Couples therapy
Couples therapy (also couples' counseling, marriage counseling, or marriage therapy) attempts to improve romantic relationships and resolve interpersonal conflicts.[1]
For other uses, see Couples therapy (disambiguation).History[edit]
Marriage counseling originated in Germany in the 1920s as part of the eugenics movement.[2][3] The first institutes for marriage counselling in the United States began in the 1930s, partly in response to Germany's medically directed, racial purification marriage counselling centres. It was promoted by prominent American eugenicists such as Paul Popenoe, who directed the American Institute of Family Relations until 1976,[4] Robert Latou Dickinson, and by birth control advocates such as Abraham and Hannah Stone who wrote A Marriage Manual in 1935 and were involved with Planned Parenthood.[2] Other founders in the United States include Lena Levine and Margaret Sanger.[5]
It wasn't until the 1950s that therapists began treating psychological problems in the context of the family.[6] Relationship counseling as a discrete, professional service is thus a recent phenomenon. Until the late 20th century, the work of relationship counseling was informally fulfilled by close friends, family members, or local religious leaders. Psychiatrists, psychologists, counselors and social workers have historically dealt primarily with individual psychological problems in a medical and psychoanalytic framework.[6] In many cultures around the world today, the institution of the family, the village or group elders fulfill the role of relationship counseling. Today marriage mentoring mirrors those cultures.
With increasing modernization or westernization in many parts of the world and the continuous shift towards isolated nuclear families, the trend is towards trained and accredited relationship counselors or couple therapists. Sometimes volunteers are trained by either the government or social service institutions to help those who are in need of family or marital counselling. Many communities and government departments have their own team of trained voluntary and professional relationship counsellors. Similar services are operated by many universities and colleges, sometimes staffed by volunteers from among the student peer group. Some large companies maintain a full-time professional counseling staff to facilitate smoother interactions between corporate employees, and to minimize the negative effects that personal difficulties might have on work performance.
Increasingly there is a trend toward professional certification and government registration of these services. This is in part due to the presence of duty of care issues and the consequences of the counsellor or therapist's services being provided in a fiduciary relationship.[7]
Basic principles[edit]
It is estimated that nearly 50% of all married couples get divorced, and about one in five marriages experience distress at some time. Challenges with affection, communication, disagreements, and fears of divorce are some of the most common reasons couples reach out for help. Couples who are dissatisfied with their relationship may resort to a variety of sources for help including online courses, self-help books, retreats, workshops, and couples' counseling.[8]
Before a relationship between individuals can be understood, it is important to recognize and acknowledge that each person, including the counselor, has a unique personality, perception, opinions, set of values, and history. Individuals in the relationship may adhere to different and unexamined value systems. Institutional and societal variables (like a social or religious group, and other collective factors) which shape a person's nature and behavior, are considered in the process of counseling and therapy. A tenet of relationship counseling, is that it is intrinsically beneficial for all the participants to interact with each other, and with society at large with optimal amounts of conflict. A couple's conflict resolution skills seem to predict divorce rates.[9]
Most relationships will experience strain at some point, resulting in a failure to function optimally, and causing self-reinforcing, maladaptive patterns to form. These patterns may be called "negative interaction cycles." There are many possible reasons for this, including insecure attachment, ego, arrogance, jealousy, anger, greed, poor communication/understanding or problem-solving, ill health, third parties, and so on.
Changes in situations, like financial state, physical health, and the influence of other family members can have a profound influence on the conduct, responses, and actions of the individuals in a relationship.
Often, it is an interaction between two or more factors, and frequently, it is not just one of the people who have been involved that exhibit such traits. Relationship influences are reciprocal: it takes each person involved to cause problems, as well as to manage them.
A viable solution to the problem, and setting these relationships back on track, may be to reorient the individuals' perceptions and emotions - how one looks at or responds to situations, and how one feels about them. Perceptions of, and emotional responses to, a relationship are contained within an often unexamined mental map of the relationship, also called a 'love map' by John Gottman. These can be explored collaboratively and discussed openly. The core values they comprise can then be understood and respected, or changed when no longer appropriate. This implies that each person takes equal responsibility for awareness of the problem as it arises, awareness of their own contribution to the problem, and making some fundamental changes in thought and feeling.
The next step is to adopt conscious, structural changes to the inter-personal relationships, and evaluate the effectiveness of those changes over time.
Indeed, "typically for those close personal relations, there is a certain degree in 'interdependence' - which means that the partners are alternately mutually dependent on each other. As a special aspect of such relations, something contradictory is put outside: the need for intimacy and for autonomy."
"The common counterbalancing satisfaction these both needs, intimacy, and autonomy, leads to alternate satisfaction in the relationship and stability. But it depends on the specific developing duties of each partner in every life phase and maturity".[10]
Research on therapy[edit]
The most researched approach to couples therapy is behavioral couples therapy.[15] It is a well established treatment for marital discord.[16] This form of therapy has evolved into what is now called integrative behavioral couples therapy. Integrative behavioral couples therapy appears to be effective for 69% of couples in treatment, while the traditional model was effective for 50-60% of couples.[17] At five-year follow-up, the marital happiness of the 134 couples who had participated in either integrative behavioral couples therapy or traditional couples therapy showed that 14% of relationships remained unchanged, 38% deteriorated, and 48% improved or recovered completely.[18]
A review conducted in 2018 by Cochrane (organization) states that the available evidence does not suggest that couples therapy is more or less effective than individual therapy for treating depression.[19]
Licensed couple therapists may refer to a psychiatrist, clinical social workers, counseling psychologists, clinical psychologists, pastoral counselors, marriage and family therapists, and psychiatric nurses.[20] The duty and function of a relationship counselor or couples therapist is to listen, respect, understand, and facilitate better functioning between those involved.
The basic principles for a counselor include:
As well as the above, the basic principles for a couples therapist also include:
Common core principles of relationship counseling and couples therapy are:
In both methods, the practitioner evaluates the couple's personal and relationship story as it is narrated, interrupts wisely, facilitates both de-escalations of unhelpful conflict and the development of realistic, practical solutions. The practitioner may meet each person individually at first, but only if this is beneficial to both, is consensual, and is unlikely to cause harm. Individualistic approaches to couple problems can cause harm. The counselor or therapist encourages the participants to give their best efforts to reorient their relationship with each other. One of the challenges here is for each person to change their own responses to their partner's behavior. Other challenges to the process are disclosing controversial or shameful events, and revealing closely guarded secrets. Not all couples put all of their cards on the table at first. This can take time, and requires patience, and commitment to the repair of the relationship.
Popularized methodologies[edit]
Although results are almost certainly significantly better when professional guidance is utilized (see especially family therapy), numerous attempts at making the methodologies available generally via self-help books and other media are available. In the last few years, it has become increasingly popular for these self-help books to become popularized and published as an e-book available on the web, or through content articles on blogs and websites. The challenges for individuals utilizing these methods are most commonly associated with that of other self-help therapies or self-diagnosis.
Using modern technologies such as Skype VoIP conferencing to interact with practitioners are also becoming increasingly popular for their added accessibility as well as discarding any existing geographic barriers. Entrusting in the performance and privacy of these technologies may pose concerns despite the convenient structure, especially compared to the comfort of in-person meetings.