Case Study

Helping Couples on the Brink

How Validating Ambivalence Can Foster Hope

Magazine Issue
November/December 2022
Case Study: November/December 2022

To facilitate an emotional bond between troubled partners, it’s always important to show up as a lively, authentic human being who can respond to their unique reality as a couple, including the many nuances of their family-of-origin issues and cultural backgrounds, with deep emotional involvement, interest, creativity, and—as appropriate—a gentle sense of humor and perspective. But by the time some couples come to us, they’re on the brink of separation or divorce. At this point, they may even have seen a few therapists and gotten nowhere. Their hope for success, or even for a small shift in a positive direction, may be at an all-time low. The therapeutic stakes, therefore, can feel higher than ever.

Therapists sometimes cope with the added pressure of working with these couples by doubling down on their existing templates and strategies for plumbing the depths of past emotional pain and stuck patterns, inquiring about difficult family-of-origin experiences, and amping up their determination and enthusiasm for hope and positive change. But even as well-intentioned therapists urgently do their best to turn the tide at such a critical relationship juncture, they may inadvertently make avoidable mistakes from the start of treatment with these couples, such as overselling the potential for change or encouraging partners to commit to a certain number of sessions over a specified time.

Validating last-chance couples’ ambivalence about what’s possible in therapy may seem counterintuitive, but it can actually help establish a genuine, trusting therapeutic relationship. Paradoxically, acknowledging and supporting an exhausted, hope-wounded couple’s need for a flexible, open therapeutic contract from the get-go can be part of what allows them to practice unfamiliar ways of speaking, behaving, and viewing themselves in the here and now.

Meeting couples on the brink exactly where they are involves structuring treatment in a way that demonstrates compassion for their ambivalence. It also means—at least initially—interweaving the need for active experiments in possibility with uncovering the underlying issues that have been feeding into unhelpful patterns. As last-chance couples actively experiment in their day-to-day lives with new behaviors and review the impact of these interpersonal experiments in session, they can begin to see—and feel—what’s truly possible for their relationship.

The Therapeutic Contract

Geetika and Aadesh had tried couples therapy for a few months without success by the time they came to see me. They’d even broken up for seven months, only to reconnect and agree to go to therapy “one last time” to see if their issues could be resolved before calling things off. Another South Asian (Indian) couple I’d helped had referred them to me.

Geetika, a 30-year-old second-generation Bengali American physician, and Aadesh, a 32-year-old first-generation Bengali American lawyer, had met online two years before our session. Initially, they were excited to match up so well in terms of culture, social class, education, intellectual interests, and professional aspirations. They had also connected around occasional race-based negative experiences as Brown people in their white-dominated professions. Yet despite their cultural similarities, they’d found themselves awash in unexpected differences, which led to acrimonious conflicts from the start, resulting in hurt, anger, bitterness, and days of brooding silence.

In our first session, Aadesh seemed to want to test my understanding of their cultural background. He asked politely, but with a sense of urgency, “So our friends mentioned that you’re familiar with South Asian cultures. How have you gotten to know about them?”

I smiled warmly, welcoming his question. Rather than aspiring to a fixed state of “cultural competence” or expertise, I aim for cultural humility and try to convey my respectful enjoyment, interest, and curiosity when it comes to others’ cultures. I admitted that I had a lifelong interest in South Asian cultures and relayed how much I’d appreciated learning about the unique strengths and challenges of South Asian families from the South Asian students in the family psychology class I’ve taught at City College for many decades. And I noted that, as a conservatory-trained percussionist, I admired the dexterity required of tabla drummers and listen to a lot of Zakir Hussain. “I even make my own rasmalai,” I told them with a grin. (Rasmalai is a delectable and delicate, but time-intensive dessert.)

“Really?” Geetika laughed. “Even my mother doesn’t make rasmalai!”

After settling into a therapeutic rapport, I learned that Aadesh and Geetika’s main issue seemed to stem from different emotional styles, which became particularly jarring and painful during conflicts. They worried about what the other’s styles indicated about their respective personalities: Aadesh felt Geetika was too sensitive, often bursting into tears and needing a lot of reassurance; Geetika considered Aadesh rude and mean when he got angry and withdrew.

Geetika grew up in a homogeneous Bengali community in New York. She liked to spend a full day each weekend with her family, in what she called “typical Bengali family life”—cooking, eating, and chatting about the week’s events. A premium was placed on expressing the details of difficult feelings and soothing one another.

In contrast, Aadesh grew up in Birmingham, England. His family was more what he called “British-style Bengali.” Discussions were limited to dinnertime, when his parents would inquire about his and his brother’s scholastic achievements of the day, or his father would pose various intellectual topics for debate. Emotional expression was overtly discouraged. Aadesh couldn’t recall a single time when he sought his parents’ soothing or ever cried to them.

Aadesh found time with Geetika’s family boring, uncomfortable, and exhausting. He acknowledged Geetika’s critique that he was frequently withdrawn and curt with her family, adding that he often found their conversations “silly” and “intellectually unengaging.” Aadesh required hours of alone time after these visits to recharge, leaving Geetika feeling rejected. Aadesh felt similarly about time spent with her friends, deeming their conversations “shallow”—an assessment that hurt Geetika deeply. As a person of Bengali background, she’d thought he’d understand the importance her family placed on connecting and spending time together. Explaining his behavior to her family and apologizing for his rudeness and emotional distance pained her. Aadesh felt frustrated that she seemed to reject his form of Bengali family life.

As I do in all my first sessions with any last-chance couple, I worked with Geetika and Aadesh to create a tentative therapeutic contract that didn’t assume they’d return for a next session. This involved fully acknowledging and validating their ambivalence and lack of commitment to a future together. I made it clear to both of them that we’d be evaluating the gains made in each session and the quality of the events of the succeeding week in terms of whether it made sense to continue. In other words, I let them know that I wasn’t assuming we could automatically settle into a multiweek or multimonth process. I always set up this contract in the very first session with last-chance couples, and I’m mindful about making assumptions. Saying something like, “Well, you made it to this session, which shows there’s hope and positive intentions, we just need to hunker down and do the work,” may seem like an innocuous statement, but this kind of attempted reassurance can be misleading, since it’s not necessarily true. In fact, therapy may not produce the changes they’re seeking.

With couples like Geetika and Aadesh, the only way to empirically assess whether the relationship can improve sufficiently to proceed with therapy is to engage in what I call experiments in possibility. These experiments are new interactions and ways of viewing self and other meant to put a wedge between what’s come before and what’s happening now, thereby possibly redefining the future. Couples often share with us the details of their painful past together, but in fact, until they try new and preferred ways of being with one another, there’s no past—just a long, Groundhog Day present, stretching back months and years.

Other important elements of my initial contract with Geetika and Aadesh included preparing them for the discomfort and sense of relational risk that might result if things did go well. Any changes they made that took them in the direction of more positive interactions, feelings, or thoughts would probably feel awkward and artificial, at first. They might even feel anxious to try, lest the gains not last and they feel even more disappointed. Also, they might not feel fully motivated to try new things. My suggestions for activities to promote improved ways of communicating and sharing intimacy and pleasure would probably make logical sense to them (and often be supported by extensive research), but might feel emotionally irrational, given how angry, hurt, and hopeless they both felt.

“Although I’ll offer positive reframes and other hope-engendering comments,” I told them, “this doesn’t mean I’m hell-bent on keeping you together. Please call me out if it seems I’m pushing you in any particular direction.” Telling couples this before you start working together can take the pressure off, leaving them more open to engaging in the therapeutic endeavor. This was certainly the case for Geetika and Aadesh, who both breathed a sigh of relief, especially when I added, “Even if things improve, you may still decide you want to end the relationship.”

“Thanks for putting us at ease,” Aadesh said, and Geetika nodded in agreement. “Our previous therapist didn’t seem to understand just how precarious our relationship is right now. She mostly just had us talk about our many fights and feelings, which frankly made things worse. She seemed to have a template that just didn’t fit for us. She didn’t offer us any tools to make things better.”

It’s understandable that therapists trained to preserve partnerships struggle to grasp the shakiness of a last-chance couples’ commitment or to recognize the urgency of the desire partners have to see if therapy can lead to observable changes in how they interact. By the time they come to us in a last-chance state of mind, they’re tired of reviewing their troubled history and have no sense of a path forward. Pointing them backward to reexamine their conflicts is often more harmful than helpful, whereas providing them with concrete guidance about how things could change for the better through implementing new behaviors offers a possible path forward, and a sense of renewed hope.

Beginning Anew and Hidden Issues

I taught them a mindfulness-based approach to communication I developed called Beginning Anew for Couples. Borrowing from the research-based Speaker-Listener and Problem-Solving Techniques from PREP (Prevention and Relationship Enhancement Pro­gram), it asks each partner to speak for up to 15 seconds, stating their feelings and perspectives (thereby avoiding mindreading), followed by the other partner repeating back what they heard to check for accuracy and provide validation (while not necessarily showing agreement). Beginning Anew incorporates practices drawn from Buddhism to create a softer, gentler style of communication through showing more appreciation, acknowledging hurt, and decreasing negative arousal through mindful breathing.

To Aadesh’s surprise, he discovered that when he fully listened to Geetika talk about her feelings from the outset—rather than withdrawing and prompting her to pursue more intensely—she didn’t have an “endless need to talk.” Likewise, the techniques provided a safe structure for him to open up more fully about his own feelings, and thereby avail himself of the capacity for care and compassion that had drawn him to Geetika in the first place. Geetika was delighted to hear Aadesh finally talk about his feelings, leading her to revise her personality assessment of him as “rude,” “gruff,” and “repressed.”

We used these communication techniques to systematically address the more fundamental themes in their relationship that had emerged early on—what Howard Markman and Scott Stanley of PREP call the hidden issues of power and control, closeness and caring, respect and recognition, integrity, trust, commitment, and acceptance.

Geetika felt that Aadesh’s reluctance to spend time with her family and his need to spend time alone afterward connected to the broader, hidden issue of feeling unloved. “When you remove yourself emotionally during visits with my family and are sometimes short and rude, I feel unloved and rejected by you, and lonely,” she admitted. “When I want to talk about my day, and you get distracted by your phone, look impatient, and say nothing, I feel unloved and hurt. And when you criticize me for crying and being ‘overly sensitive,’ that makes me even more upset.”

Aadesh looked down, pensive and remorseful. Then, he lifted his head and with a gentleness I hadn’t yet witnessed in him, he said, “Geetika, I’m really, really sorry for how I’ve made you and your family feel. I know I need to do better. I’m just not used to all this talk about feelings.” Geetika, visibly moved, cried softly. Aadesh took her hand and looked her in the eyes.

Aadesh connected most to the hidden issues of control and respect or recognition. He said, “When I tell you I just can’t take so much socializing with your family, or with friends, and you insist that we see them and even make plans without asking me, you put me in an emotionally uncomfortable position. I feel resentful and kind of frantic, because I know I just can’t muster the energy to be social for so long. I’ve told you so many times that I need a lot of private time, but you still push me out of my comfort zone. I also feel that you don’t recognize and respect how different my family is from yours. Yes, my family is Bengali, but we don’t talk a lot or spend that much time together. It hurts that you don’t seem to get that.”

As we named hidden issues influencing their relationship dynamics, Geetika and Aadesh began reflecting on how their respective parents had modeled ineffective and unpleasant approaches to addressing conflict. Geetika’s parents were constantly fighting, though they tried to appear happy in public. Aadesh knew that there was a lot of tension between his mother and father, but he never witnessed them successfully discussing their differences or finding mutually satisfying resolutions. Rather, they agreed to disagree, even though this approach apparently resulted in a gradual decline in their marital satisfaction.

“Aadesh, I hope you’ll admit this is the first time you’ve ever really heard how hurt and rejected I’ve felt,” Geetika said.

Aadesh responded, “If we stick to this technique, listening to each other for 15 seconds and paying attention to our hidden issues, it’s easier to hear you. I feel less panicked because I know we won’t descend into some endless, hours-long cycle of conflict.” In an earlier session, I’d pointed out that their pattern of Geetika approaching and Aadesh avoiding was a familiar gendered one across many cultures, but it seemed amplified by their different ways of “being Bengali.”

Spending Time

Another key theme in our work centered on coming to consensus and bridging preferences around how the couple wanted to spend their time. I shared somewhat wryly that, like most theorists and researchers in psychology who get interested in a particular topic, this was an important issue in my own marriage. My wife and I had engaged in explicit conversations about our respective desires for balancing time spent with other couples, time with just the two of us and the kids, and time alone. Geetika and Aadesh seemed to welcome my small self-disclosure, which normalized their struggles.

We spent weeks developing, testing, and refining a “time pie” that would allow Geetika enough time with her family and friends (with Aadesh working harder to be engaged); time together in pleasurable activities without others present; and the quiet time alone that Aadesh needed after social engagements. One form of time together that hadn’t occurred to either of them until I suggested it was silent time together on the couch, each immersed in their own reading—perhaps with legs entwined. This greatly reduced Aadesh’s need to honor his “deep introversion,” as he called it—he could be alone in his mind and yet together physically with Geetika. By engaging regularly in this “alone together” time, Aadesh’s need to be completely alone dramatically decreased, and Geetika no longer felt rejected by him.

They adopted a nightly practice I’ve called “the decompression chamber,” in which they’d first greet each other at the end of the workday (Aadesh was working at home, and Geetika was seeing patients in the hospital) and talk about their days and feelings for 20 minutes. Aadesh would then spend 20 minutes engaging in solitary activities that helped him “reboot,” while Geetika called family or friends. Then, they’d reconvene for dinner and go on with the rest of their evening in joint activities or alone together time. Setting this regular 20-minute period at the end of the day for talking further reduced Aadesh’s worry that he’d be overwhelmed with Geetika’s “emotional needs.” He began experimenting with being fully present to her during that time.

Once these therapeutic gains were in place, the couple had a sense of a possible future. Nevertheless, they were still feeling wary about whether it would all stick. They agreed to give themselves three months to see if they could reliably weave these changes into daily life. We decided to end therapy at that point, but to my delight, I received an email from them about a year later, Geetika wrote to say that not only had they gotten married, but they were expecting their first child.

With last-chance couples, it’s important to suspend both our judgment and our wishful thinking about their future together while providing them with new options for interacting and understanding both their obvious and hidden issues. Couples who may or may not return for a second session need to be able to experiment as allies without feeling like they’re on the hook to work through complicated, accumulated, and painful issues quickly or even successfully. This way, they can reconnect with the freedom they still have—even when they feel skeptical, discouraged, or lost—to explore their potential as a couple for themselves.


Case Commentary

by Erica Turner

The heart of all good therapy begins with meeting clients where they are, and Peter Fraenkel effectively illustrates this in his work with Geetika and Aadesh. When a couple is on the brink, honoring their ambivalence is key to engaging them in the therapy process and making them feel heard. By communicating to the couple that he “wasn’t pushing [them] in any particular direction,” Fraenkel joined the partners in the space of their own doubt, sending the message that no thought or feeling is off limits to explore in therapy, including the couple’s fears that the relationship might end.

Somewhat differently than Fraenkel, I practice primarily from an Emo­tionally Focused Therapy lens, so my core focus would’ve been on helping the couple connect to and share their emotional experience underneath their positions. However, despite differences in our approaches, I also use the framework of “running experiments” with stuck couples. These partners often struggle with a tangle of powerful, conflicting emotions, and it’s easy for them to become lost in and paralyzed by their doubt.

Because of their deep uncertainty, partners sometimes expect that I’ll tell them whether they should be together. Earlier in my career (and sometimes still), this made me anxious; after all, I was the expert, and here they were paying for my help. Shouldn’t I have all the answers? I felt I needed a way to extricate myself from the role of judge and also guide clients toward some action that would help them better understand what’s possible for their relationship. Asking them if they’d be willing to test new ways of being together helped them exit their stuckness and free me from the role of arbiter. And even with couples who have said they’re not certain if they want to experiment with new possibilities, that too can become the focus of the work, and a way to understand where they stand in regard to the relationship.

Similarly, while I don’t typically use a formalized approach to having partners share their experiences, I believe I would’ve landed on similar themes as to what Fraenkel ultimately explored with this couple. In particular, I would’ve reflected how their expectations surrounding their shared cultural background played into their frustrations surrounding the relationship. Geetika stated that she thought Aadesh would understand her concept of family, and Aadesh said that he felt that she didn’t accept his family construct. I would’ve liked to have each of them share how this disconnect contributed to the sense of rejection and loneliness they each experienced in the relationship, which is similar to where Fraenkel lands with them.

For me, reading this case was a reminder of what has been proven repeatedly in the common-factors research in our field. There are many different approaches that can be helpful to clients, and what’s most important is that we, operating from our authentic selves, meet clients where they are. This is certainly not to say that everything a therapist does is effective, but that many approaches can lead to the same end.

This case study was adapted with permission from the forthcoming book, Last Chance Couple Therapy: Bringing Relationships Back from the Brink (W.W. Norton & Co.).


Peter Fraenkel

Peter Fraenkel, PhD, is a couple therapist, psychologist, associate professor of psychology at City College of New York, and professional drummer who studied with Aretha’s drummer. He received the 2012 American Family Therapy Award for Innovative Contribution to Family Therapy, and is the author of Sync Your Relationship, Save Your Marriage: Four Steps to Getting Back on Track, and Last Chance Couple Therapy: Bringing Couples Back from the Brink.


Erica Turner

Erica R. Turner, LMFT, is the owner of Rosewater Therapy, as well as an Adjunct Faculty member in the Couple and Family Therapy program at the University of Maryland, College Park. She’s the cofounder of Therapy is Not a Dirty Word, an events and advocacy program that works to bridge the gap between therapists and the public. Visit