Effective Assignments for Couples Therapy

When a couple reaches the point where they seek relationship therapy, they may experience many mixed emotions, including fear, discouragement, or hopelessness. They may believe their relationship cannot be saved and the next step is divorce.

If you see couples in your practice, you can teach your clients techniques and skills that may save their relationship – as well as improve communication, build intimacy, and strengthen their bond.

While each couple is different, there are common themes you will see. These are common relationship problems and a summary of techniques that can help.

Communication Problems. Harmful communication patterns can be difficult to break and may include anything that leaves one partner feeling depressed, insecure, disrespected, neglected, or disregarded. Negative communication can be heard in the tone of voice and observed in avoiding eye contact or frequently looking at phones or other devices. Activities you can suggest include:

  • creating daily rituals. Couples can have coffee together each morning before work or spend 10-15 minutes in an evening check-in to connect and share thoughts.

  • scheduling family meetings. Discuss the weekly schedule, budget, household tasks, and so on so everyone is on the same page.

  • establishing rules of fighting. Make a list of what’s off-limits during a fight, and what each partner requires from the other. Help your clients develop rules to follow during conflicts.

  • eye gazing. Your clients can initiate long-held eye contact to strengthen their connection. Prolonged eye contact helps them recognize emotions, build trust, and increase intimacy.

  • mindfully engaging in deeper topics. Suggest to your clients they schedule time avoiding surface-level conversations while becoming curious about each other’s interests, goals, and opinions about current events, or any other important topic.

  • practicing reflective listening. Couples take turns being active listeners, and you can teach them to practice communication skills (such as using “I” phrases instead of “you” statements) to increase trust and build conflict resolution skills.

Affairs and Infidelity. It is possible to rebuild a relationship after a breach of trust, but it does take work and commitment from both partners. Suggest the following:

  • a commitment to honesty and integrity

  • emotional presence

  • exploring each other’s needs

  • engaging in active listening

Loneliness within the Relationship. Sometimes couples become more like roommates than intimate partners. Distance occurs because life gets in the way. Children, careers, and numerous other responsibilities can distract partners over time. Couples can rebuild their friendship and rekindle intimacy by doing any of the following activities:

  • Share a list. Every week, couples write down three things they desire from their partner. The lists may not be something partners can do every day, but a reminder of things they can do at least once a week.

  • Connect through music. Research indicates that shared music preferences create stronger bonds. Clients can curate a playlist of songs that remind them of their partner.

  • Increase cuddle time. Another assignment might be daily cuddle time. Cuddling causes the body to release oxytocin and reduce cortisol. Touch acts as a stress buffer and may help lower resting blood pressure.

  • Go on weekly dates. Partners can take turns planning date nights. They should try something new, or do something they haven’t done in a while, and avoid talking about day-to-day life issues.

Unsolvable Problems. According to Dr. John Gottman in his book 7 Principles For Making Marriage Work, 69% of problems in relationships are not solvable. Becoming aware of the differences between solvable and unsolvable problems is key to learning how to reduce conflict in relationships. It’s not about always solving every problem; it’s how couples discuss problems and work together as a team.

  • Teach clients how to increase their awareness of the differences between solvable and unsolvable problems to reduce conflict.

  • Practice healthy and assertive communication when unsolvable problems include stepchildren, household chores, pet peeves, in-laws, and so on.

Unmet Emotional Needs. Sometimes resentment, disappointment, or hurt are repressed and fester. Disconnection can begin because of unmet or unexpressed emotional needs. Your clients may do the following activities:

  • Identify love languages. Dr. Gary Chapman identified five love languages to help couples explore what makes them feel loved. This theory is based on the idea that each person has a preferred way of receiving love, including:

  • receiving gifts.

  • doing acts of service.

  • sharing words of affirmation.

  • spending quality time together.

  • engaging in physical touch.

Share this online quiz with your clients to discover their love language to better understand each other.

  • Journal thoughts and feelings to identify emotional needs.

  • Use daily rituals to express emotional needs and do specific actionable behaviors.

Mismatched Parenting Styles. Perhaps one partner is the “bad guy” and the other is judged as too lenient. You can help the couple:

  • develop a plan for how they will manage certain situations with their children.

  • create family rules and consequences and have them clearly posted so both can refer to preplanned consequences for behavior.

Coping with Contempt. Perhaps partners roll their eyes or think they are better than their partners. Perhaps they don’t value each other’s opinions, or they feel like they lack support. Couples can practice:

  • active listening.

  • Encouraging roleplay.

  • asking questions and remaining curious.

  • sharpening their communication skills.

  • expressing appreciation and practicing gratitude through in-person conversations, texts, or sticky notes in places their partner will find them or taking the time to share three things they are grateful for at the end of each day.

Intimacy Issues. Lack of sex and affection can slowly erode relationships. Couples can begin to focus on the basics to begin to rebuild intimacy. Prompt them to answer these questions in session:

  • How do they say goodbye and hello to each other?

  • Do they gaze into each other’s eyes?

  • Do they have time for intimate moments such as a massage or showering together?

They may also:

  • plan time for non-sexual intimacy like holding hands, hugging, kissing hello and goodbye, or cuddling.

  • schedule time together. Suggest couples schedule an hour together once a week to be intimate and focus on topics to improve the relationship.

  • practice partner yoga by flowing through tandem moves and synchronizing their breathing.

  • create a vision board as a reminder of shared desires and goals. Couples can write down their goals and collect pictures that embody their relationship desires. Doing an enjoyable project together can increase intimacy.

  • engaging in the 6-second kiss to add romance throughout the day.

Finances. Discussing money can be stressful and add to the tension between partners. Suggest that partners:

  • be honest and transparent with each other about money and finances.

  • develop short- and long-term goals.

  • use budgeting software.

  • actively and regularly participate in conversations about financial issues.

If you work with couples you’ll regularly see these common relationship problems in session.

To help couples build their communication skills, navigate stressful issues within the relationship, learn conflict resolution tools, enhance intimacy, and more, use these suggestions or any number of other effective techniques, Between Sessions therapy assignment worksheets, exercises, and activities to increase the likelihood couples will experience real, positive change.

If you are a Between Sessions member, you can assign couples our digital card decks in the Virtual Counseling Rooms (VCR). We offer more than 20 card decks that rework complex material into simple concepts that your clients can understand. Add a card deck to a room that incorporates many clinical techniques and skills along with interesting questions, allowing couples to open up during non-threatening therapeutic activities.

Click here to get your free worksheets, “What Is Your Love Language?” and “Using the 3-Phase Technique to Cope with Stress as a Couple.”

Find many more couples worksheets with a 14-day free trial where you will also have access to our Virtual Counseling Rooms that include many techniques you can use in couples therapy.

Using Therapeutic Card Decks with Your Clients

Therapy decks have long been used by counselors and psychotherapists to engage their clients in session. Play therapy stores have traditionally been filled with card games, mostly designed for children. But over the last several years, there has been a significant increase in card decks for sale online.

Therapeutic card decks can distill months of therapy takeaways into 20-word touchstones that clients can revisit between sessions. And since there are card decks for a wide range of clinical topics, therapists can easily find one or more to integrate into their practice.

Card decks may be a vehicle for clinical skills, but in session they can engage clients through play—the clinician is offered a doorway into the client’s world. Cards are a nonthreatening, informal way of showing you understand your client. You can use cards to establish the therapeutic relationship, initiate conversation, or simply play a game.

There are many therapy card decks to choose from, with differences in clinical focus and utility. Some decks are game-like while others teach skills or are more instructional in nature. There are decks for anxiety, depression, trauma, anger, and more. Cards can be used as journal prompts or pick-a-card to follow a “Theme-for-the-Day.” Some decks are non-clinical and meant to be used with loved ones. Others fall somewhere in between, but overall card decks seem to be part of the movement attempting to make therapeutic skills and tools more accessible to the general population.

Drs. John and Julie Gottman have created a series of card decks to help couples develop positive habits that can build a stronger relationship. The couple created fourteen decks for couples (now accessible free through their app), drawing from decades of research on thousands of couples that participated in their “Love Lab” experiments at the University of Washington. The decks help partners connect emotionally, increase intimacy, and expand understanding of each other in a fun, playful, non-confronting manner. The cards give partners a springboard to explain what they need from one another. These decks help couples get to the root of discontent, identify ways to connect, and maximize couples’ ability to communicate creatively about relationship changes.

Unlike the Gottman decks, many recently produced therapeutic card decks use “clinical” terms, but they aren’t endorsed by therapists, nor are they informed by tested clinical concepts. Use caution when you purchase decks for use with your clients. Some card decks are intended only to entertain – they don’t have a therapeutic agenda.

Would you like to create a digital therapy card deck? You can build a library of strategies to draw upon and create your very own digital deck using the Between Sessions Virtual Counseling Rooms card deck Element.

To keep the deck simple and easy to understand, limit the instructions on each card, which clients can easily digest on their own, without your assistance. Avoid complicating things with psychological jargon. If your cards are designed for children or teens, you can add colorful illustrations.

Would you rather use a deck Between Sessions has designed? The Virtual Counseling Rooms software offers 20 decks that rework complex material into simple concepts that clients can understand. Clients don’t have to understand DBT or CBT – but you can add a card deck to a room that incorporates many clinical techniques and skills along with interesting questions, allowing your clients to open up during a non-threatening therapeutic activity.

To maintain a safe atmosphere that encourages your client to share (while avoiding forcing them to respond), consistently use the card decks in session. If presented with an uncomfortable topic, your client can shuffle the deck and select another card – or you can tell them you will give them more time to think about the question or activity and return to it later.

The magic of therapy card decks is that therapeutic growth and processing happens while answering simple questions and completing basic exercises. You may want to ask follow-up questions after using a card deck.

  • What is one thing you learned about…?

  • What did you learn about yourself?

  • What is a topic you would like to explore further?

  • What is a goal you could set for yourself that reflects something discussed in this session?

Therapeutic card decks can certainly be a useful tool in your clinician toolbox. And your clients will appreciate this unique way to make progress toward their therapy goals.

Helping Your Clients Observe and Accept Their Emotions

Dialectical Behavior Therapy (DBT) encourages clients to remain in the present moment with awareness and acceptance of thoughts and feelings – without judgment. Clients begin the process by noticing their environment, thoughts, feelings, and any physical sensations without reacting to them. They simply observe what “is” without trying to change anything.

This process of observation, along with emotional acceptance, promotes mindfulness.

People with borderline personality disorder (BPD) and other disorders that involve intense emotions tend to reject their emotions as bad or wrong. Unfortunately, this can result in dangerous behaviors, such as self-harm.

When your clients judge their emotions and label them as “bad” or “wrong,” or scold themselves for experiencing certain feelings, their emotions may intensify. Thoughts they have about their emotions, and the desire to make those feelings go away, may cause more distress than the emotions themselves.

Karen is a client who is practicing observing her emotions in session. In the past, Karen typically reacted in an explosive way with her friends and family. The moment she became upset, she would lash out, send a nasty text, or give someone the silent treatment. Her relationships were unstable and volatile. She started therapy because she was facing a second divorce, and several loved ones offered her feedback that she might benefit from anger management classes. Karen tended to judge herself harshly but had no idea how to control her temper and better manage her emotions.

When you teach your clients to observe their emotions without judgment, they can allow intense feelings to pass without resorting to destructive habits. Here are some statements that can help them become more accepting of their emotions.

  • Feelings are not facts. Label emotions as “just emotions.”

  • Emotions help you understand yourself and the world around you.

  • You are not your feelings. Instead of saying “I’m angry,” or “I’m really upset!” say, “I feel angry,” or “I feel really upset!”

  • All emotions come and go, so visualize them as a wave that ebbs and flows.

  • Reflect on how you feel throughout the day. Focus on pleasant emotions and reflect on painful or overwhelming ones.

  • Accept your emotions as part of what makes you unique.

  • You are not a “bad” person for having uncomfortable or upsetting emotions.

The DBT skill of Observing Emotions is a mindfulness tool, and it takes practice, discipline, and focused attention.

According to Dr. Marsha Linehan, the founder of DBT, anyone can practice observing their emotions by:

  • noticing experiences without getting caught up in them or reacting to them.

  • allowing feelings and thoughts to come and go, like drifting clouds.

  • staying with the experience instead of pushing it away or clinging to it.

  • allowing things to unfold.

  • noticing what is experienced through the senses.

There are four steps you can teach your clients to help them begin to observe their emotions without judgment.

Identify the emotion and any judgments. Ask your client to answer the following questions.

  • Why are you experiencing this particular emotion now? Explore the possible meaning of what you feel, including specific triggers, conflicts, people, places, or situations.

  • Describe any judgments you have about your emotions.

  • How do your judgments affect how you feel about yourself?

If your client has a hard time identifying their emotions, ask them to sit for a moment and pay attention to their physical sensations and thoughts. Ask them to give the emotion a name (e.g., sadness, disgust, anger).

Allow space for observation. After your client identifies the emotion, ask them to close their eyes if it feels safe to do so. They can imagine putting that emotion five feet in front of them. Ask them to place the emotion outside their body so they can look at it. They will allow some distance so they can simply observe the emotion.

Give the emotion form. Ask your client the following questions:

  • If your emotion had a size, what size would it be?

  • If your emotion had a shape, what shape would it be?

  • If your emotion had a color, what color would it be?

Once they answer these questions, ask them to just watch it for a few moments and recognize it for what it is. When they are ready, they can allow the emotion to return to its original place inside the body.

Reflect. Once your client completes the process, ask them to reflect on what they noticed. Did they notice any change in their emotion when they got some distance from it? Were there changes in their reactions? Did the emotion feel different once the exercise was finished?

Your clients can practice this exercise once a day for a month. After a month, see if they notice any changes in how they relate to their emotions. Clients report that it helps them start to think differently about themselves and be more accepting of their emotions.

Give your clients the DBT Diary Card and Helping Your Clients Observe Their Emotions without Judgment worksheets to record their progress.

Click here to get your free worksheets, “Helping Your Clients Observe Their Emotions without Judgment” and “Using a Diary Card to Manage Intense Emotions.” to help teach clients how to observe their emotions.

Find many more worksheets on  various DBT tools with a free trial at www.BetweenSessions.com, where you will also have access to our Virtual Counseling Rooms that include DBT techniques.


Using Grounding Techniques in Your Practice

  1. “Grounding techniques are now commonly used by therapists working with clients that have experienced trauma. Key symptoms of post-traumatic stress disorder (PTSD) include flashbacks and varying degrees of detachment from the present moment. For some clients, intrusive memories and sensations can be so strong it’s as though the client is experiencing the trauma again in the present moment.

If you’re a therapist and your clients have experienced trauma, one problem they may experience is dissociation, which is a shift in their attention away from the present moment. This shift moves the client toward distressing memories and feeling threatened. This can be extremely distressing, both for clients and for therapists who are unfamiliar with dissociation.

Dissociation can involve:

  • intrusive unwanted memories.

  • intrusive thoughts and emotions.

  • depersonalization.

  • identity confusion.

  • unexplained medical symptoms.

  • loss of control.

  • compartmentalization.

  • identity alteration.

  • multiple identities.

  • reduced awareness of surroundings.

I recall a client who experienced daily panic attacks and frequent dissociation. Ellen’s daily functioning was severely impacted, and when she started treatment, she was considering quitting her job. Over several weeks we practiced grounding techniques, which she began to incorporate into her daily routine. Within a couple of months, she occasionally suffered from anxiety – but no longer had panic attacks. She was more present, and I partially attribute this to her daily practice of grounding techniques.

How do you treat clients who dissociate? In-session, having a basic knowledge of grounding techniques can help you defuse an escalating situation or calm a triggered client. Stabilization and the establishment of safety are two essential elements of treatment. This may include focusing on widening a client’s “window of tolerance,” and developing coping mechanisms by teaching skills such as grounding.

Grounding techniques help clients control symptoms by turning attention away from thoughts, memories, or worries, and refocusing on the present moment. Clients who experience dissociation, or distress that pulls them from the present moment, can be encouraged to try various grounding techniques, to see which method is most effective for them. There are many kinds of grounding exercises, including deep breathing, physical exercises, cognitive interventions, and meditation scripts.

What exactly is grounding? It is any method or technique that keeps your client in touch with reality, like touching the ground with their feet, drinking a cold beverage, or repeating their name, age, and so on.

By teaching grounding as a skills-development exercise, you can help your clients to manage dissociative reactions, reduce anxiety, and cope with stress.

Mental grounding techniques include cognitive, somatic, and behavioral exercises. These techniques can shift negative perceptions into more realistic or positive ones. They can help your client reframe difficult situations and cultivate acceptance without resistance. Here are eleven mental techniques:

Mindfulness allows clients to embrace a more mindful approach to everyday life. It refers to being present and aware of current thoughts, feelings, and bodily sensations. At the same time, it also means accepting the current reality without judging or trying to change it.

Meditation is the intentional practice of staying present with the mind and body and includes activities like breath work, intentional walks, or progressive muscle relaxation.

When clients objectively describe a situation, they separate facts from opinions. To do this exercise, your client acts as if they are a reporter who needs to stick to the facts and stay objective about a story.

The five senses exercise supports present-moment thinking by focusing on five things your client can see, four things they feel, three things they hear, two things they smell, and one thing they can taste.

Find a safe place exercise is a guided imagery exercise that promotes calmness and emotional security.

Name items in a category shifts the client into a task-oriented direction by thinking about all the items in a specific category.

Recite in order uses repetition as a helpful distraction technique. Doing so forces the client to focus on a specific task instead of the distress they are experiencing.

Affirmative safe words are simple reminders, such as “breathe” or “calm,” clients use in uncomfortable situations.

Visualizing anxiety involves imagining anxiety as a tangible item, like a rock. This exercise helps clients separate themselves from distressing thoughts.

Describe what’s around you is a series of questions that allow the client to focus on objects in the environment. Using their senses, they consciously stimulate their mind, decrease blood pressure, and reduce heart rate.

Doing math equations helps clients focus on mentally solving math problems to distract themselves.

Physical grounding techniques are structured, specific exercises that engage the senses or use specific items to provide relief. They may require more preparation and time than mental grounding techniques but are extremely helpful in managing distress.

Savor a food or beverage involves mindfully enjoying a food or beverage, focusing on the sensations involved.

The holding ice technique involves the client holding ice cubes in their hand or tracing them along their arms or legs.

Sprinting involves your client setting a timer and running as fast as they can for thirty seconds. Repeat 1-2 times.

Breathwork is a conscious exercise where the client controls how they breathe, deactivating the sympathetic nervous system while activating the parasympathetic nervous system.

Smelling something is a soothing way to calm down using pleasant scents.

Designate a safe object to serve as a grounding item. The client keeps the item in their pocket or purse and holds onto it as needed.

Clench and release the fists make clients physically aware they are using those muscles.

Feet on the floor exercise refers to shifting as much weight as possible to the feet and “grounding” them into the earth.

Create a grounding space is a designated place – either an entire room or a small section – where the client can spend time when they feel overwhelmed.

Take a shower or bath to get in touch with the body, allowing the heat to be physically relaxing.

Soothing grounding techniques allow your client to calm themselves through self-soothing activities. Here are some examples.

Seek humor to diffuse intense emotions. Laughter is an appropriate response to managing overall well-being.

Coloring can help the client focus on a pleasant task, promoting a sense of calmness and mindfulness.

Listing favorite things reminds the client of all the things that bring them joy.

Spending time with a pet can help reduce feelings of anxiety in the body.

Plan an activity to enjoy later may include things like planning a hike, preparing a meal, going to a concert, or anything else that would be beneficial.

Listening to music can be therapeutic and act as a distraction.

Practice self-compassion and positive self-talk involve writing down how your client contributes to the world and all their favorite qualities about themselves. They can look at the list frequently and it will help to ground them.

Carefully graded exposure to triggers may be attempted in session and combined with the use of grounding techniques to help clients to practice their skills.

Try the following grounding exercises in session:

Ask the client to state what they observe. You might say, “You seem to be afraid/angry/upset. This might be related to what happened in the past. Right now, you’re safe. Let’s try to stay in the present moment. Take a slow deep breath, relax your shoulders, and place your feet solidly on the floor. Let’s talk about what day it is. Describe what you see around you. What else can you do to feel okay in your body right now?”

Help the client decrease the intensity of what they are experiencing.

  • Ask your client to turn down their “emotional dial,” where they imagine turning down the volume on their emotions.

  • Ask your client to clench and unclench their fists.

  • Do a guided imagery meditation with your client so they can visualize a safe place.

  • Use strengths-based questions, such as “How did you cope with that?” or “What strengths did you possess to survive what happened to you?”

Distract the client.

  • Ask the client to focus on the external environment and name shapes, colors, and so on.

  • Ask the client to focus on recent or future events.

  • Help the client use affirmative self-talk.

  • Use counting or making lists to return the focus to the current moment.

  • Use somatosensory techniques (toe-wiggling, touching an object).

Ask the client to use breathing techniques.

  • Ask the client to inhale through the nose and exhale through the mouth.

  • Ask your client to place their hands on their abdomen and watch the hands go up and down while the belly expands and contracts.

Grounding exercises are an effective way for clients to calm themselves, get present, and reduce distress during emotionally escalated moments. Regularly practicing these skills can decrease anxiety, trauma symptoms, dissociation, and intense cravings. It is important your clients consistently practice grounding techniques, implementing them in calm situations so the techniques feel more natural when they are distressed. Encourage clients to try a range of techniques to discover which are most effective for them.

Resource: Najavits, L. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. Guilford Publications.

Click here to get the free worksheet, “Using Your Senses to Feel Grounded,” to help teach clients grounding techniques.

Find many more worksheets on the various aspects of teaching grounding tools with a free trial at www.BetweenSessions.com, where you will also have access to our Virtual Counseling Room “Grounding Techniques.”