.png)
Under the Hood
Pelvic floor physical therapist Dr. Alexandra DiGrado and sex & couples therapist Dr. Rebecca Howard Eudy get real about sexual health, intimacy, and the stuff we didn't learn about our body in school. From the clitoral hood to parenthood, no topic is off-limits. Each episode blends a combined 30 years of clinical experience with compassionate advice and humor, giving you trusted knowledge, practical tools, and the confidence to take charge of your health and relationships.
Under the Hood
Episode 42: Should You Break Up? A Couples Therapist's Honest Take
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
When a relationship is struggling, the real question might be less "How do we fix this?" and more "What's the best next step?"
Inspired by an essay from a writer who felt couples therapy prolonged a failing marriage instead of helping her see it was over, Dr. Rebecca and Dr. Alex take a hard look at the expectations around relationship counseling. Is “success” defined by staying together or by reaching clarity…even if that clarity leads to parting ways?
Whether you're navigating a crossroads in your own relationship or supporting someone else through theirs, this nuanced and compassionate conversation will help you approach either reconciliation or separation with greater care, honesty, and respect.
What you'll learn:
- What Dr. Rebecca always asks a couple before therapy even begins.
- Why some couples therapists avoid bringing up divorce directly, even when it's clearly on a client's mind.
- How many people end up communicating better during their divorce than they ever did as a married couple.
Tune in if you've ever thought:
- "Is our relationship even worth saving?”
- "We've stopped fighting. Is that a good sign or a bad one?"
- "It feels like my therapist and partner are ganging up on me.”
- "If we do end up splitting up, how do we not ruin our kids in the process?"
Helpful resources:
- Find a pelvic floor PT near you: pelvicrehab.com or Pelvic Global Directory
- Parents in Love: A Guide to Great Sex After Kids by Dr. Rebecca Howard Eudy
Connect with us:
Dr. Rebecca Howard Eudy
Website: rebeccaeudy.com
Instagram: @rebeccahowardeudy
Newsletter: Parents in Love Substack
Dr. Alexandra DiGrado
Website: bostonpelvicpt.com
Instagram: @bostonpelvicpt
Newsletter: Under the Hood
Under the Hood Podcast
Instagram: @underthehooddocs
Website: underthehoodpod.com
YouTube: @underthehooddocs
Welcome to Under the Hood. I'm Dr. Alex DeGrotto, your pelvic floor physical therapist. And I'm Dr. Rebecca Howard Ute, your sex and relationship therapist.
SPEAKER_00Hello, hello. Hey Alex. All right, this was my idea. Yes, it was. Yes, it was. As the oldest credits, or did you? No, okay. So I read a certainly not. I read a Substack article from someone who had gone to couples therapy and basically ultimately ended up feeling that divorce was the right move and felt that the couples therapy prolonged the relationship. You can't blame one thing, I suppose, but in the article, you know, people can be a little bit Yeah, yeah. Clickbaity, maybe I clicked on it. So anyway, it prolonged the relationship for 10 more years. Yeah. And really sounds like mid-couple's therapy. Yeah, right? I know. Yeah.
SPEAKER_01But it didn't solve the underlying issues. And this person felt like that was not a good thing. Yeah. They would have liked to be able to do that.
SPEAKER_00We should have totally that they it really wasn't the right relationship and it needed to end. And so it really got me thinking, and I hate to admit that I had never pondered this before, but do you, and if so, how do you help people discern that? And do you have opinions about that? I had always presumed, obviously wrongly, that the goal was to get the relationship to be successful. But now I'm realizing actually maybe you're helping them realize they're not the right fit.
SPEAKER_01Yeah. I mean, sometimes that is.
SPEAKER_00Wow. Okay. Yeah, which makes so much sense.
SPEAKER_01Yeah. So there is a particular type of counseling, which I am not certain. There's a certification to go through. It's called discernment counseling. Wow, okay. And I often refer refer people to it. Okay, cool. So when people come and they are not, you know, a lot of times there's one person who's leaning out more, or there's a lot in the relationship that I, you know, think is not viable, I will refer people to discernment counseling. And so when they go to discernment counseling, the person that they work with is going to do, it's a it's first of all, it's a limited time. Okay. So if I don't think that people are gonna make it, or they're not sure that they're gonna make it, or I don't think they're a good candidate for couples therapy, I always tell them to go to discernment counseling first because couples therapy is an emotional and financial commitment. Yes. So discernment counseling, it's four to six sessions. Okay. Limited time. I mean, it could even be less than that. Got it. But that's uh the longest that it would be and it's a combination of individual and couples sessions. Got it. So the therapist is not doing couples therapy, they are very specifically trying to help the couple to choose from three possible paths. Okay. So the first one is they break up. Yep. Second one is they do couples therapy and they commit to a certain period of time where they're not going to be talking about breaking up. So they don't commit to the relationship forever. It's not like they're renewing their vows, but it's typically like six months where they might say, okay, we're gonna move forward, we're gonna do couples therapy for six months and then reassess. Got it. Or they decide to change nothing.
SPEAKER_00Wow. And then go to couples therapy.
SPEAKER_01Or not.
SPEAKER_00Or not. Oh wow. Okay.
SPEAKER_01I mean, you know, you could say this relationship is not salvageable, we're not ready to, we don't want to invest in couples therapy, and we're not ready to break up. You know, maybe there's financial reasons for that. Maybe the kids, maybe you say, we're gonna, you know, we're gonna stay together until the kids go off to college and then we're gonna get divorced.
SPEAKER_00Okay.
SPEAKER_01But for whatever reason, right now we're not changing anything.
SPEAKER_00And so when you decide that someone needs to go to discernment therapy before they work with you, or perhaps even instead in some cases, what are some of the signs for that for you?
SPEAKER_01So it is I've never referred clients. I have tried, I have tried to refer current clients to discernment counseling. But what often happens is that they don't want to leave couples therapy. Okay. But more commonly it's during my initial consultation with someone. So when I, you know, me or any other therapist would do brief like 15, 20 minute consultation. And so usually it's when one person is leaning out. So usually people will come to me and their relationship is in crisis. Yeah. Typically the person who really wants the relationship to work is the one either doing the consultation or they're the one who scheduled the consultation. And so I always ask about the buy-in of the other partner. Yeah. That's super important. If you're gonna do couples therapy, both people really need to be bought in. Yeah. And so if that is not there, like I literally ask about that during the consultation. And if buy-in of both people is not there, then I would suggest either, you know, trying to figure out how to get buy-in. Like I might give some advice to the client that I'm talking to about how to get buy-in. Like, so for instance, never make couples therapy a fight. Yeah. If your partner does not like a particular couples therapist, it's not worth the fight. You just find a different one. You need to both be bought in and like the person and feel comfortable with them. But also the, like, if one person really wants to get a divorce and the other person is like, no, no, we really need to save the relationship, that might be a situation where discernment counseling, best case scenario in terms of if you're talking about wanting to save the relationship, you get the leaning out partner to buy in for a limited period of time so that you can do the relationship counseling. But also, if they don't, then you then have a path forward as well. And you haven't wasted time.
SPEAKER_00Okay. And so what about when you have couples in your therapy? Now I feel like we've mostly talked about steering them into discernment. What about if they're already with you? Kind of are there cases where you together as a group say, this feels like it's moving towards dissolution. Oh less than a lot of people. Whatever.
SPEAKER_01Okay. Yeah, I mean, I have often said to clients who I'm really concerned about, I'm really concerned about your relationship. Yeah. I think that, you know, a lot of times what ends up happening is that people sort of, it's it's kind of like an extreme example of the room we feel like roommates where they have an in-home separation, okay, which is not formalized.
SPEAKER_00Sure, I understand. I know a lot of people that do that.
SPEAKER_01Exactly. And so if I see that happening to one of my clients, especially if it has happened over time, yeah, I will say, I'm really concerned about your relationship. This is, you know, I think that your relationship is headed for divorce. Like, w, what are you thinking about? Like, I I think that a lot of times couples therapists are afraid to talk about divorce. Yeah, but clients are talking about divorce. Yeah, totally. And if they're not talking about divorce, they're thinking about divorce. Yes. Like it is the elephant in the room. So just bring it up. Exactly. And so if it if it's on their mind. Long before they would bring it up and talk about it.
SPEAKER_00Yeah, yeah, totally. And so you sort of allow the space for that healthy discourse essentially to say this is an option. And it might be the one that both of you are thinking of but not wanting to say, or whatever. Okay. Wow, that's that's a tough conversation.
SPEAKER_01That's what I do, I like.
SPEAKER_00Although maybe it feels like a breath of fresh air for them to like actually have a space to discuss it and sort of a safe with an objective person.
SPEAKER_01Yeah, I mean, I think that if if you don't, if as a couples therapist you are so gung-ho about saving the relationship, people don't want to disappoint you. Totally. You know, they're like, well, she really believes in the relationship. I mean, I think we should get divorced, but she really believes in it. So I'm not gonna tell her. She's the expert. Yeah, yeah, totally. She's the expert. I do think that there are certainly times when I will often say to clients, you know, this is such a strength in your relationship. Look at what you did here. That was really amazing. This was really different. Yeah. How did it feel? And helping people to reflect on the strengths in their relationship is different than not talking about what their fears, their concerns, their worries are for the relationship.
SPEAKER_00Yeah. And I think actually that's so refreshing when you feel like someone is noticing the strengths. It's nice. It's it can allow you to revive what you feel is the strengths too, I would imagine.
SPEAKER_01Yes. I occasionally, very occasionally have been surprised when a couple's gotten divorced. You know, there's sometimes where people, I'll work with them for a period of time and they get to a point where things are a little bit better and then they'll end, you know, because of logistical reasons. Sure. Or they just are like, okay, we don't want to do this anymore. I wouldn't recommend that they finish, but they end. This has happened before, and then they come back during the course of their divorce.
SPEAKER_00I also do divorce coaching to make it as sort of healthy and respectful and amicable as possible, type of thing.
SPEAKER_01Well, it becomes, if there's kids involved, when you have a divorce, both people need to be able to put aside their own feelings. All of that to focus on the kids. And it's the beginning of a new relationship. So the old all of that old bullshit that was there is done. It's done. Yeah. And it's not done the issue. And that's, you know, it during a divorce, it obviously it gets nasty and everything. But to the extent to which people can just focus on the kids and focus on respect for their former partner and their current co-parenting partner, it is like solid gold. Like what happens during a divorce sets the tone for the future relationship. And it often gets very contentious. And then a lot of times that takes that's a huge rupture. Yeah. It takes a long time to heal, especially for the kids.
SPEAKER_00So that's interesting because I've actually seen a lot of people doing that really well in more recent years. And I wonder if it's because they had somebody like you helping them kind of navigate that process.
SPEAKER_01Or perhaps a personal therapist. Yeah, oh yeah, for sure. Because you do need a place to put that. I mean, the the anger and the sadness and the betrayal.
SPEAKER_00But then your love for your kids overcomes.
SPEAKER_01Well, it's maturity. Maturity. It's emotional maturity, yeah. And that is, you know, hard when you're hurting.
SPEAKER_00You're hurting and you want the other person to feel hurt too. Yeah, that's really tricky.
SPEAKER_01So occasionally I've been really surprised that people have gotten divorced, and usually it's when they haven't disclosed, you know, they they're sometimes people just don't tell the truth.
SPEAKER_00You know, even in their That was in the article I read that the husband, according to the writer, was just lying constantly to and and making it sound like he was doing everything he could, and she personally didn't feel like he was doing anything at all, and that it was just a facade. Right. So I'm sure there was maybe some mix in there.
SPEAKER_01But well, you know, when you have someone like that who's lying in therapy and then like completely like not really willing or capable of change. I I feel like as a therapist, as a couple's therapist, I often feel like an ethical obligation to really call that out. Yeah. Because a lot of times that will come up in therapy. Yeah, totally. Because that, you know, if if someone's saying something in therapy and then outside they're doing the exact opposite or it's total bullshit, that's gonna come up. They're part of the call them out. Yeah. And so if I really think that there's a lack of capacity for change, which doesn't happen that often, usually it's just two sort of imperfect people who just are, you know, they're on baggage to figure it out. But sometimes you do have someone who genuinely is, you know, narcissistic, or they have like these really ingrained personality traits. You know, they're a, you know, pathological liar, or they are cheating all the time. And there really is a limited capacity to even want to change. Yeah. That is something that I will often talk to the partner about and say, it is this something you can live with?
SPEAKER_00Yeah.
SPEAKER_01People live with all kinds of things in relationships for all kinds of reasons. And it's not my job to say what is or isn't the right thing to live with, but we need to be realistic about who we're married to and their capacity to change. Yeah, interesting. So I think that that's one of the places where people really want to believe that their relationship can change and their partner can change. And most of the time it can to a certain extent.
SPEAKER_00Yeah. One thing that's coming up for me as you're talking is what you said earlier about both parties needing to have the buy-in. And I think there might be some stereotypes around couples' therapy where if it's a heterosexual relationship, the male partner will presume that the therapist is just gonna blame them for everything that happens. Does that come up at all for you?
SPEAKER_01You mean are male partners afraid that they're gonna get blamed?
SPEAKER_00Correct.
SPEAKER_01Oh, yeah, definitely.
SPEAKER_00Yeah. And so that would make them resistant, even though, of course, they want the relationship. Yeah. Or I shouldn't say, of course. In many instances, I would say the buy-in is not because they don't want the relationship to succeed. It's more so because they are they're hesitant about the therapy for that.
SPEAKER_01Yeah. I think that that is more often the case, is that they're hesitant about therapy. A lot of times people will, you know, say, Is does this mean we're getting divorced?
SPEAKER_00Like they're resisting. Yeah, they presume that it's something really bad, which you've said in the past, come sooner, come when you know.
SPEAKER_01It's so much. Yeah, don't wait till it's a disaster. Yeah, exactly. However, that is not a lot of people's perspective. Yeah. And so they are afraid to come to therapy. They're afraid of what it's going to mean for their relationship. That's why, you know, a lot of times, if I usually do the consultation with both people.
SPEAKER_00Okay.
SPEAKER_01But sometimes not. Sometimes, I mean, I don't make it a prerequisite. Sometimes I just have one partner who does the consultation with me. And whenever that happens, I always say, please offer this same consultation to your partner. They need to also feel comfortable with working with me. And if at any point it does not feel like a good fit, then I just refer people. I mean, I that is just, you know, not everybody's going to be the right fit for everybody. And in reality, you know, not all therapists are created equal in the same way that you say that about pelvic flower PTs. So people often come to me. A lot of times the couples that I see have seen two, three more other couples therapists. And a lot of times they've had a bad experience. Totally. Yeah. Like they've been, their couples therapist has diagnosed them with. I don't, I mean, I don't want people to scare people off the other way. Yeah, totally.
SPEAKER_00But just to say, if you have a negative experience, be brave and try again. Yeah.
SPEAKER_01Yeah. Like if it feels like that therapist is Totally. If it feels like the therapist is taking some your partner's side and you feel really say it. Yeah. Go and tell your therapist, I feel totally alienate alienated. I feel like the two of you are ganging up on me. Right. I have had clients say that to me. Yeah. And you know, sometimes couples therapists do take sides. Yeah. Like Terry Real, who's a famous, you know, couples therapist and who does training, famously says, I take sides. Yeah. So the idea that a couples therapist would not take a phone.
SPEAKER_00Could remain totally neutral. Totally.
SPEAKER_01Totally is not in not reality. But one of the things that does happen is that, you know, whenever I point out a behavior or whenever I, you know, it feels like I'm taking sides to somebody, it is not because I don't like that person. Sure.
SPEAKER_00Yeah. You're just trying to notice the behavior and bring it to light.
SPEAKER_01I want them to get more of what they want.
SPEAKER_00Yeah, yeah.
SPEAKER_01And we all have behaviors that are working against us.
SPEAKER_00So true. Yeah, the I know that you have mixed feelings about the Gottmans, but the Gottman Institute newsletter oftentimes talks about that. When someone is saying this, but they actually mean this. And if they had just said it that way from the start, you know, this really hurt my feelings. Yeah. As opposed to why the hell didn't you do this? It's so different because it's the hurt underneath the anger that gets missed.
SPEAKER_01Yeah, that's right. And so those protective behaviors, those often feel like people identify so strongly with them because they don't know what else to do. Totally. And so when those start to get challenged, it can feel really Yeah, and the verbal skills just aren't there.
SPEAKER_00You know, it's hard to know how to talk about feelings. That's why everyone needs your pillow.
SPEAKER_01The feelings pillow.
SPEAKER_00That was hilarious when I learned that there was a feelings pillow. I think it's really one of those skills that not everyone is taught. And then I was also thinking as you were talking about the life that you grew up in. So if somebody grew up in a household where perhaps the example that they lived with was not a healthy example of what a relationship could look like, then they don't actually know what a healthy relationship could look like. They're sort of just doing what they saw, doing what they learned from childhood.
SPEAKER_01Yeah. Yeah, absolutely. Those patterns.
SPEAKER_00The pattern, right. And so then, you know, it was unlucky that you didn't get that healthy example, but you could still learn it.
SPEAKER_01Yes. Yeah. Yeah. So a lot of times, the sort of along with that is when couples come to me or when they are sort of on the brink of divorce or concerned about their relationship. Yeah. They often ask me, can you save this relationship? Does this sound like something that's knowledgeable? And what I always tell them is, I don't know. Yeah. Not every relationship is meant to stay together. Yeah, right. Some couples really genuinely are happier, better off divorced. Yeah. And that is the right path for them. But I have never worked with a couple who has gotten divorced where their communication wasn't stronger during the divorce because of the work that they did. Yeah, yeah, absolutely. Of course. Of course, when you start to get divorced, the way that you communicate, the boundaries in the relationship, all of that are going to change dramatically. Yeah. But if you learn how to not name feelings, to use eye statements, to communicate in a more vulnerable way that is less protected, less defended, less defensive, less blaming, less critical, all of those things help the long-term prospects of having an amicable divorce, like a good divorce.
SPEAKER_00Yeah, totally. Versus a terrible, horrible, scarring divorce. And I think the respect there, it's so challenging when you feel hurt and wounded and, like you said, vulnerable. But if you have those skills and you keep the sort of greater good in mind, if you have kids especially, then you actually can go through that process in a healthy way. Yes.
SPEAKER_01I would never have a client that I thought that they should get divorced. I mean, think that they should get divorced. I rarely think you should really get divorced. Yeah, no, of course not. But that I have serious concerns about the long-term prospects of their relationship or really think that they're doing damage to each other. I would never work with someone and feel that way and not tell them. Yeah. That is always something that is very much part of the conversation and open.
SPEAKER_00And then maybe they say, whoa, geez, okay. You know, we we gotta really both buckle in if we want this. Or they can be like, whew, I was thinking that too. Yeah. So either way, there's maybe some clarity there.
SPEAKER_01Yeah. And so the thing that I will often do when I really when I think this is I will say, This is, these are the issues in the relationship. This is what you'd have to do to fix them. Does is that something that you're willing to do? Like, can we work on that? Yeah. And sometimes people say, Yes, no, we don't want to get divorced. I hear you, that's where we're headed. We don't want to go there. Let's do all the things. And they pull it back. I mean, I have seen couples who on the surface look like this isn't gonna happen. This is not gonna work, like this relationship is doomed, actually builds like incredibly strong, that's awesome, yeah, healthy relationships. And I have seen couples who on the surface look like they're doing just fine. It turns out not, and they get divorced. So, you know, there's no, I know the Gottman say they can predict divorce from all other things. Oh, yeah, they like with like a daily horseman or whatever.
SPEAKER_00Yeah, the four horsemen. Yeah, exactly.
SPEAKER_01So it's like they say, like, we get someone in our lab and we can predict with like 90%.
SPEAKER_00So look at the birds, and if the partner doesn't say, like, oh yeah, the birds, yeah. Yeah, yeah. I remember that.
SPEAKER_01I mean, honestly, the the their research is there. Yeah. You know, I don't have that magic skill to have people in my lab than to have so I don't know.
SPEAKER_00I just I remember that example that it's turning towards the bid. That's all yeah, yeah. I don't know the words.
SPEAKER_01I mean, these gotmins have so many, like what they take these like very complex existil.
SPEAKER_00Oh, it's they do it so for the lay person.
SPEAKER_01Yeah, they do it so brilliantly. There's so much to learn from them.
SPEAKER_00Yeah, but it's not always that simple, I'm hearing you. Yeah.
SPEAKER_01Yeah, I get that not for a clinician.
SPEAKER_00Sure. Yeah, yeah, I get that. Wow, this has been so illuminating. Thank you very much. You're welcome. Thank you for listening to Under the Hood. If you liked this episode, please take a minute and leave us a review. And we'd love to hear from you. If you have any ideas for future episodes, please let us know.