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Leonardo Niño Rodríguez, a journalist in Colombia South America, recently interviewed me for a state-of-the-art assessment of couples therapy. The four questions he asked me on behalf of readers of SEMANA Magazine, the leading Colombian news magazine, struck me as questions that may be of interest as well to readers of PsychologyToday.com.
Leonardo understood that many people who are experiencing relationship difficulties feel cautious about trying out marriage counseling. The best antidote for anxiety is information, so Leonardo asked four questions:
(1) What is therapy supposed to accomplish?
(2) How can folks tell if their treatment is likely to be effective, or, heaven forbid, if it might end up harming what's good in their relationship?
(3) Do both partners need to go?
(4) Is there information folks should know about what has developed within the marriage therapy profession since it first started in the 1970's?
Thank you Leonardo for sending me your questions. Thank you also for giving your permission to post our discussion on my PsychologyToday.com blog, Resolution, Not Conflict.
1. What is the real purpose of couples therapy and why is it useful?
Couples therapy can include many different goals and differing techniques. In this regard, it's less like asprin and more like salad, with many optional and varied ingredients.
I will explain therefore the goals for couples treatment as I do it, that is, using the treatment methods I write about in my book From Conflict to Resolution.
Couples come to treatment because they are unhappy, usually because they have been unsuccessful at resolving their conflicts. They therefore have either disengaged emotionally because of their differences, or have become overly argumentative.
In both cases the primary job of the therapist is to assist in moving the couple from conflict to resolution. That generally requires:
- Guiding the couple through a win-win problem-solving process to resolution of each of the issues on which they have been stuck.
- Teaching skills so the couple can handle their subsequent differences collaboratively on their own. No more need either to disengage from each other or to fight.
- Teaching skills for keeping the emotional tone between them happy and loving. No more anger, depression, or anxiety. Lots more sharing of affection, appreciation, hugs and smiles.
- Gaining insights into the childhood origins of their problematic habits and preventing further excessive emotional reactivity.
Couples therapy is useful to the extent that it accomplishes these four objectives so that the couple can enjoy a collaborative (no more fighting), affectionate (including sexually intimate), long-lasting and long-loving partnership.
2. What are the secrets for making a couples therapy succeed?
An effective couples' therapist guides clients with a firm hold on the reins so that no negative interactions lure the couple off the friendly and constructive path of cooperative shared problem-solving. As soon as one partner speaks, for instance, in a way that is critical or controlling rather than insightful, the therapist intervenes to set the dialogue back on a collaborative track.
Effective therapists teach skills so that the couple learns to talk tactfully, listen responsively, and resolve differences in a way that consistently leads to solutions that please both partners.
Effective therapists teach anger management so the partners learn to remove themselves from a situation in which tempers are getting too hot for dialogue to stay productive and safe, calm themselves down, and then as soon as possible return to resume their attempts to find mutual understandings.
Effective therapists clarify that each spouse's job in therapy is to focus on his or her own learning and growth, not to try to get the other person to change.
An effective therapist encourages occasional brief looking back in the rear-view mirror of how each partner learned habits that now are problematic. Most of the treatment though focuses on resolving current conflicts and teaching better interaction skills for the future.
The effective therapist enourages the couple to talk with each other. The therapists's job is to coax and coach better skills so that the partners learn to resolve their own problems. It is not to have each partner complain to him or her and then serve as judge or come up with solutions for the couple.
3. Recent studies and some therapists say that couples therapy for one partner can help to solve the conflicts in a relationship. Do you believe this could help, or is it necessary for the therapist to interact with both partners?
The involvement of both partners is strongly preferable but not essential. Two partners in treatment is better than one. One is sometimes better than none in treatment...sometimes.
One person going to individual therapy for a relationship problem though is risky business. It can increase the odds that the relationship will end. The therapist has to be especially skillful at helping the in-treatment spouse stay focused on what s/he can do differently to upgrade the home situation, resisting the temptation to validate how awful the spouse seems to be and therefore to inadvertently encorage simply leaving the marriage.
The surest way to destroy a relationship, and especially a marriage, is for each partner to have their own individual therapist. A therapeutic system with two separate therapists is almost guaranteed to pull the couple apart. Each has only half-inforation, and will tend to become an advocate for their patient rather than a supporter of helping both of them to explore new ways of handling their partnership.
Likewise, having one therapist for couple therapy and another (or even worse, two therapists) for individual therapy with the spouse(es) is a second recipe for therapy-induced marital destruction. One therapist needs to handle both the individual therapy and couple therapy components of treatment. Two or more therapists (one for the couple treatment and one for each partner to work with individually) can doom treatment, and the marriage, to failure. Too many cooks spoil the broth.
4. Couples therapy exploded in the 70's when the divorce rates started rising. What is the actual state of couples therapy now: How has it changed, and is it less or more popular than at that time?
As divorce rates, as you say, "exploded," people began to realize that many divorces were both needless and very detrimental, especially to children. The movement to fix marriages instead of simply throwing them away like paper plates led many couples to seek marriage help.
At the same time, systems theory was emerging, enabling therapists to go from seeing spouses as individuals to understanding the impact of "the family system" on each participant, and of circular interaction cycles in which both partners feed into their mistaken interactiions
In the 1990's research began into what healthy couples know and do that couples with problems could benefit from learning. The save your marriage movement opened up to a new field called marriage education. Marriage education focuses on emotional self-regulation, communication, and conflict resolution skill training so couples are more effective vis a vis the challenges of partnership.
Unfortunately however, quality control in the arena of couples therapy has been minimal. Many therapists call themselves marriage counselors without sufficient training in cooperative communication and conflict resolution, skills that are essential for marriage success. A degree as a psychiatrist, psychologist, social worker or counselor does not insure that a mental health professional has adequate training in the specialty area of couples counseling.
Nonetheless, individuals and couples who are experiencing relationship difficulties have become increasingly likely to seek professional help. Both marriage education and marriage therapy are on the rise, and overall that is probably a good thing. Many couples hit rough spots in their marriage. Research has established that most of those who succeed in riding through the storm end up with highly satisfying marriages in the long run.
At the same time, I would caution folks who are seeking help to choose your therapist carefully. Trust your gut, as well as the suggestions above, of what to look for to assess the quality of the treatment.
If you do not feel fully confident that the approach of your therapist is helping you, discuss your concerns with the therapist. If his or her answers feel insufficient to you, try someone else.
As my mother used to say, "There's plenty of fish in the sea."
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Susan Heitler, PhD, a Denver clinical psychologist, specializes in marriage therapy. Author of a book on marriage therapy, From Conflict to Resolution, and a book for couples, The Power of Two, Dr. Heitler's current project is PowerofTwoMarriage.com, an interactive marriage education website that teaches the skills for marriage success.
