Category Archives: Couples Distress

couples therapy

Couples Therapy in NYC: What You Need To Know

Who Benefits from Couples Therapy?

I see two kinds of relationships in couples therapy. Many come in because of dissatisfaction. But a second group are very healthy, but are hoping to enhance existing strengths or work on a few minor issues to have an incredible relationship.

Couples in New York City face the same issues as those living elsewhere. With that said, the pace and demands of NYC often seem to exacerbate some relationship issues. The number of people in Manhattan add stress, temptation for infidelity, and challenge some to realize the one they are with is right, regardless of endless other possibilities. Here are some common issues and problems I see in couples therapy:

  • Angry and resentful partner
  • Depressed partner
  • Anxious partner
  • Constant arguments and fighting
  • Low sex or no sex
  • Waning chemistry
  • Infidelity
  • Loss of trust
  • Poor communication
  • Emotionally cold or disconnected partner
  • Inability to commit
  • Constant blame
  • Inability to forgive
  • Discrepancies in values, interests, and lifestyles
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NYC Couples Therapy

NYC Couples don’t have time for couples counseling. New Yorkers are pressed to be productive every minute. Competitive careers, commutes, demanding exercise regiments, children, social scenes– there is no rest for the weary, much less time for marriage counseling.

Who has time to work on a relationship?

Many New York couples have come to my office, not because they have spare time, but because they’re scared if they don’t, their misery will get worse, their relationship will end, or they’ll end up staying in a very unhappy relationship for too long, or be stuck indefinitely.

My Approach to Couples Therapy

I immediately assess the strengths and weaknesses of the relationship, identify the current problems, historical patterns, and set goals for therapy. Then together, we begin the work of understanding the reason the problems exist, learn the skills necessary to solve these problems. The work is very collaborative. And I am very active in session by:

  • Presenting models to illustrate how couples problems develop
  • Providing concrete tools for couples to use outside of session
  • Conducting exercises and using techniques in session to improve:
    • communication
    • emotion regulation skills
    • problem solving

The couple will certainly be the ones practicing and doing the work, but I am active at providing structure and guidance, as well as validation and help each partner understand each other when necessary.

How much does couples therapy cost in NYC?

New York is by every account an expensive city. Couples therapy can cost anywhere from $125 to $400 in NYC. Some insurance plans will reimburse couples for a portion of that or you may even be able to find a couples therapist who takes your in-network insurance. One advantage to the kind of couples therapy we offer is that our goal is to provide clients with skills as quickly as possible. So while more sessions could be helpful, our goal is to be as effective as possible, as quickly as possible. The last thing I want is for clients to become more stressed because of they are spending more money or time than they have.

Contact me here if you have questions about Couples Therapy

Couples Therapy isn’t for the faint of heart

People resist couples therapy for many reasons. The very nature of a romantic relationship conjures images and ideals that are in stark contrast to a those commonly associated with the scientifically trained clinician.  You may ask yourself, “How can these practical, even mechanically sounding tools and techniques improve my capacity for love?  And I’m supposed to share intimate details of my relationship with this clinically-minded stranger?”  Some of our earliest memories of romantic relationships likely reflect those all too ideal versions only found in Disney movies or television series with a target audience consisting mainly of young teens.  The plots found in these productions did not tend to feature characters faced with financial stressors, nighttime feedings, or waning sexual desire; these modern realities may be demanding something we weren’t expecting.

How to sign up for Couples Therapy in NYC

New York City couples can start couples therapy typically within the week. There are many couples therapists in NYC, so finding one soon is very likely. The key though is finding the right fit. Admittedly, sometimes that is more challenging for a couple than for an individual.

Here are some tips to find a couples therapist:

1. Identify the relationship problems. Write down why each of you want to see a couples therapist. If only one of you really wants to go, and the other is only going for the sake of the other, write that down. You don’t have to share this with each other yet if that is going to cause a fight.

2. Couples Therapist referral from a friend. Get recommendations from friends. If any of your friends have had good experiences that they have shared, follow up. Ask them to let you know if they are comfortable with you seeing the same person and ask for the couples therapist contact information.

3. Professional referral for couples therapy. Ask your physicians, or individual psychologist, clergy, or other professional for a recommendation to a marriage counselor or couples therapist.

4. Review the couples therapist. Once you have at least two or three names, take a few minutes to read their bios. Pay attention to their approach. You may see terms like Behavioral Marital Therapy, Integrative Couple Therapy, Imago Therapy, Psychodynamic Therapy, or Eclectic. Make note of the kind of therapy the couples therapist does.

5. Call and ask questions. Contact the therapist and don’t be shy. Ask why they use the kind of therapy they do with couples. Ask them if they are familiar with the scientific support for that therapy, i.e., does it work for couples? And if you are comfortable, ask them how often they have treated the kind of issues you have. Don’t expect a free 30 minute session during the call, but whoever is answering the phone should be able to tell you about the kind of therapy they offer and maybe even point you to a website that explains the approach. If the person is defensive or seems threatened by these questions, you may want to consider someone else.

6. Schedule an initial session. I encourage people to be advocates for themselves when working with health professionals. That means asking any questions you have and recognizing that if it isn’t a fit, you can always stop going to sessions. I also recommend when it comes to therapy, that clients give it around four sessions before deciding (unless something occurs that is inappropriate or really uncomfortable). There needs to be a little time to build rapport and for the therapist to do enough assessment to really understand how best to help.

Contact me here if you have questions about Couples Therapy


Casual Sex

Casual Sex’s Surprising Science

Science of Sex

Casual sex has been on the rise for decades. This has been concerning for many reasons.

But, did you know that 75% of casual sexual encounters may lead to a relationship?

Did you know that 45% of men hoped their last casual sex partner had turned into a steady relationship?

Or what about for those suffering from depression, casual sex may improve their mood (although for those with a healthy social life, they may feel worse)?

Ok- these are the positives, and there are clearly some negatives. Regret and shame are two emotional possibilities, and unwanted pregnancies, and sexually transmitted diseases are also serious risks.

But, this article by Pere Estupinyà sheds light on a side of casual sex that may have been overlooked. This is by no means an endorsement, only an example of how science can uncover aspects of a behavior we may not have previously understood.

In this case, more casual sex may not be a good thing. But it does seem evident the studies (and interview) he references indicate a few things in need of further investigation.

To start, it does sound as though many people are looking for steady relationships, even though they may engage in a “casual” encounter without that in mind.

Is this the healthiest and most effective strategy for initiating a long-term relationship? I believe most of us would assume the answer is no, but it is an empirical question. Perhaps it saves time.

Or perhaps there is a breakdown in our current socialization for us to understand what we really desire, e.g., a long-term relationship, and/or we don’t know how to communicate about that, so instead we end up in casual encounters. Perhaps developing greater self-awareness and effective communication skills could reduce casual encounters, while increasing the number of healthy long-term relationships if that is the goal.

In any event, we have a lot to learn (and I hope we do it quickly) about how changes in the media are impacting our sexual and relationship behaviors.


happy couple

Couples Therapy – How can you tell if you need couples therapy?

Healthy Relationships and Couples Therapy

The previous blog on couples therapy reviewed the efficacy rates of couples therapy. It is clear that some therapies have the potential to help the majority of couples improve. This is good news, but there may be even more pressing questions for a husbands, wives, boyfriends, and girlfriends, i.e., is what I’m experiencing in my relationship normal? Is how I’m being treated typical? Do I deserve more, do healthier relationships really exist, or do they all descend into what I’m experiencing? Maybe this is as good as it gets. When is the time for change (either improving this relationship by each partner learning new behaviors or improving life by leaving the partner) and when is the time for acceptance?

Regardless of your creed, hopefully the serenity prayer’s request to know the difference between the things we can change and those that require acceptance is wisdom we would all like to acquire. Both change and acceptance can be difficult and applying them to the wrong things is certainly a waste of resources. So how do we know if the relationship could use some work in terms of change or acceptance? First let’s touch on a few things that a healthy relationship may possess and then we can look at a few questions in different areas that are similar to what you might hear from a couples therapist if you begin marital counseling or couples therapy.

Here are some of the hallmarks of a healthy relationship according to some couples theorists (Jourard & Landsman, 1980):

1. Good communication
2. Realistic expectations in the relationship and reasonable demands on your partner
3. Genuine concern for the well being of your partner
4. Freedom to be oneself

While some of us may take these four components to be common assumptions, others may struggle with a few of them. At a minimum, even with both partners endorsing the component, partners may disagree about the meaning, or have difficulty successfully executing.

Good Communication

Few clients I have seen in couples therapy have ever said they believe good communication is a bad idea. But the vast majority of couples have at least one partner who believes their partner does not communicate enough, communicates too much, or communicates incorrectly, and often both partners take one of these views. The stereotype that men do not communicate as much about their feelings is something supported in the research, and is something I have seen men in heterosexual and homosexual relationships. With that said, I prefer not to operate with that assumption, as I have seen enough exceptions in couples therapy, in terms of women who do not share and express certain if not all emotions, and some men who are very emotionally expressive. It becomes very obvious in early sessions how comfortable and how able each individual is at identifying their emotions, wishes, desires, frustrations, etc. and how willing and able he/she is to express them to the partner.

One fundamental skill that can be taught as a communication skill in couples therapy is assertiveness training. Simply put, assertiveness is comprised of both communicating feelings, thoughts, wishes, wants, desires, and requests in an effective way and accepting the response or lack of response from one’s partner. The second part is often something that is not emphasized enough. But it is critical that each of us learn to accept (that does not mean agree or endorse), i.e., acknowledge and effectively take appropriate actions. Specific statements can be learned and certain provocative aspects are to be avoided when assertively communicating. But even once these skills are learned, it takes lots of practice to reliably execute them. For most of us making requests of others or making ourselves vulnerable by sharing our intimate wishes is an extremely charged experience, and so it takes doing it again and again, even while having emotions to make it a dominant way of communicating.

Expectations and Demands

These are components of a relationship that are highly variable both in partners in a particular couple and between couples. While each partner doesn’t have to share the same expectations and demands for the other, agreement is necessary to make the partnership satisfactory.

Fairness is a theme that comes up a lot in couples therapy, and it often elicits feelings of anger, resentment, and at times guilt. It is rare that two people will have the same strengths, weaknesses, or tendencies. So the division of labor may differ, their capacity to be emotionally intelligent may vary, and one may be more equipped to financially support them both. Fairness then is unlikely to mean each does the same thing for each other, but rather that it is clear and acceptable what each expects and demands from him or herself and the partner.

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I have seen many couples where deep resentment exists as a result of an admittedly slight difference in the workload between them. Likewise I have seen perfect harmony achieved when one partner is clearly burdened with the majority of responsibilities in the relationship. What is critical is that each is transparent about what is expected and required and that there is open communication about this, which can include appreciation.

Welfare of others

In couples therapy work, you do find times when the resentment has been growing for so long or a recent transgression has elicited so much anger that concern may not be something that is readily exhibited. But even in the latter case, when a sincere conversation explores the topic, there is often concern for the general well being of the other (although not always). What I see more often in couples therapy, is a partner who “He clearly isn’t concerned about my feelings or well being, or he wouldn’t treat me like this.” This requires both individuals to do some work. And this is not always easy to hear, especially for the person who believes he/she isn’t being cared for. Without question the couples therapy has to address the behavior that is or isn’t occurring that leads one partner to believe the other doesn’t care. The other piece though, may include both partners as they uncover what attributions are being made about that behavior. For example, one partner may state, “He doesn’t care about me because I tell him how stressed I am about making my work deadlines in order to get my next promotion, yet he is constantly guilt tripping me to leave the office. If he cared about me, he would support me right now, instead he says the very things he knows hurt me.” In a case like this, uncovering what each believes the other’s reasons are for the behavior, i.e., calling her to come home and staying late away from home to complete work, is going to be critical for them to achieve understanding and change the emotional and behavioral pattern in which they have become stuck.

Free to be me

Some of us may find this component to be one that shouldn’t be included in what makes a couple healthy. Isn’t being in a relationship about merging? Shedding our individuality in search of a more meaningful union? In fact, I have treated many couples where one complains that the partner’s very desire to “be him/herself,” is the problem. There is a fine line to walk when it comes to understanding what this freedom constitutes. No matter how open a couple is, clearly some expectations of each partner change when couplehood is undertaken. But what that looks like varies greatly. Does that mean every guys’ night is eclipsed by a date night, or girls’ weekends can never happen because weekends are family time? Those are questions very much in need of discussion and often times, negotiation.

I have seen people in couples therapy where the presenting problem centers on this issue. One partner doesn’t believe the other has changed enough, or matured enough. “He will never grow up and put away his toys, it is like nothing has changed- there is no growth.” Meanwhile some partners give up activities or relationships that are central to who s/he believes s/he is. This can create resentment or depression- and some times both.

Healthy romantic relationships certainly take on an identity of their own, but it does appear to be critical for them to thrive that each partner also has an identify of his/her own and has time and aspects of his/her life that are his/her own. It is easy to see how frequently there is interplay among the four components of a healthy relationship. To balance this component there needs to be clear communication and negotiation as well as explicit expectations and an understanding of what it means for each partner to maintain certain aspects of his/her identity or to preserve certain activities or relationships. Depending on what the activities are or who the relationships are with, the decision to maintain these may be more or less acceptable to the partner. But before a lot of communication is required on this topic, self-inventories are a good idea. Each partner really needs to understand what these activities and relationships (e.g., time with friends, coworkers, family, etc.) mean to him or her and how dissatisfied s/he would be without or with less of each.

Once it is clear to each partner how much of a priority each of these are, communicating about what it means to the partner begins the dialogue. Again attributions are crucial to the negotiation process, as it is often what the partner believes it means that is more important than how many guys’ nights occur. Likewise, once it is clear why the freedom bothers the partner, there may be practical tradeoffs that can be made in order to satisfy both parties. Maybe two guys’ nights are acceptable, as long as that partner takes care of breakfast on the weekends.

Couples therapy is a process of identifying areas of dissatisfaction, understanding the function of each problematic behavior, and recognizing what strengths can be built upon, and what behaviors may be missing that can be added. With those targets in mind, it can be an exciting process. Of course, there are many apparent barriers that present themselves- but with careful self-inventories, an understanding of the meanings that are being made, and communication and negotiation many of these can be overcome, and some of those that can’t be, can be accepted, leading to greater personal and relationship satisfaction. If your relationship could benefit from couples counseling, you can contact a couples therapist at at New York Behavioral Health.


Lovesickness- Stirred Up By Your Own Body’s Chemistry

Toxic Love Cocktail

What grownup hasn’t experienced, at least once, that giddy, first stage of falling-in-love in which you can’t eat, sleep, or concentrate on anything except the object of your affection? During those times, your body doesn’t do what you want it to, because, as scientists have learned, it is busy concocting a dangerous drug that may cause you to feel mildly or seriously ill, even to the point of losing a considerable amount of weight and neglecting all your responsibilities. This mixture of neurotransmitters, composed of phenethylamine, dopamine, norepinephrine, and oxytocin, produces great spurts of energy, mood elevation, appetite suppression, and general feelings of well-being. The reward center of your brain responds to this concoction in the same manner it would if you had smoked crack cocaine.

Physical Symptoms of Lovesickness

Can you remember—if you’ve ever experienced a crazy, whirlwind infatuation—the feelings of highs (when you were with the person) and lows (when you couldn’t see him/her for a period of time, regardless of how brief)?  If you have, it’s quite possible you evidenced physical symptoms, e.g., nausea, dizziness, lightheadedness, pounding heart, chest pressure, etc. These are actually some of the same ones associated with panic attacks. And lovesickness does present itself like fear, anxiety, and panic in brain scans. But, with lovesickness, the symptoms (that make us quite ill) can hang around for weeks, months, or longer.

The Natural Way

It all makes sense in the big (evolution) picture. Scientists explain that nature expects us to be attracted to a mate and become “lovestruck,” concentrating intensely on that human being, all in preparation for procreating the species.

Can some people become so ‘lovesick’ that they need to see a doctor? To take medication? Or to undergo psychotherapy?

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Is Your Spouse or Partner Bad for Your Health

Effect of Long-Term Relationships

While many studies have shown the advantages and health benefits of being married or in a long-term committed relationship (e.g., lowering risk of cardiovascular disease), new research indicates that these same relationships may contribute to acquiring poor health habits from one’s partner.

Bad Habits

The researcher describes three ways that these unhealthy habits are promoted.

  1. A partner can be a bad influence because of his or her own unhealthy habits. In straight relationships, men were unanimously seen as the culprit.
  2. The partner who observes unhealthy habits in the other may not take personal responsibility to try to help the other change.
  3. Synchronicity may be operating. That is, even though one partner might have the desire for an unhealthy habit, he or she may not engage in it . . . but, if the other partner also demonstrates a desire for it, then they both are likely to endorse it for each other. Thus, both wind up backsliding. This synchronicity is particularly exclusive to gay and lesbian couples.

Should a spouse or partner try to shape the other’s behavior if that behavior is believed to be detrimental to the second partner’s health? For example, if she smokes, should you urge her to quit? If he is overweight, should you suggest an exercise routine for the two of you and then accompany him to the gym several times a week? Or should we just let our partner make the decisions concerning his or her own health and fitness?

Do you think that, by trying to change health-related bad habits in your partner, you might hurt his/her feelings, damage the trust relationship you already have, or even push your partner away? Some people feel that any small improved health status in the partner may not be worth risking a positive, long-term, intimate relationship. What do you think?

How would you, if you so desired, try to modify unhealthy habits of your partner?

Do you agree that men are usually seen as the bad influence? And, if so, do you feel they deserve that recognition?


Married Couple in love showing affection with optimism

“Don’t Stop Believin’” Excessive Optimism about Partner Makes for Happy Marriage: Psychology of Relationships

I’m sure you’ve heard the old adage, “the honeymoon’s over.”  Obviously, it means that the initial euphoria of being in love and/or being married usually wears off or transitions into a more realistic and less idealistic relationship. Why does this seem to happen?

Most partners, when initially committing to each other, have strong positive biases regarding their significant others’ traits, including both strengths and weaknesses. However, often the blinded-by-love opinions of the spouse become less favorable as time wears on.

This phenomenon was examined by researchers using 222 newlyweds as subjects over a three-year period, and their results were recently published in Psychological Science. All the participants were found to be relatively happy early in the marriage but their satisfaction declined over the three years of the study. However, one group—made up of couples in which both spouses had the most idealistic views of their partners at the beginning of the study—showed no decrease in marital satisfaction.

Which comes first—positive biases you have about your spouse, feeling better about yourself because your spouse idolizes you, or the rosy feeling you have when you’re sure your love for someone is being returned to you in spades?

The key to happiness seemed to be viewing your mate and the relationship in a very positive light (even more positively than others would) and being sure that the two of you can work through and resolve problems that arise. Are these young marrieds simply donning rose-colored glasses? Or do you think this approach to relationships is necessary for them to be lasting ones?



Women, Men, and Sex- Modern-Day Gender Differences in Human Sexual Response

For as long as we’ve been pondering human sexual behavior, it’s been sort of “common knowledge” that men are just interested in sex (intercourse) and women more often want intimacy. Isn’t that what you’ve always heard? On that note, the results of a newly published international study by the Kinsey Institute at Indiana University may surprise a lot of people.

Over 1,000 couples in long-term, committed marriages or relationships—in five countries including the United States—participated in the study. It was not surprising that couples in general expressed more satisfaction if they hugged, kissed, and had sex more often. Sexual satisfaction also increased if they had been together more than 15 years.

Some findings that might not have been anticipated, however, were that, overall, men seemed to desire more cuddling, touching, and kissing than did women . . . and sexual satisfaction was more important to women than to men. Can that really be true? At least for this relatively large sample of stable, long-term relationships, it proved to be so. It certainly does quash the usual stereotype, though, and give us something to think about. Could it be that men (and women) with those particular proclivities have the best chance of developing and maintaining healthy, committed relationships? What do you think?

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[fontawesome icon=”fa-file-text-o” circle=”no” size=”medium” iconcolor=”#000000″ ] The jig is up — guys like to cuddle more

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NBC News

NBC News Anthony Weiner Sexting Scandal and Rehab

NBC News interviews psychologist regarding behaviors in the public eye.

Dr. Fuller was featured on a segment on NBC news about how sexting and potential compulsive behaviors may emotionally impact individuals. Recent coverage of Anthony Weiner’s mayoral race has raised this issue.  Social media and technology both create the potential for compulsive behaviors, and mechanisms by which such behaviors may become public.  Identifying the most effective treatments for compulsive use of smart phones, social media apps, and the internet in general may be critical to our mental health.

Dr. Ryan Fuller interviewed on NBC about  New York Congressman Anthony Weiner, Sexting, Rehab, and Powerful Men Cheating

Dr J Ryan Fuller

Pregnant in Heels (Rosie Pope): Couples Counseling & Experiential Avoidance

Dr. Ryan on Pregnant in Heels with Rosie Pope working with couple as therapist

For anyone who knows me well, television may be the last place he or she would expect to see me.  I’m fairly self-conscious (ok- very) and generally uncomfortable with attention.  In fact, I had no idea I was on the Rosie Pope show tonight, until I received emails and text messages letting me know.  And writing this is no piece of cake – but I’m pushing myself.

My anxiety has been largely responsible for how long it has taken me to even begin a blog- what will my colleagues think? What about academics who don’t know me? Or the ones who do?  At the same time, making cognitive-behavior therapy (or any effective treatment) more accessible to those who may be needlessly suffering or getting in their own way of leading a more satisfying and meaningful life is something that is also important to me- so I experience significant ambivalence around putting myself out there, even when I can disseminate treatments that work.  Wanting to avoid an uncomfortable feeling and at the same time knowing I won’t be fully participating in something important to me, mirrors the issue I addressed in the show.

On the Rosie Pope show, I briefly mentioned a concept known as experiential avoidance.  Experiential avoidance is an unwillingness to prolong experiencing an internal state, such as a memory, feeling, sensation, thought, urge, or craving.  Western cultures, in particular, tend to promote this strategy.  I often refer to our culture as the Heineken-Hallmark culture, not to pick on these two brands, because any beer commercial or even psycho-pharmaceutical marketing campaign sends a similar message – and most box office hits do too (air brushed, smiles, lounge chairs- is any viewer imagining the thought bubbles of the models in these ads are self-loathing rants or existential angst of a 7-year-old Woody Allen character?).

Happiness, from this perspective is pretty neat and tidy, it is the absence of negative thoughts and feelings, and a lot of good feelings and positive thoughts – and if you just do or buy the right thing, you can get rid of all of those negative thoughts and feelings.  If you are feeling anxious or sad- take a pill, buy these shoes, go to this casino, or resort.  Get into the right college, land the right job, marry the right person and you will live happily ever after- maybe you will. But my guess is, if you think you can’t fail, tolerate a disappointing entry level position, or risk rejection – you may be less likely to reach those mile markers, savor them less if you do, and be unclear if they are really yours- or something you are supposed to do. That could be said for dropping out of school, choosing to be unemployed, and never opening up to a meaningful relationship, just as easily. The key is understanding what is important to you, and willingly walking through the storms on the journey.

This may sound strange coming from a psychologist.  Isn’t therapy about eliminating “bad” feelings?  That is the notion many of us hold. My overall goal is to improve clients’ satisfaction with life – happiness.  That often means clients do shed some of the excess time and intensity of particular emotional episodes.  But how we approach that work matters a great deal, and is specific to each individual.  The bottom line is that for most of us, the things that are most meaningful require struggle, i.e., hard work and the experience of aversive emotions and thoughts.  And that’s where I help clients go, when they are willing.  Now most of the time their beliefs shift and they don’t feel “bad” as often or at least aren’t as upset about feeling the “bad”, but it isn’t because they think they can’t or shouldn’t feel bad.

Ultimately, we often have to feel bad to get better.  There are few things that are meaningful that don’t require walking through emotional storms or carrying tough thoughts with us.  The work in life (or psychotherapy) may be learning how to relate differently to these emotions and thoughts, so we are less distressed about having them, creating a greater capacity to carry aversives with us, while increasing our ability to go and do the things that matter most.

If I believe I can’t handle being rejected- I won’t ask anyone out.  If I’m unwilling to be hurt, I won’t open my heart.  If I’m unwilling to lose – then I can’t play the game, and I’m bound to only watch.  Do you want to be in the stands when the whistle blows, or on the field?  There isn’t a right answer, just a choice.

But, if we close the door to the negative emotions and thoughts, it is closed to the possibility of some of the richest of life experiences- we can’t leave the room we are in, we simply limit where we can go.  It isn’t necessarily the wrong approach, just one I encourage each of us to make in a conscious informed way.

What do you want?  What “bad” feelings and thoughts appear to stand in your way?  How long could you choose to have them if it meant you could still pursue what you want?  No really – will you consider answering those three questions?