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Marital Therapy in Perspective

Mark Dombeck, Ph.D.

Marital Therapy In Perspective

When most people think of therapy they think of individual therapy - where one therapist works with one client. Marital or couples therapy works somewhat differently than individual therapy in that the therapist thinks of the couple as a whole as his or her client rather than either of the partners considered separately. Treating the couple as the client keeps the focus of therapeutic discussion more firmly fixed on healing the couple's troubles, and helps the therapist resist siding with one of the partners at the expense of the other.

together and apart street signsMarital therapy works best when both partners are physically and emotionally present. It can be initiated by one of the partners in the absence of the other, but it cannot effectively proceed unless both partners are willing to attend and be engaged by the process. Therapy is worth initiating even when one partner will only attend under duress, but it is unlikely to produce useful change if the unwilling partner remains disengaged throughout the process.

Like many theraputic interventions, medical and otherwise, marital therapy isn't perfect and doesn't always succeed in helping couples to preserve their marriages. Those forms of marital therapy that have been studied have a success rate that stands around 65%. Marital therapy is highly recommended, nevertheless, as it remains the single best thing that a troubled couple can do to help themselves. Even when therapy does work and couples do come to relate better towards one another, results can sometimes be modest, with disagreements and unresolved conflicts continuing to be present. Couples who have benefited from marital therapy and who have subsequently relapsed may find it useful to return to therapy for 'booster' sessions.

There is no single 'marital therapy'. Rather, there are different schools of marital therapy, and therapists often pick and choose techniques from among these schools in eclectic fashion. Even so, therapists trained in particular mental health professions will often most closely ally themselves with schools favored by those professions. For example, social workers tend to favor techniques and perspectives drawn from the 'Family-Systems' school, and psychologists tend to draw on Psychodynamic, or Cognitive-Behavioral techniques and perspectives. Though it can be fairly said that all surviving techniques and perspectives have merit, those drawn from the behavioral school have received the most scientific scrutiny, and are consequently most standardized, understood and evidence-based. We recommend couples look for a behaviorally based marital therapist if they want to maximizing their chances of receiving effective therapy in the absence of a trusted referral.

The best therapists combine education and experience with an empathic and compassionate but sharp and attentive personality. They are perceptive individuals and tend to see through partner's manipulations and drama. Just the same, they work to find non-threatening ways to provide corrective feedback to their clients. Though behavioral therapy techniques are arguably the best available, they will be relatively ineffective in the hands of a therapist who does not possess the right personality and motivations. For this reason, the best way to locate a good martial therapist is often to obtain a referral from someone who knows a therapist's professional work; someone who has been in marital therapy, or someone who is themselves a healthcare provider. If a therapist is good, the specific techniques they bring will matter less. When a referral from a known source isn't possible, it then makes sense to select a therapist based on their approach (Various professional societies representing particular schools provide telephone referrals).

The 'chemistry' between a couple and their therapist(s) is also important. Effective therapy requires trust on the part of all parties. If one or more partners fail to see their therapist as fair and impartial, the therapy is likely to be compromised. For this reason, it is not a particularly good idea to recruit a therapist who has previously worked with one member of a couple. Rather, partners are generally best off with a therapist who is initially unknown to both. Therapists and couples also must pay attention to and talk about how their relationship feels over time so that any partner's perception that the others are ganging up on him/her is minimized.