things. I appreciate their openness and make sure that I am honouring them and their openness [Appendix 16].”

WCI5 also added that a therapeutic bond was very important for the couple to work

at their issue together. She stated the reason for that:

“Because without that therapeutic bond they won’t come back or work at

it together. Nor will they facilitate their own healing unless they see the importance the therapist places in them [Appendix 16].”

“Regarding a therapeutic bond, I use the elements of reflecting back and

understanding their situation to validate them individually and as a couple. I normalise their life stage and say normalising is common. I avoid making them feel they are weird normalising things and their situations. Validating them as individuals and reflecting back what I understand allow them to know that I understand and I am with them [Appendix 16].”

WCI15 gauged successful couple therapy by noting what the situation

was when the couple came into therapy. She evaluated and explored where the

couple were at the given moment, reset goals, and planned a session to look at

where they had got to up to that point.

“Obviously, therapists use their own judgement of people making progress.

I ask the clients for a feedback since they are the ones committed to coming to sessions. They need to confirm whether they are making progress, think this is going well, and whether they are getting better at it. The other fact is that people may not always complete therapy [Appendix 12].”

WCI15 also stated the importance of being realistic with the couple from the start.

Therefore, her first session focused realistically on what the couple were hoping to

achieve from coming to therapy.

“The end goal must be realistic. It is always about being realistic with the

clients and having sufficient motivation as well. The therapist should always ask the clients in the first session what they are hoping to achieve from coming to therapy. Then the therapist works on that with the client and determines whether or not it is realistic [Appendix 12].”

If clearly understood goals were not mutually identified, disappointment could

follow for the couple:

“The elements of it being successful couple therapy are determined by

what the couples think is successful. That can vary. I may feel the couple has moved on and achieved a lot. They do not think so. They have not achieved what they thought they were going to achieve. That is when people set unrealistic goals. The thinking on being successful is very individual. It is very important for those engaged in the process to keep evaluating as they go along. The therapists have to rely a lot on the feedback they get from their clients [Appendix 12].”

The successful element that they could achieve was clear to WCI15. Thus, she

explained to the couple why their unrealistic goals would not work. Then she had

to offer them alternatives that could be negotiated.

“The couple want to achieve A, B, C. The therapist thinks there is no

chance of that happening. She is very honest with them, expressing some of the reasons, why they might not be able to do that. She thinks they could take D, E, and F. That is negotiation. There are a number of elements involved in what is successful or not. The outcome would be what the couple thinks is successful. It might not be what they thought would be the outcome. Some couples are just not compatible. They cannot forgive adultery, for example. No matter how they try to work it out, one of them in the relationship just cannot. Some people feel happy that they did their best to try everything to work out the issue. It can be more helpful for people to come to the right conclusion [Appendix 12].”

Other therapists offered differing perspectives. WCI16 clearly stated the

necessary components of successful couple therapy:

“The most important thing is that they both want to be there. Both must

want to be successful in reaching the goal. Both must have the same level of commitment. It does not work when one of them really wants to do their homework and the other partner could not be bothered doing it [Appendix 11].”

WCI13 felt that a good relationship between the couple and the therapist

was very important.

“I think the most important thing first of all is that they have a good

relationship with the therapist. That is the most important and I think it is being shown in surveys. They have to trust the therapist. The most important thing is that the client-therapist relationship has to be good. That is the most important thing for successful therapy. That is the first thing. After that once you have established trust and their motivation is good, one or other might not want to be there. But if the motivation is good, then it doesn't really matter what approach you use as long as the therapist is skilled and the client wants to do some work and change, then any approach I think will help them. Because what the therapist is trying to do is just to get a different handle for them. There are difficulties there that they are having, and the therapist helps them see the problems in a new light and in a more positive way [Appendix 14].”

WCI14 prized flexibility and a good therapeutic relationship as the key to

successful couple therapy. There had to be flexibility in the sense of being

broadminded as well as flexibility in the use of tools when theoretical approaches

were applied to the couples. She found that it was important to maintain an open

relationship with the couple, as they could have been conscious of the power of the

counsellor, who was ‘the expert’.

“It is being flexible in the mind, in which tools to use, and in terms of

theoretical approaches, according to the couple. It is also very important to maintain an open relationship with them. There is the implication that they are paying to see an expert. This fact gives the counsellor or therapist sufficient power and it should be acknowledged. Keeping that in mind, the therapists should be open enough to question whether the work they are doing is useful for the couple they are working with. Taking that on board and maintaining the proper relationship, it is not just a case of the therapists giving the couple something. The latter also have to engage in the process of work and change. It is of paramount importance to maintain a very good therapeutic relationship with both of them [Appendix 13].”

MCP9 agreed with WCI13 and WCI14 on the need to establish good

relationships with both of the couple to allow for the different points of view

expressed. MCP9 established a good relationship and offered a safe space for the

couple to express themselves as fully as possible.

“I need to establish relationships with each of them and with their

‘relationship’, using the six conditions. When I contract, I explain I am there for their relationship, and will try not to take sides, nevertheless recognising that they probably have very different points of view. I offer a safe space for them to express their feelings, stories, points of view etc; the person talking has themselves as the primary audience; then their partner and me [Appendix 15].”

WCI32 emphasised working with the partners in the same room and the

motivation of both of the couple.

“In my experience certainly, being able to work with the partners in the

same room is extremely helpful. It is also helpful if there is a degree of motivation to succeed on both parties. It is going to be very very hard if

one of the couple has almost completely closed it down. But there is a good chance when both parties are motivated to try and make it work [Appendix 10].”

This section has shed light on some of the different ideas about the

elements of successful couple therapy. Firstly, an element of successful couple

therapy is openness in a safe environment. For the couple to be open, honest, and to

feel safe, it is the therapist’s responsibility to establish the environment that is conducive to where they can feel secure and able to express themselves freely.

Some therapists believe that some questions, and the genogram3, can be the tools to

help the couple to open up. Secondly, the therapeutic bond is central: without it the

therapist cannot work with couples. Some therapists believe that trust in the

therapist is basic to successful therapy. As long as trust is established and

motivation is good, any approach works for them. Thirdly, goal setting is an

element of successful couple therapy. It is important to make a realistic goal with

the couple from the start. In the first session some therapists focus realistically on

what the couple are hoping to achieve from coming to therapy. Lastly, the effort

made on the part of both of the partners is an element in successful couple therapy.

For couple therapy to be successful both partners of the couple must be willing to

be present at the session. Both must want success in attaining the goal. Both of

them need to be equally committed to the session and to put their best effort into

doing their homework.

3 _{Murray Bowen first proposed the word ‘genogram’ in the 1970s as a replacement for the longer}

term ‘family diagram’ being used in his work to plot an individual’s family background. McGoldrick and Gerson (1999) developed and popularised genograms, and they standardised the symbols used.