Untreated Psychiatric Disorders Can Affect Couples Counseling

We all come to couples counseling for a variety of reasons. As a couples therapist, I often hear similar complaints from clients, “he just doesn’t listen to me,” or, “we fight all the time.” Also on the list, “we’ve stopped having sex,” or “can you just change her?” While couples counseling can be the perfect venue to give you tools and tips on how to communicate better, resolve conflict differently, liven up your sex life, and make important relational changes, there are a few things that will stop the process right in its tracks.

Untreated psychiatric disorders will make couples counseling incredibly difficult. If you’re struggling with depression, anxiety, ADHD or any other psychiatric disorder, it is imperative that you get individualized treatment, first. Treatment typically includes a thorough assessment by a specialized professional, either a psychiatrist or a therapist in that particular field of study. If you don’t get individualized treatment first, your couples therapist will give you tools and tips that either you’re unable to utilize (yet). Your therapy sessions will be met with either failed attempts or frustration. All things that you want to avoid as you venture down the vulnerable journey of couples therapy.

While it is the hopes of many clients to change their relationship, such as wanting better sex, more aliveness, stronger communication, less fighting, and so on – the very first step is to take a look at yourself. If you are struggling independently, your treatment comes first , before couples therapy.

One example to illustrate this point is the classic case of someone struggling with undiagnosed adult ADHD. One partner complains that the other is late, lacks of organization, has the inability to prioritize and is unaccountable. It is easy for the other to potentially pin this on characterological factors, saying things like, “he’s just like this,” or “he’s selfish and doesn’t think of me.” However, what if your partner has undiagnosed ADHD? Your partner could be struggling with something outside of their control.

Another excellent example to display the importance is that of undiagnosed depression. A partner may complain that their spouse “never gets out of bed,” is “irritable,” often is “tired and lacks motivation.” Again, these are all signs that could point to a diagnosis of depression – but what if your spouse is convinced that it is because “you just don’t care,” or “you’re lazy.” Your spouse will end up persecuting you on behaviors that may have be out of your control.

Clients struggling with reoccurring symptoms that seem out of the ordinary may need individualized treatment. Through a thorough assessment, skills and coaching, the client has the ability to make individual changes that will impact their relationship. Once the psychiatric disorder is stabilized, couples counseling can be extremely beneficial. Skills such as communication, conflict stabilization, sex, and intimacy issues can be addressed – the very ingredients that help couples and relationships have stronger and more intimate connections.


For more articles and information from Erika Boissiere, MFT – Founder of the Relationship Institute of San Francisco, please visit www.trisf.com or  call 415-519-6446.

10 Signs You Need Couples Counseling

Written by Erika Boissiere, MFT of The Relationship Institute of San Francisco.


Is it time for us to consider couples counseling?

Everyone has his or her own way of determining when it is time to seek couples counseling. Wherever you are in your relationship, here are the Top 10 Signs that it might be time to seek professional help.

You’re unhappy in your relationship.

Plain and simple – you are unhappy. You have no interest in talking to your partner, consistency tune them out, or hide at work to avoid returning home and seeing them. The weekends together seem long and there are a lot of moments where you wonder how you got to this place.

You are no longer attracted to your partner nor do you have interest in sex with them.

No matter how much we convince ourselves that sex is not important, the truth is, sex is an essential part of a healthy committed relationship. Through sex we connect at an intimate level and share an experience that fosters closeness and human intimacy. Without sexual intimacy, you and your partner are best friends who share a household together. If that is okay with both of you, then perhaps counseling isn’t needed. However, if one partner wants to have sex and the other doesn’t, it might be time to discuss the situation with a professional.

You fundamentally don’t trust your partner.

You may have experienced infidelity or other events that have caused you to lose trust in your partner. If you are checking their phone, reading their email, or constantly asking, “Who were you with?” – then you have trust issues and counseling can help.

You are considering a divorce.

If you are considering separating from or divorcing your partner, now may be the time to give counseling a try. In some cases, the only reason that a couple ultimately chooses to stay together is because they sought counseling for help. Often those who leave one relationship to enter another without working through the underlying issues through counseling will again encounter similar issues from partner to partner. Consider working on the current relationship before calling this one quits.

You have disdain for your partner.

You dislike your partner, have contempt for them, and often find yourself rolling your eyes at them. You didn’t always have these feelings towards your partner, but something along the way has gone awry. Couples counseling can help identify what is creating this situation and if there is an opportunity to make it right.

Every disagreement turns into an argument.

Your fighting marathon continues day after day and you are completely exhausted. If you are fighting over trivial matters, but are not able to get to the resolution phase, it might be time to seek a couples therapist. Disagreements are normal, however, constant fighting is not.

You are having an affair.

Infidelity can be a relationship killer. If you are having an affair, and want to either end the affair or tell your partner about it, one approach is to consider consulting with a couples’ therapist. There are many reasons why people have affairs. Couples counseling can help discover what is really going on in your relationship and help things to change.

You have very different life dreams

You want a baby; your wife doesn’t. You want to move out of the city, but your partner doesn’t. You want to sail around the world, and your partner is a workaholic. Could your life dreams and aspirations be more different?  If you want to continue in this relationship, it is critical to address – either in therapy or between yourselves, how you will navigate major life decisions. If you do not find a way to bridge this gap, the difference in your visions will likely cause resentment as one partner may feel as if their dreams do not matter.

Family trouble.

Do you despise your mother-in-law, father-in-law, or in-laws in general?  Do you dread spending time with them or think they should just mind their own business? If you and your partner are fighting consistency about your in-laws, it’s time to consider sorting things out, once and for all.

Relationship tune-up.

You love your partner, but things just feel off. Your sex life has dwindled, your responsibilities have increased, or maybe you are just not the same person you were five years ago. Something is fundamentally different, and you feel stuck. Couples therapy can provide a safe place to address what is going on within you and your relationship and get things back on track.