Including significant others to individual therapy sessions


Health Individual therapy Relationships


Daniela Rocha IJzerman

I regularly read an article that I enjoy reading and that I find relevant for psychotherapy. I summarize it and discuss how I see it as relevant for clients on my blog. Do you have questions, comments, or suggestions for other articles to read? Leave a comment below the post. 

Discussion of Relationship status and perceived support in the social regulation of neural responses to threat

Relationships can make our lives easier in many ways. In this blog post, I discuss a study that presents evidence for the idea that brain regions associated with threat detection are activated less when people have familiar-others holding their hands. What are this study’s implications for psychotherapy? What are potential applications and potential benefits for clients having the presence of a significant other during psychotherapy sessions? Are there any potential limitations for clients that I see?

The Study

There is now a large collection of studies showing that social relationships are linked to longevity and being healthier, summarized in a so-called meta-analysis by Julianne Holt-Lunstad and her colleagues. This meta-analysis even shows that well-known risk factors for our health, such as smoking and obesity do not represent a greater risk than the lack of social connection. 

But what are the potential mechanisms that can explain the beneficial effects of relationships? In the article I chose to comment on this post, James A. Coan and his colleagues suggest that emotional support can help regulate affect when under threat. They study this by investigating brain responses when one of the partners receives an electric shock and they held the hand of the partner. The researchers assessed perceived social support using a self-report questionnaire and the relationship status of their participants (i.e., whether they were married, dating, cohabiting, or platonic friends). They found that holding hands with a familiar-other, regardless of the type of relationship people had, reduced the activation of brain regions associated with threat detection. Holding hands with strangers or being alone didn’t reduce such brain activity. 

Amongst participants who perceived to have greater social support, brain areas associated with threat were activated even less when they were holding their partners hand. On the other hand, brain activity in those areas increased when they were holding hands with strangers. In other words, the researchers found that more familiar people seem to have a greater impact in reducing our feelings of threat and this effect is larger when people recognize the social support they receive. 

Implications for clients I see during therapy

How do I see this study’s relevance for clients I see during psychotherapy? During therapy, people talk about difficult events, which usually brings up feelings of sadness, stress, or at least some level of discomfort. At the start of therapy with a client, I am a mere stranger and I ideally hope to start serving as a more secure base as therapy progresses. Towards the end of the therapy, I hope to reduce clients’ unpleasant symptoms of anxiety or depression and to increase their feelings of meaning to grow further in life. Life will however certainly continue to present challenges after therapy is over and other “threats”  will arise. 

If clients could have a significant other either at the start or during the therapy sessions and they have a supportive relationship, they will likely feel safer and possibly relieved of the many uncomfortable feelings they may experience when recalling difficult memories. By inviting significant others to join individual therapy sessions, I can probably also direct the therapeutic process to helping clients to better sustain or even build stronger bonds with their partners, family members, or friends. Clients will then probably be better equipped to face tough times ahead. 

Limitations when applying the study to therapy

Even though I think a partner can be crucial to the success of therapy, there are various instances in which that is not the case. I thus need to ensure that my clients feel safe in opening up from a vulnerable position. I was trained to help create and maintain a safe therapeutic environment and to protect my clients from difficult interactions when those occur, including identifying potential contraindications. After all, revealing vulnerable points to someone who reacts with criticism can be traumatic. 

There are also some things to be reminded of from a research perspective. In psychological science, there have been avid discussions around sample size and “statistical power”. The sample size in this study was modest, which means that as a therapist, I need to be careful with how firm the conclusions are that I draw. Further, the clients that I see are quite different from Coan and colleagues’ participants from Charlottesville, Virginia, United States. My clients are either expats in Europe or Brazilians who live in Brazil or elsewhere. It is unknown how Coan et al.’s results generalize to the clients I see as my clients can have dramatically different backgrounds than his participants. As a therapist, I take great care in interpreting these different situations in supporting my clients during therapy. 


Altogether, psychological science has been consistently providing evidence for the importance of social relationships to our health. Psychotherapy can draw lessons from psychological science by integrating these findings into practice with clients. As a therapist, I thus heed the lessons in how to make individual therapy more “social” by having clients’ significant others join the sessions.

Image by Alex Green

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