A Life-Cycle Approach to

Treating Couples
A Life-Cycle Approach to
Treating Couples

From Dating to Death

Anne K. Fishel

MOMENTUM PRESS, LLC, NEW YORK

A Life-Cycle Approach to Treating Couples: From Dating to Death

Copyright © Momentum Press, LLC, 2018.

All rights reserved. No part of this publication may be reproduced,

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First published in 2018 by

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www.momentumpress.net

ISBN-13: 978-1-94664-614-9 (paperback)

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­ ollection

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 Abstract
Every couple can be located on a developmental time line, from first dates
to final good-byes, and compared to the millions of other couples who
have faced similar developmental challenges. Clinical knowledge about
life-cycle stages serves as a reference point for the couple therapist, much
as diagnoses do for the individual therapist.
Based on 30 years of couple therapy experience, Dr. Fishel, a Harvard
Medical School professor, offers a practical guide for therapists at any
stage of their own professional development. The author includes case
examples and research findings about clients diverse not only in sexual
orientation, but also age, race, ethnicity, class, and health.
The book focuses on the six major life-cycle changes that couples
­typically traverse, from dating to death.

• Stage one is about dating, partner selection, and the decision

to make a long-term commitment.
• Stage two focuses on the couple’s transformation during the
transition to parenthood.
• Stage three is about midlife couples when there are increased
work and parenting demands as well as care-giving of aging
parents.
• Stage four is about late midlife couples who may be l­aunching
children, heading for retirement, and becoming grandparents.
• Stage five focuses on late-life couples, facing issues of aging,
mutual dependency, and generational role changes.
• Stage six is about death as an endpoint to marriage, with a
focus on illness, legacy, and saying good-bye.

For each stage, the author shares scientific research, common presen-
tations and rich case examples, followed by developmentally-informed
questions and topics for couple therapists to pursue.

Keywords
cohabitation, conflict, couple therapy, couples at end of life, couples in
later life, couples at midlife, death, divorce, empty nest, family of o­ rigin,
vi Abstract

gay couples, gender differences, grandparents, illness, late midlife cou-

ples, launching children, lesbian couples, LGBTQ couples, life-cycle
transitions, life-cycle, loss, marriage, midlife couples, parenting, post-­
retirement, retirement, same-sex couples, sexual functioning, sexual
­intimacy, ­sexuality, stages of development, transition to parenthood
 Advance Praise for
A ­Life-Cycle Approach
to Treating Couples
A seamless integration of elegant theory with in-the-office pragmatism,
Dr. Fishel’s graceful prose accomplishes the impossible task of making
a text all things to all practitioners. Her comprehensive synthesis of the
field’s evidence into developmental stages, combined with a diligent
anticipation of diversity among individuals and circumstances main-
tain the high utility that has defined all of Dr. Fishel’s writings. The
work is a most convenient framework for inquiry and intervention, giv-
ing as much attention to the when of relationships as to the who that
­comprise them.
—David Rubin, MD, Director,
Massachusetts General Hospital Psychiatry Academy;
Director of MGH Child and Adolescent Psychiatry
Residency Program

In her beautifully written portrait of the life cycle of couples, Anne Fishel
has woven together research, memorable examples from her ­ clinical
­practice and helpful suggestions for practitioners into a truly helpful
guide. I was particularly impressed by her ability to approach couples in
an accepting, nonpathologizing way. Any family therapist who reads this
book will find him or herself better equipped to meet and help couples of
any age on their marital journey.
—Michael Thompson, PhD,
co-author of Raising Cain

Anne Fishel has provided us with a rich, comprehensive, and evocative

look at therapy for couples at different stages of the life cycle. She uses
what is known from research and from vivid vignettes to provide help-
ful questions for therapists to pose to partners at each stage of life that
viii ADVANCE PRAISE

will enrich their conversations and connections with one another. This
­volume will be invaluable for psychologists, psychiatrists, social w
­ orkers,
and those who train professional therapists to work with couples. I d
­ aresay
it would also be eye-opening and helpful to couples themselves, who will
surely find themselves in many of its rich examples.
—Carolyn Pape Cowan, PhD, Adjunct Professor of Psychology
Emerita, University of California, Berkeley; Coauthor of When Partners
Become Parents: The Big Life Change for Couples

In this exceptional book, Fishel draws on her years of experience and

accumulated wisdom to produce an informative, reassuring, and practical
reference that should be on the desk of every couple therapist. Organized
logically and sequentially within a normalizing developmental frame-
work, each of the carefully crafted chapters provides useful contextual
information, vivid case examples, clinical strategies, some great questions
to ask in session, and additional resources for understanding and inter-
vening with distressed couples. This sensitive and timely text includes
information for treatment with clients diverse not only in sexual identity,
but also age, race, ethnicity, SES, health, and physical ability. Psychother-
apists of all persuasions and all degrees of experience will find this a fasci-
nating and welcome addition to the literature on working with couples.
—Martha B. Straus, PhD, Professor of Clinical Psychology, Antioch
University New England, and author of Treating Trauma in Adolescents:
Development, Attachment, and the Therapeutic Relationship

With this book, Anne Fishel has contributed a major advance to our
understanding of couples and the practice of couple therapy. Her life-­
cycle perspective places the clinical at the center of the couple’s world, and
her many compelling case examples and relevant questions offer prag-
matic help for navigating the challenging terrain of couples therapy. This
is a book that complements the work of all couples therapists regardless
of their preferred models.
—Douglas C. Breunlin
Program Director, Master of Science in Marriage and Family Therapy
Clinical Professor, Department of Psychology, Northwestern University
 Contents
Acknowledgments�����������������������������������������������������������������������������������xi

Chapter 1 Applying the Life-cycle Perspective to Couple

Therapy����������������������������������������������������������������������������1
Chapter 2 Transition to Being a Couple: Dating, Partner
Selection, and Making a Long-Term Commitment���������17
Chapter 3 Transition to Parenthood: Expanding the Dyad��������������39
Chapter 4 Midlife Couples: Increasing Demands of Work,
Parenting, and Care-giving���������������������������������������������57
Chapter 5 Late Midlife Couples: Launching Children,
Heading for Retirement, Becoming Grandparents����������73
Chapter 6 Post-Retirement and Late-Life Couples: Aging,
Dependency, and Role Changes��������������������������������������89
Chapter 7 Illness and Death����������������������������������������������������������103

References�������������������������������������������������������������������������������������������119
About the Author��������������������������������������������������������������������������������137
Index�������������������������������������������������������������������������������������������������139
 Acknowledgments
My heartfelt thanks to friends and colleagues at Massachusetts General
Hospital who have supported my teaching and enhanced my understand-
ing of couples’ relationships over many years. In particular, I am grateful
to the members of the decades-long MGH Reflecting Team, where I have
spent hundreds of hours discussing couple therapy and learning from
a very knowledgeable and generous team: Carol McSheffrey, LICSW;
David Rubin, MD; Ellen Godena, LICSW; Pat Giulino, LICSW; Ginny
Sigel, LICSW; Marie Herbert, LICSW; Nicole Simi, PhD; Julia ­Coleman,
MD; Cindy Moore, PhD; Juliana Chen, MD; Shiri Cohen, PhD; Lisa
­Montanye, LICSW; and Abby McDonald, LICSW.
I am also very grateful to those clinicians who allowed me to inter-
view them about their particular areas of expertise and who also pro-
vided perspectives on the manuscript: Bob Waldinger, MD, shared his
knowledge about late-life couples, based on men and women who par-
ticipated in the Harvard Study of Adult Development, which he directs;
Paula Rauch, MD, and Cindy Moore, PhD, offered their deep stores of
clinical experience about end-of-life-issues, based largely on their work
at MGH’s P ­ arenting At a Challenging Time program, which Dr. Rauch
founded and directs, and where Dr. Moore is the Associate Director; Leah
Rosenberg, MD, a palliative care and hospice specialist at MGH, shared
her wisdom about easing patients’ suffering at end of life; Caroline Mar-
vin, PhD, and Larry Rosenberg, PhD, senior clinicians in private practice
with decades of couple therapy experience, talked with me about their
work with same-sex couples. Eva Schoenfeld, PhD, Chris McElroy, PhD,
Nancy Bridges, LICSW, Beth Harrington, PhD, Sue Wolff, MD, and
Corky Becker, PhD have offered invaluable insights about couple work.
Several other therapists offered essential feedback on various c­ hapters
of this book. I am so appreciative of the thoughtful and incisive c­ omments
from Juliana Chen, MD; Melinda Morrill, PhD; Laura Prager, MD; and
Abigail Judge, PhD.
xii Acknowledgments

Special thanks to three people who helped me track down articles

during a wide-ranging literature search. Martha Stone, MS, the librarian
at MGH’s Treadwell Library, and my research assistants, Cara Lucke and
Shay Haregnesh, went over and beyond in their efforts to find articles for
this book.
I am very appreciative of initial feedback from Corinne Datchi, PhD,
about the scope and focus of the book. I felt honored to have my former
student, and now esteemed colleague, Anthony Chambers, PhD, offer
a close reading of the entire book. He has certainly made the prose flow
more smoothly and has greatly improved the content of the book.
I am very grateful to the hundreds of couples whom I have had the
privilege to work with and learn from. If I know anything about the life
cycle, it is from witnessing your lives.
Most of all, I want to thank my husband, Chris Daly, who is always
my first and most trusted reader. He is unstinting in his encouragement
and gentle with his criticism. Together we have traversed much of the
life cycle together, from dating to the launching of our two adult sons.
Although I know that there are special times in the stages that lie ahead,
I’d really like to go back and relive all the stages again with him. To para-
phrase the French writer Andre Maurois—a happy marriage is a long
conversation that you wish would never end.
 CHAPTER 1

Applying the Life-cycle

Perspective to Couple
Therapy
To everything there is a season, and a time to every purpose, under
heaven.
—The Book of Ecclesiastes

If I were young again, I’d pay attention to that little-known dimension

A taste of endless time.
Just like water—it runs right through our fingers,
But the flavor of it lingers—Like a rich, red wine.
—Chris Smithers, Leave the light on

As therapists, we hear an abundance of stories, information, and anguish

shared by couples during an initial evaluation and even more so, in
­therapy. This outpouring of data is a challenge for couple therapists to
organize and render into a coherent framework for treatment. A life-cycle
perspective locates every couple on a developmental timeline that starts
with courtship and ends at death, divorce, or a relationship break-up,
and offers context and a compass for what may feel like a confusing and
cluttered landscape. Once the stage of development has been identified,
a particular couple can be compared to the millions of other couples who
have faced similar challenges at that same stage of development. Couple
therapists, guided by the research on different life-cycle stages, can find
their footing as they explore the challenges of a particular couple.
The couple’s clinician can use the research on each stage of develop-
ment in much the same way that the clinician trained in individual ther-
apy uses research on diagnostic disorders. If, for example, an individual
2 A LIFE-CYCLE APPROACH TO TREATING COUPLES

patient complains of low energy and a sad mood, a clinician will bring
to bear all that is known about depression and ask questions accord-
ingly—about feelings of worthlessness and guilt, disturbances in sleep
and appetite, and difficulty concentrating. Most likely, every individual
experiencing depression will not respond affirmatively to all of these que-
ries, but the panel of questions will direct the therapist to explore a wide
swath of experiences common among depressed individuals.
A couple therapist, with a focus on relationships rather than on indi-
viduals, does not rely on diagnostic categories like depression or anxiety.
Instead, the couple therapist will compare a couple who presents at a par-
ticular stage of development with large groups of other couples who have
been studied at that same stage. So, for example, when interviewing a
couple with an infant, a couple therapist will ask about increases in fight-
ing and decreases in sexual activity, as these behaviors have been identi-
fied as common features of thousands of couples making the transition
to parenthood. A particular couple with a newborn may not endorse all
the same experiences found in studies, but questions, rooted in research,
will help orient the therapist to ask about a baby’s temperament, sleep,
and eating behavior, as well as to normalize disruptions in the couple’s
relationship. These questions can offer respectful, normative explanations
of a couple’s challenges. For example, “Most couples experience a decline
in their sexual relationship in the first two years after becoming parents.
How has this adjustment gone for you?” If a couple responds that they
have transcended the normative expectations of this transition by avoid-
ing fights about who is doing what and are having frequent and satisfying
sex, it is an opportunity to inquire about their strengths and resources
that have made this possible. If, on the other hand, they describe having
the worst fights of their lives, the couple therapist can normalize the fights
as a developmental event and offer suggestions for making the fights less
toxic and damaging.

What Is the Life-cycle Perspective?

The notion that there are universal, predictable stages in human develop-
ment has long been a cornerstone of the field of child development, as
evidenced in the widely accepted writings of Erikson (1951) and Piaget
 Applying the Life-cycle Perspective to Couple Therapy 3

and Inhelder (1969). It is a somewhat newer idea that adults continue

to develop past college years (Dawber, 1980; Friedman & Martin, 2011;
Levinson, 1978; Sheehy, 1976; Vaillant, 2012) and newer still that rela-
tionships in a family follow a developmental arc (McGoldrick, Preto, &
Carter, 2016; ­Carter & McGoldrick, 1989).
One longitudinal study of 80 years duration (and still ongoing) has
focused on both the individual lives of men, and later, on their marital
relationships. The study is composed of two groups of men. The first
is the Grant study, which began in 1938 as an attempt to study opti-
mum health and potential by focusing on privileged and healthy men at
Harvard: They were sophomores at the start, and now many are in their
90s. The second group, the Glueck cohort, made up of young men from
low-income urban neighborhoods in Boston, was added in 1940.
Writing about this research, Vaillant (2012) cautions that “stage is a
metaphor.” While one can see clearly delineated stages in how the embryo
develops, adult development is not nearly so step-wise and predictable. In
particular, the life trajectories of both the privileged and the low-income
men revealed that childhood experiences did not reliably predict what
happens in the future. Lives did not unfold smoothly from strong, posi-
tive early experiences through happy mid-life and onward to a satisfying
old age.
Those looking at resilience over the cycle also note the absence of lives
progressing in lock-step from a negative start to a disastrous end nor from
a charmed childhood to a ripe and happy old age. Rather, people have
many opportunities to turn their lives around when a good ­marriage, or
gratifying work, or the advent of parenthood can disrupt what seemed
like a negative march through time (Walsh, 2016). Drawing on longi-
tudinal studies, Werner and Smith (2011) also found that difficult early
experience did not doom later-life trajectories. Rather, a supportive mar-
riage or satisfying work could interrupt a negative start to life and catalyze
a more positive spiral. This view suggests that stages do not need to be
completed successfully before moving on to the next, but rather that each
stage offers another chance at altering a couple’s narrative.
Relationships have a beginning, middle, and end. Time is the river
that flows through all couples’ relationships. But rivers, like relationships,
get dammed, form oxbows, make detours, circumvent obstacles, shoot
4 A LIFE-CYCLE APPROACH TO TREATING COUPLES

over waterfalls, settle as swamps, and pick up and deposit detritus and
sediment as they meander, so their journey is never a straight shot. Just as
a river rushes, or meanders toward the ocean, so time propels every couple
through terrain with recognizable landmarks. Time, or biological aging,
has an impact on all aspects of a couple’s life—work, sex, health, ­conflict,
connection, and caregiving. There are six major life-cycle stages that
­couples typically traverse from dating to death, divorce, or separation.
These stages are rooted in a westernized view of relationships and may
look different across cultures and across historical periods (­McGoldrick,
Carter, & Preto, 2016; Carter & McGoldrick, 1989).1

• The first one begins with opening up to a stranger, falling

in love, often cohabitating, and deciding to commit to a
future together. The central task of this stage of courtship
and ­commitment is for each member of the couple to separate
enough from families of origin so that the couple can make
decisions jointly.
• The second stage is the couple’s transformation from a dyad to
a triad, with the addition of a baby where work and relation-
ship needs are renegotiated, and the couple makes room for
a new person.
• Stage three is about maintaining the couple’s bond at midlife
as work commitments deepen, increased flexibility is required
in parenting adolescent children, and aging parents may
need caregiving.
• The fourth stage, now the longest adult stage, begins with
children’s leaving home and ends with the start of the couple’s
retirement.
• In the fifth stage, retirement, grandparenthood, and aging are
the focus; couples’ tasks include maintaining their connec-
tion in the face of health problems, adjusting to more time
together, and finding meaning as time runs out.

1
  I am grateful for the seminal and ground-breaking work on life-cycle stages put
forth by Monica McGoldrick, Nydia Garcia Preto, and Betty Carter over the last
three decades.
 Applying the Life-cycle Perspective to Couple Therapy 5

• The sixth stage centers on the loss of the relationship through

death, divorce, or separation.

This trajectory is, of course, not the only one that couples take, and
not all couples traverse all these stages. Other transitions—like migration,
traumatic losses, and disability—may be much more formative than these
developmental ones. There are also many variations of life experience for
couples who stay together on a long developmental arc. Three variations
are particularly important in clinical practice. First, the inclusion of
parenting in stages two, three, and four of the life-cycle stages requires
that clinical attention also be provided to represent the experience of the
many couples who will choose not to have children, but who stay mar-
ried over the same period of time as couples with children. Second, the
legalization of same-sex marriage (Supreme Court, 2015) is so recent that
there is scant longitudinal data on long-term same-sex marriages, so we
must wait for research data on how the developmental stages may differ
or overlap with those of heterosexual couples. In the meantime, clinical
knowledge and an emerging body of research on same-sex marriages can
offer guidance about same-sex couples. Divorce and remarriage is a third
normative variation over the life span. In the last 30 years, divorce has
supplanted death as the endpoint for the majority of marriages. This shift
has prompted some couple therapists to regard divorce as a normative
life-cycle event that may be positive or negative (Pinsof, 2002).
Life-cycle theory posits that couples experience the most stress at the
transition points, as one stage turns into another, and often as family
members are added, as in marriage and the transition to parenthood, and
lost, as during the launching stage and at the death of a spouse. When
moving from one stage to the other, the organization of the couple must
change. It is not, however, merely the transitioning from one stage to
the other that creates strain on a relationship. If, in addition, there is an
accumulation of stressors that coincides with a transition point, as when
a couple is expecting a first child at the same time that the husband’s
mother is diagnosed with metastatic cancer, and the couple has to relocate
to a new city without any supports, they may struggle. A transition point
can also be exacerbated if it resonates with difficulty encountered in a
previous generation at a similar stage of life, as when an expectant couple
6 A LIFE-CYCLE APPROACH TO TREATING COUPLES

grew up in families where there were miscarriages or deaths of children.

This couple may anticipate the transition to parenthood with an extra
burden of anxiety and apprehension.
At the core of this life-cycle perspective is the notion that family rela-
tionships shape our identities, with each generation connected to the ones
behind and ahead. The generations are mutually influencing and inform-
ing of one another so that is not only that parents guide their children’s
development, but it is also the case that children’s unfolding lives rever-
berate in the life choices made by their parents and grandparents. Take,
for example, the way that adolescents’ burgeoning sexuality and dreams
about their open-ended futures may inspire their middle-aged parents to
take stock of their more limited time that lies ahead.
There are two other dimensions of time that are critical to an under-
standing of life-cycle theory. First is the historical context of each cohort
of couples who is experiencing a particular life-cycle transition, as people
born at a given time will share certain opportunities and sociopolitical
experiences (Elder & Giele, 2009). Consider, for example, the cohort
differences of same-sex couples born in 1990 who came of age seeing
gay marriage legalized, compared with couples born in 1950 when gay
and lesbian identities were often regarded as signs of mental illness, and
sodomy laws could be used to criminalize individuals. When lesbian and
gay teens were recently surveyed about their attitudes toward marriage
and parenting, 92 percent of lesbian youth and 82 percent of gay youth
stated that wanted to be in a long-term monogamous relationship within
the next 10 years (D’Augelli, Redina, Grossman, & Sinclair, 2007), while
more than half of these same young men and women stated that it was
very or extremely likely that they would be raising children. These attitudes
among current lesbian and gay youth stand in stark contrast to the clos-
eted and constricted attitudes of similar youth in the 1950s whose best
hopes for marriage and a family were to hide their identities and enter a
heterosexual marriage.
The second dimension of time is the subjective one that all humans
experience, an internal clock that tells whether one is traversing a given
life stage at the expected time and provides an awareness of how much
time one has left. Bernice Neugarten, a psychologist, is credited with
identifying the notion that we each have a sense of what is a normal
time to accomplish different stages of the life-cycle (Neugarten, 1979).
 Applying the Life-cycle Perspective to Couple Therapy 7

Comparing ourselves to friends, siblings, work colleagues, and parents,

we have an idea of when is the best time to move in with a partner, marry,
have a child, settle on a career, or retire. This sense of timeliness is histor-
ically constructed, contextualized by the experience of our families and
by our particular cohort. So, for example, a pregnant medical student in
her late 20s may feel on time in terms of her family’s expectations, and
in step with 21st century culture in general, but early compared with
her cohort of medical students, who are largely postponing childbearing
until completing their medical education. For another couple, having a
child in their early 30s will feel late compared with their parents’ histories
of starting families in their early 20s. Neugarten made the observation
that life-cycle transitions are made more difficult when they happen off
cycle. For ­example, it is not children’s leave-taking at midlife that creates a
developmental crisis, but rather children’s not leaving home when they are
expected to do so, consistent with cultural norms or familial expectations.
According to the socioemotional selectivity theory, one’s chronological
age shapes an individual’s choices of present and future goals (Carstensen,
Isaacowitz, & Charles, 1999; Charles & Carstensen, 2009). People who
are young and healthy tend to view the future as open-ended, prioritizing
goals of gaining knowledge that can be deployed for future pursuits, while
older people are more present-focused. Younger people are also more like
likely to have a larger network of friends, than older people, who tend to
focus on a smaller cohort of friends and families (Fung, Carstensen, &
Lang, 2001). When time horizons are shorter, due either to old age or ill
health, people tend to emphasize emotion and meaning and to pay selec-
tive attention toward positive rather than negative stimuli. When couples
occupy two different perceptions of time, either because of a wide age
difference or because one partner is facing a life-threatening illness, time
itself can be an area of conflict.

Clinical Example: Not Age but Stage of Development

When Daphne and Martin2 first came for couple therapy, I was initially
struck by their sartorial dissimilarities—Martin was not afraid of color, from

2
  This case, as all others throughout the book, has been deidentified in order to
protect the identity of my clients.
8 A LIFE-CYCLE APPROACH TO TREATING COUPLES

his boldly patterned socks to his bright orange shirt and green vest, while
Daphne was dressed head to toe in black. Next, I noticed another contrast,
and one that they warned me not to be judgmental about—a 40-year age
difference. At 33, Daphne, a Euro-American woman, had just finished her
graduate degree in art history and was looking for a job, while Martin, a
72-year-old Jewish artist and writer, was still working full-time with no plans
to retire. There were more developmental asymmetries: Martin was at the
height of his career and Daphne was just starting out; Martin had four chil-
dren and several grandchildren, while Daphne was uncertain about whether
she wanted to have any children; Martin had accumulated wealth, two
houses, and an art collection, while Daphne was still living in graduate school
housing; M ­ artin was keenly aware of limited time and wanted to focus just
on those projects and people whom he knew were interesting and compelling,
while Daphne wanted to explore many new friendships and travel. Focusing
on their developmental tasks, biological clocks, and relative sense of future
time as points of difference gave a way to talk about their relationship. This
focus also led us to look squarely at the power differences that their different
developmental locations reveal. Age, parent status, money, and professional
standing are power issues as well as developmental ones.
Daphne described her challenges in the relationship this way: “I feel like
I’m fitting in to his life, his house, his family. If I weren’t here, he’d be making
the same decisions about his life. I’m not having an impact. He can’t hear me
unless I get angry and upset. I have spooned myself around his life. Being with
him means that his relationship with his children will always be stronger than
with me. The balance is off.” Martin talked about the guilt he felt, inviting
Daphne to share a life that would likely leave her widowed and childless when
she was in her middle-age years. He was unwavering about his wish not to
have a second family in his 70s.
And still, there were commonalities between them and ways their emo-
tional needs were interlocking. They both had childhoods where they were left
on their own, by parents with mental illness. Daphne had developed a strategy
of not relying on anyone, but found that Martin was steady and trustworthy,
the first man she could turn to for help and reassurance. This was the first time
she did not worry about finances; consequently, she experienced a freedom to
experiment with career options, and artistic pursuits, that she had yearned for
 Applying the Life-cycle Perspective to Couple Therapy 9

as an adolescent and young adult. Martin, for his part, had always been the
caretaker in his previous relationships, but with Daphne, Martin felt he could
be vulnerable and expose his feelings in a way he could not when he was the
sole provider of four children and adhering to more old-fashioned 1950s style
versions of masculinity.
Daphne and Martin worked hard in couple therapy for over two years.
Both felt that this was the most intimate relationship of their lives—they
deeply loved and felt cherished by the other. Martin wanted to marry Daphne
and told her so, but their developmental issues proved insurmountable. Some
of these issues pertained to their different perspectives on time. Like many older
individuals, Martin often wished to let go of their conflicts and focus instead
on the positive aspects of their relationship, while Daphne was more interested
in engaging in and working through conflict. Also congruent with those in late
life, Martin wished to spend time with Daphne and a small group of friends
and family he knew and loved already, while Daphne, with a more expansive
future, was far more interested in making new friends, having adventures,
and novel experiences. Most profoundly, their developmental differences piv-
oted around Daphne’s wish to live on her own, so that she could develop
her career out from under Martin’s powerful shadow and decide whether she
wanted a child. With much sadness, some regret, and deep affection, they
parted ways.

Changing Social Forces Have Affected Life-cycle Stages

The length, definition, and even existence of different stages of the life
cycle are shaped and influenced by larger social and historical forces.
For example, over the last 100 years, the extending of life expectancy
and the shrinking of family size have created the longest stage of adult
development. Americans are living 30 years longer than they did 100
years ago. In 1900, life expectancy was 47 years, while today, about 75
­percent of the population lives beyond their 65th birthday (Skolnick,
2013). The launching or empty nest stage is now the longest stage in adult-
hood, whereas it used to be the shortest one. When a woman had a large
family, having a last child when she was in her 40s, she or her husband
would likely die before they reached the empty nest stage. With couples
10 A LIFE-CYCLE APPROACH TO TREATING COUPLES

now having fewer children, completing child-bearing earlier, and living

longer, this stage, which begins when children leave home and ends with
retirement, can be 20 or more years (see Chapter 5).
Definitions of marriage have experienced major revisions and edits
over the last few decades. Most significant for Americans has been the
legalization of same-sex marriage recognized in June 2015 by the U.S.
Supreme Court. Leading up to this vote was Massachusetts’ legalization
of same-sex marriages in 2004, with 36 more states and the District of
Columbia following suit by March 2015. As of 2015, 40 percent of all
same-sex couples are married, while cohabiting and divorce rates are sim-
ilar to those of different-sex couples (Gates, 2015). As many as 2 to 3.7
million children have an LGBT parent, but only about 200,000 are being
raised by same-sex couples. In Chapters 2 through 7, clinical guidance
will be offered for therapists working with same-sex couples navigating
the different stages of the life cycle. These suggestions have been gathered
from the author’s clinical experience, interviews with couple therapists
who work primarily with LGBT couples, and from the growing research
in this area. Special attention will be paid to the observations of research-
ers and clinicians in Massachusetts working with same-sex couples who
have had the opportunity to have the longest legal marriages.
Legalization of same-sex marriage is not the only major shift in the
marital landscape. The age at which men and women marry for the first
time has increased significantly over the past 30 years. From 1980 to
2016, the median age of first marriage for men rose from 24.7 to 29.5,
and for women, from 22.0 to 27.4 years of age (U.S. Census, 2016).
Not only are young men and women postponing marriage, but also more
young adults are choosing cohabitation over marriage. Marriage rates are
at an all-time low. Between 1980 and 2016, the proportion of married
men has declined from 63 to 53 percent, and for married women, from
59 to 51 percent (U.S. Census Bureau, 2017). And, it is not just marriage
that is being postponed. Many women are delaying childbearing due to
educational opportunities or difficulties finding a partner, with higher
rates of infertility as an unintended consequence.
While many couples struggle with unwanted childlessness due to
infertility, there are growing numbers of couples who choose to remain
childfree. In 2006, 20 percent of women ages 40 to 44 had never had
 Applying the Life-cycle Perspective to Couple Therapy 11

a child, compared to half that number in 1976 (Dye, 2008; Osborne,

2003), numbers that include women who are childless both voluntarily
and involuntarily. Married couples who choose not to have children do
so for a variety of reasons: they may want to remain more mobile, with
ample time and flexibility to invest in their careers; they may want to
maintain a more intimate marriage; they may feel unsuited to parenthood
or feel worried that they will pass along a difficult genetic loading; others
may postpone childrearing decisions to a time when biological reproduc-
tion is no longer an option. Regardless of whether by choice or by default,
childless couples tend to be better educated, more likely to be urban-­
dwellers, and less likely to be religiously affiliated (DeOllos & Kapinus,
2002; Keizer, Dykstra, & Jansen, 2008). Over many studies, researchers
have found that couples without children experience similar or higher
levels of wellbeing at most stages of the life cycle than couples who
are parents (Koropeckyji-Cox, Pienta, & Brown, 2007; Nomaguchi &
Milkie, 2003; Pudrovska, 2008; Umberson, Pudrovska, & Reczek, 2010;
Wenger, ­Dykstra, Melkas, & Knipscheer, 2007; Zhang & ­Hayward,
2001). In general, couples who did not choose to be childless were less
happy and more depressed than those who were voluntarily childfree.
In addition, g­ ender and marital status have an impact on w ­ ellbeing. For
example, childlessness had the biggest negative impact on those who were
­widowed, particularly among men (Zhang & Hayward, 2001).
Postponement of marriage and childbearing, increased numbers of
couples not having children, more couples cohabitating with and with-
out children, and legalization of same-sex marriage are only some of the
changes to current living arrangements. We are also seeing more gen-
der equity in modern marriages. Most married women work outside the
home, contributing to a rise of shared decision-making as a cultural value.
There has been a dramatic increase in dual-earner couples, such that 70
percent of couples with children under the age of 18 are dual earners,
up from one-quarter in 1960 (Pew Research Center, 2015). It is not just
women who are contributing to the gender rebalancing of home and work
roles. The number of stay-at-home fathers has doubled over the last 30
years (Livingston, 2014), while men in general are playing a more active
role in childrearing. In the last two decades, fathers have more than dou-
bled the time spent on household chores and tripled the time spent with
12 A LIFE-CYCLE APPROACH TO TREATING COUPLES

children (Parker, 2016). Several studies suggest that couples in egalitarian

marriages experience higher marital quality (Amato, Booth, Johnson, &
Rogers, 2007; Frisco & Williams, 2003; Kamp Dush & Taylor, 2012).
There are, however, gaping class divides that undermine this ­picture
of increased equity. Highly educated women are more likely to marry
than less educated women. Of those with a college education, 88
­percent of women aged 33 to 44 are married, and their divorce rate is
17 ­percent in the first 10 years. By contrast, 79 percent of women in the
same age bracket with less than a high school diploma have married, and
the divorce rate for them in the first decade of marriage is 50 p ­ ercent
(McGoldrick, Carter, & Preto, 2016; Stevenson & Wolfers, 2007).
­
Low-income couples are more likely to move in with each other quickly,
have children at an earlier age, and move on if the relationship does not
work out. Children living in cohabitating or single-parent families are
two to three times more likely to be living in poverty than children living
in married families. It is ironic, indeed, that as marriage becomes more
equitable for some, the class divide around marriage and divorce rates
grows more pronounced.
The intersection of race and marriage reveals that there are significant
differences in marriage rates among White, African–American, Hispanic,
and Asian couples. For couples who married for the first time between
2006 and 2010, the chance of a 20-year marriage is nearly 70 percent for
Asian women, but only 36 percent for Black women and 50 percent for
both White and Hispanic women (Wang, 2015).
Over recent decades, marriage rates have dropped much more precip-
itously for African–Americans than for Whites. In 1960, 78 percent of
African–American households included a married couple, while 40 years
later, the rate had plummeted to only 16 percent (Pinderhughes, 2002).
By stark comparison, the marriage rate decreased much less dramatically
from 74 to 56 percent among White couples during that same period.
When children are included in the family calculus, the racial divide is
also obvious. About three-fifths of African–American children will grow
up in a single-parent family as compared with only one-quarter of White
children (US Census Bureau, 2017).
These racial disparities are not reflected in attitudes toward marriage.
Blacks and Whites value marriage similarly, and Blacks are significantly
 Applying the Life-cycle Perspective to Couple Therapy 13

more likely than Whites to disapprove of divorce. Despite these beliefs,

rates of singlehood are high among African–Americans, in part due to a
male shortage that is attributable to higher rates of poverty, incarceration,
and drug use (Chambers & Kravitz, 2011; McKinnon, 2003; Teachman,
Tedrow & Croder, 2000). Added to these factors is higher unemployment
among African–American men, a deterrent to marriage.
Family composition has also changed over the past 30 years. Fewer
than half of the children under the age of 18 years live with two married
parents, and about 40 percent live with single or cohabitating parents
(Livingston, 2014). Increasingly, marriage and parenting are becom-
ing uncoupled. Adding to the complexity of family life is the number
of Americans living in multigenerational households, which doubled
between 1980 and 2012 (Fry & Passel, 2014). As a consequence of later
marriage rates and longer educational paths among higher-income young
adults, as well as declining employment and wages among many lower­-
income young adults, 25 percent of adults ages 25 to 34 lived with their
parents in 2015 as compared to only 11 percent in 1980.

Divorce Is as Common an End to Marriage as Death

In 1900, two-thirds of marriages ended within 40 years as a result of one
partner’s death. The year 1974 was a watershed as it marked the point
at which marriages were more likely to end in divorce than in death
­(Hagestad, 1988). Spikes in divorce occur at predictable points during
the life-cycle, with the largest one after five to seven years of marriage,
and another at 15 to 17 years of marriage (Gottman & Levensen, 2000).
Recent surveys suggest that, while divorce rates among younger couples
are declining, the divorce rate among couples in their 50s and older dou-
bled between 1990 and 2010 (Brown & Lin, 2012). This spike may be due
to a cohort effect of Baby Boomers who were responsible for the increased
divorce rate in the 70s continuing their patterns of high marital instabil-
ity in subsequent marriages (Kennedy & Ruggles, 2014). Or, the rise in
divorce in older individuals may represent changing social and historical
forces, such as a longer life expectancy that makes a many-­decade marriage
too heavy a burden, or increased gender equity that allows more women
the freedom to leave a marriage with her own income and retirement
14 A LIFE-CYCLE APPROACH TO TREATING COUPLES

benefits. In any case, if half of divorces occur within the first seven years
of marriage, another quarter of all divorces occur in couples who are 50
or older. Divorce rates are inextricably linked to class, as well as to age.
For college-educated women, there is almost an 80 percent chance of still
being married after two decades, while for women with a high school edu-
cation or less, their chances are only 40 percent (Wang, 2015).

Clinical Example: The Use of a Developmental Reframe

The developmental lens not only provides context and orients the cou-
ple therapist to common challenges but can itself be an intervention. By
introducing a previous stage of life that was skipped over, a developmental
reframe can shift a couple from blaming one another toward adopting a
dyadic and nonjudgmental view of their current difficulties.
When Maria and Ralph, an African–American couple in their early 30s,
came to a Boston-area clinic, they complained of feeling like siblings, the kind
who squabble and then go their own way. Married for five years, they had two
daughters, Anna age 5 and Sophia age 2. Although the reason they gave for
their clinic visit was their older daughter’s second expulsion from a pre-school
due to biting other children, other difficulties—more typical of couples who
are older and have been married for decades—came tumbling out. They met
seven years earlier, shortly after the death of Maria’s mother. Not long after
that, Maria was diagnosed with early-stage breast cancer for which she was
treated with radiation, chemotherapy, and surgery. During cancer treatment,
the couple moved in with one another and only a month later, Ralph’s mother,
following a fall that was the first symptom of Alzheimer’s, moved in and con-
tinued to live with them until her death a year ago.
The couple sought a diagnosis for their daughter, and they wanted help
managing her temper outbursts at home. As their therapist, I was torn between
focusing on their current problem and wondering how their shaky start as a
couple might be interfering with their difficulties collaborating as parents.
As part of my feedback after the first few sessions, I offered a developmental
reframe. “It is no wonder that you are feeling more like siblings than like
partners as you face a parenting challenge with Anna. It sounds like life threw
crisis after crisis at you, like the death of a parent, a serious medical illness,
and the care-taking of an ill parent that most couples don’t have to deal with
 Applying the Life-cycle Perspective to Couple Therapy 15

right out of the gate. Because you had to deal with challenges more typical of
older couples who already know each other well, you skipped an important
developmental stage—creating an identity as a couple.
“In addition to figuring out a good plan for helping Anna, I’d like to
suggest that we do some time travel in here. Let’s go back to the developmental
stage you missed out on and take some time to have conversations you might
have had if you hadn’t had to race ahead. For example, ‘Where do you want
to live?’ ‘How do you resolve disagreements?’ ‘Who are your friends?’ ‘What
role, if any, does religion or spirituality play in your lives?’ ‘What rituals, like
dinner or holiday get-togethers, are important to you?’ ‘What do you like to
do together when you have leisure time?’ ‘What is important to you as you
envision a future together?’ These are just a few topics that we might discuss.”
The developmental reframe is a normalizing intervention that recasts
a current problem as indicating that a couple bypassed an important
­earlier stage or has gotten stuck at a prior stage. With Maria and Ralph,
their current distant and contentious relationship was interfering with
their ability to collaborate on a parenting plan for their elder daughter.
By offering an empathic explanation for their difficulties—that they got
derailed in developing their relationship by having to take on respon-
sibilities more typical of an older couple—they were offered a way for-
ward that sidestepped any assignments of blame. This developmental
reframe also gave an entry point to talk about the losses they experienced
together, and how their caretaking of each other had shaped their current
relationship.
In the coming chapters, the developmental perspective will next be
applied to each stage of a couple’s lifespan. Starting with courtship and
the decision to marry or commit to one another, we will explore the
research on the transition to marriage with an eye to better understanding
this opening act. We will look at common presentations for therapy and
make suggestions for questions and interventions that a couple therapist
can offer to help couples as they initially embark on a life together.
 Index
adolescent children, midlife couples, cohabitation, 4, 10–13, 18
59–62 cohort difference, 6
adult children, late-midlife couples, communications, positive, 36–37
75–76 conflicts and estrangements, late-life
African-Americans. See Blacks couples, 98–100
aggression, physical, 32 conflicts, positive moments, 52–53
aging, 91, 93, 102 co-parenting, 54–55
American Association of Retired couples at end of life, 108, 111–116,
Persons (AARP) study, 66 117–118
American Society of Reproductive couples at midlife. See midlife
Medicine (ASRM), 43 couples
amyotrophic lateral sclerosis (ALS), couples in later life. See late-midlife
105 couples
Asian couples, 12, 19, 75 couples with illness, 108–109
assisted reproductive technology couple transition, 17–19
(ART), 43–45 clinical presentations, 19–21
family-of-origin issues
baby temperament, 54 family background, 29
Blacks, 10, 12, 13, 14–15, 57, 62, LGBT children, 27
90, 95 parental disapproval, 29–31
parental divorce, 27–28
Caribbean Blacks, 62 sibling relationships, 26–27
childbearing, marriage and, 11–12 wedding, 28–29
childfree couples, 10–11, 90 issues of timing
childhood experiences and roles, 27 pregnancy, 22–23
childlessness, 10–11 sex, 23
children significant loss, 25–26
adolescent, 59–62 sliding vs. deciding, 23–25
adult, 75–76 teenage couple, 22
African–American, 12 relational dilemmas
in late life, 96 fighting, 32–34
late-midlife couples, 82–84 infidelity, 31–32
launching, 79–84 physical aggression, 32
LGBT, 27 Cowans’ Pie, 48
step-children, 45
chronic stress, 91 dating, v, 4,17,18, 20, 23, 118
clinical presentations day-to-day interactions, late-life
couple transition, 19–21 couples, 100
late-life couples, 96–100 death, legacy, 116–117
late-midlife couples, 79–81 dependency and closeness, late-life
midlife couples, 62–63 couples, 101
140 Index

dependency and intimacy, late-life grandparents, 78

couples, 96–98 Grant study, 3
depression, postpartum, 50 the gray divorce, 74
developmental reframe, 14–15
developmental crisis, 7 Hispanic, 12
dinner, 15, 27, 34–35, 52, 53
disapproval, parental, 29–31 illness
divorce, 5, 13–15, 103 clinical issues, 103–108
late-midlife couples, 74 couples with, 108–109
parental, 27–28 and end-of-life, 108, 111–116,
dual-earner couples, 11 117–118
intergenerational history, 107–108
empty nest stage, 9–10, 75–76, 82, 84 legacy, 116–117
end-of-life, illness and, 108, 111–116, LGBTQ individuals, 107
117–118 life-cycle of, 105–106
equity, 12 losses, 110
erectile functioning, 76–77, 85–86 narrative, 109–110
expectations, parenting relationships, 111
labor and delivery, 49–50 individual changes, midlife couples,
postpartum depression, 50 67–68
prenatal marital quality, 46 infertility, 10–11
relationships, 46–47 infidelity, 31–32
supporting, 49 information, disclosing, 20
visualizing and discussing, 47–49 in vitro fertilization (IVF), 42, 43, 50
issues of timing
family backgrounds, 29 pregnancy, 22–23
family composition, 13 sex, 23
family of origin significant loss, 25–26
family background, 29 sliding vs. deciding, 23–25
LGBT children, 27 teenage couple, 22
parental disapproval, 29–31
parental divorce, 27–28 labor and delivery, 49–50
sibling relationships, 26–27 lack of time, 40–41
wedding, 28–29 late-life couples, 89–90
fidelity and commitment, 20–21 conflicts and estrangements,
fighting, couple, 32–34 98–100
future plans, late-midlife couples, day-to-day interactions, 100
86–87 dependency and closeness, 101
dependency and intimacy, 96–98
gay and lesbian, 6 gender roles and dependency needs,
gay couples, 19, 31, 42, 43, 86 93–94
gender differences, 23, 28, 66 mortality in, 96
gender roles and dependency needs, relationships, 102
late-life couples, 93–94 sexual intimacy, 94–96, 100–101
Glueck cohort, 3 trends in, 92–93
Gottman, J. M., 32–33, 36, 46, 51, vulnerabilities and illnesses, 91–92
52–53 late-midlife couples, 73–74
 Index 141

adult children, presence of, 75–76 late-midlife couples, 74–75

children’s wellbeing, 82–84 pregnancy, 22–23
divorce, 74 race and, 12
future planning, 86–87 rates, 12
grandparenthood, 78 same-sex couples, 19
leave-taking, children, 84 teenage couple, 22
LGBT couples, 79. See also lesbian, Marvin, Caroline, 43
gay, bisexual, and transgender menopause, 77
couples mental/physical illness, parenting,
marriage, positive impact on, 69–70
74–75 midlife couples, 57–59
primary relationship, 84–85 adolescent children, 59–62
retirement, 81–82 individual changes, 67–68
sexual intimacy, 85–86 leave-taking, adolescent, 70
sexuality, 76–78 losses, 64, 70–71
two-parent family children, 79–81 money issues, 64–65
launching children, 79–84 parenting, 68–70
leave-taking, adolescent, 70 presentations, 62–63
leave-taking children, late-midlife sexuality, 65–67
couples, 84 midlife crisis, 59–60
legacy, death, 116–117 Midlife in the United States
legalization of same-sex marriage, 5, (MIDUS), 60–61
10, 11 money, midlife couples, 64–65
lesbian couples, 6, 18 mortality in late-life couples, 96
lesbian, gay, bisexual, and transgender Moore, C.W., 113–114
(LGBT) couples, 27, 57, 79
LGBTQ couples, 107 narrative, illness, 109–110
libido, 40, 59, 66–67,77, 86, 95 National Cancer Institute, 106
life-cycle perspective, 2–9 National Survey of American Life
couple therapy, 7–9 (NSAL), 62
dimensions of time, 6–7 Neugarten, B., 6
longitudinal study, 3 new parents, experience
notion, 2–3 attention, paying, 53–54
stages, 4–5 baby’s temperament, 54
transition point, 5–6 conflicts, positive moments, 52–53
life-cycle stages, 4–5 fighting and sex, 51
social and historical forces, 9–13 relationships, 54–55
life-cycle theory, 5–6 rituals, 51–52
losses
illness, 110 orgasm, 66, 76, 77, 78, 86, 95, 101
midlife couples, 64, 70–71
low-income, 3, 12, 13, 50 Papernow, P., 45
parental disapproval, 29–31
marital distress, 47 parental divorce, 27–28
marital satisfaction, late life, 92 parenting
marriage, 10 expectations
and childbearing, 11–12 labor and delivery, 49–50
142 Index

postpartum depression, 50 physical aggression, 32

prenatal marital quality, 46 relationships
relationships, 46–47 couple, 46–47
supporting, 49 illness, 111
visualizing and discussing, 47–49 late-life couples, 102
inclusion of, 5 late-midlife couples, 84–85
midlife couples, 68–70 parenting, 54–55
new parents sibling, 26–27
attention, paying, 53–54 remarriage, 5
baby’s temperament, 54 retirement, 81–82, 90
conflicts, positive moments, and late-life couples (see late-life
52–53 couples)
fighting and sex, 51 rituals, 34–35, 51–52
relationships, 54–55 Rolland, J.S., 104–106
rituals, 51–52 Rosenberg, Larry, 31–32
stressfulness, 39–42 Rosenberg, Leah, 106, 108, 117
ART, 43–45
attention and care, 46 same-sex couples, 6, 19
high stress, experiencing, 46 wedding, 28–29
same-sex parents, 42–43 same-sex marriage, legalization of,
step-family dilemmas, 45 5, 10
Parenting At a Challenging Time same-sex parents, 42–43
(PACT), 106–107 secrets, 96, 114, 114
Pew Report, 11, 75 sexual desire (see libido)
physical aggression, 32 sexual functioning, 76–78, 94–95
pile-up of stressful events, 21 sexual intimacy
positive communications, 36–37 late-life couples, 94–96,
positive moments, parenting, 52–53 100–101
postpartum depression, 50 late-midlife couples, 85–86
pregnancy, 22–23 sexuality, 23
prenatal marital quality, 46 fighting and, 51
presentations, midlife couples, 62–63 late-midlife couples, 76–78
primary relationship, late-midlife midlife couples, 65–67
couples, 84–85 sibling relationships, 26–27
protective factors significant loss, 25–26
positive communications, 36–37 sliding vs. deciding, 23–24
rituals, creating, 34–35 social and historical forces, 9–13
psychological processes, 25–26 socioemotional selectivity theory, 7
stages of life-cycle, 4–5
race and marriage, 12 stay-at-home fathers, 11
racial and ethnic differences, 62 step-families, 45
racial disparity, 12–13 stressfulness, parenting, 39–42
Rauch, P.K., 106–107, 113, 117 ART, 43–45
relational dilemmas attention and care, 46
fighting, 32–34 high stress, experiencing, 46
infidelity, 31–32 same-sex parents, 42–43
 Index 143

step-family dilemmas, 45 U-shaped curve, 61

The Study of Marital Instability over
the Life Course, 61–62
Vaillant, G. E., 3
supporting, parenting, 49
visualizing and discussing, parenting,
47–49
teenage couple, 22
vulnerabilities and illnesses, late-life
tensions, couple, 19–20
couples, 91–92
time and rituals, 52
transition point, 5–6
transition to parenthood. See parenting Waldinger, R.J., 92
trends in late-life couples, 92–93 wedding, 28–29. See also marriage