Susan Heitler on Couples Therapy

Susan Heitler on Couples Therapy

by Randall C. Wyatt

Susan Heitler outlines how she integrates conflict resolution techniques into couples therapy, the importance of intervening quickly, and what she means by being "pro-marriage."
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The Interview

Randall C. Wyatt: Dr. Heitler, it's good to have you here. Let's start with how you first got into conflict resolution and marital therapy work?
Susan Heitler: I think this is a profession I have been in since I was 3 or 4 years old. When I was just a child, my parents would battle and I would be the one that would step in and bring some calm or reason to the situation.
RW: Were your parents a high conflict couple?
SH: My father was a high conflict individual and my mother would react but was somewhat clueless about what to do.
RW: So what did you do? How did you intervene as a 3-year-old?
SH: I have a sense of myself as having my two hands up - one facing him, one facing her, standing in the middle like, "Cut it out." Cut it out would be too strong; "enough," "calm down," "Stop, listen, listen!" would have been more like it. (Laughter...)
RW: As you grew up did your parents listen to you much? Did you get them to stop or quit arguing so much?
SH: I think on the whole they did. It is a little bit amusing now that they are elderly, 91 and 86. And when my mother introduces me, she will typically say, "This is my daughter, but she thinks she is my mother." I must say, though, that she was a marvelous, marvelous mother.

... Continue Reading Interview >>
RW: Wow! That's pretty amazing. We have interviewed several master therapists of all stripes on Psychotherapy.net and that is the earliest beginning we have heard. What began to influence you to get into couples work?
SH: I don't recall a single course in couples work being offered at NYU graduate school ('75) nor at my internships, where I got otherwise excellent training. The phenomenon of couples work just didn't exist like it does now. I was fortunate to work with a doctoral fellow from Israel who was studying at Denver and he knew a lot about family therapy and the beginnings of couples work. He suggested readings and we did cases together. And then the rest of my training has been either from seminars and workshops or from listening very closely to couples. Also, conflict resolution theory and techniques have mainly originated in the realms of business negotiation, international relations, and legal mediation, which I have incorporated into my work.
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Conflict Resolution and Marriage

RW: When did conflict resolution enter the picture?
SH: I had the notion that what I was doing seemed to be about helping people to resolve conflict, both intrapsychic and interpersonal.

Yet the only time I heard about it was from a one-hour lecture by an organizational psychologist who talked about the new literature on conflict resolution in the world of business. It stunned me that here we were helping people resolve their conflicts and yet not a single therapist that I had met seemed to know squat about conflict resolution. So I filed it in my mind that maybe, someday, I would learn all I could and one day write a book about it, which I did - From Conflict to Resolution.


RW: In the business world, conflict resolution and communication skills are much different then when people are in love or married. Lovers and married folks can be very touchy and can quickly regress, suddenly losing all the communication skills they have ever learned
SH: Yes, I think it's a sad state of affairs that most people behave far more maturely at work than they do at home. Now, the good news is that means most people are bilingual. They do know how to talk in a civil way and, even if they are beginning to get agitated, they will calm themselves down and resolve conflict in a fairly cooperative way. The bad news is how sad it is that we use a lesser language - the language of arguing - at home.
RW: Why do you think it is that lovers, married folks - who begin with such caring and consideration - find they can't talk about hard things without arguing or withdrawing? They become their worst selves.
SH:
Why do people become more degenerate, more argumentative, more agitated, and more aggressive at home than at work?
Why do people become more degenerate, more argumentative, more agitated, and more aggressive at home than at work? Early on we see the difference. Many children fight a lot with their siblings and yet when they go to school virtually never have a fight with anybody. Even in abusive situations, many abusive spouses handle work conflict in a more collaborative way. There are three main realms where we learn the language of interaction: interacting with siblings and parents, and watching our parents interact. And, there are many more decisions that need to be made in a family.
RW: At home, it becomes a matter of the heart too and the stakes seem that much higher.
SH: Well, the stakes are higher and decisions need to be made about so much: money, whether to have kids, where to live, intimacy and sex, how to treat in-laws, how to treat children, how to spend leisure time, do we watch the football games on TV or do we have people over for dinner, or do we spend a lot of time going out together. Multiply that over and over again about all the decisions involved in making a life as a team, yoked together as partners. Those decisions are not only more quantitatively frequent but they are qualitatively different.

At work, you know for the most part who has power and what the expected roles are. At home, that needs to be negotiated. So, in families where everything becomes an issue, there are often underlying issues about how much power do I have, how much am I listened to? Or does he love me? Does she really care about me? We know that the more emotional intensity there is, the more likely people will regress in their collaborative dialogue skills.

RW: Clearly, as you point out, love is not enough since most couples love each other to begin with.
SH: Shall I give you the good news?
RW: Yes, the next question is: What can be done about that? What can you offer them?
SH: That's exactly what I was thinking about. I have come to see maturity as a function of skills. For example, as a tennis player, I have observed that there are plenty of people who just go out and play tennis. They never raise their skill level. There are others who go out and get some instruction or watch good players on TV or play with better players. Those people are definitely elevating their skills. It's much more fun for me to play tennis when I play better.

Living well as a couple means living with an excellent skill set - a skill set for dealing with conflicts, for dialoguing and sharing information effectively, for relaxing and enjoying life, and also skills for emotional self regulation. So, instead of getting agitated and angry, people stay calm and are able to use their skill sets to deal with difficult issues.

RW: It is nice when someone can communicate directly and calmly, but this seems unrealistic to expect people to just talk so directly and rationally. Some people tend to be more passionate, emotional, and some people are more private, more casual, shy, and some are super rational. People seem to have different ways of arguing and different ways of solving problems. Plus, there is a great deal of cultural variation in communication styles. How does your approach account for all these different ways since a lot of therapies want people to "speak directly, be clear, be rational," yet that does not seem to fit everyone's style so well.
SH: Right, there are certainly cultural variations, many of which are harmless. They are like the multiple flavors of ice cream. There are other cultural variations that have a major impact on how collaborative a couple is going to be or how likely they are going to be split off into separate realms. In some cultures, the roles between men and women are more defined and problems are dealt with indirectly instead of through direct communication. In most American couples, however, there is a lot of necessity for husband and wife to be able to make shared decisions, to function as a team. If the goal is to have a collaborative relationship, then there are certain principles of information flow.

I like to tell my patients I work on flow. A good analogy is traffic flow. Cars crash if the traffic is flowing too fast which is the equivalent to too much emotional intensity. Cars also crash if people don't follow simple traffic rules and guidelines.

RW: I have read that if traffic is going less than 30 mph there will be a traffic jam.
SH: This is exactly right. If you never get on the roads at all, you are not going to get where you want to go which is a mistake that many people make. They never even bring up the issues and talk about what is concerning them.
RW: Going another step: people seem to use communication skills and I-messages when they are calm but lose it when stressed out.
SH: The pivotal factor is that the more important the issue, the higher the level of agitation and emotional intensity, and the harder it is to have good communication.
It is just like driving a car, where speeding takes more driving skills but someone with excellent driving skills can still manage 90 mph. In terms of communication skills, most of us can go up to 30-40 mph with ease but we are in trouble when we go faster.
It is just like driving a car, where speeding takes more driving skills but someone with excellent driving skills can still manage 90 mph. In terms of communication skills, most of us can go up to 30-40 mph with ease but we are in trouble when we go faster.
RW: So what should we do when our emotional speed is too hot and we are traveling out of control?
SH: I teach couples that as soon as they are beginning to get out of their effective zone, just take a break and get a glass of water, learn to calm oneself, and then we go through this step by step. I teach each person this shared choreography so they don't feel like the other person is walking out on them. The agreement ahead of time helps monitor their emotional intensity. And, each person is responsible for calming themselves down and rejoining the discussion.
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Heitler takes on Gottman's Unresolvable Problems

RW: And what has your success been in working with couples to teach them these skills and resolve their problems?
SH: A significant proportion of my clients are referred by divorce lawyers. I also get newlyweds and people who are beginning to have some problems. I really like getting the 'last chance' cases. That's what I am known for in Denver, I am sort of the court of last resort. I would say, of those cases, the vast majorities end up with great marriages; they just never had the skill set.

What I hear over and over again is, "I wish someone had taught us these skills when we first got married. All those years and all that dreadful modeling we have done for our children wouldn't have happened. All those years of suffering, all those years of portraying how to make each other miserable wouldn't have happened if we had just known how to interact more maturely, more effectively."

Now does everybody do better? The reality is some people would rather stay how they are. My approach is a kind of a coaching approach to therapy and just like some people will prefer to stay beginners on the tennis court, some people aren't interested in learning in their marriages.

RW: So is learning the skills the whole of it for these couples?
SH: What you said earlier is very true. Once there are deeply felt issues, it evokes strong emotions even if people take breathers, that when they return they become so emotionally reactive on those issues or to each other that they will have a hard time using the skills. So a combination of skills training and therapy is really important.
RW: How and where does therapy enter into your couples work?
SH: In therapy, as people are getting hot, I would be more likely to help them see where their initial issue came from, their own marital issues or family issues from their past. I agree with the research that says skills alone won't work with difficult couples. First, the guidance of a coach who knows the skill set and, secondly, also knows traditional therapy skills of accessing family-of-origin material.
RW: You have questioned Gottman's findings that often there are certain interpersonal problems couples have that will not be resolved, rather that over the years they will come to manage or work around these repetitive problems. How do you differ from this view?
SH: Yes, Gottman and I have had some dialogue in this regard and I have given him my books From Conflict to Resolution and The Power of Two. He has looked at them and said, "Yes, that's very interesting." I have been told by others that he refers to my work on conflict resolution in a positive way.
I have continued to hear Gottman say that some conflicts can't be resolved, that conflict resolution is an unrealistic goal. I take great exception to that.
I have continued to hear Gottman say that some conflicts can't be resolved, that conflict resolution is an unrealistic goal. I take great exception to that.
RW: Let's hear it.
SH: Gottman and others have contributed excellent research on marital communication skills, but his writings do not include the advances in the conflict resolution theory that enable fights to transform into cooperative problem-solving and conclude with mutually satisfactory, win-win solutions - this is where my work is focused.

If there are conflicts between two people who have the cognitive flexibility to really listen to each other and work together till they can come out with win-win solutions, then those conflicts can be resolved. Of course, I would say that we all know some people aren't willing to learn the skills of win-win conflict resolution, but that is the exception. For example, I get conflicts about whether to have children or how many children to have. I have had a number of those cases in my practice and they have always come up with excellent win-win solutions. You would think either we are going to have a baby or not have a baby and that should be a zero-sum game, right? Wrong! It's how you decide to have a baby or if you decide not to have a baby. So even that is quite amenable to a win-win conflict resolution.

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Hot Buttons: Geography and Religion

RW: You and Gottman seem to agree that some couples don't solve their problems, but you emphasize that with the motivation to learn, most issues can be worked through. I would like to see this debated with Gottman, but, for now, what are the most difficult conflicts that you find couples having?
SH: There are some conflicts that are inherently more difficult, the two most difficult issues being geography and religion.
RW: I thought it was politics and religion.
SH: Right now, politics - I have found, that if people have very good skills, that most people can listen to the underlying concern and let it go after awhile.
RW: So then what about geography and religion?
SH: There are deep attachments that people often form not only to their family that might live in a certain area but also to the land. Now, I do think the more mature and more flexible people are, the easier it is.

I am thinking of one poignant couple, for instance, where she was rather a brittle person who felt very much of a New Englander. Now, myself coming from New England, I can identify with that. She grew up in an old small subculture there and she felt safe there, she felt she belonged. Unfortunately, her husband, a lovely fellow who had been very successful in business, went through 3 or 4 years where he was unemployed. It was terrifying for him since he wanted to support his family. Finally, he got a job in the Southwest and she tried to move with him but just couldn't do it. She wasn't able or willing to make new friends. She strongly missed being away from her parents and felt they needed her since she was the only child. It was multi-dimensional and a very difficult issue to find a middle ground on.

Now, remember conflict can be at a shared decision making or conflict resolution level. Shared decision making is what we call the process if it's going smoothly. We call it conflict resolution if the couple is getting oppositional. In this case, they were going beyond oppositional to desperate because they each felt so strongly wedded to their own concerns and unable to embrace it in a broader way to take into account the concerns of their partner.

RW: A very difficult situation, certainly. I saw a couple recently where the man felt strongly that they should move to the country so the kids could have a more peaceful life in a small community. And his wife felt they should stay in the suburbs near her friends and family. They both believed strongly that God was leading them to follow their own path in this matter and they went round and round on it.
SH: With religion too, that is double trouble.
RW: Since they were so adamant, I said, "Maybe God wants you to get divorced, the way things are going."
SH: And then that would pose problems for me because I see myself very much as a pro-marriage therapist.
RW: My comment was tongue in cheek, said to make the point that they were falling into a trap of using God to support their personal preferences as a fixed solution that they had both become entrenched in; yet it was not merely an either-or solution.
SH: So this situation is extremely difficult.
RW: They actually share many of the same values and goals, but have different ideas about how to accomplish them. Understanding their shared values brought the conversation to a manageable level.
SH: Excellent! And again, if they are flexible, they would find some way to go to the country for the summers and live in the city during the school year.
RW: Yes, they are going in that direction for now at least - they live in the suburbs and go hiking and camping more often.
SH: And that takes both cognitive flexibility and financial flexibility that some people realistically just don't have. So, are there always options? Yes. Are they always within what the couple realistically can do? Once in a while, you find a real difficulty.
RW: Can you speak briefly on religion and marriage?
SH: Religion brings on non-negotiables. For instance, if you are an orthodox Jew, you just don't drive on Saturdays. You don't eat certain foods in certain places. You don't bring certain kinds of food into your home. As a reformed Jew, you can have greater flexibility in these matters. Basically the choices are doing things the more religious person's way, or finding someone whose lifestyle is more like your own. Now even that's not 100% true because there are plenty of orthodox Jews who think flexibly and creatively, who have married less observant spouses, and they find some way to accommodate each other's needs.
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Changing the Argument Cycle

RW: You have done lots of consultations with therapists and trainings. What do you find are common mistakes therapists make in working with couples
SH: I see the same pattern everywhere. First, even experienced therapists are quite clueless about how to do conflict to resolution approaches. Second, virtually everyone takes too long to intervene with couples. So when I demo a case or when people watch my video that demos a case, one of the first comments I virtually always get is...
RW: I have seen the video, so it is striking to see how quickly you intervene and interrupt the arguing.
SH: If I am on my toes, they would never argue in my office because I intervene preemptively. Do you intervene after a car has rolled off a cliff or do you intervene when it begins to hit the soft shoulder? In fact, I intervene when they are just beginning to cross the line where there is still a little place before they go on the soft shoulder.

If a couple is accustomed to arguing, that means a lot of intervention. Intervention not just after they have argued but lots of setting them out to do it right. So, for instance, one person starts to says something... I can see the "b" of the word "but" forming on their mouth so I would interrupt them right there and offer alternatives.

RW: What is your thinking behind interrupting them and stopping their argument? Many couples therapists and writers will let them go on but try to help them argue better?
SH:
Well, I don't know what they mean by "argue better." It's an oxymoron from my point of view. Effective dialogue is almost always collaborative. Emotion and passion are fine but only up to a point.
Well, I don't know what they mean by "argue better." It's an oxymoron from my point of view. Effective dialogue is almost always collaborative. Emotion and passion are fine but only up to a point.

I am referring particularly to what I call crossovers when people are labeling others or speaking for the other person versus people speaking for themselves. Are they listening to take in information or they are listening like a hockey goalie to bat it away? Did they digest what the other person said out loud or do they just move on to their own thought? So there can be a perfectly civil collaborative tone but each person ignores what the other says rather than what I call breathing the dialogue. The couple needs to have a positive experience versus just repeating what goes on at home.

Also, many people don't know how to ask good questions. In other words, the alternative to you-messages is not just I-messages, it's good questions. Good questions almost always begin with "What?" or "How?" and many people don't know how to ask those questions. Lastly, many couples lock into a tug-of-war over "I want X," - "No, I want Y." Many people don't know how to switch levels to the underlying concerns that fuel such tensions.

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Sharing Therapist Reactions in Couples Work

RW: Couples therapy involves the couple's relationship and you have a relationship with them too. Are there times when you share your own reactions, personal feelings, your own life stories with clients?
SH: Well, I assume you might have noticed already I get tearful easily, so when I am touched, I am not going to fight it - it shows. And couples have often given me feedback later that my getting tearful in response was meaningful to them.
RW: What about anger coming out or other emotions that are not so tender?
SH: I do have anger. I am a human being and anger is very, very important as a feeling to know when something is wrong. So I use my feelings of anger to validate for myself when I feel that a couple or an individual is getting off track. For instance, I recently found myself getting very angry with a teenager in a family session with her parents. Did I act in an angry manner towards her? No! Did she hear some built-up tension and the firm manner of my voice? Yes! You could label her borderline or you could just say she had real difficulty self-soothing, very quickly misinterprets what is going on, and becomes angry and provocative; she had controlled her parents forever in this way.

So I used my anger in service of the work by allowing myself to feel my own anger and express my experience with her parents... that this girl evoked that response in me and does so with others as well, but the parents continued to enable this oppositional behavior. I essentially told them they needed to address it, talk quietly with her about this, and help her learn skills so she would not continue to be provocative in that way. But I showed them how anger could be used well instead of just going head-to-head with her.

RW: That is nice. It seems more and more therapists of various orientations are using their own reactions to bring about more immediacy in the session, which seems to lead to a more real and effective therapeutic engagement.
SH: That is a very good question for therapists: when and how do you share aspects of your life? The technique I most often use is if there is something in my own life that is relevant to them, I will talk about it in the third person or from a general perspective. At the same time, it's a little too complicated and risky to talk about oneself. But I don't have that as an ironclad rule. There are times when being able to share something about my own world facilitates the normalization of what they are experiencing. At the same time, it's their therapy, it's not my therapy. So that's got me wondering: do I not want to talk too much about myself?
RW: Too much or too little would be a problem.
SH: I think one can't err very often on the side of too little. If you never talk about yourself, I think that's fine. There are moments when something in my own experience could be very relevant and very helpful.
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Saving Marriages

RW: Let's go back to what you meant by pro-marriage. You said that you are pro-marriage and your website states that you specialize in saving marriages.
SH: Correct. Marriage happens to be good for people and there is very good research now out. For example, Linda Waite and Maggie Gallagher summarize the research very well. The research shows that people who are married are more fortunate than those who are not in terms of money, sex life, happiness, as well as physical and mental health. Now there are some exceptions to that. In general unmarried women do better than unmarried men. But, on the whole, marriage - particularly a good marriage - is a great blessing in people's lives. I think it's important to therapists to be unequivocal that marital health is good for people and marriage is a great blessing. And even the average kind of marriage seems to be far better for couples for the most part and particularly for men than a divorce.
RW: How does getting divorced or being single play into it?
SH: It's one thing to be single and it's another to be divorced. It turns out that people who have always been single adjust fairly well in life. More and more research is coming out showing not only negative consequences of divorce for the children, but also physical consequences for the couple as far as 20 years down the road. So, you can see why I am pro-marriage. 'Marriage friendly therapist' is the going term now. There is a new website at marriagefriendlytherapist.com.
RW: Marriage friendly therapist?
SH: Yes, my approach is friendly and supportive of marriage and I am dedicated to teaching people how to do it better. At the same time, nothing is simple. It is one thing to be rigidly against divorce and I certainly would not put myself in that category. There are definitely marriages that should be terminated. All people have the right to be safe in their marriage.
RW: So that's what I was going to ask you, do you ever see couples and think, "Why did they even get married?" or "They should get a divorce." What do you then?
SH: I lay it on the line to them. For instance, I remember one couple that I worked with over a period of months. She was a very fast-talking, highly energetic woman from New York, a very successful entrepreneur. He was a slow-moving guy, nice looking but kind of laidback Appalachian kid who had grown up in a dirt-poor environment. They had economic clashes plus educational, lifestyle and income differences. She was doing fabulously. He could barely hold a job. They used to argue a lot about everything since his way was radically different from her way.

Yet I was able to teach them some skills and help them to see their family of origin and cultural roots in context. But no real progress was made,
and at some point, I said to them, "I hate to admit this but I truthfully can't see how I can help you make a real marriage out of this. I can't see how to bring the two of you together. I see on each issue that we discussed such radical differences. I don't see how it can work."
and at some point, I said to them, "I hate to admit this but I truthfully can't see how I can help you make a real marriage out of this. I can't see how to bring the two of you together. I see on each issue that we discussed such radical differences. I don't see how it can work." I apologized to them.

To my surprise, they came back the next week and said, "Thank you so much. That was so helpful. We have stopped fighting." They came a few more times and I did not see them for years. I ran into her downtown one day and she told me an amazing story. She said that about three months after they finished therapy, she was diagnosed with breast cancer and he was an angel to her. His real mission in life... this story still makes me cry when I tell it now...was to care for her. And he was so loving, so marvelous. That's really why she made it through. It makes me tear up just to think of them.

RW: It seems you're admitting how difficult their situation was and your sense of helplessness gave them a way to look at reality and do something about it. Plus, they rose to their life crisis in a way that transformed their lives.
SH: Absolutely. And this was maybe 10 years ago. I saw them recently and they said that they have continued to have a marriage where they both feel very blessed to have each other.
RW: What touched you so much about this couple?
SH: I think probably the limits of my own or of any therapist's ability to know what's good for another couple. They knew at a deep level that they were somehow meant to be together. So I could do what I could do, teach them a few skills, help them see the differences in their background and implications of that. I could go part of the journey with them and that was okay. And such a single limit of my... oh no I will start to get tearful again... of my ability to have to do more there, that there are bigger forces than therapists in the world and fortunately they take care of these things.

Now, at the same time, there are couples that the research would certainly say they ought to get divorced. If couples are fighting a lot, the research is unambiguous that it's better for the children for them to disengage; a climate of war in the house is not conducive to child rearing. Medved and Quayle partnered on a fine book called The Case Against Divorce where they outline 9 factors where divorce is indicated.

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What to do with Secrets in Couples Work?

RW: What is your approach to seeing couples together and individually, and how do you deal with secrets?
SH: That's a very important question. I have written an article, Combined Individual/ Maritial Therapy: A Conflict Resolution Framework and Ethical Considerations, that sets me at odds from the conventional wisdom in the field. If a couple is in individual work with another therapist, I make it my policy not to see them in couples therapy unless the individual therapy is done with me. The individual and couples work needs to be under the guidance of one person or else it just doesn't work. If the therapy is split among therapists, they are almost inevitably going to have two different databases so that the therapist becomes a source of iatrogenic doctor-induced damage.
RW: I would think this is even more so with high conflict clients, though yes, it goes against the grain in the field.
SH: The therapist is unable to correct the distortions because they can't see for themselves what the other person is doing. The client in individual therapy presents as being so perfectly nice, very warm, very nurturing, very interested in changing... you see their healthiest side. Many times I saw this in working with just one person then was stunned to see what happens when they are interacting with their spouse.
RW: How do you set up who comes in to see you?
SH: If they are in a relationship or married, we encourage them to come in from the very first session as a couple. Then we will work out to what extent they do individual work, couples work, or some combination of both. Also, when you are stuck in the couples work, switch to individual and you will find out what the 'stuckness' is about. I recommend that they each do a similar number of individual sessions. The client is able to relax and speak more freely, take in new information, or experiment with new stances in a way they may not be allowing themselves to do while the other is watching. Then you have more leverage with that person when you return to the couples work. In real troubled couples, I will consistently see them both alone and together.
RW: What about keeping secrets and confidentiality in this flexible approach?
SH:

It is very important that a therapist have a policy and state it clearly in the first session. The prevailing policy seems to be that there are no secrets: if you tell me something in session, I have the option of disclosing it to the other.

I am truthfully horrified by this no-secrets perspective because it means that if one person really does have some information they don't want the other party to know about for whatever reason, they are not going to disclose it to me.
I am truthfully horrified by this no-secrets perspective because it means that if one person really does have some information they don't want the other party to know about for whatever reason, they are not going to disclose it to me.

After laying out the foundation of confidentiality, I turn to each of them and say, "When I work with either of you alone, the confidentiality that I am bound by limits keep me from saying to your spouse what we have talked about. Each of you can trust in that privacy." Then I explain that they are free to speak with each about their own therapy or to play the session tape because I audiotape every session and give them the tape so they can listen to it. I am the only one that's bound by confidentiality. The tape, by the way, radically increases a therapist's effectiveness since patients benefit greatly from listening to the session.

RW: Many experienced couples therapists I know take an approach that gives each person confidentiality in their own sessions. But I agree with you that the no-secrets approach seems to predominate in graduate training. New therapists are afraid of keeping any secrets for fear of becoming confused about who said what. My experience has been that people keep private things all the time in life and people appreciate it in therapy as well. You don't necessarily tell one good friend what another friend said about them. With tact and permission, I find that most people want to bring out important issues in the couples session as well.
SH: Exactly. And people tell their spouse information and they don't expect them to tell others. Privacy and maintaining boundaries of privacy is an important maturity skill. I think I learned this lesson years ago when I saw one of my first couples and, sure enough, it was a situation where the man was having an affair. I don't know why it happened that he spoke alone with me at some point, but we had one session on the affair. Through that session, he realized, "I don't want to be having this affair. I want to get out but feel so stuck in it," which is so common. And so we role-played how you end such a relationship and he learned that skill set. He ended it and we subsequently went on to deal with their problems and concerns which we handled virtually immediately.

I saw them some 15 years later when I was downtown.
remember thinking, "Thank heavens I disobeyed the conventional wisdom of the time and did not insist that everything come out in the open."
remember thinking, "Thank heavens I disobeyed the conventional wisdom of the time and did not insist that everything come out in the open." My guess is he has never told her; it was one of those stupid mistakes people do. They have a wonderful relationship. They never wished for Humpty Dumpty to fall apart. And I at least have no responsibility for whether he told her or didn't tell her. I care that they have raised five wonderful children and have a great marriage.
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Heitler's Husband and Tennis Coach Teach Her Some Things

RW: On a different note, what have you learned from your own relationship and marriage to help you in being a couples therapist?
SH: A lot. If it doesn't work at home, I am surely not going to teach other people to do it. My husband has been my accomplice or coach in this whole practice of learning about what principles keep data flow moving comfortably, playfully, effectively. He's been wonderful about that.
RW: Do you have an example?
SH: There is the classic therapist dilemma which is when I know the rules and he doesn't in terms of effective dialogue. It's not going to work for me to coach him when we are in the middle of the discussion because that's what I call a crossover, telling him what to do. And what my husband taught me to do was use my own ideas with him. I can talk about myself or I can ask about him. But it's not for me to either examine his way of talking or tell him how to talk or what to feel or think. So all I can do is model it or ask "How?" and "What?" questions myself.
RW: What about for therapists who are married to one another; often people think they should have some perfect relationship...
SH: And they should.
RW: Really?
SH: If they can't do it at home, what are they doing talking to other people? Would you want a tennis coach who can't play tennis?
RW: We would want a tennis coach who can learn from his mistakes and could correct them, but I think therapists can overanalyze things to a point where it gets in the way of living life. Indeed, some coaches are so good at their sport that they become perfectionists and can't coach beginners well. Some of the best coaches are just fair players.
SH: That would not be enough for me if he really wasn't good at the game. But yes, some great players have forgotten what beginners do. So I think one doesn't have to have a perfect relationship. One does have to have a good strong skill set, like my current tennis teacher, Charles, who I am very fond of.
RW: I can tell. What makes you so fond of him?
SH: He is a dear of a person, has a marvelous eye for what the next technique is that would move me to the next level of playing. And part of the fun is that although he is a good player, I can still win some points off him. He reminds me of what it is like to be a great therapist.
RW: Let's hear more about that. What about his coaching is like being a therapist?
SH: As long as I feel like I am learning every single lesson from him, I feel like I still want to be taking lessons from him. He is actually a very unusual tennis coach in terms of where he came from in life. He is an African American fellow in his 20s who grew up in a very poor area where for years he was doing all the riskiest things in his life. But he has always been a very good athlete who had a great tennis coach. Eventually, the head coach at my tennis center found him and said, "Hey this guy is a gem," because he has strong skills and has an engaging charismatic, fun personality. Charles just lets himself be Charles out there. He is upbeat, full of enthusiasm when I do things well, like he really cares how I do. He's really in there, connected with me. So I think what I am saying is that therapy too should be skill-based work and fun.
RW: Good coaching and good therapy have lots in common. What other advice would you give for young to mid-ranged therapists?
SH: You can't coach if you have no skill sets, so a therapist has got to really be well-schooled in at least the main couples techniques that I set out in my book The Power of Two. To me, those are the skill sets that one needs to be a quality therapist.
RW: What about the ability to form a positive relationship or working alliance with couples, to be able to approach problems in a collaborative way?
SH: The ability to have an alliance with a couple is a function of therapist attunement to the couple. If you are only listening without also being a person there commenting on what you hear, then you don't have attunement or a relationship. So I spend very little time at the outset of therapy worrying about building a relationship. I build a relationship because I am an attuned and responsive human being as we talk about their problems. Within the first five minutes of seeing a new patient where we are interacting, I am in there with them.
RW: You are not building a therapeutic relationship, you are having one.
SH: I love that way of describing it.

Heitler's Hats
Coaching Hat: Teach people the skills that enable them to have successful relationships. These intrapsychic and interpersonal skills facilitate self acceptance, coping with stress, emotional self-soothing, and soothing of others. Couples can learn these skills, be prompted, and can reinstate them after failing to use them in a tense situation.
Healer Hat: Use traditional therapy skills to understand the patient's past, family-of-origins issues, understand depression, anxiety, anger, obsessive compulsive and addictive disorders and know how to reduce or eliminate the symptoms.
Mediator Hat: Walk people through their intrapsychic and interpersonal conflict. Help them to tolerate emotional exploration while using the dialogue and question skills that enable them to keep moving forward in the three steps of conflict resolution: express initial position, explore underlying concerns, and create mutually satisfactory solutions responsive to all the concerns of the participants.





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Still Having Fun

RW:
SH: Obviously after more than 30 years in the field...
RW: Obviously you have kept your enthusiasm in the field and it shows. What is it that still excites you about the work?
SH: Like with my tennis coach, I enjoy my clients and the work. I am playful, we laugh a lot, we have a good time. I don't think therapy has to be this deeply serious thing all the time. Certainly, there are issues that carry more emotional weight and need to be given their due. Even more than that, when I think of all the next generations that are benefiting from their parent's growth, because the skill sets get passed on from generation to generation. We therapists are very, very fortunate to be able to have this kind of impact on our world and the generations to come. And it's also a great fortune to be able to spend one's life making other people's lives radically better.
RW: Thanks for sharing your work and yourself with us today. I agree it has been fun.
SH: I have enjoyed it as well, thank you.

Copyright © 2006 Psychotherapy.net. All rights reserved. Published January 2006.
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Susan HeitlerDr. Susan Heitler is a clinical psychologist specializing in saving marriages. In her clinical practice as a marriage therapist in Denver, Colorado, Dr. Heitler has been helping individuals and couples for over 25 years. She also has written a book, a workbook, and led workshops called The Power of Two to help more couples learn the skills that lead to marital success. Dr. Heitler graduated from Harvard University, earned a masters degree in education at Boston University and then a doctorate in psychology from New York University. She and her husband, married over 30 years, have enjoyed raising four children, now young adults with children of their own. Dr. Heitler has lectured on her therapy methods nationwide and abroad, including in Spain, Austria, Lebanon, the United Arab Emirates, Israel and Australia. Dr. Heitler, a popular radio and television talk show guest, is frequently interviewed in magazines such as Fitness, Men's Health, Women's World, and Parenting. Her cases have appeared often in the Ladies Home Journal column "Can This Marriage Be Saved?" In May 2004, Dr. Heitler appeared on the CBS Early Show where anchor Harry Smith introduced her as "the most influential person in my life—my therapist." He encouraged his viewers similarly to seek therapy when they are emotionally distressed and premarital counseling when they are contemplating marriage. You may learn more about Dr. Heitler and her work at TherapyHelp.com.

See all Susan Heitler videos.
Randall C. Wyatt, PhD is a practicing psychologist in Oakland and Dublin, California. He specializes in working with post-traumatic stress, cross-cultural therapeutic relationships and couples therapy and has extensive teaching experience.
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