Therapist Confessions: Top 5 Problems Couples Share On The Couch

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Relationship therapist Sherry Amatenstein reveals what problems she hears over and over.

As a relationship therapist who counsels singles and couples, I have been privy to the fears, compulsions, deepest secrets and desires of those hoping to figure out what it takes to find and sustain love.

No matter what their ages, histories or financial portfolios, the questions patients ask and the wishes they drop in my lap are heart-touchingly similar. It is likely their secret concerns echo yours. And knowing you are not alone in harboring these emotionally debilitating feelings can be a giant salve, a step toward healing. MyDaily: Secret Regrets: What Do You Regret Doing—Or Not Doing—Most In Life?

So I am opening my office door to reveal the five most common problems unhappy-in-love patients bring up on my couch:

1. "I have to hide who I really am, because who I am is unlovable."
Beneath the bravado and anger a patient exudes when bemoaning that no one (this can include a current partner) seems truly capable of giving love often lies a bone-deep, crippling belief: Something in me is inherently unworthy.

This crippling fear people causes people to hide their true selves, even with the one who shares their bed. *Janet B., a 34-year-old divorcee, admitted, "Bill was an open book. But I held back so much—an abortion I'd had as a teen, even guilty thoughts I had about co-workers who got bigger raises than me. I didn't want my husband to think I was a bad person." She laughed ruefully as I pointed out, "Instead, your withholding made you become strangers."

Love Tip: Obviously the seeds of such low self esteem are rooted in one's psyche, thus difficult to root out with a 1-2-3 abracadabra shrink trick. But it is helpful in moments when you feel, "Oh, I can't say that to him. I'll sound too awful," to tell yourself, "Even Mother Teresa had mean thoughts. No one is perfect. Would I rather pretend to be perfect or try to be real and make a genuine connection?"

2. "My partner doesn't understand or care about how I feel."
Here is the ultimate irony of relationships circa 2011: In an era where thousands of "friends" are available at the click of a mouse, we long for a soul mate who will truly "get" us, thus assuaging our sense of isolation. Yet 60% of the patients I counsel complain of feeling more alone in their double bed then when they slept solo.

Especially in long-term partnerships, there is a danger of partners becoming emotionally estranged as they stop believing their one and only sees their side. *Kate M., 40, said in a therapy session with her husband of three years, "Don just doesn't get that I need to hear the words 'I love you' more than twice a year or I don't feel cared about." Her spouse rebutted in a resigned tone, "And she doesn't get that it hurts me that she thinks I don't love her."

Love Tip: Couples may watch their spouse's lips move but the words often land like lyrics to a long-recorded-to-memory soundtrack—verbal wallpaper. Here's a terrific exercise to help partners reboot their listening and comprehension skills: Take turns talking. When in listening mode, pay attention as if you are going to be graded on the answer. Repeat the gist of what your mate said. When your mate finally says, "Yes, that's right!" it is your turn to talk, be listened to and correct false assumptions until you feel truly heard. MyDaily: Flirting With Danger: 3 Reasons Why Women Cheat More Than Men

Once Don understood that Kate felt her father never really loved her, he didn't take her need to hear those words as an accusation that he wasn't loving enough toward her. And once Kate truly saw that her spouse had been raised by parents who took emotional displays as a sign of weakness, she realized the high cost to her mate of being verbally effusive.

3. "My walls have walls"
Even when they're naked (for some, especially when they're naked), many patients report still feeling garbed in in a clunky, painful, albeit invisible suit of armor.

*Tara P., 39 and living with her fiancé, admitted, "Whenever I'm in a relationship, I put the guy through a series of 'tests' to prove his loyalty to me. If Dan doesn't remember I had an important business meeting today it proves he doesn't really love me. If Dan does remember it only means he made a point to ask me how it went because he was afraid I'd have a fit if he didn't. With a test this rigged, a losing score is inevitable for both parties.

Love Tip: During therapy, once layer upon layer of defenses is slowly, carefully peeled back, what is typically left is a child petrified of being abandoned. That is the scary place you go to when you make yourself vulnerable to another person. Thus the emotional "cover-up."

True, it's wise to protect yourself with people until they prove worthy of your trust. But, once someone has proved over and over and over he is on your side, before putting him through yet another exam, take a breath and ask yourself, 'In this situation is there a valid reason for mistrust, or is my inner child running the show?'

4. "Even when I'm in a good relationship, I'm afraid I'll mess it all up."
Patient after patient has sat across from me and confessed that while she has fairly good self-esteem and believes herself capable of love, there is a secret fear of ultimately doing something to "mess things up."

For instance *Sharon M., a 42-year-old single mother confessed, "In my work life I'm Pollyanna. I'm secure things will work out the way I want ...Yet, perhaps because I followed in my parents' footsteps and had a messy divorce, I feel romantically jinxed." She added with a semi-laugh, "Of course with that kind of belief I create a self-fulfilling prophecy."

Love Tip: Sharon is correct: Her (your?) doomsday mindset is in large part responsible for a lack of success in the love department. Instead of automatically giving free reign to that belief, stop recycling the 'poor me' card and start repeating a new mantra: "I'm sick of being a victim. It's in my power to sustain a great relationship."

That objective becomes easier to achieve by looking for positive romantic role models to emulate—couples that have been together 10 years or more and are happy to share their secrets.

5. "I love my partner. Why am I still unhappy?"
This wistful lament is familiar to anyone who has hoped that finding love can heal an inner emptiness. But the job description of a partner is to add to your life, not make your life fulfilling.

*Jenna E., 29 and single, has a history of serial monogamy. She landed in my office to work out mixed feelings about her current boyfriend. "Things seemed wonderful at first—I get such a high from being in love. But then I start not feeling as close and the person starts seeming like part of my problem." She concluded, "I don't want to leave Eric because that's what I always do. He's a good guy but things feel flat." MyDaily: How Much Fighting Is Too Much? A Couple's Guide To Fighting Fair

Love Tip: Again, alas, no easy fix but the 'solution' is to realize that happiness is an inside job. The more you look for external sources to feed you the hungrier you will be. A lover can't just be a temporary distraction from loneliness. Focus on things you love about yourself, activities that feel good, and, most important, on being able to feel good when alone. It takes work, true, but there's a big payoff!

* Names changed

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Written by Sherry Amatenstein for MyDaily

This article was originally published at . Reprinted with permission from the author.

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