Couples Counseling


Tokyo Mental Health is here to support you and provide you with the help you need.

What is Couples Counseling?

Do you feel like your relationship or marriage has hit a breaking point?

Has romance been replaced by arguments?

Are you hoping to find new ways to connect with your partner?

Do you often feel misunderstood or find yourself having the same argument with no end?

Every couple has problems, misunderstandings, and hard times; this is the reality of human relations. However, although conflict is inevitable, addressing dysfunctional patterns in your dynamic can help improve your relationship and connection to your partner. Our therapists are sensitive to a variety of relationship challenges that couples face, especially for those that are from different cultures, and are living abroad far from home and familiarity.

Couples Counseling is based on providing support to improve communication between two parties, while teaching strategies to change ineffective repetitive patterns of thoughts and behaviors that erode the relationship quality. It is a safe space where a couple can openly talk with each other, with the assurance that each partner will be heard and supported to reach a solution together.

Handling a relationship requires commitment and effort from each partner, and the same applies during the counseling process. Issues that drive the couple apart can be jointly coped with, if each partner invests equal effort into the counseling process. Endless arguments, disinterest, anger, and resentment can all be effectively dealt with by working with a therapist trained in couple’s counseling.

The therapist’s role is to serve as mediator to guide both parties in identifying their role in their relationship problems, and to provide tools that empower them to make improvements. The therapist helps the couple to tackle immediate problems and prevent further damage to the relationship, while simultaneously working to strengthen the partners’ bond for the future.

What is Couples Counseling Like at TMH?

Methods in Couples Counseling

There is a wide variety of couples counseling approaches. Some of the most common are:

Helps with the externalization of problems and communication issues through the techniques developed by Michael White. In this approach, “people are not the problem, the problem is the problem.” Read More

This model views the relationship as a system and focuses on understanding how the dynamic works. Systemic therapists help couples to identify the unhealthy interactions through exploring each partner’s beliefs and communication patterns.

This approach aims to help the couple develop their tool box to identify, define, understand, and solve problems in an optimistic way to navigate the conflicts and stressful events in the relationship.

Restoration Therapy focuses on identifying destructive interactions and patterns in the relationship that are related to issues of identity and safety. By gaining insight into these patterns and utilizing self-regulating practices, the couple can develop new patterns that do not lead to increased conflicts, but greater intimacy.

Utilizing a thorough evidence-based assessment, this approach combines individual and couples sessions to create a treatment plan to address the relationship areas of growth and enhance its existing strengths. It focuses on strengthening the relationship in three areas: friendship, conflict management, and the creation of shared meaning.

EFT helps couples enhance their emotional connections by increasing both partners’ emotional accessibility and responsiveness. It changes the ineffective interactions so our fundamental needs of safety and love can be met. Read more

What to Expect in Your Appointment

Although our couples therapists at Tokyo Mental Health work in different therapy models, there are some common components in how all our therapists work:

Before coming to your appointment at Tokyo Mental Health, you will sign a consent form, outlining our policies regarding our services, confidentiality, cancellations and emergency contact information. You will need to provide both partners’ full name and email address to your therapist in order for us to send this to you via Docusign.

Your therapist may suggest you complete some relationship assessment tools such as Gottman, or mental health screening tools before your first appointment with them. This would help therapists to have a fundamental understanding of the background information, areas of growth, and strengths in your relationship.

In the beginning of your first session, your therapist will introduce themself and you will have an opportunity to ask questions about your therapist. They will also review the information on your consent form with you. Your therapist may also ask you to introduce yourselves.

During the session, your therapist will try to balance both partners’ space and time in therapy to express yourself. Your therapist may stop one partner from interrupting the other partner, asking one partner to share more insights, or pause one partner’s sharing to check in with the other partner. 

It is common to have arguments in couples counseling. Sometimes you bring in existing arguments outside of session and sometimes you pick up arguments in the session. Your therapist may stop your arguments and help you practice managing the conflicts in a novel way. Occasionally, they may let the arguments continue for a while so they can observe. This is to help your therapist understand better about your interaction pattern.

Some therapists may have a structured way to assess the history and dynamic of your relationship such as using a questionnaire such as that developed by Gottmann. Other therapists may have a less structured way such as asking a more general question and seeing where the conversation flows in order to understand the relationship. Regardless of the therapeutic style of your therapist, the first appointment will generally include the following topics.

  1. The presenting issues and their history – Other than the main problems that bring you into therapy, the therapist will also want to know the history of the problems you have faced together.
  2. Background information – Such as: How long have you been together? Are you living together? Are you married? Do you have any kids? Have you ever separated in the past? Were there any significant events in the relationship that you would like your therapist to know?
  3. Communication/Interaction – Based on your interaction in the session, the therapist may identify the pattern of communication in the relationship together with you. This may be the focus later on in the therapy process.
  4. Safety/Risk – Your therapist will assess if risks are presented in the relationship or at the individual level, including suicidal thuoghts, self-harm, or abuse. They will go through a safety plan with you if you present some risks such as these. They may also refer you for individual therapy if there are safety issues in the relationship, or to psychiatry if there is a mental health need.
  5. Goals – Goal setting is very important in therapy. Your therapist will ask both partners’ goals and expectations for couples therapy.

Towards the end of the session, you and your therapist will decide the next steps together. Your therapist may ask you to commit to specific numbers of sessions, depending on the type of therapy, discuss the frequency of sessions, and outline the treatment plan – this process will vary depending on the therapist’s approach. They will also leave time for you to ask any questions to clarify the uncertainties you have about the process.

It is possible your therapist will ask you to each have an individual session with your therapist to talk about your relationship separately. Your therapist may also refer you to individual therapy with another therapist and explain the reasons for the referral. Possible reasons are elaborated in the section below – “What are the conditions for couples counseling?”

Cultural Differences In Cross-Cultural Couples​

In relationships where both members come from the same country, communication problems are common. The meanings of words and their use are not always the same for everyone, even within the same community. Likewise, the new couple must get used to differences in ideas, customs, and lifestyles when they begin to live together. This process is difficult for couples from the same culture, but can be a very different challenge for couples who come from different cultures and countries.

At Tokyo Mental Health, we have extensive experience with cross-cultural couples, where a trained therapist will support the couple in the development of better communication strategies, respect, and tolerance techniques. In a cross-cultural relationship, it is especially important to take into account what the couple has in common, while respecting the differences.

Do We Need Couples Counseling?

How Many Sessions Do We Need?

When it comes to how many sessions are needed for couples therapy, the most common answer is ‘it depends’. If we look up the research on what the evidence says, we can find answers varying from 8 to 20 sessions on average. There is no precise number to answer this question because there are various factors that can affect the length of therapy needed. Let’s take a closer look on some common factors:

  • Commitment to therapy: How committed and engaged each individual is can affect the therapeutic relationship and process of change.
  • Frequency of therapy: Higher frequency means more opportunities to clarify presenting issues and practice exercises outside of therapy. It is beneficial especially in the beginning of the therapy. 
  • Ineffective communication: In general, the longer the couple experiences ineffective communication, more time is needed to develop the new communication style.
  • Childhood trauma: Since trauma has an impact on how we attach to others, you may need more time to change some patterns of interaction. Although this means therapy may take more time, some studies have shown couples therapy is effective in treating some types of trauma.
  • Other Mental health issues: When other mental health issues are affecting an individual’s function, therapists sometimes would suggest both individual therapy alongside couples therapy to achieve the best results.
  • Infidelity, violence, and substance abuse: Experiences or events that violate trust in the relationship will usually require more time in therapy to rebuild trust.

What Are the Conditions for Couples Counseling?

Couples need to come to couples counseling together from the beginning

We usually cannot have an individual session with only one partner in advance of seeing a couple together. This is to avoid the imbalance of the multiple therapeutic relationships in the session, or any perception of bias on the therapist’s part.

If your partner is not willing to come to couples therapy, then you could start with individual counseling first. This can help to understand the relationship dynamic and how to communicate from your end. Once your partner is ready to start couples counseling, then you would need to see a different therapist who specializes in seeing couples.

No ongoing Intimate partner violence/abuse

If there is concern about the possibility of intimate partner violence, most couples counselors will not see a couple together, but instead offer individual sessions. Intimate partner violence is considered by many to be a contraindication for couples counseling. Couples counseling provides an equal and safe space for both partners to make changes together. This means both partners need to take responsibility in making the change happen. It is unsafe to work on the relationship when emotional abuse and violence are still used to dominate, control, and manipulate a partner as this risks escalating the abuse.

No ongoing infidelity

Infidelity is often a topic that can be addressed in couples counseling. However, if the affair is ongoing or unadmitted, couples counseling can not be provided. It is important both partners are accepting the accountability necessary to work on the change in relationship together in couples counseling.

Addiction or mental health issues should be treated

If addiction or mental health issues are identified in couples counseling, it is possible your therapist will refer the affected partner to individual therapy. Since mental health issues could affect an individual’s function, there is the possibility of pausing the couples counseling until progress has been made on these issues in the individual therapy. Your couples counseling therapist and individual therapist will work together and plan how this would work with you.

We Are Told Couples Counseling Is Not Suitable for Us. What Can We Do?

If you had a first couples counseling appointment at Tokyo Mental Health and were referred to different therapists for individual therapy, your therapist will assist you with the referral process. They will connect you with the therapist to schedule the appointment and work with the therapist together to assist you better. We can also arrange psychiatric input where needed through Dr Andrew Kissane at American Clinic Tokyo.

If you have any questions, please visit our FAQ page where we answer our frequently asked questions. Got a question that is not there? No problem. Email us at [email protected]. We are happy to help you.

Tokyo Mental Health Couples Counselors

Yoriko is a licensed Marriage and Family Therapist (LMFT) and is a member of the California Association of Marriage and Family Therapists (CAMFT). Yoriko worked as a Lead Clinical Supervisor at the Community Mental Health Center in the USA seeing clients and training licensed and unlicensed clinicians before she relocated to Japan. Yoriko has experience working with individuals of all ages, from young children to older adults, with depression, trauma, ADD/ADHD, PTSD, adjustment disorders, general anxiety, social anxiety, behavioral problems, schizophrenia, bipolar disorder, and many other conditions. Her treatment approaches include cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, object relations, seeking safety, interpersonal therapy, play/art therapy, and solution focused therapy.

Counselor Counseling and Psychotherapy at Shintomi Office

JouAn Chen, also known as Anne, holds a bachelor’s degree in Clinical Psychology in Taiwan. She completed her Master’s degree in Marriage and Family therapy and also received Certificate of Advanced Study in Child Therapy from Syracuse University. Anne provides services, in English and Mandarin, to individuals, couples, and families. Her theoretical orientation includes training in systemic theory, narrative therapy, solution-focused therapy, emotionally focused therapy, and CBT.

CounselorCounseling and Psychotherapy at Shintomi Office

Ryota Sakurai is a Licensed Industrial Counselor working toward getting an MFT license. He has worked with clients with depression, general anxiety, social anxiety, behavioral problems, PTSD, schizophrenia, bipolar disorders, and substance misuse. He uses cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, object relations, and seeking safety. He also has experience working with couples and families.

Counselor Counseling and Psychotherapy at Shintomi Office

George Takeda holds a Master of Science degree in Marriage and Family Therapy and is a Licensed Marriage and Family Therapist (LMFT) in the state of California with over 9 years of experience. George has provided counseling for a wide range of people of different ages, ethnicities, religions, and socioeconomic backgrounds to treat various mental health struggles, including depression, anxiety, trauma, anger management, grief/loss, relationship issues, etc. While supporting children with overcoming their struggles, George also worked with parents on parenting skills and crisis management so that they have the tools they need to effectively support their children.

Counselor Counseling and Psychotherapy at Shintomi Office

Estefania Ospina-Alikhan is a Licensed Clinical Marriage and Family Therapist (LCMFT) that is fluent and bilingual in English and Spanish. She has had consistent experience working with clients of all ages and diverse backgrounds conducting individual, family, and couples therapy. Through this clinical experience and ongoing individualized training, Estefania is equipped with a variety of therapeutic skills to provide specialized treatment for adults seeking to address mental health challenges. These include depressionanxiety, bipolar disorder, grief and loss, childhood trauma, abuse, relationship distress, and navigating life transitions. 

Clinical Psychologist Counseling and Psychotherapy at Shintomi Office

Adam received his Doctorate in Clinical Psychology from the California School of Professional Psychology, Los Angeles campus. At TMH, Adam works with clients experiencing a wide range of challenges, using cognitive behavioral therapyperson centered counseling, and emotionally focused therapy based approaches. Through providing sincere empathy, warmth, caring, and unconditional positive regard, Adam offers a safe place for people to tell their whole story, including their strengths and resources, and feel deeply understood while also gaining greater insight and becoming more of an expert on themselves.

Clinical Psychologist Counseling and Psychotherapy at Shintomi Office

Dr. Durkin completed her dissertation at Stanford University, specializing in Vicarious Trauma and Early Intervention. She co-founded a clinic with Palo Alto University, the US Department of Veterans Affairs, and Stanford, using a preventative medicine approach to catch trauma before it became a debilitating condition. She served as a medical service corps officer in the military for 8 years, treating service members and their families.