What Individual Therapists Commonly Get Wrong About Couples: The Relationship-ectomy
Saturday, September 5, 2026.
What Individual Therapists Routinely Get Wrong About Couples
William J. Doherty, founder of Discernment Counseling, has a memorable term for one of psychotherapy’s least examined complications: the relationship-ectomy.
The procedure requires no anesthesia. It usually begins with empathy.
A distressed client describes a spouse who is cold, controlling, narcissistic, avoidant, emotionally unavailable, or insufficiently supportive.
The therapist listens carefully. The spouse is not present, of course.
Their behavior cannot be observed. Their account cannot be heard.
The interactional sequence—the part each partner plays in evoking and reinforcing the other—is invisible.
But an alliance forms.
Pain becomes proof.
A tentative interpretation hardens into a clinical conclusion.
The therapist stops hearing the client’s account of the marriage and begins hearing the marriage itself.
Soon the client is encouraged to establish boundaries, protect their peace, honor their truth, and consider whether they have outgrown the relationship.
None of this language is inherently wrong.
In abusive or coercive relationships, individual therapy may help someone recognize danger and leave safely.
But in ordinary distressed marriages, therapeutic language can become an exquisitely respectable instrument for removing complexity.
The client has been psychologically separated from the marriage before the marriage has been competently examined.
The problem is not empathy
Clients deserve to have their suffering understood. But understanding someone’s pain is not the same as confirming their explanation for it.
A therapist can say:
“You felt abandoned when your husband withdrew.”
That validates an experience.
It is different from saying:
“Your husband withdraws because he is emotionally unavailable and unwilling to meet your needs.”
That assigns motive, character, and responsibility to someone the therapist has never met.
Dr. Doherty offers an essential distinction: align with the client’s therapeutic goals, not with the client against another person.
A competent therapist can validate pain without ratifying every belief about its cause. The inability to make that distinction is not compassion. It is clinical mediocrity wearing the manners of empathy.
One person’s truth is not the relationship
Individual therapists often imagine they are receiving half the story. They may be receiving considerably less.
They are hearing one person’s current experience of a recursive process while observing none of the process itself.
They do not hear tone, pacing, escalation, failed bids for repair, or what happened immediately before the reported injury. They cannot see how one partner’s protection activates the other’s.
The client’s account may be completely sincere and systemically incomplete.
An individual therapist hears:
“Whenever I try to talk about our relationship, she becomes defensive.”
A systemically trained therapist becomes curious:
What does “trying to talk” sound like?
Does concern arrive as criticism?
Does one partner pursue until the other becomes overwhelmed?
Does withdrawal intensify pursuit, which then deepens withdrawal?
What is each partner protecting?
What does the client do that makes sense internally but lands differently on the partner?
Could this be a union of mixed neuro-types?
This does not mean responsibility is always equal. It rarely is. It means relational causality can be circular even when accountability is asymmetrical.
Knowing that difference is part of the job.
How the operation happens
Consider a composite example.
A husband tells his therapist that his wife monitors his whereabouts, questions his spending, and becomes angry when he comes home late.
The therapist wonders aloud whether she is controlling. Over several sessions, controlling becomes emotionally abusive.
The husband begins using both terms at home.
What the therapist does not know is that the husband recently concealed substantial debt and maintained an affair with a coworker.
His wife’s vigilance is not necessarily healthy, but it did not emerge from nowhere. It belongs to a post-betrayal system neither the therapist nor the client has fully described.
The therapist has correctly recognized the husband’s distress while misreading the marriage producing it.
Now reverse the partners.
Change the injury. Change the diagnosis. The structure remains the same.
The error begins when the therapist mistakes the perspective available in the room for the reality of the system outside it.
Clinical Mediocrity Forecloses Curiosity
Clinical mediocrity is not merely a shortage of techniques. It is the premature foreclosure of curiosity.
It is mistaking alliance for accuracy.
It is diagnosing the life partner who is not in the room.
It is treating the most articulate partner as the most reliable narrator.
It is confusing emotional intensity with evidentiary weight.
It is assuming that whoever presents as wounded must be contributing least to the pattern.
It is using narcissist, avoidant, toxic, unsafe, and gaslighting as conclusions rather than hypotheses requiring assessment.
Most of all, it is failing to know what one does not know.
A therapist who treats relationship distress individually is influencing a human system while seeing only one member of it. That is not a reason to refuse the work. It is a reason to approach it with unusually deep humility.
Without that humility, therapy becomes a courtroom in which the plaintiff is the only witness, the defendant is never notified, and the therapist quietly serves as both fair witness and judge.
The Seduction of Becoming the Good Object
Individual therapy creates a particular temptation. The therapist becomes the person who finally understands.
At home, the client feels criticized, neglected, unwanted, or misunderstood. In therapy, the client encounters patience, affirmation, focused attention, and emotional precision. The contrast may be helpful—but it can also become intoxicating.
The therapist is experienced as safe because the therapist does not share a mortgage, raise children with the client, need reciprocity, become exhausted, forget anniversaries, resist demands, or carry fifteen years of accumulated disappointment.
Therapy is a structured relationship in which one partner’s experience occupies the center.
Marriage is not.
If the therapist forgets that difference, the therapeutic relationship can become an implicit indictment of the spouse:
Why can’t your partner understand you the way I do?
The unspoken answer is that the therapist is being paid to organize an hour around the client and is not attempting to build a mutual life with them.
The therapist becomes the idealized good object.
The spouse becomes the disappointing bad object. The clinician then mistakes the resulting split for insight.
That is not sophisticated therapy. It is an enacted triangle.
When Validation Becomes Collusion
Validation communicates that an emotional response is intelligible from inside a partner’s experience. It does not require declaring their interpretation accurate, behavior effective, or partner guilty.
Yet some therapists validate the entire narrative package:
The feeling.
The interpretation.
The attribution of motive.
The diagnosis of the spouse.
The client’s innocence.
The proposed verdict.
The client leaves not merely feeling understood, but professionally authorized:
“My therapist says you are a narcissist.”
“My therapist thinks you will never change.”
“My therapist says this marriage is unsafe.”
The clinician may never have spoken those exact words. A raised eyebrow, leading question, strategic silence, or repeated enthusiasm for one interpretation can communicate the same conclusion.
Therapists influence through emphasis, omission, expression, sequencing, curiosity, and the hypotheses they reward.
Neutrality may be impossible. Unexamined influence is not.
Therapy Can Make Leaving Feel Like Growth
This was Michelle Weiner Davis’s reason for becoming a therapist, she told me.
The most dangerous relationship-ectomies do not feel destructive. They feel clarifying. That is why squishy therapists are so insidious.
Once the absent partner has been cast as disordered, avoidant, narcissistic, unsafe, or incapable of change, remaining begins to look pathological.
Ambivalence becomes codependence.
Loyalty becomes trauma reenactment.
Sacrifice becomes self-abandonment.
Forgiveness becomes poor boundaries.
Commitment becomes fear.
Leaving, meanwhile, acquires the vocabulary of development: choosing oneself, reclaiming identity, ending a cycle, stepping into authenticity.
Sometimes that is exactly what leaving represents.
But a decision is not autonomous merely because it is expressed in therapeutic language.
Clients can be influenced toward divorce just as surely as earlier generations were pressured to remain married.
The ethical problem is not that a therapist may help someone leave. It is that the therapist may help determine the verdict without possessing the competence required to understand the case.
The Profession has Evidence of the Problem
Doherty and Steven Harris studied clients who brought relationship problems into individual therapy.
Participants reported therapists suggesting that the absent partner would never change, had pathological motives or a mental disorder, that the relationship was beyond repair, or that separation was the best option.
Relationship-undermining statements were associated with poorer relationship outcomes and shorter treatment.
Because the study relied on retrospective client reports, it cannot establish simple causation. Difficult relationships may elicit greater therapeutic pessimism, and dissatisfied clients may remember treatment differently.
Those limitations matter.
They do not make the findings comfortable reading.
Doherty and colleagues later examined reports from partners who had attended couple therapy.
In that sample, 40% reported at least one relationship-undermining statement from the couples therapist.
Such statements were again associated with poorer outcomes and shorter therapy, although causality remains uncertain. Read the study.
The problem, it seems, is therefore larger than individual therapists over-identifying with clients.
Even some clinicians treating couples may lack the systemic framework, technical skill, or emotional stamina to remain useful when two compelling realities enter the room.
Couples Therapy is Not Individual Therapy With an Extra Chair
A license does not confer systemic competence
A clinician can be excellent at treating anxiety, depression, trauma, or personality organization and still be dangerously simplistic about intimate systems.
Competence does not transfer merely because the same human beings are involved.
Couples work requires the ability to:
Hold competing narratives without selecting a winner prematurely.
Track circular interaction rather than assign only linear blame.
Validate each partner without confirming every accusation.
Recognize asymmetrical responsibility without inventing false equivalence.
Distinguish abuse from mutual dysregulation, coercion from conflict, and danger from discomfort.
Notice when the therapeutic alliance reproduces the couple’s polarization.
Preserve hope without manufacturing optimism.
Respect separation without quietly campaigning for it.
Ignorance of these nuances is not an innocent gap in specialization when the therapist is actively influencing marital decisions.
It is the very definition of clinical mediocrity: possessing just enough authority to affect a family’s future without possessing sufficient systemic knowledge to understand what one is affecting.
The Ethical Alternative
A relationship-sensitive therapist is not an unpaid attorney for marriage. The therapist does not presume reconciliation is always desirable, minimize mistreatment, or keep someone trapped in danger.
The therapist maintains epistemic discipline:
I know my client’s suffering directly. I know the absent partner through my client’s account. I do not yet know the marriage.
That therapist asks:
What happened?
What meaning did the client make of it?
What remains unobserved?
What is the client contributing?
What might the partner say is happening?
Is this relationship dangerous, destructive, distressed—or some combination?
Has the couple received competent help?
Is the client seeking clarity, repair, permission, or an ally?
Would couples therapy or discernment counseling provide a more appropriate container?
Which decision accords with the client’s considered values rather than this week’s emotional weather?
This stance does not diminish clients. It treats them as capable of self-examination rather than as fragile protagonists whose every interpretation must be protected.
Some Relationships Should End
Some relationships are coercive. Some are violent. Some partners refuse accountability, sobriety, fidelity, treatment, or basic decency. Some marriages have received every reasonable opportunity and remain destructive.
Leaving may be an act of sanity.
But that conclusion should emerge from careful assessment—not diagnostic gossip about an absent spouse, cultural suspicion of commitment, the therapist’s unresolved divorce, or the professional vanity of becoming the first person who “finally believed” the client.
A relationship-ectomy may ultimately be the right operation. Some relationships are malignant. Some cannot be repaired. Some should not be preserved.
But before participating in the removal of a marriage, a therapist should know whether it has been examined, whether the clinician is qualified to assess it, and whether less destructive interventions have received a competent trial. Especially in cases with a captive audience of children.
Anything less may sound warm, validating, and therapeutically fluent.
It may even earn the client’s gratitude.
But it is not clinical excellence.
It is clinical mediocrity with a pleasing bedside manner.
Be Well, Stay Kind, and Godspeed.
References
Doherty, W. J., & Harris, S. M. (2022). Relationship-undermining statements by psychotherapists with clients who present with marital or couple problems. Family Process, 61(3), 1195–1207. https://doi.org/10.1111/famp.12774
Doherty, W. J., Harris, S. M., & Mussa, K. (2024). Relationship undermining in couple therapy. Contemporary Family Therapy, 46, 243–248. https://doi.org/10.1007/s10591-024-09702-2