Couples Therapy – The Good, the Bad and the Ugly.

Couples Therapy – The Good, the Bad and the Ugly.

In the article “Bad Couples Therapy- Betting Past the Myth if Therapist Neutrality“, William Doherty, professor and director of the marriage and family therapy room at the University of Minnesota, tackles issues within the Couples therapy specialty.  He claims that although Couples therapy may be the hardest form of therapy, most therapists doing Couples therapy have had little to no specialized training on Couples work.  Doherty notes that therapists may be skilled in some areas and not be in others.  For example, a very effective Couples therapist can have difficulties connecting with a couple struggling with a specific issue such as blended families, fertility, etc. 

Throughout the article, he also illustrates that couples could benefit from trained and skilled Couples therapists who 1) believe that marriage takes work and 2) who are not ready to jump ship on the couple within the first sessions. Further, even with specialized training, inexperienced and advanced Couples therapists still make some crucial mistakes, but these tend to be very different. 

In summary, the inexperienced mistakes are:

Having little structure in sessions, which may lead to energetic conversations as the couples get issues on the table, but at the same time leads to more reactivity.  More importantly, with little or a lack of structure there is little learning and little change, resulting in the couple feeling demoralized.  Doherty adds that therapists may conclude that some clients are not good candidates for couple therapy when there is high reactivity, some of which could have been better managed with structure. 

No Plan for Change.  Doherty makes the point that helping clients develop insight is not enough to help couples. He recommends that therapists give recommendations for day to day changes, and have clients try different ways of interacting in session and through homework assignments. 

Giving up- Some therapists may give up on the couple and conclude that they are not fit for Couples therapy because they are overwhelmed with the couple’s problems without taking into account their own skill level; is it that the couple is not good candidate for Couples therapy or that the therapist is not skilled to manage the couple’s treatment.

Per Doherty, these are the experienced Couples therapists’ mistakes:

Using a “one couple fits all” strategy.  For instance, Doherty explains that remarried couples with stepchildren are a sort of specialty, and therapists who work with these couples should also be skilled in parent-child therapy.

Not standing by marriage.  He states that whereas beginners may give up on a couple because of lack of skill, experienced therapists may give up because of the values they hold i.e. Putting individual needs ahead of the needs of the Couple.    

In conclusion, Doherty, claims that the two main problems facing Couples therapy are 1) incompetence and 2) the myth that therapists are neutral.  There is no such thing as absolute neutrality, he concludes that therapists have moral values and these will influence clinical decisions.   

Some Tips: 

·       I believe that unless there is a history of violence and continuous high reactivity despite good employment of structure and skills, a therapist should be able to work with the Couple and not immediately suggest substituting with individual therapy.  Individual therapy with another therapist can be a great complement to Couple therapy. 

·       It is also my belief that Couples therapists should have solid foundation and training in specific strategies i.e. mediation, problem solving and crisis management, etc.  Therapists who are not effective when facing high reactivity or disruptive interactional patterns, should get additional training before engaging in therapy with couples and families. 

·       Before you make a commitment to a therapist, do your homework and ask questions, this is your life and you are the driver.  It is imperative that when you make the first contact to a therapist that you ask if he or she has had specialized training and experience in Couples work. 

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