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.

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.

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.

Letting go of past hurts is a critical skill in any relationship, and for couples, it is critical if the relationship is going to continue to thrive and flourish. Forgiveness is a conscious decision to release feelings of resentment, and it is an important tool in processing hurt and moving forward. Even though your clients may find forgiveness difficult, it is an essential element in healthy relationships. Forgiveness may be one of the most important ways to keep a relationship strong. In fact, the capacity to seek and offer forgiveness is one of the most significant factors contributing to marital satisfaction and a lifetime of romantic love.

Forgiveness is more difficult if your client’s partner is not remorseful, but they will still find value in forgiveness. Some transgressions are so damaging relationships cannot survive, yet forgiveness can still play a role – even if divorce is inevitable. Forgiveness is not the same as forgetting what happened, condoning bad behavior, giving up claims to a fair settlement, or reconciliation. First and foremost, it will help your client heal. Here are some scenarios I observed in my work with couples (names have been changed).

• Lisa scheduled a session because she was having difficulty moving on and forgiving her husband Jack for racking up gambling debts. Jack was in treatment for his gambling problem, but Lisa simply could not forgive him for damaging their finances.
• Lucy and Phil came to see me because Lucy had a short-term affair with another man. Phil was angry and their relationship deteriorated because he could not let go of the pain of betrayal and forgive her.
• Chris realized her partner was lying to her about issues – big and small. She believed trust was damaged beyond repair and that breaking up was the only solution.

Being ‘unforgiving’ takes a physical and mental toll. Holding onto old hurts, disappointments, annoyances, betrayals, insensitivity, and anger wastes your clients’ time and energy. Nursing the hurt can eventually turn into resentment, hatred, contempt, and bitterness.

We know it’s important to practice forgiveness. Researchers at Johns Hopkins report practicing forgiveness can reduce the risk of heart attack, lower cholesterol levels, improve sleep, reduce pain, lower blood pressure, as well as decrease levels of anxiety, depression, and stress.

As I demonstrated with my clients, you too can teach your clients various techniques that can help them foster forgiveness. Teach clients to:

• be open and receptive to forgiveness.
• make a conscious decision to forgive.
• think of a calming place when they are distressed about the situation.
• do something to distract themselves when flashbacks of the betrayal trigger negative thoughts and upsetting emotions.
• refrain from constantly bringing up the situation with their partner or using it as ammunition in an argument.
• accept they may never know the reason for the hurtful behavior.
• avoid seeking revenge or retribution.
• remember that forgiveness does not mean they condone hurtful behavior.
• be patient with themselves as the forgiveness process can take time.

If your client caused hurt or betrayed their partner, they can begin to rebuild trust by asking for forgiveness. They can:

• show true remorse for the pain they caused.
• make a commitment to avoid repeating hurtful behavior.
• accept the consequences of the action that created the hurt.
• be open to making amends.
• make a heartfelt verbal apology.
• create an action plan to make things right.
• be patient with their partner.

Here is an exercise you can do with your clients in session.

1. Ask your client to write down three ways distressing emotions have impacted (or are still impacting) their marriage.2. Explore ways they can process these emotions, such as journaling, practicing yoga, improving their physical health, and expressing thoughts, feelings, desires, and wishes in a respectful way. Resentment increases when people bury upsetting feelings.
2. Discuss small steps they can take to repair the relationship and let go of grudges.4. Identify ways they can accept responsibility for their part. Perhaps they owe their partner an apology as well.
3. Challenge beliefs and self-defeating thoughts about holding on to painful feelings. Processing what happened can release resentment.
4. Focus on accepting that people do the best they can (this does not mean condoning others’ hurtful actions).
5. Help them practice forgiveness by actively thinking like a forgiving person, letting go of grudges, and stop playing the role of victim.

BetweenSessions.com offers many worksheets for couples to help your clients included with your Library of over 2,500 tools. We also offer a Room in our Virtual Counseling Rooms software where couples can practice forgiveness.

Click here for two free worksheets on Practicing Forgiveness and Creating a Forgiveness Ritual.

Angie Doel is the head writer at Between Sessions Resources and she has published several therapeutic assignment workbooks. She practiced as a psychotherapist and life coach for several years prior to her writing career.