[00:00:00] Have you ever found yourself sitting in a couples session thinking, am I helping? Should I interrupt? Do they want me to take sides? Maybe you’ve had moments where you feel more like a referee than a therapist. Just trying to find the moment to interject and just calm things down. For those who do couples therapy, who work with couples and families, you know that couples work is hard.

Hello and welcome to Inside Social Work. I’m your host, Marie Vakakis accredited mental health social worker, couples and family therapists, podcaster and trainer. On this podcast, I go behind the scenes of different areas of social work practice, messy, meaningful human parts of the job that we don’t always get to talk about from clinical work to community-based practice.

I’m gonna dive into the moments that challenge us, stretch us, and sometimes surprise us. And couples work definitely has a lot of those things. In today’s episode, I’m talking about working with couples without getting caught in the [00:01:00] crossfire. This conversation was originally featured on the Mental Works Podcast with Dr.

Bronwyn Milkens, and I thought it’d be a really good one to share with you. On the Inside Social Work Podcast. We unpack what actually goes into couples therapy beyond communication skills and conflict resolution, things like how to structure your session so you’re not just reacting to the loudest person in the room.

How to manage power dynamics ruptures, and the pressure to fix something that’s been unraveling for years. We talk about how important it is to slow down, assess thoroughly and hold space where both people can feel seen and heard, even when their needs and narratives are totally different.

We also get into some of the trickier stuff. What happens when one person is clearly dominating the room? How do you deal with clients who are already on the verge of separation and what do you do when you are feeling that emotional pull into their dynamic? There’s plenty of practical discussion too, how to use Gottman informed tools like the sound relationship house and the card decks.

How to approach sexual desire, [00:02:00] discrepancies with compassion and clarity and why. Talking about the talking is often the most therapeutic thing you can do. We also reflect on some of the emotional toll of this work. Why working with high conflict couples can be activating how to take the pressure off yourself and the value of good supervision, and knowing your limits, whether you’re new to couples work or avoiding it all together.

Maybe you’re trying to build more confidence in the space. I hope this episode gives you some tips and tricks and some ideas and things to think about.

And if you’re interested to learn more about couples therapy as a process, check out my podcast This Complex Life. I did a whole series where I interviewed different couples, therapists, and we talked about sex and relationships and all of that. , All that stuff. You’ll find a link to that in the show notes as well.

I hope you enjoyed this episode that was originally featured on the Mental Works podcast, and now is on inside social work.

Bronwyn: Hey, mental workers. [00:03:00] You’re listening to the Mental Work Podcast, your companion to early career psychology. As always, I’m your host, Dr. Broden Milks, and today we are talking about working with couples. When you work with couples, you are really helping clients to build healthy relationships, and you might be seeing couples at the start of their relationship or at the very end, and everywhere in between, there can be lots of conflicts.

Also lots of insights and it can be a very rewarding area to work in. I reckon It’s an area that every psych should be aware of as clients frequently present with difficulties in their relationships, even in individual therapy. So it’s good to be aware of what happens in couples here. To help us unpack everything is our return guest, Marie Cus Hi Marie.

Hello. Thanks for having me back. My pleasure. It’s such a delight to have you back. And Marie, could you please remind listeners who you are and today’s question is. What famous person would you love to meet? 

Marie Vakakis: I think very topical. Preparing for this, uh, this [00:04:00] topic today. I would have to say as cliche as it is, a bit of a draw between maybe Brene Brown and Esther Perel.

Oh. Um, thinking about two really strong women who embodied this sense of vulnerability and authenticity, maintain boundaries. It kind of forced us to be reckoned with, but not in a, in a way that we might’ve expected someone to be so impactful. I really think I’d love to meet them and be around them. Uh, I remember seeing Esther Perel in her life, um, like as q and a workshop or whatever you call it, and just such a captivating person.

And I, I just think you’re really cool. 

Bronwyn: No, that’s a great suggestion. In my mind, I’ve just got, I wish we could sticky tape them both together and then I could just see them both and not have to choose between. And could you remind listeners who you are? 

Marie Vakakis: Yeah, so, uh, my name is Mariva Carcass. I’m an accredited mental health social worker and couple and family therapist, and I like to work a lot with [00:05:00] that intersection between mental health and relationships.

So I started off very kind of clinical mental health, uh, very medical model, diagnostic sort of treatment based. And as I moved into more family therapy and systemic work, I started to have a real appreciation for relationships and interpersonal skills and that connection. So. I still work a lot with individuals and I consider them within their system.

And then I do some kind of couple and family work as well, 

Bronwyn: I guess out of 100, what percentage would you say is couple work for you? 

Marie Vakakis: Probably about 40%. 

Bronwyn: Oh wow. Cool. So let’s get into it. So what’s gonna happen is I’m gonna read out a case study and then we’re gonna unpack and just deep dive into that.

Sound good? Sure. Sounds great. Awesome. So the case study today is with Mark and Emily. Mark is 40, Emily is 38. They’ve been married for 10 years and they have two children, age eight and six. Mark works as a financial [00:06:00] analyst, and Emily is a teacher at a local primary school. They’ve always considered their relationship to be strong and supportive, but recently they’ve been experiencing some challenges that have led them to seek couples therapy.

Their relationship has undergone some changes over the past year. Mark’s demanding job means that he’s been working longer hours and traveling frequently. Meanwhile, Emily has been juggling her teaching responsibilities with caring for the kids. With Mark’s increased workload and time away from home, tension has been building between him and Emily.

They find themselves arguing more frequently, often over trivial matters, and AMLO feels overwhelmed and unsupported while Mark feels unappreciated and frustrated. Emily’s perceived lack of understanding about the demands of his job. Another source of tension in their relationship is their sexual intimacy.

Mark expresses a strong desire for physical closeness and sexual connection with Emily, but she often feels too tired or preoccupied with other responsibilities to want to engage, and this has led to feelings of rejection, insecurity for Mark, [00:07:00] and guilt and pressure for Emily. They’ve come to therapy now ’cause they recognise that their attempts to address these issues independently have been unsuccessful and they feel really stuck from therapy.

Mark and Emily really want to improve their communication and address sexual intimacy so that they can have mutually satisfied solutions there. And that’s the case study. 

Marie Vakakis: Wonderful. Where, where should we start? What are your questions 

Bronwyn: very Esther? Yeah, so Mark and Emily, they’re experiencing increased conflict, so they’re not communicating as well as they used to.

And they’re also got some discrepancy in their sexual desire. Mark really wants some intimacy. Emily doesn’t feel like she’s able to provide that. And I guess maybe the first thing I’m wondering is how common is this presentation? 

Marie Vakakis: Very and. It’s, it’s probably one of the, the big reasons that people seek out couples therapy is increased conflict, and one of those areas of conflict tends to be sexual [00:08:00] desire or sexual appetite within the relationship.

But I think because of the, the listeners are people who maybe are interested themselves in. Attending couples therapy or might be referring to couples therapy. Yeah. I might sprinkle in some of the, sort of the stats and the research to kind of help people know a little bit more. One of the things with conflict is we know that and through the Gottman research, um, so those who aren’t familiar, the Gottman Institute has some really great resources and has a training, um, modality called the Gottman Method.

Their research has shown that about 69% of. Problems in a relationship are what we call perpetual problems. So there are things that might not, they might never go away, and conflict in itself is inevitable. Even if you lived with your identical twin, who is literally got the same DNA as you, you’ll have conflict.

So just two people being together are going to have conflict. So that in itself is not a bad thing. It’s how it’s resolved, how it’s [00:09:00] handled, how it’s repaired, that are really big factors in, I guess, relationship satisfaction. And then there’s also the absence of fun. So they’ve done some research where they looked at FOD and admiration and building kind of connection and conflict, um, management skills or tools.

And what they found is if you just focus on conflict. You’ll get some improvement. If you focus on both conflict and relationship building and that fun stuff, you’ll get really good improvement as well. And the same amount of improvement of just focusing on the good stuff. Mm. So sometimes we don’t need to just focus on conflict resolution.

We also need to build in some of the fun stuff as well, that friendship. 

Bronwyn: I assume that’s something that you might tell clients as well. So they’ve come in being like, okay, we just need to disagree with each other better and manage that conflict. But it sounds like something you’d be saying to them is like, but you also need to have more positive interactions with each other.

Marie Vakakis: Yeah, absolutely. And I, most of my [00:10:00] training in couples work is using the Gottman method. So I would schedule in a session and I, I explained to them at the start. The first kind of four sessions is really an assessment. So just like if you went to the doctor and you said, my stomach hurts, and if the doctor didn’t touch it, didn’t look at it, didn’t ask you anything else, like, you know what, I know it’s gonna fix that and just kind of jabbed you with a needle.

You’d be like, what the, what are they doing? Yeah. And, and, and that’s why I like the Gottman method. Those first few sessions really forms a really solid assessment process that you can really get into some of the areas of conflict for the family for the couple. They’ve got a framework, a kind of assessment framework that they use as well.

So I would say the first four sessions were unlikely to get change. I’m actually just trying to understand what’s happening for you and being really directive around, I’m gonna, you know, take note of that, or I’m gonna park that. That’s bring it back to what, what I need to do is really get to understand the problem, where it started, what your strengths.

[00:11:00] I also wanna know their history, what uh, shapes their ideas of a relationship, what it was like when they first met, what are some of the early challenges they face. So it’s really kind of thorough assessment process. And then we would kind of bring that back and say, okay, what are your thoughts? What’s been coming up for you?

What are your areas of priority? This is why you said you first came. Here are some of the things I’m noticing. And then I would bring in those psychoed bits if that’s an area that it feels relevant to them. 

Bronwyn: I’ve heard that retention is really hard for couples therapy, and I can understand this, and even in.

My experience working with individuals, they might have seen a couple’s therapist and a frequent thing they’ll report to me is like, oh, but my partner didn’t like the therapist, so we’re not going back to see them. I’m wondering, is it, is it true that retention is hard for couples? And if it is, like, how might you address this?

Like, do you tell them like, give me four sessions? 

Marie Vakakis: I, I [00:12:00] do. Um, like, I had a, a, a session, um, prior to this recording where that was, that’s the spill. I’m like the first session. Is very structured. Then I meet with you each individually. I give you a at home to fill out questionnaire. Then we come back together.

So really it’s, it’s setting up really clear expectations, which I think gives you better, better chance of those good therapeutic outcomes. So it’s in that really clear communication. It’s saying, this is how I work and this is how I do it. And that starts for me personally, from before they’ve even come to see me.

It starts with what’s written in my bio on the website. What’s written underneath couples therapy, what’s in our intake paperwork, what admin talks about in the first sort of point of contact. And then I reinforce that. So really someone’s not coming in thinking, what are we gonna do? Are we gonna have like rubber battens and be, you know, whacking each other like in an old Simpson movie episode?

Yeah. Um, is it gonna just say, let it rip and we yell, um, is this person gonna referee our arguments? So [00:13:00] it’s really containing and saying, look, this is what it might take. Prescribing that and saying, you know, you’ve been having these problems for X amount of years, they’re not going to just resolve straight away, this is what it’s likely to, the change we’re likely to need.

Um, or the frequency of sessions to get the change that you desire. And that can be quite confronting. ’cause I think some people hope that the therapist will tell their partner how wrong they are. 

Bronwyn: Yeah, that sounds like it would be a hope. Yeah. I mean, so that brings up for me, I’m like, what if one member of the couple feels ganged up upon, and they’re like, okay, therapists deciding with them, I don’t like this.

Is that something you address in the process or is that something you tell them explicitly? 

Marie Vakakis: It’s, it’s both. It’s like with any relationship with a client, it’s sort of you’re checking in and you are using what’s happening between you. As, uh, a therapeutic intervention. So I might be able [00:14:00] to interrupt and I, I would ask permission and I would structure that from the start saying, look, this is quite a, um, engaged process.

I might interrupt you at times. I need to keep us on track. And I might then say, look, I just need to interrupt you there. I might look at the other person and say, I feel like I’m losing you right now. What’s, what’s happening? And, and also being honest saying you both might not. Like me and that’s okay. I can refer you to someone else or if it’s something I can adjust.

We might have some sessions where we talk a bit more about what’s happening for one while the atna is hold other’s holding witness to it. So it’s, it’s whatever you do, having some clarity around that and ting that and talking about that with the couple. So if we go back to someone like Mark and Emily.

There might already be preconceived notions of what they’re coming into thinking based on maybe my, my gender or my age, or if I have kids or not have kids, or who am I gonna side with? So we can overt some of that stuff if it feels relevant and useful. 

Bronwyn: Yeah. Cool. [00:15:00] Is there anything else that you might do in introductory session or in the first four sessions when you’re assessing really deeply?

So I’ve gotten that. You’ll see them together, then you’ll see them separately, and then you’ll come back together. You’ll set the expectations from the start even before they come to see you. Is there anything else that you think is important? 

Marie Vakakis: Yeah, so, um, the Gottman method quite has quite a structured approach.

So there is like an oral history interview, so we are looking for. Uh, their story, how they met, and then even in the way they respond to things, we are, look, that’s part of the assessment. So we’re looking for, can we see fondness and admiration? Can we see perspective taking? How do they talk about their past?

Do they have shared value? So some of those aren’t explicit questions. It’s through observation of how those other things are being spoken about or answered that you get to observe. Some of those patterns or interactions or kind of areas for intervention. And [00:16:00] so I’d be looking for all of those things and sometimes I just let things kind of unfold because if a fight comes out, if someone’s like, no, but that’s not what you said.

And that’s, and I might let that go for a little bit because the benefit, one of the many benefits of, of couples work that I don’t get an individual. ’cause I get to see what’s happening. Live, 

Bronwyn: yeah. 

Marie Vakakis: Rather than just one person’s perspective of it. So I can see that as, I guess more, um, information to kind of keep informing my, my work with them.

So I might let that sort of play out for a few minutes and then sort of see what happens. Is one person flooded as one person withdraw? Do they go towards criticising, like, I, I kind of let some things play out. And then I can check in and see, is this what happens at home? Is it a bigger response, a smaller, like it’s really good live.

Information. And I joke sometimes that I want to do I IKEA therapy where I buy some sort of [00:17:00] flat pack furniture and I set it up in the room and the couple walks in and I’m like, okay, today’s assessment is to put this Billy bookcase together. And I just, I really wanna see how people, how do they do that?

How do they resolve conflict? How do they cooperate as one per like, and I really think it would be quite a funny, 

Bronwyn: uh, intervention. I think it’d be great assessment like. Whenever I set up IKEA furniture or the like with my partner and we do it successfully, I’m like, we just like climbed a relationship mountain.

Like I do feel like it’s a real test. 

Marie Vakakis: Yep. So ikea, if you’re listening and you wanna sponsor some research into this, uh, method of therapy, hit me up would be great. Look, 

Bronwyn: I’m surprised I haven’t done it already. It’s genius. 

Marie Vakakis: You heard, you heard it here first folks. Yeah. 

Bronwyn: Pattern pending. Marie with that, what if you see a live argument and then through that, I’m not sure if this is what you see in chlorine projecting.

I’m probably projecting, but what if you are thinking, you’re like. Emily’s the problem. I can see this. She is calling him names, she’s [00:18:00] putting him down. She’s not listening, she’s not perspective taking, Mike is doing everything right here and like how do you, how do you deal with that when one partner is like air quotes the problem?

Marie Vakakis: I have, I’ve yet to find it be the case where one person is solely kind of the problem. Because even if, if they were always like that, then the other person still chose them. Okay. So they made an active decision there. But often it’s if that person is really heightened or if we’re working with someone who’s got, you know, quite a, a mental illness, that’s quite impactful.

Think something like borderline personality disorder that might require extra sensitivity and. Not alienating either of them. So it would be really, I would be able to be in a position to notice, whoa, there’s a lot of pain behind what you’re saying right now. And I wanna just remind you, we’re trying to say it in a way that doesn’t come across as criticism.

So could I get you to redo it? Blah, blah, blah. So I might have a [00:19:00] script. We would have a, a, maybe a role play or I might paraphrase for them. So I get to role model. In front of them how we do that. And so that can still be I, I’ve yet to sort of work with a couple. I’m like a hundred percent this person’s fault.

Bronwyn: Mm. Okay. Good. That’s good to know. It’s good to dispel that miss. I’m probably like bringing in Hollywood interpretations of couples or what you’ve seen, but it sounds like it’s quite different when you get in the room. Like couples really wanna work most of them towards a better relationship. 

Marie Vakakis: So often I find that there’s conflict for usually one of three reasons to be in control.

To be correct or for communication to feel kind of heard and and connected. So most of the time people are, if they’re trying to get control, then that’s something you can work with if they’re trying to be, you know, correct. And, and that’s something, um, but often I’m finding those big misattunements, it’s around connection.

Bronwyn: Mm. Could you [00:20:00] elaborate on that one a bit more? What might be an example of an argument where one partner is trying to connect, but they’re kind of going about it not in a less helpful way? 

Marie Vakakis: Yeah. So it could be like, um, Bronwyn, you are always on your phone. 

Bronwyn: Mm, 

Marie Vakakis: no, I’m not. Well, you, you are, you’re only on your phone.

Well, I, I’m not like, well, you’re always on your phone and then you start a fight about being on the phone when really it could be. I want some quality time with you. I want to connect. Can’t you see? I’ve had a tough day and I’m looking at you and you’re scrolling through your phone, not not seeing my, my, my suffering or my pain or my fatigue.

Bronwyn: So in couples therapy, you might help the couple identify that what is actually happening here is wanting connection rather than, like, it’s not about the phone necessarily, right? It’s about wanting attunement and connection with each other. 

Marie Vakakis: Yeah. And if that’s then [00:21:00] the area of most need for the couple, I might bring in some more sort of emotionally focused therapy.

So some EFT techniques. But it’s, it’s really trying to get people to start to realise, you know, how you ask for it also then creates a response in your partner. And if this has been happening for weeks and weeks and months and years, perhaps that can feel so loaded. 

Bronwyn: Are couples generally receptive to this kind of framework when you’re pointing out that, Hey, what you’re wanting is connection here, how can we go about that mixed?

I think some still, if they’re, if 

Marie Vakakis: they’re really quite entrenched in that conflict, they feel so hurt that until I can build enough empathy with them, for them to feel that I’ve really understood them, they might not be ready to accept that. Because if you’re constantly in conflict with your partner, it can be really hard to maybe soften.

Accept that they might still wanna be around you or be with you or want your care when you are maybe not feeling so fond about [00:22:00] them. Mm. So it, it really depends on how, how dissatisfied they are in the relationship or how much we, you know, there’s that, what we call a negative sentiment override, like how much of that vibe is in the relationship.

It can really, it can really depend. 

Bronwyn: And what kind of homework might you give for clients who wa are wanting to improve their communication and reduce their conflict? 

Marie Vakakis: I use, um, a range of different things. So there’s a really good free app that the Gottman’s developed that used to be literally cards you had to hand out.

So if people kind of Google the, I think it’s called the love deck or the card deck. Yeah, it’s really great. And then I might prescribe one of those. So within that app, there’s then like several, essentially like decks of cards. Um, and there’ll be ones around, like around perspective taking, around sex, around dreams.

There’s all these different categories. And I might pick a category and say, I want you to do X [00:23:00] amount of cards before the next session. Or I might even be more direct and say, we are seeing each other fortnightly in that middle week. I want you to put this same time slot in your diary and go through these things.

So. I don’t wanna set someone up to fail, and I really wanna be aware of what other commitments and responsibilities they have during the week or the fortnight. Because if they’re wrangling children to activities and extracurricular things, and they might have aged parents or stressful periods at work or house renovation, I don’t wanna set down with a fail by saying, can you please make sure you’ve done this by the next week?

And then one partner’s like, we haven’t done our homework. And the other’s like, well, you never reminded me. He’s like, well, I always remind, and then it becomes a fight. So. Whatever I do, I really want to try and simplify it, contain it, be specific, and then see what happens. 

Bronwyn: That sounds sensible. I’m just wondering for couples, I’m wondering if you also recommend that they increase fun time together, [00:24:00] like they do activities.

Look, 

Marie Vakakis: it depends on the assessment. So through that assessment process, I get a really comprehensive report and then I match that with, uh, like I’ve sort of got a case formulation tool, so I’ll be looking at. What the, the Gottman’s use the sound relationship house as sort of a visual to represent what they’re looking for.

So we’re looking at these two side pillars of trust and commitment. And then we’ve got, you know, fondness and admiration turning towards positive perspective, managing conflict, making life dreams come true, and creating shared meaning. So depending on where the couple’s strengths are or areas for maybe growth, then it would kind of.

Change what I’m recommending. So if they’re already doing really great on that fun fondness and that, if that bit’s really strong, I might say just keep doing it. That’s working for you. Keep that up. 

Bronwyn: Yeah, so it’s really important to have the case formulation and base the interventions and techniques that you use on that.

Marie Vakakis: Like any other [00:25:00] therapy, you find the modality that you align with that works for you, and then you have a kind of way of conceptualising that person’s presenting problem within that model or framework, and you want whatever assessment process you use that then informs the treatment. 

Bronwyn: Yeah, that makes sense because I guess like the specific situation I was thinking was like, let’s say Mark and Emily, it’s like it’s gotten so bad that they can barely get two sentences out to each other before it turns into an argument.

I’m just wondering if like a recommendation might be to somehow just say, we’re not gonna argue, or something like that. Like how do we, how do we make a dent? How do we start with that? If, if everything turns into conflict. 

Marie Vakakis: If it’s in the session, I might be really directive and and intervene and paraphrase.

And then sometimes I find the action of coming to regular therapy and knowing when those sessions are. Some people feel like they can kind of put their grievances on [00:26:00] pause and bring them into the therapy space, so it might help some couple compartmentalise and be like, look, I don’t need to keep bringing this up, or actually.

No matter how I bring it up, it does not come out the way that I want. I’m going to kind of mentally put that in the box to talk to Marie about. So it, it really, it really depends, like I’m not taking the full responsibility of fixing a relationship that may have had, I mean, you know this couple, you’re saying they’ve got an eight and 6-year-old, so they might have been together over a decade.

I’m not proposing or taking the responsibility that in one session I’m gonna fix that. Or several sessions, I’m going to be this wonderful therapist that fixes all their internal conflict and relationship issues and attachment styles and any mental health challenges, and solves a systematic diff difficulties that couples face raising children.

And like it’s not have to take some, take a step back and be like, it’s not all on me. [00:27:00] And they’ve been dealing with this fighting for months and months and months before they got to me. A few more weeks or a few more months. They might, they can, they can suck it up ’cause they have been, and we’ll do what we can to shift things in the time that we have available.

So really trying to take the pressure off. It’s not my job to fix it all. 

Bronwyn: Mm, that sounds really sensible. Um, and it’s like a great perspective to take and expanding on that, let’s say Mark and Emily come and from your assessment. It kind of seems like they’re at the end of their relationship and maybe they might, may, maybe separation would be mm-hmm.

Best for them. I wonder how you deal with this as a therapist. It’s like, maybe from your perspective you can see that maybe separation would be good. They’re not seeing it themselves, or maybe they are. Yeah. How do you take the pressure off yourself to be like, I know what’s best for this relationship. [00:28:00] 

Marie Vakakis: I would say that for a couple that’s talking about that, I would still, I would say, look, you’ve brought it up, you’ve mentioned it, so it’s on the table and you’ve got kids together.

So either way, there is some areas of your relationship and how you interact that you would benefit from improving for the sake of co-parenting. So I might come at it from that angle of. You might decide to stay together or you might not. Either way, there are some bits that I think really are really, really important or even crucial that you find a way to work through for the sake of co-parenting and to role model for your children what a healthy relationship looks like.

So I, I am not particularly, you know, invested in. Someone never getting divorced, or it’s not like it goes against any sort of my, you know, value, religious values or beliefs in, in that sort of way. If that’s what someone wants, that’s fine. [00:29:00] Uh, if there’s a mismatch, then we talk about that. I do want to show, share with them what I’ve noticed and how by improving those bits, then that might help.

So maybe for this couple, if they’re saying, look, separating on the table, be like, okay, so let’s not worry about your sex life. Let’s talk about how you handle conflict. How are you? How can you, how would this look if you lived over separate houses? Where are you getting stuck? So it can still be really, really valuable.

Bronwyn: Yeah, that prompts me to think about countertransference and when couples concerns might be hitting close to home or touching on beliefs that you have. You mentioned like religious beliefs there. There might like, we all have beliefs about relationships and what works and what doesn’t, and we’ve all got experiences most of us do with relationships.

And I’m wondering how you manage that because I think that would be fairly unique counter transference. 

Marie Vakakis: I think it can. [00:30:00] It definitely can be, and I do have to work a little bit harder in protecting myself when I do more couples work. The, the benefit of the family therapy training in particular was most of the sessions that you run with families are with your reflective practice group watching you.

So a large component of that course is actually spending time on looking at how you. What comes up for you? What gets, uh, triggered or activated in you, and you do a huge piece of work on your own family of origin, your own attachment style, how you handle conflict, and, and really kind of understanding that.

So I think that’s a little bit more robust for me, having had that experience and then adding the couples therapy. Modality on top of that, because I’m not just learning it from, I mean, the first two levels of the Gottman training were online. It wasn’t, I didn’t even get to do role plays or anything like that.

Bronwyn: Yeah, same. Yeah, I’ve done the first [00:31:00] two levels and yeah, entirely online and kind of really didactic as well, like talking at you. 

Marie Vakakis: Uh, and the third one I’ve actually, I’m doing, uh, in a couple of weeks, which is really cool. So I think those things I can overt as well and I can sort of say. Just like I might say, I’m not from that culture, or I might not understand what it means to have, you know, polyamorous relationship from a lived experience.

I can own some of those bits if it does feel too much, you know, if it is a conflict of interest, then we have those conversations and provide the appropriate referrals. You know, I have my supervision, I have my own ways of debriefing. So I think it’s, it’s really just checking in with all of those things.

And then sometimes I just wanna, you know, come home and just, you know, just be left alone for a little bit. Because observing conflict can be a little bit more taxing than when it’s one person in the room and they’re, they’re venting. Yeah. Um, they’re, they’re not [00:32:00] getting activated and charged in the same ways when it’s two people who are just really charged.

But then I use that, that’s also information that if they’re making me, if I’m feeling that way, witnessing that. How must their children be feeling? Yeah. What, what impact is that having on their nervous system? Being around that day in and day out? Like if I’m feeling agitated after maybe 50 minutes and I’ve got all these tools and skills and resources that I’m not invested in the outcome of the fight in the same way they are, whoa.

What must it feel like for those around them? Mm-hmm. So that’s also useful information. 

Bronwyn: It does sound really useful. It does sound like there might be some additional self-care that’s required, because I imagine that some therapists may have grown up in households that were angry or where there was conflict and might, that might be quite activating for them.

And there just might be other triggers in [00:33:00] couples that remind people of their own parents. Um, and yeah, I don’t know. Would you agree with that, that there seems to be maybe more or different self-care that’s required for working with couples? 

Marie Vakakis: Self-care, definitely. But I also think there needs to be probably a little bit more ownership and responsibility on the therapist to recognise what they are capable of containing and making sure that they’ve got the things in place so they don’t feel.

Easily flustered. Um, you know, I’ve had terrible experiences as a, as a, as a client in couples therapy. Uh, I even had one who I reported to the health board, like I’ve had some really terrible, terrible therapists, and I was like, they could not hold their own self. They couldn’t hold the space. They got too caught up in their own stuff and.

I think that’s really, it does a really big disservice to the community. And it’s hard because it’s not a, it’s not [00:34:00] a, uh, a strict registration like it might be in the US where you have a license, like an LMFT. Yeah. Uh, like, and you can lose your license here. You could have, you could not be registered with anybody and be a psychotherapist who works with family therapy or couples therapy and have no kind of formal body that you report to, or you might not be up or registered or.

So that it’s really quite tricky to choose someone who’s got the clinical skill and whether it’s temperament or in, you know, capacity to self-reflect. I think there’s, there’s a, an extra skill that’s really required for people doing that kind of work. 

Bronwyn: I agree. And I’m sorry to hear that you’ve had negative experiences, but it’s interesting because it’s something that through my own clinical work, so I see individuals and in the past, more than once, more than twice.

I’ve had people come and see me and recount experiences of seeing couples, therapists and some of the things [00:35:00] that they’ve recounted to me have been quite concerning. And then as an individual therapist, I’ve needed to soothe, reassure, uh, help them emotionally restore hope in their relationship. It’s been quite difficult and yeah, I don’t know what my question is, but it just does sound like.

Yeah, being able to know yourself and what you’re capable of containing sounds very important for couples work. 

Marie Vakakis: Yeah. But also what you’re touching on is we’ve gotta be careful you don’t get triangulated into that dynamic. So the, yeah, tell me about that. So if one person is sort of saying, um, you know, they have a sensitivity to something being said in a particular way, and I may be paraphrased.

Something that their partner said and they took that as dismissive, and then they go to their therapist and say, the couple’s therapist is always taking his side. She’s dismissive of everything I do. I just can’t get a word in and then pulls you [00:36:00] in to align with her or him. Then it’s the two of you against me.

And that might be the exact same pattern that is replicated elsewhere in that person’s relationship. So we really wanna make sure when we’re working with someone who has another therapist, that we’re not alienating the other therapists, that we’re not falling into a, a triangle there. And if possible, having a brief kind of.

Check in or handover, or update so that people can kind of be aware of what’s happening, what we’re working on. Provide some context and instruction to each person involved so that it, it can feel a little bit more containing. Okay. 

Bronwyn: So as an individual therapist, how can I not be pulled into that? Is it about maintaining a stance of neutrality?

Like what are some specific things I can say to a client if they’re like, God, that couple’s therapist is horrible. They said this to me. I, I cried. 

Marie Vakakis: You could unpack it like you would with some other [00:37:00] interactions instead of trying to solve it or go straight to what the therapist is doing or not doing.

Just saying, tell me a bit what happened? What was the impact of that? Okay. What made it hard to say what you really wanted to in that moment? So you could kind of break some of those things down based on whatever other work you already have been doing with that client. So if you know that, that that person has had difficulty, maybe they appease a lot, and so they just go along with it and they did this again in the session and they’re really frustrated with themselves, then you might be able to say, Hey, this is the work we’ve been doing, and I wonder if you’re actually finding it really tough.

To share your perspective. Is it worth us talking about how you might do that? Mm-hmm. You know, so then like you can help them to work on that. If it’s actually really bad therapy and it’s, it’s unsafe, or it’s in something like that, then you might say, look, that might not be okay, but we have to allow for some risk of rupture.

You’re working with two people with two different needs, two [00:38:00] different agendas in a 50 minute session, maybe a week or many weeks apart. There’s a lot that could go wrong. Uh, so allowing for, okay, you’re, you’ve, you’ve gone to couples therapy to improve interpersonal skills or to resolve conflict. This might be a conflict that you have with the therapist.

I can help you ground yourself, what to say, do a script so then you can go back into that session and talk about what you need. So you, you might help them advocate for themselves. You might help them. Figure out what role they can play in, if that was a rupture on how to repair it. Are they going to old coping strategies of just so saying, nah, that’s, that’s it.

I’m falling away. Like you can use what’s happening as part of your assessment of what you’ve been already working on 

Bronwyn: with them potentially. This makes a lot of sense and I think it’s more helpful than what I’ve been doing, to be honest, which is I think. Empathising with the client’s perspective, and I think what I’ve been doing is also, I [00:39:00] think I’ve been trying to maybe overbalance the client’s autonomy and I’m like, okay, they don’t like them so they don’t have to go back.

You could find a different couple’s therapist, but I wonder if in doing that I’m maybe perpetuating some dynamics that they’re having in their relationship and maybe it would be more helpful to try and repair with the therapist maybe. Maybe. Hmm. Yeah. Okay. No, this is good for food, for thought. Marie, I am liking this.

Mm. Another question I have around that is for individual therapists, I have heard that if your client comes in with, say you’re seeing an individual client and they come in with difficulties in their relationship, and then you as the individual therapist are trying to resolve these. These issues, but with an individual rather than the couple, then you can unintentionally increase the client’s negativity towards their partner.

Um, have you heard of this? 

Marie Vakakis: I [00:40:00] haven’t heard of it that way, but what I would say is what, what’s hurt in relationship is healed in a relationship. Oh, that’s good. So the, there’s a part that requires the relationship there to heal it. 

Bronwyn: Okay. So is there a point in individual therapy where I would be like, look, I think this would be better healed in, in couples therapy 

Marie Vakakis: potentially.

Yeah. And um, you know, there’s a blog post on our, uh, on the Therapy Hub website that’s when to refer individuals for couples therapy. Oh, I love that. Might give you some pointers, but absolutely like, just like you would be thinking if you were a medical practitioner, okay, now I need to send you off to get this piece done, or to an ultrasound or to an x-ray, or maybe you need to see a gastroenterologist.

We need to also accept that mental health is so broad and we might not be the right fit for everything or new things might come up, so you might refer on to. Couples therapy, you might prescribe that saying This would be really helpful if you [00:41:00] did this. I suspect this type of therapy might be best for you, or, you know, uh, this workshop or this, uh, course on conflict.

So consider all of those things in your recommendations for further resources or further development or treatment. 

Bronwyn: Awesome. Up, up then the show notes. Okay. Moving along. I’m interested to talk about sexual desire discrepancy, um, because I’ve read, I read an article that said that this is probably like top three presenting concern to couples therapy, but it’s something that I haven’t received any education about.

I’ve literally read that one article and it was talking about using emotionally focused couples therapy to help people with sexual desire discrepancy. I’m just wondering like. Do you have an approach for this? What have you seen as helpful? 

Marie Vakakis: It’s, it’s really, really complicated and sometimes it’s not actually about.

Sex, uh, it could be what that represents. It could be what role that serves. It could be understanding what that means and even going [00:42:00] deeper and sort of saying, well, what actually constitutes sex? So if we’re talking about a heterosexual cisgendered couple, they might have very, um, narrow views of that is penis in vagina.

And so if I have erectile dysfunction, sex is off the table, or if my, uh, vulva hurts because of childbirth, sex is off the table. And that might be, that’s all they know. So some of it could be, I guess a really good place to start is educating yourself, getting comfortable using the correct language, the words not feeling uncomfortable.

’cause if you’re uncomfortable asking, they’re going to be. Uncomfortable. There’s some really good training. So Monash Health has, uh, a three day kind of sexual health workshop series. It’s online now so people can access it anywhere. So that’s a really great one. Um, there’s Ship’s psychology, which has some really great online stuff, stuff I love ships.

Um, in terms of books I would recommend, um, Emily NGO’s come as you are. [00:43:00] 

Bronwyn: Great book. 

Marie Vakakis: There’s a workbook for that as 

Bronwyn: well. 

Marie Vakakis: There’s the new one come together. 

Bronwyn: Yes. Yeah. 

Marie Vakakis: Um, for more understanding around just the different raw sex can play Esther Perls mating in captivity. Um, and then for, for, for women, sometimes I would recommend even the book burnout, which just kind of looks at sort of the body’s stress response system because you don’t want pleasure when you are in stress.

When your body is, is in that, in that stress response. So. I think starting with some of that and knowing where your limitations are as a therapist and ting that with them as well. Saying this is not my expertise and I don’t wanna give you wrong advice. I don’t want to mis inform you. You might want to go to a sex therapist or couples therapist or do some sensate focus therapy or you know, start to refer that out.

So start with just getting comfortable. Yeah. With that language yourself. 

Bronwyn: Yeah, no, absolutely. I think those are really good tips. ’cause having studied sexology myself, it’s really [00:44:00] important I think, to recognise your own biases, your attitudes, like what do you consider to be sex? Like if your view is restricted to like penetrative sex, then you are not gonna be able to explore the smorgasbord of sexual options with your clients.

Marie Vakakis: Absolutely. Yeah. 

Bronwyn: Yeah. And I guess like with, with that like sexual aspect, that can be a really big aspect in a lot of romantic relationships. Like is it something that you feel comfortable, uh, discussing with clients or do you feel like that’s something that you refer out for 

Marie Vakakis: it? It’s something I, I do talk about with clients and I really enjoy it so.

Sometimes do think about going back to study, to study, um, sexual health. And I was like, no more, no more university. I don’t, I don’t need it. Surely this can be done through workshops and sort of training. Yeah, so there are times where, especially with particular physical injuries or other sort of areas that might extend past what I can offer, but usually the couples that are coming to me based on my bio, based on the referral [00:45:00] pathways I have.

Aren’t coming for that sort of really detailed sex therapy resources. They’re, they’re really coming for overall relationship dissatisfaction. So there’s a lot of work we can do and sex is one component of that. 

Bronwyn: Yeah, absolutely. Yeah. Yeah. I think, um. I don’t think you necessarily need to study sexology to be good at this.

I think that my, my recommendation to listeners would be to do a sexual attitude and reassessment webinar, like workshop, and that’s where you. Have a look at all your attitudes towards sex. You get comfortable with looking at different types of sexual interactions, and so it pretty much is like exposure therapy for sex.

It’s really good, really helpful, really makes sure that you use the right words. You can’t go into client sessions using like, oh, and your hoo-ha like, and stuff like that. You can’t use euphemisms. It’s, yeah, you have to use the accurate words. And then I would recommend ship psychology. I love ships. I think they do a great [00:46:00] job.

And those books that you recommended as well, sometimes I’ve had. Really good responses with clients just by talking with them about breaks and accelerator, like from Emily NGO’s work, and that’s like a revelation to them. 

Marie Vakakis: Yeah. I do have an episode that I’ll air soon where I interview, um, Sarah from ships and we talk about Oh, fantastic.

That’ll be really cool. Yeah. 

Bronwyn: Ah, fantastic. I’ll make sure I link that when this episode comes out. 

Marie Vakakis: Wonderful. 

Bronwyn: Yeah, one last, 

Marie Vakakis: one last. Have we fixed Mark and Emily? 

Bronwyn: Probably not yet. But any one takeaway with Mark and Emily? We’ve worked out the expectations. We know that this is not a 10 to one session and you get fixed.

Um, we understand that there are differences in conflict, but what we need to do is understand each other’s emotional needs and what we’re looking for with our communications practice, different ways of actually getting the needs met in that relationship. Increasing fondness and admiration if that’s absent in the relationship.

Oh, I guess the only other thing I’m [00:47:00] thinking is that with Mark and Emily, so Mark travels a lot for work and he has very long work hours, and that might, let’s just say Emily, like really needs that physical comfort and soothing, like it’s, you know, it’s different. It’s a phone call, it’s, you know, video conference.

It’s different. How do we help couples with. Difficult real situations where it’s like Mark can’t give up his job. Um, and maybe it could, I don’t know. 

Marie Vakakis: Look, I would probably do either the dreams within conflict script of the Gottman’s where we’re looking at what’s behind some of those big, uh, needs or desires, or I might even bring in some act based work and then use that for the couple.

So I might look at where, what are your values like right now? And. Most of the time there’s some overarching values in, I want stability, security. I want my kids to be happy and healthy. Yeah. Worried about being, uh, irrelevant or [00:48:00] redundant in a job if I change. So there’s, we need to look at some of those big things before we can start looking at problem solving.

And then we can start, once we’ve understood it, we’ve empathised with both positions. There might be a gridlock that both, it’s not their preference. And they accept this is what has to be done right now. He has to travel for work. If he doesn’t, we don’t have the quality of, of housing or education for our kids.

And knowing that, here’s what we can then problem solve. So then you figure out, do we set a budget for every second trip one might fly up and, and spend the, the trip there. Just they have one where. Say no to their boss. Is it that one gets to extended family, like family holiday time and what’s, you know, building up, um, you know, RDO hours or something like that.

So you can’t prob, if you go straight into problem solving, you really miss the [00:49:00] validating, the empathising, understanding the root cause of that, and you’re missing teaching them that as well. So by being able to slow it down, understand what it’s really about. Asking questions in front of each, you know, each person being there, you’re giving them through osmosis a, a language to be able to say those things and hopefully that they get to, you know, a little light bulb goes off of, ah, it’s not about just that they’re not trying to control me or restrict me or abandon me or piss me off or reject me, not reducing it to a character flaw.

We’re really understanding the meaning behind that. Then you’ll be surprised when people feel really heard and allow the space to maybe grieve what a preference might be or a dream scenario. They’re pretty good at coming up with some practical solutions themselves. I might give some ideas, but if I can do all that other work around it, I find that they’re pretty good at thinking [00:50:00] of some really funnel creative things themselves.

Bronwyn: No, that’s really awesome. I really like that. And I really like your approach to couples as well. I, I think particularly from our conversation, what I found helpful is your way of taking your pressure off yourself as a therapist to fix everything. And I think like if, I feel that probably listeners feel that as well.

’cause I think as early career therapists, we can just place a lot of pressure on ourselves to like have all the answers, have all the solutions, fix everything. 

Marie Vakakis: Yeah, absolutely. 

Bronwyn: Yeah. Hmm. Um, so Marie, what is the biggest takeaway you hope listeners learn from the conversation today? 

Marie Vakakis: Don’t be scared to broach further kind of work in, in say, couples work.

It is really, really rewarding. I think I liked what you were saying around that, like the sexual attitudes webinar, I think those sorts of things where you’ve got to. Really figure out your exposure to stuff. So we don’t want your first reaction to be negative or kind of grimacing or pulling a funny face in front of someone who’s [00:51:00] already talking about something really, really vulnerable.

That’s more highly stigmatised often than individual therapy. So have a think about that and I, I don’t recommend resources without having done them myself or read them myself or watched them. So you can start there. One of the books. I absolutely love and I recommend, I reckon anybody in a relationship can do it.

Is the eight dates book by the Gottman? 

Bronwyn: Oh, I haven’t read that one. It’s fabulous. 

Marie Vakakis: Yeah. It’s really, really good foundational work of each chapter is one date. Cool. And so you read that chapter, it gives you prompt questions, you go on a date, you talk about that. And it covers the things like intimacy, trust, fun, sex, relationships, goal, like it has broken it down into eight key areas.

So doing stuff like that, you know, parallel to your couple, you know, if you’re doing couples work, is really important. So being able to, to know what it feels like to have those tough conversations with your partner. To know what it’s [00:52:00] like to be vulnerable. I think some of this stuff, I don’t know if I would trust a therapist who had never been to therapy, who doesn’t know how uncomfortable it feels to be sitting on that other seat or to talk about their vulnerability.

So I think couples work can be a bit like that. You don’t have to have the exact same scenario, but I think to have a, um, a tolerance for sitting in that discomfort and in that unknown and get some really good supervision. 

Bronwyn: Oh yes. No, that’s a must. Thanks, Marie. Marie, if listeners wanna learn more about you or get in touch, where can they find you?

Marie Vakakis: So I’m on all the socials. So my private practice is the therapy hub, so you can find that on Facebook, LinkedIn, Instagram, and then, um, me under my name. So I also have the podcast is Complex Life. So in the next couple of weeks, or maybe even by the time this episode has air, there’ll be a new season of episodes where we’re looking at.

Substance use sex, yoga to treat addictions, um, men’s depression, eating habits, all sorts of really cool, fun stuff. I [00:53:00] taught ethics. Yeah, some really good stuff coming out. 

Bronwyn: Awesome. Thank you. And I’ll make sure that I have those links in the show notes. And thank you so much for coming on Marie. It’s been really enlightening.

Thanks for putting up with my like pointed questions where I’m just like, no, I love it. So what if this, what if that? I really appreciate it. 

Marie Vakakis: It’s like people get to hear almost like what a supervision session might kind of be like. Yeah. Um, I think it can be really, you know, peek behind the scenes. 

Bronwyn: Yes.

I’m dis annoying in supervision as well. 

Marie Vakakis: Not annoying. I like it. 

Bronwyn: So as always listeners, thank you so much for listening. Listeners, if you really like the show and you don’t wanna miss the episode, do press follow on your podcast listening app. That means that episodes will automatically go into your feed so you don’t have to search them anywhere.

They’re just in your nice and easy in your podcast app. That’s a wrap. Thanks so much. This is mental work. Have a good run. Catch you next time. Bye.

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