Ask Octave: Do I Need to Start with Individual Therapy Before Doing Couples Therapy?
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Q: My partner and I have been having communication issues for a while, and it’s creating distance between us. Every time I approach her about going to couples therapy together, she tells me I need to see a therapist first. Do I have to go to individual therapy before I see a benefit from couples therapy?
If you’re considering couples therapy with your partner, that’s probably enough of a reason to do it. But therapy is never a one-size-fits-all approach, so there’s no definitive answer about whether it’s best to start with individual therapy or couples therapy.
While there are technically no rules that you should start one before the other, there are a few things to consider before making the decision.
When Individual Therapy Is a Must
Individual therapy doesn’t necessarily have to come first – and there are plenty of benefits of starting in couples therapy. But if any of the following situations are true for you or your partner, it’s best to start individual therapy first.
In cases of unsafe relationships
An unsafe relationship is marked by fear, whether it’s fear of being yourself, fear of speaking up, or fear of violence (even if physical violence hasn’t happened). Where there is any risk of danger within the relationship, prior individual work on, say, anger management may be essential. No client should be put in a position where discussion of their vulnerabilities might be risky or used against them by their partner.
If there’s suspected disordered eating
If either of you are struggling with an eating disorder, individual therapy may be necessary, as these conditions often require specialized treatment and support. Addressing the underlying causes and patterns of disordered eating may be best approached in an individual therapy setting before exploring couples therapy options.
When there are significant mental health issues
If there are any significant mental health issues, such as a personality disorder like Narcissistic Personality Disorder, severe depression, or schizophrenia, individual therapy should be prioritized first. The decision to pursue individual therapy first can also be made in consultation with a qualified clinician who can assess the specific needs and circumstances of the individual and their relationship.
If there is unresolved trauma
About 70% of adults have experienced some type of traumatic event in their lifetime, and while only a fraction of them develop Post-Traumatic Stress Disorder, or PTSD, serious trauma even if it hasn't developed into PTSD should still be addressed.
Whether unaddressed childhood trauma, witnessing death or serious injury, the unexpected death of a loved one, or experiencing a life-threatening illness or injury, unresolved trauma can have lasting impacts on your mental well-being. It’s been linked to anger issues, lack of trust, low self-esteem, control issues, anxiety, depression, and substance use disorder.
If there is a substance use disorder present
Substance use issues like heavy drinking can significantly impact relationships and may necessitate individual therapy to address the root causes and develop healthier coping strategies. Prioritizing individual therapy in these cases can help people focus on their recovery journey and establish a solid foundation for healthier interactions within the relationship.
Couples Therapy Has Benefits for Personal Issues
In your situation, you are right that addressing your communication issues in your relationship in couples therapy is probably the best option. Considering the nature of relationships and mental health, couples therapy offers a unique platform for addressing both individual and relational challenges, simultaneously.
Discussing personal challenges in a safe space.
Mental health struggles don’t happen in a vacuum. Any mental health issue is likely affecting both of you and your relationship. Couples therapy can open up the conversation for either of you to discuss your challenges in a safe space.
There is also a positive effect where the reduction of depressive symptoms positively impacts the couples’ satisfaction with their relationship, leading to improved relationship quality. Evidence suggests that people change and respond differently when they are being observed — particularly when it is by someone they feel close to.
Creating enhanced understanding by healing together.
A significant aspect of couples therapy involves each partner becoming more attuned and responsive to the other’s thoughts and feelings. Being present while your partner is working on improving their mental health can facilitate the development of this close responsiveness, offering insights into the causes of mental health struggles, the process of recovery, and the skills needed to maintain that recovery.
Physical display of partner’s support.
From a purely practical perspective, therapy can be intimidating for those who have not ever tried it. So a partner who can provide support — whether physically, emotionally, or mentally — can make a difference in taking the first step.
If I suspect that individual therapy is needed, I will be upfront with the couple from the start. Couples therapists will often recommend individual therapy to one, or both. If there’s resistance from either person in the pair, it’s an open forum to discuss that resistance with support from the therapist.
At the end of the day, if something isn’t working in your life or relationship and you feel you could benefit from therapy, choosing either couples or individual therapy will help you. Pursuing either of these types of therapy is better than continuing to try and figure things out on your own.
Go with the avenue that feels less intimidating and more accessible to you and your partner. Remember, the most important step is taking action to prioritize your mental health and well-being. Whether you embark on this journey individually or as a couple, know that you are taking a positive step toward growth, healing, and a healthier future together.
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