Recently, Dr. Amber Berkoski shared her reflections after reading “A Research-Driven Flow Chart to Approach Change in Couples,” Capozzi (2025). Her response highlights an issue many systemic clinicians quietly observe—but don’t always name clearly.
Too often, therapists assume that if they are competent working with individuals, they can seamlessly transition into working with couples. But individual therapy and couples therapy are not interchangeable skill sets. They require different lenses, structures, and ethical decision-making models.
As Dr. Berkoski noted, many couples arrive in her practice having been unintentionally harmed—not by unethical therapists, but by well-meaning clinicians who lacked a clear systemic framework. Without a structured decision-making model guiding whether to provide individual therapy, couples therapy, or both (and how), the work can quickly drift into triangulation.
When a therapist works individually with one partner while also attempting couples work without clear boundaries, predictable patterns emerge:
- Alliances become imbalanced.
- One partner feels unheard or pathologized.
- Therapy reinforces existing power struggles.
- The relationship strain intensifies rather than resolves.
This is not simply a technical mistake—it is a systemic one.
Couples therapy is not “individual therapy times two.” It requires a shift from intrapsychic formulation to interactional formulation. The identified problem is not housed within one partner; it is organized between them. Without a systemic frame, therapy can inadvertently place pressure on one person to change, reinforcing the very dynamics the couple is seeking relief from.
Dr. Berkoski’s appreciation for Capozzi’s research-driven flow chart speaks to something essential: structure protects both clinicians and clients. A clear model guides ethical decision-making. It helps therapists discern:
- When individual work is indicated
- When systemic work is necessary
- When combining modalities risks harming the alliance
When couples present for help, they are struggling with chronic problems in the relationship and want insight into who needs to be ‘fixed’. However, systemic practice tells us the question is not, “Who is the problem?” but rather, “What problems reside in the relationship we can better understand?”
In systemic practice, structure is not rigidity. It is protection. It protects the alliance. It protects the couple. And it protects the therapist from drifting into triangles that feel helpful in the moment but destabilizing over time.
Couples therapy deserves its own decision-making model and a commitment to systemic thinking. When clinicians embrace that distinction, couples experience feeling heard, understood, and held within a coherent therapeutic structure.