Marital conflict
Marriage and couples counselling at the Psychological Help Centre, Karachi — in clinic in DHA and PECHS, or online wherever you are.
If you or someone else is in immediate danger, this page is not the right place. Here is what to do →
What people describe
Most couples describe one argument that has been having itself for years. The subject changes — money, the in-laws, the phone, whose family you went to on Eid — and the shape never does. It starts the same way, escalates at the same point, and ends in the same place — nowhere.
Others describe the opposite, and find it harder to explain. Nobody shouts. Nobody has done anything. The two of you are polite and functional, and there has been nothing to say to each other for a long time — living like efficient flatmates who share children and a budget.
Then the small things people apologise for mentioning. Sleeping in separate rooms and telling nobody. A phone turned face down. A message left on read for six hours as a way of saying something. Conversations that only happen through the children.
Almost everyone describes the performance. At a shaadi, at a dinner, in front of parents, the two of you are fine — and in the car on the way home, nothing.
And very often one of you has been ready to do something about this for two years and the other one has just agreed to read this page.
Recognising your marriage in a paragraph on a website is not the same as knowing what is going on. This page describes; it does not assess anyone, and there is nothing here for you to score your marriage against.
When it is worth speaking to someone
Couples argue, and a marriage without disagreement is not the goal anybody is working towards.
What a clinician pays attention to is pattern and cost. The same disagreement arriving in new clothes every few weeks. Contempt where there used to be irritation. Distance that has stopped being a phase. And decisions postponed for years because neither of you can raise the subject.
One thing said plainly. If you are being hurt, frightened, threatened or controlled by your spouse, that is not a communication difficulty and couples counselling is not the right first step. There are more urgent routes than this page, and we will tell you honestly whether we are the right service.
Only a qualified clinician can tell you what is going on — a website cannot. What a page like this can tell you is that couples do come, that most come far later than they meant to, and that coming is not a step towards ending a marriage.
How PHC approaches it
PHC is an assessment-first practice. Before couples work begins there is an initial session, and its job is to work out what is actually happening — including whether the difficulty is between the two of you or sitting inside one of you.
- An initial sessionWe ask what has been going on, for how long, and what it is costing you both. This can be together or separately, whichever makes starting possible. Nothing is administered before this conversation.
- Emotional assessment and symptom screeningWhere one partner is carrying more than the situation explains, a structured screening of emotional functioning and presenting symptoms is used, with internationally validated instruments — you will not be given tests you do not need. Depression, chronic stress and difficulty from long before the marriage all show up as marital conflict, and are not worked with as marital conflict.
- A psychologist matched to what the assessment foundPsychologists at PHC are not assigned on availability. Assignment is based on speciality, presenting needs and clinical fit — and for couples work, on whether both of you can speak freely in front of that clinician.
- Therapy, reviewed as it goesPHC's route for this is marriage and couples counselling, structured rather than a repeat of the conversation you have already had at home. Where the difficulty runs wider than the two of you — in-laws, a household, adult children — family psychotherapy may be indicated alongside or instead. Sessions are 50 minutes, in clinic at our DHA clinic or in PECHS, or online.
Who you would see
Psychologists at PHC hold a minimum postgraduate qualification in clinical psychology and over 800 supervised clinical hours. Aymen Ramzan names marital concerns directly; Shakir Adam names relationship and family concerns.
Aymen RamzanClinical Psychologist · 5+ years
MS Clinical Psychology, Bahria University. Marital concerns and relationship issues, anxiety and depressive disorders, trauma and PTSD, personality disorders. DBT, behavioural therapy, psychoanalytic, Gestalt, humanistic and art therapy.Read their profile →Who you see is decided at the initial session, not before it — ask us beforehand and we will tell you.
Questions people ask first
My husband — or my wife — will not come. Can I come alone?
Yes, and a lot of couples work begins with one person. One partner can look at their own part in a pattern, at what they want and at what they are prepared to do next — which is also, quite often, what makes the other person willing to come later.
Will you tell us to separate, or to stay together?
No. That decision is not a clinician's to make. What the work does is make it a clear-eyed decision rather than one taken in the middle of the same argument at one in the morning.
If I say something in an individual session, does my spouse hear it?
How information from individual sessions is handled is agreed at the start, before any of it is said, and your psychologist will set out that arrangement in plain terms. Ask at the initial session.
We have already involved family elders. How is this different?
Elders are usually trying to settle a dispute and are rarely neutral. A clinical psychologist is not deciding who is right and has no stake in the outcome, and the sessions are structured around the pattern between you rather than the last incident.
Confidentiality, session length, fees and choosing your psychologist are answered in full in questions people ask before booking.
Speaking to someone starts here
PHC is appointment-only. Message or call and a real person answers — Monday to Saturday, 10am to 8pm PKT.
Not sure whether this is us? Contact us anyway. We will tell you directly whether we can help, and refer you elsewhere if we cannot.
Six details, and we can match you
- Name of the person who will attend
- Their age
- What is going on, in your own words
- Whether you would prefer a male or female psychologist
- Online, or in clinic in Karachi
- Whether the person attending is a minor or elderly
If someone else is paying, we will also ask for guardian or payer details. A slot is held once the booking payment is received — half the fee, at least 24 hours ahead.