If you're part of a couple in distress, you may feel that there's no way out of your troubled relationship. Myths about the low success rates of couples therapy and counseling only make your situation seem worse than it is. Recently, New York Times columnist Elizabeth Weil reinforced that unfortunate impression in her column "Does Couples Therapy Work?" She concludes that, even regarding the most effective methods: "Both types of therapy are structured, and the results of both are well documented, at least in follow-ups for a few years. Still, the entire field of couples therapy suffers from a systemic problem." The problem she refers to is real enough: couples often wait until very late in the game to seek intervention and by then, one or both may have decided to call it quits. It's also true that, as she observes, being an effective couples therapist requires different skills than those demanded by being an effective individual therapist. Nevertheless, the data largely refute Weil's claims. When properly conducted, couples therapy can have demonstrably positive effects.
UCLA psychologists Lisa Benson, Meghan McGinn, and Andrew Christensen recently published a major review of over 40 years of research on couples therapy (Benson et al., 2012) in which they synthesized the approaches of the most successful methods of intervention. They've boiled down this massive amount of research to show that across major theoretical orientations within the field, couples can benefit when they receive treatment that follows five underlying principles. Although one therapist may subscribe to a behavioral approach and another to an emotional approach, as long as both use similar strategies to help their clients, both therapists can produce positive and effective change.
Evidence-based approaches are key to understanding effective therapy, whether for individuals or for couples. This means that the therapy you are receiving was tested against alternative methods, preferably in randomized controlled trials. Psychologists who provide evidence-based treatment don't stick to one particularly theoretical orientation just because they learned it in graduate school. Instead, they adapt their approach to ensure that they are following the best evidence—both clinical and research.
Unfortunately, articles such as Weil's reinforce the public's view from television and movies that therapists suffer so much from their own human failings that they are unable to provide effective care. Weil points out that being a couples therapist can be draining. In comparison to individual therapy, there's less time to sit back, reflect, and provide a response to a client's statements. If you sit back too long, the session may devolve into a shouting match, she claims.
Being a couples therapist does require special skills, but that is what the training is about. Individuals who go into marriage and family counseling or therapy take years of rigorous coursework and supervision, go through an arduous credentialing and licensing process, and continue to receive education throughout their careers to learn about the field's newest developments. There inevitably is self-selection involved in who decides to become a family therapist and, even more so, who stays in the profession. The chances are excellent that the couples therapist you see is someone who is providing this treatment because he or she is committed to helping couples enact positive changes in their lives.
Let's turn now to those five basic principles of effective couples therapy, which, according to Benson and colleagues:
1. Changes the views of the relationship. Throughout the therapeutic process, the therapist attempts to help both partners see the relationship in a more objective manner. They learn to stop the "blame game" and instead look at what happens to them in a process involving each partner. They also can benefit from seeing that their relationship takes place in a certain context. For example, couples who struggle financially will be under different kinds of situational stresses than those who do not. Therapists begin this process by collecting "data" on the interaction between the partners by watching how they interact. Therapists then formulate "hypotheses" about what factors may lead to the way the partners interact. How they share this information with the couple varies based on the therapist's particular theoretical orientation. There's empirical support for a variety of approaches, from behavioral to insight-oriented. Different therapists will use different strategies, but as long as they focus on altering the way the relationship is understood, the couple can start to see each other, and their interactions, in more adaptive ways.
2. Modifies dysfunctional behavior. Effective couples therapists attempt to change the way that the partners actually behave with each other. This means that in addition to helping them improve their interactions, therapists also need to ensure that their clients are not engaging in actions that can cause physical, psychological, or economic harm. In order to do this, therapists must conduct a careful assessment to determine whether their clients are, in fact, at risk. If necessary, the therapist may recommend, for example, that one partner be referred to a domestic violence shelter, to specialized drug abuse treatment, or to anger management. It is also possible that if the risk is not sufficiently severe, the couple can benefit from "time-out" procedures to stop the escalation of conflict.
3. Decreases emotional avoidance. Couples who avoid expressing their private feelings put themselves at greater risk of becoming emotionally distant and growing apart. Effective couples therapists help their clients bring out the emotions and thoughts that they fear expressing to the other person. Attachment-based couples therapy allows the partners to feel less afraid of expressing their needs for closeness. According to this view, some partners who failed to develop "secure" emotional attachments in childhood have unmet needs that they carry over into their adult relationships. They fear showing their partners how much they need them because they are afraid that their partners will reject them. Behaviorally based therapists assume that adults may fear expressing their true feelings because, in the past, they did not receive "reinforcement." Either way, both theoretical approaches advocate helping their clients express their true feelings in a way that will eventually draw them closer together.
4. Improves communication. Being able to communicate is one of the "three C's" of intimacy. All effective couples therapies focus on helping the partners to communicate more effectively. Building on principles #2 and #3, this communication should not be abusive, nor should partners ridicule each other when they do express their true feelings. Couples may, therefore, require "coaching" to learn how to speak to each other in more supportive and understanding ways. The therapist may also provide the couple with didactic instruction to give them the basis for knowing what types of communication are effective and what types will only cause more conflict. They can learn how to listen more actively and empathically, for example. However, exactly how to accomplish this step requires that therapists turn back to the assessments they performed early on in treatment. Couples with a long history of mutual criticism may require a different approach than those who try to avoid conflict at all costs.
5. Promotes strengths. Effective couples therapists point out the strengths in the relationship and build resilience particularly as therapy nears a close. Because so much of couples therapy involves focusing on problem areas, it's easy to lose sight of the other areas in which couples function effectively. The point of promoting strength is to help the couple derive more enjoyment out of their relationship. The behaviorally oriented therapist may "prescribe" that one partner do something that pleases the other. Therapists from other orientations that focus more on emotions instead might help the couple develop a more positive "story" or narrative about their relationship. In either case, the therapist should avoid trying to put his or her own spin on what constitutes a strength and let this be defined by the couple.
We can see, then, that people in troubled relationships need not give up in despair if their situation seems bleak. By the same token, people afraid of entering long-term relationships can be encouraged by learning that trouble relationships can be fixed.
Looking at the flip side, these five principles of effective therapy suggest ways that couples can build and maintain positive close relationships. Take an objective look at your relationship, to get help to reduce dysfunctional behaviors, feel that you can share your emotions, communicate effectively, and emphasize what's working. Most importantly, by remembering that each relationship has its unique challenges and strengths, you'll be giving yours the best chances for survival.
For more information on couples and family therapy, check out the American Association of Marriage and Family Therapists as well as the American Psychological Association's Society of Family Psychology.
Copyright Susan Krauss Whitbourne 2012
Benson, L. A., McGinn, M. M., & Christensen, A. (2012). Common principles of couple therapy. Behavior Therapy, 43(1), 25-35. doi:10.1016/j.beth.2010.12.00