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Confessions of a Bad Teacher

Koren

By ELIZABETH WEIL Published: March 2, 2012

WEVE all had that horrible experience: you throw a party or invite a couple over for dinner, and they start fighting, right there in front of you the character assassination, the barely controlled anger, the neurotic transference of their cooled sexual attraction onto, say, the hygiene of the family dog, all of which makes you want to fake choking and hide. Surely bearing witness to couples quarrels feels less bad to

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the pros, those credentialed and compensated marriage and family therapists whose job it is to help significant others work through issues and pain?
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Oh, no, says Terry Real, a prominent psychologist and one of a growing number of family therapists speaking out about how couples therapy feels from their chairs. Its so much worse. At the dinner table, Dr. Real explains, youre just a bystander, collateral damage. In a therapy office, he says, Youre supposed to do something about it. The fact that couples therapy stresses out therapists has long been an open secret. The field, however, seems to have decided that now would be an appropriate time for its practitioners to address their feelings and vent. It started with the November/December issue of the trade magazine The Psychotherapy Networker and its cover package, Whos Afraid of Couples Therapy? Its widely acknowledged that couples therapy is the most challenging, says Richard Simon, the magazines editor. The stakes are high. Youre dealing with volatility. There are often secrets. We were just trying to make explicit something people whove done couples therapy already know: You often feel confused, at odds with a least one of

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your patients, out of control. Part of the problem is that the kind of person who tends to become a therapist empathic, sensitive, calm, accepting is generally not the kind of person who is a good couples therapist. The traditional, passive uh-huh, uh-huh is useless, Dr. Real says. You have to like action. To manage marital combat, a therapist needs to get in there, mix it up with the client, be a ninja. This is intimidating. Its frightening to be faced with the force of two strong individuals as they are colliding, he says. Peter Pearson and Ellyn Bader, psychologists and founders of the Couples Institute in Palo Alto, Calif., which offers both therapy and training for therapists, describe the experience of counseling high-conflict couples in equally violent if metaphorical terms, as like piloting a helicopter in a hurricane. Compounding the tender-empath-caught-in-the-crossfire problem, couples therapy, as it is practiced today one therapist and two spouses together in a room started in what might be seen as a convoluted way. Before the early 1960s, husbands and wives most typically sought counsel singly, not together; that counsel was provided by a clergy member, a medical doctor or a social worker, and the mode

Gretchen Ertl for The New York Times

'A therapist needs to get in there, mix it up with the client, be a ninja. This is intimidating.' TERRY REAL, Psychologist Enlarge This Image

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of conversation was didactic (heres what you need to do), not therapeutic (lets figure out why you feel so bad). But then through the late 60s and 70s, divorce rates started rising and the field of marriage therapy exploded. Building off the family therapy model, in which families were treated as a whole or as a system, the term of art therapists started seeing most couples in pairs. This was a nice enough idea, maybe even a good one, but there was no research to support it. As a result, the practice, known as conjoint therapy, was blasted in psychology journals as seriously lacking in empirically tested principles and a technique in search of a theory. One theory the field latched onto was psychoanalysis: now married couples had problems because of neurotic interactions and individual psychopathology. (Great, right?) Another framework came from the human potential movement. Virginia Satir, known as the mother of family therapy, was also the first director of training at the Esalen Institute in Big Sur, Calif., where Jack Kerouac and Joan Baez, among others, retreated to find themselves. Ms. Satir claimed that the goal of marriage therapy was not to maintain the relationship nor to separate the pair but to help each other to take charge of himself.

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'Most psychological theories about change are just that, theories.' WILLIAM M. PINSOF, President, the Family Institute at Northwestern University Enlarge This Image

Who or what is to be saved or taken charge of remains unresolved in some couples therapy practices. Is the client one of the spouses? Both of them? The relationship? The tangle of needs and obligations can lead to problems from Session 1. For starters, theres an ever-present risk of winning one spouses allegiance at the expense of the other spouses, explains William J. Doherty, the University of Minnesota professor of family social science, in his groundbreaking 2002 article on the topic of awkward couples counseling in the Networker, titled Bad Couples Therapy. All your wonderful joining skills from individual therapy can backfire within seconds with a couple. A brilliant therapeutic observation can blow up in your face when one spouse thinks youre a genius and the other thinks youre clueless or worse, allied with the enemy.

Stephanie Colgan for The New York Times

'One spouse can think you're 'allied with the enemy.' WILLIAM J. DOHERTY, Professor of family social science, University of Minnesota

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Timing is also crucial, far more than in individual therapy, and it causes stress for therapists as well. Let a couple Read All Comments (155) interrupt each other for 15 seconds, and pretty soon you have them screaming at each other and wondering why they need you to do what they could do at home, Professor Doherty says by phone. With individuals, a therapist can stall. You can always say, Tell me more about that, and take a few minutes to figure out what to do next, he says. In couples therapy, the

emotional intensity of the couples dynamics doesnt give you that luxury. Then theres the possibility that one of the partners has sought out counseling in order to commit what the professor describes as therapist-endorsed divorce. This is rarely made explicit. Even couples who have given up on repairing a relationship may want to be able to tell themselves that they have tried everything, especially if they have children. So they will start a course of couples counseling, claiming that they want to change their relationship, when really what they want to do is change their partner. You often see Partner A dragging in Partner B because Partner B is behaving in ways that are unfulfilling and insufferable, Dr. Real says. On the intake Ill ask, Whats wrong with the marriage? and Partner A will say, Bob. So Ill ask, Whats wrong with Bob? and Partner A will say, His Bob-ness. Some types of couples therapy are known to work better than others. One of the most promising methods is based on the attachment theory of parenting: good relationships are built on secure attachments, ones that are engaged and emotionally responsive. And another teaches couples to be more accepting of each other while at the same time working to change some of their assumptions and automatic behaviors. 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. Couples often resist seeking help until they have been distressed for a long time Brian D. Doss, an assistant professor of psychology at the University of Miami, says the average couple is unhappy for six years before seeking couples counseling at which point relationship problems are very difficult to fix. Thomas Bradbury, a professor of psychology at the University of California, Los Angeles, compares a troubled

couple to a man with a broken leg. Seek help straight away and youll heal up just fine. Hobble around injured for months or years, and a full recovery becomes nearly impossible, as by that time, Professor Bradbury says, the therapist has to attend not only to the psychological equivalent of the broken bone but also to the swelling and bruising, the sore hip and foot, and the infection that ensued. So what is the field trying to do, for everybody involved? Along with the venting, some therapists are seeking to get better at their jobs by putting a greater emphasis on accountability and feedback. Most therapists dont know how much they have helped their patients long term or how their track records, if known, compare with others in their field. William M. Pinsof, a professor of clinical psychology and president of the Family Institute at Northwestern University in Evanston, Ill., is trying to fix this. As part of a study he is conducting to gain a better understanding of the empirical basis of psychological and behavioral change what the patterns of change look like and what therapist behaviors are associated with them he has therapists ask clients to fill out an online questionnaire about their lives before every session. After the session, the therapists fill out a questionnaire about what they did. Dr. Pinsofs goal is to create a database that could be predictive for both patients and therapists (for instance, couples who start therapy with low trust, low flexibility and high commitment typically respond well to X type of treatment), taking some of the guesswork out of couples counseling. Most psychological theories about change are just that, theories, Dr. Pinsof says. They are not studies of how people actually change. Already, before he has finished his study, Dr. Pinsof is using the information he is collecting on individual couples. Take a client who is a depressed woman in a bad marriage. Which is chicken and which is egg? Dr. Pinsof

asks. Is the depression impacting the marriage more or is the marriage effecting the depression more? Tracking how her depression and her marriage are changing week to week and showing both her and her partner graphs of those changes on a computer screen in the therapy office can help a therapist guide and control the therapy, he says, thus making it less stressful and intimidating for everyone. A lot of people who primarily work with individuals feel overwhelmed by the number of variables they have to deal with when they work with couples, Dr. Pinsof says. You have to be very active in structuring the session, or the system can blow you away. Still, none of this is going to resolve the real underlying problem. Says Dr. Pearson of the Couples Institute: If youre seeing couples, no matter what you do, youre going to see a lot of anger and volatility. Youre going to see people fighting in your office, and that triggers a lot insecurity and doubt all your issues from your own childhood, your own relationships. Who wants to sign up for another serving of that? Elizabeth Weil is the author of the new book No Cheating, No Dying: I Had a Good Marriage. Then I Tried to Make It Better (Scribner). This article has been revised to reflect the following correction: Correction: March 4, 2012 An earlier version of this article misidentified the employer of William J. Doherty, a professor of family social science. It is the University of Minnesota, not the University of Wisconsin. An earlier version of a photo caption also included the incorrect information.

A version of this article appeared in print on March 4, 2012, on page ST1 of the New York edition with the headline: Threes a Crowd.

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ES

San Diego, CA

The very simple starting point of couples therapy should be to help the couples actually take each other seriously, and to listen. Most people when they are angry and disappointed with someone they are close to have trouble with the other persons point of view. Disdain for the other is a huge factor in the problems couples have. How we get to the point of disdain is one of the keys. If you think of how hard it is to find a good auto mechanic or dentist, dont be so bitter that you tried therapy and ended up with a lemon. Find another therapist or another therapist. You might actually find a good one. And dont expect them to be perfect. They are human, just like you.
March 5, 2012 at 12:22 p.m.
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sross

steamboat springs, co

Great insights provided in the article! Couples therapy involves real people with common problems such as ADHD,

depression, impulse control issues, alcholism. Most couples only find out about their mate's family medical histories until after a significant stress-oh say parenthood. Perhaps couples could practice honestly, trust, and openness and forego a burnt out therapist.
March 5, 2012 at 12:22 p.m.
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hiflo

chicago

we were 4 1/2 years in couple therapy after I discovered my ex-husband was a closeted gay. he wanted so hard to maintain the marriage, and I was so lost. we saw together 2 different one: the 1 st, an MD, told us to " swipe this under the rug ". the 2 nd, an social worker "specialized" in couple therapy told me to manage my anger. I saw another MD alone, who said the answer was a psychoanalysis and asked me about my father.. Not one of them suggested I should run away from such dysfunctional relationship. needless to say, I am happily divorced now. There is no control of the profession, and some " therapists " will continue to see clients for the sake of the hourly check.
March 5, 2012 at 12:22 p.m.
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Karen Ray

Manhattan Beach, California

What about honesty in couples therapy? Little note here of the requirement of full honesty by both partners if couples therapy is to be of any help.
March 5, 2012 at 12:22 p.m.
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ptkane1

WI

I endorse the comment made by "bv" above noting the work of John Gottman and his research demonstrating the effectiveness of his techniques. Another resource using similar strategies is Brent Atkinson at "thecoulplesclinic.com."

March 5, 2012 at 12:17 p.m.

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Ms. Massachusetts

Acton MA

Correction to previous comment: "That is, the therapist should NOT have been doing couples therapy . . . "
March 5, 2012 at 12:16 p.m.
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JM

NC

My husband and I are extremely lucky to work with a wonderful therapist--one who must have come from a different planet from the ones described in these comments. We both have our wounds, our difficulties, our pathologies but our therapist is able to help each of us understand how those impact our relationship. It's hard work for all of us but I have learned more about myself through couples therapy with this therapist than I have in any individual therapy environment. I'm not new to therapy and have fired more than one therapist who was sub par. The idea of a marriage not surviving therapy sounds like blaming someone else for your problems, ditto the idea of a therapist's "covering himself." I can't presume to assess another couple's particular experience but there are lousy therapists out there and some who are just not a good match. And then sometimes the marriage really is too far gone to be saved, just as in the medical analogy. That isn't the fault of the therapist.
March 5, 2012 at 12:16 p.m.
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Zach Franks

maui

Went to a couple of brilliant therapists. One before we got married, one after. Got a lot of personal insight through their work, but neither of us changed much. Personality is fundamental and not easily mutable in a middle aged adult. Divorced after two years. As far as it went, a good, if short, marriage. Did therapy help it? So far as I can tell, not much. But it was interesting and for the

therapists, profitable.
March 5, 2012 at 12:13 p.m.
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Virginia Kelley PhD

New York, NY

I guess it makes sense for an article on this topic in the Style section to focus on things like how (some) therapists have a hard time working with couples who don't get along, and to keep it mostly anecdotal. I hope, though, that somebody will write another article where s/he locates and interviews well-respected people who write and train other people about therapy with couples, who might share some actual concepts about what they do and how they do it. And about how they understand a marriage relationship in the first place, as people's different assumptions and ideas have a lot to do with their goals for a couple and with the techniques they employ to see if the couple can achieve some progress toward those goals.
March 5, 2012 at 12:12 p.m.
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Anonymous

NYC

I ended up in couples' therapy this past summer with my husband and his longtime therapist. I had misgivings from the beginning because I didn't see how she could be objective when she knew my husband so well and me not at all except through his observations. In fact my husband had said he was not viewing it as couples' therapy, but the therapist clearly did and said so. It ended up being sessions in which my husband and the therapist told me what I needed to do to help him and meet his needs. One of their complaints was that I had talked about myself and an issue at work through an entire meal with my husband the week before. My response was, after 15 years of therapy with Ms. X therapist, you couldn't speak up and tell me to be quiet? Ms. X therapist thought that was unfair. If we seek couples' therapy again, we will look for someone neutral who knows neither of us.
March 5, 2012 at 12:08 p.m.
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JLK

Taiwan

I think it would be tricky to even define 'success' in couple's therapy, as success doesn't necessarily mean that the couple stays together. In some circumstances divorce could be seen as the happiest outcome, particularly for abusive or chronically dysfuncitonal relationships,. A friend, a few months into a rocky and acrimonious marriage (which was the attempt to 'fix' an acrimonious and rocky relationship) went to couple's counselling. They quickly decided to divorce and go their separate ways. No children were involved, and it made much more sense to get out of the relationship than spend years of misery and thousands of dollars trying to produce a healthy relationship out of a fundamentally flawed pairing. It also occurs to me that in couple's counselling, you don't have the underlying assumption that the patients actually want to fix anything. You have, as the article mentioned, spouses who are set on divorce, want to make it look like they've tried everything. You also have the spouse who doesn't believe in counselling in general, the spouse who thinks that they are fine and it's all the other person's fault, the spouse that thinks the marriage is just fine and is there under protest, and the spouse who is quite content with things the way they are, because the disfunction is in their favour. In that sense, it can be more like trying to treat someone mentally ill or suffering from addiction who has been forced to counselling by the courts or their family.
March 4, 2012 at 11:57 p.m.
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Gina M.

Seattle

All I can speak from is my own experience with couples therapy. My boyfriend of two years and I decided to go to couples therapy a few months ago because we felt we should find a way to work through some differences we were having now rather than ten years into marriage, at which point the resentment is usually too great to get through. I can honestly say that our therapist has been wonderful. When my boyfriend and I argue, there are only two perspectives.

Our therapist offers a third, more inclusive and loving one. She helps us understand our roadblocks and how we can get around them. Overcoming these obstacles that were coming up time and again for us is invaluable. We have become closer, more honest and happier with the relationship in general. I really don't know how couples do without therapy. I think most people just figure they have to live with a certain amount of dissatisfaction, or be passive. If therapy isn't working-find a new therapist! There are a lot of great ones out there who love what they do.
March 4, 2012 at 11:18 p.m.
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Diana Daffner

Florida

I am fortunate that my work with couples takes place at workshops called Intimacy Retreats. Rather than delving into the specifics of each couple's relationship, we guide them to experience each other in a fresh way, focusing on the immediacy of being connected with their partner. When couples lose that connection, the relationship begins to unravel. Between group sessions, couples return to their rooms where they privately explore deepening their intimacy on a physical level. (There is no public nudity or sexual activity.) Couples show up at their "best" during these workshops, perhaps because it's presented not as therapy but as education. Few of us have ever learned how to be authentically present with another person. It's not taught anywhere. And yet it's what we all crave.
March 4, 2012 at 10:46 p.m.
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AR

Chicago

Having now read quite a number of the previous comments, I find it appalling to see so many readers declare, essentially, that there is no existing research to back claims regarding the efficacy of psychotherapy. In fact, there are reams and reams of solid research, spanning several decades, on innumerable aspects of the field. It's unfortunate that these commenters (or their friends/family) have had negative experiences - there are, indeed, bad therapists out there, and

maybe some (though a smaller number) who are either self-aggrandizing, mercenary, or both. But it's also true that there is overwhelming evidence that psychotherapy helps an enormous number of people. Check your facts, folks don't just surf along on the tidal wave of the science-averse, and then publish your unfortunate anecdotes as "proof" of anything other than your personal experience.
March 4, 2012 at 10:33 p.m.
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RN

NYC

I don't think the those denying evidence supporting psychotherapy are "science-averse"! It is usually the other way around!
March 5, 2012 at 12:12 p.m.
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Sarah Usher, PhD

Toronto, Canada

I was interested to read how "frightening" couples therapy can be for some therapists. I find this work difficult, but incredibly rewarding. As a psychoanalyst (one of the fields that couples therapy has "latched onto"), I have found that analytic theory has served me--and the partners in the couples I see-well to understand their early lives and their relationships to their parents, and in so doing to discover why they have come to this point. I think couples therapy training needs to focus more on the interaction of the partners--in addition to their effect on, and interaction with, the therapist--and on the richness of the results of mutuality: that is, of three people working on a problem together. I also think that a couples therapist without a sense of humor will never enjoy this work. (Author of "What is This Thing Called Love? A Guide to Psychoanalytic Psychotherapy with Couples," Routledge.)
March 4, 2012 at 9:23 p.m.
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Dr.Meh

Boston

There is no point in publishing any article about psychology and psychiatry anymore. Too many people are convinced that anyone who works with the troubled mind must be a charlatan or freak. None of these lovely commenters have ever encountered someone with a serious mental illness. I hope that they tell that suffering person that his problem isn't real. Then, I hope they get to attend that person's funeral when shame over needing treatment leads him to kill himself. Watching a weeping family try to find meaning in a suicide is a very effective way to reduce sanctimony.
March 4, 2012 at 9:19 p.m.
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Anonymous

New York, NY

I recently went to a family therapist with my father. I had already spoken with a psychotherapist for several years. From that therapist I was told my father suffered from Narcissistic Personality Disorder and I was experiencing depression due to internalized anger and rage at my father and family situation. I repeated this diagnosis to the family therapist, and I gave him some information that my father had alienated other relatives and co-workers besides myself. Despite that NPD diagnosis and the accounts of others, the family therapist started to side with my father. For me, family therapy was a waste of my time, so I stopped seeing the therapist. I agree with the comments that say that psychotherapy is too commodified to be trusted. I have not seen or heard or read evidence that psychiatrists or psychologists ever turn potential patients away for the reason that the patients are mentally healthy. Yet if the general population is only about 13% mentally ill, it isn't likely that the sample of that general population visiting psychiatric offices is 100% mentally ill. So what happens to all of the normal people who feel a little off one day, see a psychiatrist, and are told that they are actually suffering from depression or mania or bipolar? The probability that all of these people are really mentally ill--unlike the general population--is very low. What kind of MDs and PhDs randomly assign disease labels without ensuring some

sort of credible testing process?


March 4, 2012 at 8:27 p.m.
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Richard

San Antonio

No one goes to see a psychiatrist or any other mental health professional because they "feel a little of one day." They go after suffering badly enough for long enough and after everything they have tried to reduce their suffering has failed.
March 5, 2012 at 12:12 p.m.
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Sarah Edwards

Pine Mountain Club, CA

I was surprised to read that "couples therapy stresses out therapists." I do not get stressed out when doing couples therapy. I find it invigorating and rewarding. Perhaps that is because of how I have chosen to do it. Years ago I disliked doing couples therapy because the sessions were so unpleasant. When I resumed doing it due to limited therapeutic resources for couples in the remote area where I now practice, I use a completely different approach from traditional talk therapy. There is a very specific set of rules the couple must review and agree to follow when in a conjoint session. For example, there is to be no yelling, no name calling, no blaming, etc. I do not allow communication outside of these rules to proceed as I never find it to be productive. Communication in therapy violating these rules is a waste of everyone's time and only makes matters worse. If the couple cannot follow these basic communication rules, they need to come separately until they are able to follow them. They are expected to work on following these same rules at home during the week and to identify the factors that seemingly prevent them from sticking to the rules. The couples I see find their therapy sessions to be helpful. I know this because I check that out at the end of each session - "Has this been helpful?" - and because I can watch their communication improve and see love and caring return to their relationships.
March 4, 2012 at 7:34 p.m.
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David

New York

You screen out everyone who doesn't follow a strict set of rules and then cue those who remain to tell you that it has been helpful. You enjoy it, and your work may be helpful to some of this narrowly selected group, but these assertions don't really tell us much.
March 5, 2012 at 12:12 p.m.
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Molly Sullivan, Ph.D.

Berkeley, California

Obviously couples therapists, as well as individual therapists, witness & deal with trauma every day -- all day. So do medical doctors, as well as social workers & special ed teachers in their daily work. We have the opportunity to facilitate growth & wisdom for suffering individuals -- that process is our reward. Yes, it's difficult to sit with the suffering & strife -- but our ability to not be damaged by it is a terrifically important piece of the process. Unfortunately this article has omitted reference to one of the most important voices in the field -- Sue Johnson, Ph.D., (author of Hold Me Tight). Her methodology is fascinating, compassionate, & unique in the field. I have long experience in couples work, & I heartily recommend her writings to anyone interested in couples therapy -- I have found that it has transformed my clinical work.
March 4, 2012 at 6:57 p.m.
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David Bullard

San Francisco

There are couples therapists who truly enjoy and are passionate about this work, and who help people have deeper conversations: by learning to see with compassion the truth of each other's feelings underneath either "right/wrong" competitiveness and anger or deadness and avoidance. For these therapists, it is a privilege to sit in a room with people - spouses, partners, adult children and their parent(s), business associates, et al. - who are engaged in the challenges of intimacy, vulnerability and communication. It is a human endeavor and there is

an art in helping others experience and learn more effective ways of responding to the inevitable disappointments of intimacy. This short article itself is in many ways a disappointment, but will stimulate a lot of interest. And each of us who has read it, has the chance to grow from looking at the responses of others, as well as from our own. David Bullard, Ph.D.
March 4, 2012 at 5:14 p.m.
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Leon Zacharowicz MD

New York

There are so many variables in couples therapy working against success that it is impressive when success does occur. We live in a society which extolls materialism, immediate gratifcation, eroticism, and the notion that the "grass is always greener on the other side." We have enabled an overly sexualized media to convince us that we need more and more gratification to be happy. Some of us have too much time on our hands, and too much of that time is spent watching TV and online fantasies about marriage. We have eliminated the traditional views of marriage and done away with the extended family as a means of support for young children and struggling parents. We no longer attend church or synagogue, where we would have had social and spiritual support, as well as moral guidance. Isn't it telling that the separation and divorce rate is much lower in religious couples? Could it be that our modern secular lifestyle is playing a role in the destruction of the notion of the sanctity of marriage?
March 4, 2012 at 4:46 p.m.
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Jim

NY, NY

I would say it is equally plausible that religious couples have lower separation and divorce rates because they view divorce as a sin, the breaking of a promise made "in the presence of God," and due to social pressures from their like-minded peers. It could just be that religious

couples tough it out longer, and suffer more as a consequence.


March 4, 2012 at 9:21 p.m.
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RN

NYC

Can I assume from your comments that you are not a couples therapist? Otherwise, your practice would have to be limited to religious couples. As a happily married secular person my marriage is not held together based on the belief in a deity. I cannot imaging anything as dismal as that!
March 5, 2012 at 12:12 p.m.
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Dr.Meh

Boston

Alternately, it's that religion punishes divorcees so much (the women even more) that couples would rather suffer in a marriage to avoid hell than to allow themselves happiness on earth.
March 5, 2012 at 12:12 p.m.
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Dan Conroy

San Luis Obispo, Ca.

My specialty is coulpes therapy, and I love it. There's a ton of good, solid theory and application protocols available. Sue Johnson's attachment model, Bader and Pearson's differentiation model, and Gottman's behavioral work all come to mind. The key in doing this work is helping couples to develop attachment security while encouraging individual development in each partner. The strongest "we" is made by the ongoing contributions of two well defined individuals. Challenging partners to move past the twin pitfalls of papering over over differences or berating each other in attempts to prevail keeps the developmental edge nicely sharpened.
March 4, 2012 at 4:10 p.m.
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MJones

San Francisco

Couples therapy is typically a hoax lacking any scientific basis whatsoever. There is no evidence that it improves the outcome of divorces - either by making them less adversarial, or by healing the relationship in order to continue the marriage. I think psychology is 80% myth and 20% helpful. But sometimes, it can at least provide a path of communication between two warring participants, whether between a child and a parent, or a parent and a child. I think most drugs given for psychological problems are extremely harmful and ineffecitive - but they are enriching the giant pharmaceutical medicine industry in this country - at the expense of those who fail to be served. Perhaps this is somewhat better than the Dark Ages, but not much. A straight-talking best friend or relative would be a much better couples therapist than a myth-spouting paid hypocrit.
March 4, 2012 at 4:08 p.m.
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Dr.Meh

Boston

Who wants to be a friend who is constantly thrust into verbal battles between members of a couple? Who wants to spend most of their time giving someone else advice instead of watching movies or cooking dinner? I value my friends too much to expect them to solve more than the occasional problem with me. They are wonderful to me, yes, but I know how draining it is to be the personal support system for someone in constant crisis. As for 80% myth and 20% helpful, you have never, I take it, been in the room with someone experiencing a full-on manic episode or talking a person out of killing themselves. Everyone like you should be forced to spend a week in an acute-care psychiatric hospital. You'll waltz out

singing a different tune.


March 4, 2012 at 9:14 p.m.
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Dr. Leslie Melman

Bala Cynwyd, PA

As a psychologist who works with couples, I found this article very disappointing. I agree with the reader who questioned why there was no mention of the work of the Gottmans. I also wonder why no female therapists were quoted, with the exception of Ellyn Bader, who was included as Peter Pearson's partner. Couples work can be challenging, stimulating, and rewarding, and can have a positive impact on the children and their future as well as on the pair who come to treatment.
March 4, 2012 at 3:50 p.m.
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Neal Jettpace

Indianapolis, IN

Therapists charge upward of $100 / hour for their services. It occurs to me the adage "If you can't take the heat, get out of the kitchen" might find good application here.
March 4, 2012 at 3:35 p.m.
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Tara McGrath

San Diego, CA

Why doesn't this article cite John Gottman at all? He has done years of research on couples therapy.
March 4, 2012 at 3:35 p.m.
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Elizabeth Coppock

Dsseldorf

I'm a linguist and one of the areas I work in is "Pragmatics", the study of how the meanings of sentences depend on the conversational context (what you get if you "read between the lines", you could say). I wonder if linguists could somehow contribute to solving this problem, both the need for empirical data

and the stressful nature of the practice.


March 4, 2012 at 3:35 p.m.
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Eh Reader

Canada

There's a BIG disconnect here. I'm reading the comments. SO many therapists LOVE seeing couples. and yet SO many couples complain it's pointless and ineffective. My takeaway is that couples therapy is an entirely flawed product. A lot of theory and bla-bla but nothing of substance.
March 4, 2012 at 3:35 p.m.
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Ms. Massachusetts

Acton MA

Back in 1988, my then-husband and I went to couples therapy. Although my husband was volatile, explosive, controlling, and contemptuous, the therapist took his side. I later learned that, when there is abuse, couples therapy is contra-indicated. That is, the therapist should NOT having doing couples therapy when my husband's anger problems were not under control. She should have recommended individual therapy for each of us. I hope that, with increased awareness of domestic violence, therapists no longer practice couples therapy when one or both partners is abusive.
March 4, 2012 at 3:35 p.m.
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Karen

Brooklyn

Amen. My therapist did not overtly take the side of my violent, rageaddicted former husband, but she spent all her time trying to appease him. He had convinced himself with selective interpretations of reality

that she was on his side, and this fueled his clueless, self-righteous rage. I knew differently, but that didn't help me much. There was no check whatsoever on his behavior and no accountability. I finally turned to him and said "If you don't stop screaming, I will leave," then turned to the therapist and said "If he doesn't stop screaming, I will leave." He kept screaming, and I got up in the middle of the session and left. I moved out with my children 2 months later. I do think there can be a place for couple's counseling with an abusive partner-- especially because in individual counseling, the abuser inevitably lies to the therapist, and the other partner is the only one who can provide certain information about what is going on-- but the counselor has got to be clear about calling a spade a spade. Treating abusive behavior as an expression of emotion that deserves to be dealt with on par with the abused partner's feelings of violation and fear is illogical and totally pointless.
March 4, 2012 at 6:25 p.m.
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Michelle

Seattle

I agree. That is why couples therapy did not work for us (Gottmans) because the therapist didnt even recognize the abusive atmosphere in my marriage. I have learned that this is very common, how therapist cant recognize an abuser, get manipulated by the abuser in sessions and even side with the abuser unknowingly. I came out of the sessions feeling emotionally drained and on top of it, I got abused by my husband after the sessions.
March 5, 2012 at 12:12 p.m.
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denise flori

Edmond, OK

Author relied on psychological mental health perspectives and avoided marital and family therapist informants which led to a biased article. See evidencebased work on relatinships by researcher/clinicians such as Susan Johnson, John Gottman, and UCLA's Andrew Christensen.

All couples suffer. Suffering is an invitation and challenge to personal and relationship growth. Unlearned lessons are doomed to be encountered again and again.
March 4, 2012 at 3:35 p.m.
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RN

NYC

Life lesson #1-Avoid noxious stimuli. Life lesson #2-Suffering is bad.


March 5, 2012 at 12:12 p.m.
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Lori

Manhattan

This is on couples therapy, but I see an issue on many psychology-related stories in NYTImes. I really don't like it when therapists (or other professions) use the Comments section to advertise/self-promote. Look back (and forward?) on these comments, with all the blogs, self-references, websites, listed. Its a turn off.
March 4, 2012 at 3:35 p.m.
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DD

Los Angeles

Time for a reality check. Therapy is a business, and most therapists are business people like other selfemployed individuals. It's easy to lose sight of that while spilling your guts to them. What this means is that their desire to help and get you to the point where you don't need them any longer is at odds with their desire to keep you coming back because they need to pay next semester's tuition for one of their children. I've attended therapy sessions twice in my life, and both times I found the therapists to be sanctimonious, manipulative, and somewhat condescending.

They both alternated between making me feel good and making me feel badly as I left their office, a means to keep me coming back and paying that hourly fee. I'm not saying therapy is worthless, but I am saying it's relevant to think of it as a business like any other, where repeat customers, not 'cures', ensure success.
March 4, 2012 at 3:35 p.m.
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Ms. Decatur

Decatur, GA

Agreed DD. I also find it difficult to accept the opinions of Terry Real given his penchant for publicity and apparent hypocrisy of his teachings. I attended two of his workshops, only to find that there's a serious disconnect between the dysfunction he has perpetrated in his own marriage, and his supposed "world renowned" expertise. Businessman indeed.
March 4, 2012 at 5:50 p.m.
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RN

NYC
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If you need couples therapy, you need a divorce!


March 4, 2012 at 3:35 p.m. 7

Francesca Fontes

Mexico
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yes, I agree
March 5, 2012 at 12:12 p.m. 1

Lori

Manhattan

The thing I see with many couples is their difficulty being a "couple." With all our culture's emphasis on individuality, most people don't really want to give up what they personally want for the sake of the "other" or the "relationship." They want their lives to be the same as when they were single. Or else, they just have an affair (with another person, sports, the computer, shopping, alcohol, whatever). I don't blame the people I blame the culture.

March 4, 2012 at 3:32 p.m.

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RN

NYC

In reality there are only individuals. Hopefully, those who choose to be married or maintain other arrangements can do so happily so that both parties have satisfying lives. I think that society is to blame for emphasizing the "relationship". It's a rather nauseating expression. Also, therapy minded people love to talk about "working on their relationship". Another nauseating phrase! Unfortunately, some people spend their lives "working", or more appropriately, toiling over their relationships.
March 4, 2012 at 7:22 p.m.
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Baylis Thomas, Ph.D.

New York City

As a couples therapist I find that the unique advantage of seeing couples together rather than individually is the chance to see how each partner treats and reacts to the other: tone of voice, degree of respect or affection, hidden complaints and hurts to be explored in front of, and heard by, the partner without interruption or defensive counterattack. Respect for another's perspective or even their personal distortions is possible in love.
March 4, 2012 at 2:01 p.m.
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kilgatron

NE Kansas

Before initiating a therapy session, it might be a good idea to have each partner in the marriage take a survey which would include at foremost, their interest or lack of interest in the marriage. That way, time and money are saved and both partners know before therapy begins, that the intended outcome is separation or divorce. Cynically though, the fact that a couple needs "counseling" seems childish and

the outcome, predictable. In many cases, one of the marriage partners or both wants out as is elaborated above. My ex-wife and I use to say, "If you need a marriage counselor, you need a divorce." Yes, there are exceptions to my comments and positive ones at that, but exceptions nonetheless, at least in the experiences I know about.
March 4, 2012 at 1:36 p.m.
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Shamus

Canada

That's like saying if you need personal counselling you should just kill yourself. It doesn't make any sense.
March 4, 2012 at 3:35 p.m.
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Michael L

Westport, CT

As a practicing couples therapist, I believe that it is important to observe at least some overt conflict in a couple, if for no other reason to understand the dynamic between the two people. Of course it makes no sense to let a couple fight interminably or repetitiously, but if you have no stomach for conflict, you should not be doing couples therapy. I am a firm adherent of John Gottman's approach to couples work. Since it is unrealistic to expect a couple to never have any conflict, the question then becomes, how does the couple handle conflict? Teaching people how to deal with each other effectively, even when the other person is at their worst, is one of the best things a therapist can do for a couple that is struggling. And one of the ways to tell if a relationship is truly past the point of saving is if one (or both) of the partners refuses to learn how to fight "fair," which means actually listening to the other person's point of view and validating their position, even if you do not agree with it. It's hard to tell someone to care about how a person feels when that other person doesn't seem to care about how they feel. Because in the final analysis,

the most important thing in an intimate relationship is how both people feel about each other.
March 4, 2012 at 1:34 p.m.
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Dano50

Bay Area CA

There a lot of cynical statements here. The better issue to be addressed here is to consider what marriage is, and how best to live it rather than trying to fix an archaic model of human relating greatly informed by un-inspected JudeoChristian dictum's and parochial restraints. My wife and I (over 43 years together) have had an extremely unconventional lives, let alone an unconventional open marriage. It all comes down to that our relationship is based upon truly loving one another, (not based upon the merely romantic model) accepting that we don't own each other, (love is not about possession) that we're not solely responsible for each others happiness, (that's between you and God) and that everything else (as to what limits we set and observe) is negotiable. We have also been blessed to have a skilled therapist-counselor who has helped guide us to higher human growth and a marriage relationship is one of the best places to do that, IF both partners are committed to transcending childhood patterns of reactive betrayal and punishing and truly becoming mature in human terms. Part of having a good marriage is just about growing up, and seeing life in terms of being a responsible adult, being committed to love rather than punishing reactivity for the feeling of not feeling loved.
March 4, 2012 at 1:13 p.m.
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SMD

California

Glad you've made it past all of your "childhood patterns of reactive betrayal and punishing" with your "skilled therapist-counselor" guiding

you to "higher human growth" and maturity. What you're really saying is that you've learned to have your cake and eat it too. You're just saying you've decided to partner up with someone and still each be incredibly self-indulgent. Good luck with that; I'll take the "archaic" and "parochial" model every time. It's true, "Love is not about possession." But I don't think it's what you're espousing either. [Pardon the pun.]
March 5, 2012 at 12:12 p.m.
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RN

NYC

The problem with psychotherapy/psychoanalysis/counseling theories are that they are almost exclusively base on case reports or case series. The publications of Sigmund Freud, for example, are case reports of interactions with his patients, without any raw data. Who knows what was actually said during these sessions? Who knows whether there is consistency between practitioners of even the same methods?
March 4, 2012 at 12:24 p.m.
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Lee

MN

A formerly married friend and spouse saw one of their community's most prominent family therapist when after 20 yrs of marriage H began to feel "depressed and unhappy." Perhaps guilty too, since H was having an affair, but failed to mention that. The therapist's approach was to emphasize the couple's long time together, how it was "normal" that people change and grow apart over such a long period, yadayada, giving H the exact tools he wanted to severe the marital ties! No mention of looking to make use of the factors that had held together a near quarter century long relationship and produced a large loving family. My friend will most certainly never again seek out a therapist for her problems, and I don't blame her.
March 4, 2012 at 12:20 p.m.
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11

Zach Franks

maui
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Lee Remick?
March 4, 2012 at 3:35 p.m. 1

WR

Berkeley CA

The opening question, "does couples therapy work?" is difficult to answer, in part because it is asked passively, as opposed to actively. It's a bit like asking, does a can opener work as it sits in the drawer, or do fitness programs work. The answer lies in whether or not you show up and use it properly. As a therapist working primarily with couples, the answer is "yes, couples therapy works," but certain conditions must be met. First, the therapist must know what she or he is doing, and of equal importance, the clients must be willing to do their share of the heavy lifting. Change isn't for lightweights. Sustained change requires self-awareness and sustained effort. And volatile couples, people deeply entrenched in battle, frustrated people who have grown to hate each other (or close to it) do require a therapist who can handle the heat. Bad couples therapy skews the data, leaving many to think "it" didnt work. While any licensed therapist can see couples, doing effective work requires specialized training and a strong stomach for marital strife. It requires understanding and knowing how to work with each individual while working with the relationship as well. This can be especially important when one or both spouses are unsure about continuing the relationship. In my opinion, even the most troubled relationships can be repaired through proper guidance, encouragement, and hard work. Regardless of how challenging the issues are. Winifred Reilly, MA,MFT Berkeley, CA

March 4, 2012 at 12:19 p.m.

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Neal Jettpace

Indianapolis, IN

Note however the difference between what you have just described versus the success of using antibiotics. In the case of antibiotics, there are virtually no such caveats. Can 'success' as defined so circumscribed really be called "success"? For example, almost all human societies that are able have adopted the use of antibiotics. And as a result, the mortality rates due to infection are relatively few. And they adopted such use because of the incontrovertible success. As regards psychology however, there are still multitudes of very unhappy people out there. Were religions, therapy et al. so successful at curing this, it would seem to be they would no longer exist. And both have had decades (millenia in the case of religion) of existence to prove their worth. Real solutions quickly eliminate the problem at hand.
March 4, 2012 at 12:53 p.m.
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jsibley

Montclair, NJ

What a shame that this article might discourage couples from seeking help that could really make a difference in moving the relationship from frequent fighting to greater trust and happiness. As a couples therapist, I love working with couples. While more complex than working with individuals (one does have to find a way for each partner to trust the therapist, even when the partners hold what seem to be diametrically opposed views), the work is incredibly rewarding. It's true that there is no point in allowing couples to have the same fights, in the

same ways, in the therapist's office. They can do that at home. It is also true that the therapist can keep his or her foot on the brakes (figuratively) and help the couple to slow things down enough to understand what they are really fighting about (usually along the lines of "can I count on my partner?", "does my partner really care about me?", "do I matter to my partner?", "can I turn to my partner for support?". As the article says, this is firmly based in attachment theory, as is the empirically supported couples therapy that I use, Emotionally Focused Therapy for couples. One thing to bear in mind is that individual therapy, if there are issues in a relationship and the therapist doesn't have a couples-oriented orientation, can be quite detrimental to a relationship. It can to tempting for the therapist to take the side of the client in the room, at the expense of the other partner.
March 4, 2012 at 12:05 p.m.
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Ann

California

I sat in one group therapy session where the highly respected therapist sat passively by while the couple talked, mostly the wife, screamed at her husband. At minimum, this convinced me therapists need to keep the sessions emotionally safe and respectful. Doesn't mean difficult feelings, experiences can't be aired--just ground rules that respect the other, what you'd expect in a friend, need to be followed. The practice of NVC--teaching self-responsibility and to listen for the feelings and needs--struck me as much more effective, honest, and healing.
March 4, 2012 at 11:32 a.m.
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David Rosen

Oakland, CA

While I support therapy in principle, I am struck by the fact that, in this quite young field there is little in the way of clearly established and reliable methodology. There are many theories and practices, of course. But effectiveness is uncertain. Despite this, therapists charge substantial fees.

There often doesn't see to be any clear acknowledgement of this contradiction. Certainly it's easier for the therapist to suggest that there might be a mismatch of client and therapist or that the client is unreceptive than to explicitly admit, "I don't entirely know what I'm doing". And yet there is little doubt that this is often, at the least to some degree, in fact the case. To be fair, dealing with human emotions and relationships is very far from a simple matter. And in any case, therapy remains an important and worthwhile enterprise. But just as a client is liable to benefit from acknowledging personal issues, the same applies to the field as a whole. It does little good to hide behind credentials while failing to see that the track record of therapy is uneven. The ongoing evaluative approach mentioned in the article seems an important step in the right direction. A process by which therapists can pool experience with different approaches to different circumstances might be especially helpful. But no database can capture the nuances of therapy interactions. Perhaps a discussion and presentation network for therapists would be worth considering.
March 4, 2012 at 11:29 a.m.
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Neal Jettpace

Indianapolis, IN

David, all of this is exceedingly well put. It occurs to me that the field of therapy is more willing to admit uncertainty (and failure even) in the case of couples therapy than individual, simply due to a foreclosed ability to blame the patient(s) should therapy fail. In the case of an individual, my experience has been assigning blame for failure on the part of the patient is both widespread and accepted. (The same is true of primary education, sadly.) However given that there are two such patients at hand in couples therapy, the probability that both are to blame and not the therapist is

much lower. As well, there is a very well defined measure of success here. Namely are the patients still married at the end of it all? I contend that all of the difficulties described at play in this article are in fact also at play in individual therapy. The difference being that with individual therapy the temptation to brush them off and simply claim unwillingness on the part of the individual is often too great to overcome.
March 4, 2012 at 1:07 p.m.
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Toni Coleman

McLean, VA

As a psychotherapist and relationship coach, I have worked with many couples over the years. I find this work challenging, dynamic and rewarding. While I understand and can relate to the points made in this piece, I realize I must be in the minority of therapists who do this work. Early on, I saw the unique challenges and found ways to address them from the first session. I also realized that you can't do individual therapy when working with couples- which is what too many therapists fall back to. Instead of going back to childhood hurts/experiences/modeling and how these shaped the individual, the focus needs to be on the dynamics between the couple, where these come from and active work on interrupting them and changing them. Yes, it's true that some people come to counseling with the hidden agenda of divorce, however, a good therapist can sense this from the beginning. I typically spend at least part of one session with each individual alone in order to get them to open up and ask them things that would be hard for them to come clean about in front of their partner. This is very useful. There are many other things I do as well- and yes, I have had couples get into a conflict in front of me- but I stop it immediately, set ground rules and structure how they will address each other in our sessions. I take charge and model this for them until they can do it for themselves. It's job a job for the faint of heart- but I love the work and find it rewarding and productive.

March 4, 2012 at 11:29 a.m.

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Don Best

Butler, Pennsylvania

I am not a therapist but am married to one. We've been together for 37 years and married for 32. My unprofessional opinion regarding problem marriages is too much emphasis on the wedding itself. The wedding industry has everyone convinced they must spend massive amounts of money that could be better utilized getting off to a good, sound financial start to life. Focus on your future lives together and have a small wedding with only important people in attendance.
March 4, 2012 at 11:21 a.m.
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Anonymous

Northampton, MA

No stronger argument for psychotherapy as shamanism and malpractice. Note the last sentence: "who wants to sign up for a second serving of that?". The truth is often the therapist completes his or her work to battle their own inadequacies and neurosis. Unlike psychiatrists, who are at least trained, licensed medical professionals who take the oath of Hippocrates, psychologists are a modern invention of wishful thinking by an industry convinced it helps by taking money from the government, the private individual, and the insurance companies in the belief that somehow their "work" of listening, suggesting, contemplating, allowance is somehow helpful to society.
March 4, 2012 at 11:19 a.m.
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RC

Pompano Beach FL

"psychologists are a modern invention of wishful thinking by an industry convinced it helps by taking money from the government, the private individual, and the insurance companies in the belief that somehow their "work" of listening, suggesting, contemplating, allowance is somehow helpful to society." Eloquently stated. Thumbs up. You're kinder than I in your

assessment(s). These "shingle hangers" won't be satisfied until every man, woman, child, couple... is in therapy and/or medicated... and continues to stay in therapy/medicated *for years*... due to the co-dependency that they altruistically, benevolently, benignly, and intentionally create. And people, in droves, buy into it. If Jim leaves the window open, and his beloved parakeet flies away, and Jim is feeling down... someone in the lay public will invariably give the most often spoken advice heard in modern America, when it comes to any personal issue: "Jim. Maybe you should see somebody. You know... like a therapist. They can talk to you and give you something to make you feel better." Jims true friend, could advise Jim, gratis: "Jim. Your budgie is gone and aint coming back. Get over it. Buy a new one. Let's go have a beer... or two."
March 4, 2012 at 3:35 p.m.
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Lori

Manhattan

Thank you for your comments. You are partly misinformed. Psychiatrists have an MD but it is mostly for prescribing psychiatric drugs. Very few have much training in psychotherapy these days. A PhD psychologist has at least 4 years graduate school training, an MSW and Marriage and Family therapist each have at least 2 yrs graduate training. All these practitioners are licensed by the state and must practice ethically, or lose the licesne. A Hippocratic oath is more a ritual than any binding obligation. I am sorry many people have a negative impression. Scientific research finds that in general psychotherapy is quite effective. However it

depends on the training of the therapist and the quality of the professional relationship between therapist and client. Sometimes a therapy experience doesn't work and the client never tries again with someone else, they just damn the whole field.
March 4, 2012 at 3:35 p.m.
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Judith D. Schwartz

Bennington, Vermont

I was surprised that, while mentioning my co-authors Ellyn Bader and Peter Pearson of the Couples Institute, the article didn't note that they've developed an effective model for couples work. The author is correct that most couples therapy relies on models of family or individual treatment. Bader and Pearson's practice draws on Margaret Mahler's separation/individuation stages of child development: that falling-in-love stage is the symbiosis, after which the two partners need to differentiate in order for themselves and the marriage to develop and grow. They brilliantly observed that marital tensions and deceptions most often occur upon one or both partners trying to hold onto the symbiosis (as in, "if I keep my real wishes to myself we can pretend everything is just fine.") I was privileged to get an in-depth look into their work, which has brought hope and transformation to many couples. Here's our book: http://www.amazon.com/Tell-Lies-Ellyn-Bader-PhD/dp/0312280629/ref=sr_1_... (If you see this, hi Ellyn, hi Pete!) -Judith D. Schwartz, MSJ, MA Counseling
March 4, 2012 at 11:13 a.m.
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Andrea J. Coleman

NYC

I read this article with great interest. I am a divorce mediator and lawyer who sees many of the couples for whom couples therapy is unsuccessful. There is a relatively new field in the mediation sphere called marital mediation. It has a number of benefits that couples therapy often cannot provide. For one, as many

of the comments assert, a couples therapist not adequately trained to deal with couples, and not trained in particular about the importance of avoiding bias toward one party, is bound to run into problems. For a mediator, on the other hand, neutrality is one of the core principles of the discipline, and is ingrained in mediators from the outset of their training. Also, I believe, from what many clients and prospective clients have said to me, couples therapy often doesn't work because many men are just unwilling to go. Marital mediation, I think, could be more palatable to therapy-wary men, both because it is not therapy, and because it's often a short-term proposition. How is it different from therapy? Mainly in that it is focused on the future, as opposed to the past, and in that it aims to zero in on the most significant problem a couple is dealing with, and then help the couple come up with some concrete steps that might help them resolve this problem. Once the couple understands how the process works, and sees some actual benefit from it, they are able to stop coming to mediation sessions and work on the less significant issues on their own.
March 4, 2012 at 11:08 a.m.
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Ellen Garbuny

Butler, PA

Doing couple counseling is interesting and challenging for me, and I like to have a few couples in my practice. When a partner in a couple calls to set up the initial appointment, I screen for willingness to work on change and acceptance by asking the caller to imagine a stoplight. I use this analogy: green light for commitment to remaining in the relationship, recognizing responsibility of one's own's actions that may be a contributing factor to the problems in marriage, and willingness to change behavior. Yellow light represents ambivalence to the relationship and counseling process, but curious to check it out. Red light: one partner has emotionally checked out of the relationship and is coming in to publicly state this, so the other is convinced. I can work with green or yellow lights but the red light is a couple killer. The red light story is the 'too little, too late' scenario. Years of asking for support go unheard or with token efforts to change that are quickly forgotten. For example

it seems that a vulnerable time is when the last child leaves the nest. The wife is fed up, and wants to leave, the husband wakes up and begs her to stay, promising to help out more, to get off the easy chair. Wife has heard it before and is finished. It's helpful for therapists to connect with other therapists when they encounter difficult couples, for us to vent and to brainstorm. I also relish coming home to my sweet husband after an evening of counseling.
March 4, 2012 at 11:08 a.m.
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Anne

New York City

As a therapist, I have seen many times two of the phenomena noted here: Couples who wait too long to seek help, and couples in which one (sometimes both) member(s) have already decided to leave the relationship. At the same time, I have worked with some couples who only needed some help with communication. The success of a relationship depends on how badly the couple wants to preserve the relationship. Couples counseling cannot supply motivation for a relationship when that motivation doesn't exist in one or both members. --Anne Rettenberg LCSW
March 4, 2012 at 11:05 a.m.
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Lucy

NYC

Couples therapy doesn't work because couples in trouble usually have lost their loving connection to one another. How can they possibly work on problems when their foundation is so broken? The foundation of their relationship needs to be rebuilt before anything can possibly be fixed, with or without the aid of a psychotherapist.
March 4, 2012 at 11:01 a.m.
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SMD

California

This is the thing most people don't realize. Many loving successful longterm marriages go through times where you "feel" like you've "lost" your loving connection. The mistake is to take this as an unchangeable reality. Things left alone tend to decay. To make things better takes conscious effort and work. You cannot do anything to change the other person; start with yourself. Do loving things, say loving things even if you don't "feel" them. What is the truth? If you are angry at your child, your sister, your father, your mother, your husband or wife, etc. because they've done something wrong do you stop loving them? No, you don't. Feelings are temporary; commitment is under your control. Commit to be loving, kind. Meet your partner's faults with grace and forgiveness instead of condemnation. You may still need help, but you should never ever give up hope. Of course, this assumes an absence of abuse and no mental health issues, such as narcissism, etc. Some relationships are poison, pure and simple, and it's better to get out before you're destroyed.
March 5, 2012 at 12:23 p.m.
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Charles

Slough, UK

I think it's true that most couples wait far too long before seeking counselling, and by that time it's too late. In my opinion, what works is individual therapy.
March 4, 2012 at 11:01 a.m.
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Scott Haas

Cambridge, MA

With all due respect, since when did Terry Real become a Dr? He is a social worker.
March 4, 2012 at 11:01 a.m.
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READ ALL 4 REPLIES

Lori

Manhattan

@Kas: I think you misunderstand. In the field of psychotherapy today, most clinican social workers have as much or more training and experience in doing psychotherapy as do physicians or even psychiatrists. I never said an MSW is a "doctor". First of all, there is no training whatsover in psychotherapy in medical school. None. "Doctors" may have an MD but they have not studied psychotherapy. If an MD does a residency in psychiatry, they do learn minimal psychotherapy, but mostly brief cognitive-therapy, not couples therapy. It is true that they have long, arduous study in medicine, but they rarely study interpersonal relations, psychology, sociology, or anything used in psychotherapy and especially couple therapy. The MD degree prepares them to prescibe drugs, electroshock treatment, inpatient hospitalization, etc. Just because an MD studies science (quite hard, I know) doesn't mean they know a lot about couples therapy. Now, esp. with "managed care" psychologists, social workers, MFT, etc. study psychotherapy for much longer than most MD's. Some psychiatrists do do some therapy but they often aren't that well trained anymore. There seems to be a "doctor" issue here, that if you are a "doctor" you know eveything. Similar to MD's advising on losing weight (ie, eat less, don;t eat fat) when nutrionists know much more. Would you, for example, want your airplane flown by an MD rather than a pilot because maybe the MD studied longer? PS: I have a PhD myself.
March 5, 2012 at 12:12 p.m.
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David

New York

I know nothing about Terry Real but what Lori said is: ... "but many clinical social workers have more THERAPY training and experince than a "doctor" and especially most psychiatrists who work with couples." So "kas" seriously misquoted Lori by writing "more training." If you are going to criticize someone's comment as "ludicrous" at least quote them accurately.
March 5, 2012 at 12:18 p.m.
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Just Sayin'

New York, NY

My ex-wife and I attended two consecutive multi-month couples therapy sessions, run by a psychiatrist and a psychiatric social worker, at a New Hampshire Ivy League medical center, which shall remain nameless. Of the eight couples treated, seven divorced, and one stayed together, sexless, loveless, hopeless. The therapists fared better: they split with their spouses and married each other. So, does couples therapy work? Not so much in northern New England..
March 4, 2012 at 11:01 a.m.
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36

Harry The Dog

Los Angeles

Nice to read an article that confrmed my own painful - and costly! - experience at the hands of two well-meaning but utterly hopeless 'therapists'. My marriage survived only because at one point my wife and I basically looked at each other and realized we were smarter than the buffoons we were paying to help us. In our case the 'therapy' bordered on patronizing, with 'games' and 'role playng' and 'exercises' thrown in when it was obvious our 'doctors' were utterly lost. In their defense, and in retrospect, we had both gone, looking for a safe place to vent. I no longer believe such places exist. When that Pandoras box of grievances is opened, it is well nigh impossible to close and very few of these

people have the experience, IQ and sensitivity to achieve it. Somehow that line from Crocodile Dundee resonates even more: when hearing that she has to go to see her therapist he asks 'Are you nuts?' she replies 'No', she just needs someone to talk to. Mick then says to her sadly, 'Haven't you got any friends?'
March 4, 2012 at 11:00 a.m.
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RN

NYC

It sounds like you and your wife have intelligence, a great sense of humor, and that you actually like each other! The last part helps!
March 5, 2012 at 12:12 p.m.
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Lori

Manhattan

The thing about couples therapy is not to even think about taking sides. You have to see it as a system. Like the Dylan song: "Your right from your side and I'm right from mine. We're just one too many mornings and a thousand mile behind." Each person incites the other at a specific point, usually because they feel they are not getting a need met. Then the other partner reacts to this, feeling their need it not met. Now you have a viscious cycle. Both fight, both withdraw, or one tries to fight and one tried to withdraw. You should focus on the process of how this is initiated and sustains, not a "he said-she said." I also don't think it helps to allow long drawn our arguing in the therapy room, because the couple probably does this at home anyway. They don't have to pay for it. The therapist must be strong, active, and have a plan of why and how they are intervening. Working on"communication" is vague and often useless. One concept is working on what each person brings in and erroneously expects and projects from childhood. Another concept is seeing, interrupting and teaching news skills around the vicious cycle. Another is seeing if contempt has entered the relationship; then it is really hard to change.

March 4, 2012 at 10:59 a.m.

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RC

Pompano Beach FL

Dump the "therapists"... save youselves from these self-appointed priests/priestesses/experts, that often carry more personal psychological baggage than Fed Ex...and remember the words of an anonymous Einstein... "Life sucks. Then you get divorced." Take the money that you would have otherwise wasted... and give yourself a well earned vacation from the "Institution". That's good old-fashioned self-medicating therapy.
March 4, 2012 at 10:58 a.m.
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Tim Page

California

In my own experience, couples therapy is best understood as a preparation for breaking up with as little collateral damage as possible.
March 4, 2012 at 10:58 a.m.
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Annie

Chicago

My experience with couples therapy helped me end a marriage that was going to end anyway but gave us the best ways to help our children through the mess of separation and divorce. It was invaluable
March 4, 2012 at 10:57 a.m.
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21

DDH

CT

Americans seem to feel entitled (or at least compelled) to complain about their work - from an NPR piece on how tough it is to work at a fulfillment center to airline stewards and on to investment bankers and their 20-hour days. Even my

grandparents' generation (WWI, the Depression, WWII) would be aghast at the level of complaining (whining?). Work is hard - that sort of defines work. Not working is often more pleasant - unless it was someone else's idea (I'm sorry but your position with the company is no longer...). There are plenty of blue- and white-collar workers who would love to have a job to complain about. As for therapists, time to rein in the empathy. You're an emotional mechanic identify the problem and fix it. Ten sessions is about the limit. If it's not getting better, time to move on.
March 4, 2012 at 10:57 a.m.
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18

RN

NYC

Unless you were blessed to be Bertand Russell with wealth and intelligence and the leasure to pursue the pleasures of your ingenious inclinations for a living, then your job probably sucks!
March 5, 2012 at 12:12 p.m.
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Chris Roach

Tampa, FL

I should hope some of the recent insights of evolutionary psychology-popularized on the internet as men learning "game"--might be useful to couples therapy. A lot of relationships die by this cycle of a) female demandingness b) male accomodation and c) increasing female contempt. Male leadership and "manliness" saves many a relationship because people often want something different from what they say they want. So the premise of therapy--talking things out reveals needs that people can meet--doesn't work in this sense. Of course, when a man has become defined as an unattractive beta by his spouse, he might already be too far gone. Men: learn to be an attractive man, which means learning game. Try this, as it actually works, and when you role back the tape of your own life you see this. The jerks got what they wanted in HS and the jerky guys often have the better marriages, both for themselves and their wives. Of course, jerks is an

exaggeration. You don't need to be a jerk. But you do need to be a man, and that means putting your own needs and wants first, providing leadership, and not jumping when your wife says jump. Angry feminists and harpies may not like this. But if you look at the numerous complaints by females of their husbands passivity and lack of backbone, it has some truth. Since women initiate divorce at 2X the male rate and probably cheat nearly as often, it's worth thinking about whom they do that with and why.
March 4, 2012 at 10:57 a.m.
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gskev

chicago

Read "No More Mr. Nice Guy", by Dr. Robert Glover a few years ago and he elaborates on what you are saying. Recommended. Haven't heard of "Game", not much to google there, but sounds interesting. I went through the whole wife goes to therapy, we go to couples therapy, we get divorced. Quite the windfall for therapists, real estate agents, lawyers, etc.
March 4, 2012 at 3:35 p.m.
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D. E. Franks

Grafton, VT

"Angry feminists and harpies"? Is that what they're calling human beings who expect mutual respect these days? I think there are quite a few men and women out there who have evolved past the relationship needs and patterns you're describing.
March 5, 2012 at 12:12 p.m.
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bv

austin, texas

How do you write a column about couples therapy without even mentioning the two giants in the field who actually have evidence-based results spanning 20-30 years?!! If you are truly interested in the field read about Susan Johnson and emotion-focused couples therapy or John Gottman.

March 4, 2012 at 10:55 a.m.

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MG

Minneapolis

I was wondering the same thing. Johnson's method, as I understand it, is widely considered the most successful.
March 4, 2012 at 3:35 p.m.
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Dr Barbara Fontana

Shoreham, NY

I am a psychologist who loves working with couples. It is a challenge to hold the space for two people to feel safe and respected during sessions. It's also gratifying to help couples improve their relationship and have them tell me that their marriage is better than it's ever been because of the work they did with me. I don't let people yell at each other in my office. I try to help couples understand themselves and their partners. I use Imago Relationship Therapy in my work with couples. It is a very effective approach with research to back it up. I think it's very important that couples find someone who is WELL-trained in couples therapy; otherwise it can be a disaster. Anyone can find a well-trained therapist on the Imago website: www.gettingtheloveyouwant.com I also write a Tip of the Week for couples via my website: www.drbarbarafontana.com
March 4, 2012 at 10:55 a.m.
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Bill

Ft Myers, FL

Whatever happened to the requirement of personal therapy for the therapist? In the end the therapists best resource is him/herself
March 4, 2012 at 10:55 a.m.
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Minerva19

Rockland, Maine

How do you judge success? By how many marriages stay together? I will confess, I was one of those people looking for a "therapist sanctioned" divorce. I wanted out, but I wanted out with help and without slashing my partner to pieces. Was the counseling a failure? I don't think so. I changed in ways I never expected. I stayed in therapy for several years, learned how I got into such a dysfunctional relationship and when I married again, I choose the right person. I knew how to fight constructively and 22 years later, I remain really happily married. The same is true for my ex-husband. He did not want the divorce, he came to counseling only because he thought he could save the marriage, but the therapy was so helpful to him that he stayed in counseling for two years afterwards and he too, has been happily married for 22 years. Success is complicated, really the goal has to be a whole, healed individual who understands how to connect and be in relationship with anyone, respectfully.
March 4, 2012 at 10:54 a.m.
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47

NS

NC

The errors by therapists creep in when the therapist sees their job as one of figuring out the clients problems and then providing advice. The most powerful way to assist any couple in conflict is through "strategic listening", "non-violent communication" methods and other mediation methods. The therapist/mediator's job is to allow the clients to identify their needs and interests and to have difficult conversations with one another. If a therapist does not provide advice or form opinions about "the truth" then they don't end up falling into the error of advocating for one side. I would imagine that people trained in Family therapy draw from the types of

methods used by mediators.


March 4, 2012 at 10:45 a.m.
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Neal Jettpace

Indianapolis, IN
RECOMMEND

And we're to pay them $100 an hour to do this? No thank you.


March 4, 2012 at 3:35 p.m. 1

Lori

Manhattan

It is true that while most therapist are well trained in individual therapy, they don't usually study couples therapy, yet do it anyway. There is no regulation of this, only the ethics to practice "within the area of one's competence." Of course they have a low success rate. So if you go for couples therapy, ask the therapist where (or even if) they studied couples treatment. One resource is the world known and long established Ackerman Institute for the Family in NYC that has a 2 year training program and also makes referrals. Also, I have heard that in Ethiopia, when a couple gets married, they choose a married couple as "marriage parents" (like godparents) who are mentors. They go to this couple throughout their lives whenever they have problems. Great idea! Indigenous therapy.
March 4, 2012 at 10:35 a.m.
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Michael Mesmer, MFT

San Rafael, CA

Couples therapy is and should be about helping people take better care of themselves, their children (if any) and their relationship (ie treat their partner with respect and affection). Having an explicit goal of "saving" a marriage or relationship regardless of its effects on its participants and witnesses is illconceived, for therapist as well as couple. If therapy doesn't help us lead more satisfying lives that are less harmful to ourselves and others, then it isn't

therapeutic, it's just homeostatic ie in service of the status quo. Working with individuals, couples and/or families can and should be empowering, helping each person learn what they want and need to be healthier and happier and how best for them to go about living such a life. A good couples therapist also has the personal strength and composure to manage conflict in their office effectively -making a safe container so it stays healthy, and thus modeling what every relationship should do: make space for each person's truths to emerge. At the same time, IMHO, we must keep in mind that only part of the truth about people and their lives is brought into the therapy office -- being mindful of unspoken domestic violence, infidelity, addiction, and mental illness can help therapists see beyond what's presented and treat the real relationship.
March 4, 2012 at 10:30 a.m.
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Ed Schwartzreich

Waterbury, VT

As a recently retired generalist psychiatrist who performed couple therapy both when people walked in the door asking for it, and also when it seemed acutely needed in the treatment of a spouse, I think I can say that I never was presented twice with the same situation. Often one member of the couple, or both, had significant psychiatric illness (major depression, PTSD, ADHD, alcoholism, and so forth) which needed individual treatment in addition before anything could be accomplished. Several other times, when I was asked to do individual treatment, it became apparent that I needed to see the couple (with or without a co-therapist) in order to make any headway. But each situation was notably unique and called on all the active skills I had in me. More often than I would have expected, my extemporaneous jumping into the couple milieu actually helped. Couple therapy is demanding and draining, but it also can be exhilarating and moving for the therapist. When some positive movement occurs, it is more powerful in the couple setting than individually, as things get rapidly reinforced. I think the facts of my personal life (an unhappy marriage followed by a solid

enduring one) gave me a solid emotional understanding of many other couples. But most of all, I experienced couple therapy as a part of life: as a therapist, you gave it your best effort, were alert to cues, and unafraid to be spontaneously active.
March 4, 2012 at 10:26 a.m.
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24

Kalidan

NY

I am not sure whether marriages were supposed to be happy, or that they were supposed to work in any way other than for procreation. I suppose they can, and some do. Most clearly don't. It is evident in the 50% divorce rate, and the rapidly expanding demographic of single people living alone (of which many were never married). Once we had snake oil salesmen, now we have quacks who took a three course sequence at a university - who with mock seriousness - can drown the unsuspecting couple in psychobabble. After 27 years of marriage, I can say that they are likely affected by neurochemical, cognitive, affective, visceral, behavioral, societal, technological and likely ecological factors (never mind children, in-laws, and relatives). I.e., too many factors that could possibly be remedied by talking to a third person who gets paid by the minute. Therapy likely makes sense for people who think everything comes for free, or that complex problems have easy solutions, and that gratification must be instant (an hour on a couch once a week will cure your basic problems). These people deserve to pay someone who can tell them (without bursting into a chuckle at the sheer gullibility of the listener) to: be open and honest, communicate, tell then how you feel, have integrity to yourself. I.e., read aloud from the cliff notes. Kalidan

March 4, 2012 at 10:22 a.m.

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JudyH

Baltimore, MD

I agree that many therapists are doing marital counseling without extensive training in the special modality they use. This is equivalent to doing drug and alcohol counseling without any training. Often students graduate from programs in social work and psychology with a generalized knowledge of human behavior and very little specialized training. Few go on to fellowships and advanced clinical training. Consumers of marital therapy rarely know what questions to ask of potential therapists. Most are completely unaware of the various approaches available. In a state of crisis, they often make appointments with the first available person, or someone reccomended by a friend or insurance company. And consumers, upon learning that medical insurance does not cover "marital counseling", often go with the least expensive therapist they can find. (Therapists, on the other hand, may play the insurance game and call it "family therapy", lableling one partner as the "patient".) After 40 years of (1) working hard to hold my own marriage together, and (2) providing therapy for children and adolescents, the last thing I want to do is listen to two adults fight for an hour in a "therapy" session.
March 4, 2012 at 10:19 a.m.
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Italian Special

NY

I too wasted three years in couples therapy at the beginning of my marriage. At best, it offered a place to vent for each of us. I felt our therapist was given an impossible task, namely, maintaining a therapeutic alliance with two people terribly at odds with one another. Initially, she so believed my husband, that I felt it worsened his behavior. Then, when I complained and persisted, she ultimately took my side and told my

husband she could no longer help him and referred him to another therapist within a different modality. My husband and I are still married but not because of couples therapy. Really, our success came from a commitment to each other and a determination to stay together. This led to radical compromise and acceptance -- the hardest thing I've ever done. What helped us? Our spiritual paths(within a non-Christian religion) and our spiritual teachers and community -- the very same community before which we made our life vows of marriage. I thought our couples therapist was a skilled individual therapist. But couples therapy was an impossible modality for her and us.
March 4, 2012 at 10:12 a.m.
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MSW

Rhode Island

Terry Real was a student at Smith College School for Social Work when I was, back in l978. We were both getting our masters degrees in clinical social work. He made an impression on me as a bright, intense, creative and enthusiastic guy. He went on to study family systems and eventually developed his own unique theory and business of working with families and couples. I knew that Terry would make a success of himself because he had a way with words, could connect with people, was more driven than the average student, had a great sense of humor, all of which is evidenced in his highly successful books. However, it behooves us as marriage therapists to admit that there are as many different marriages and couples relationships out there as there are couples therapy theories. As therapists, we are drawn to a style that suits our personality, background and needs. To the readers of this piece, choose a therapist that makes you feel hopeful, listened to, and challenged in positive ways that stir you and make you want to come back the next week. Over the past 30 years I've practiced, if there's one thing I know for sure, it is that everyone who walks in my door wants a solution to their dissatisfaction, whether they think this comes from within or without. As for therapists, either

we feel prepared for and actually love couples work or we feel lost. To those who feel lost, do the clients a big favor and refer them out. - Linda C. Thomas, LICSW
March 4, 2012 at 10:12 a.m.
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ama

los angeles

working with couples can be an utterly exhausting endeavor - i worked (for a very short period of time) with a couple who were so aggressive with each other (physical, emotional abuse), that all of my attempts to help them see how they both triggered unresolved family of origin issues in each other (and how they both needed individual therapy - with a different therapist) and acted them out vis a vis projections, defenses etc, finally convinced me that despite the horrible way they treated each other, they both got powerful secondary gains out of staying in this horrible marriage. for many, (this couple in particular) being in a bad relationship is better than being in no relationship at all. no amount of communication skills, loving kindness, empathy and compassion could have helped them either get along better or throw in the towel and divorce. sometimes people should be apart, but the dynamics between the a severely damaged couple are so primitive and powerful, that they dismiss any sincere, otherwise effective attempts of a competent therapist to help them understand each other's motives and gain enough insight that will help instigate behavioral change. they never ever stay in the treatment long enough. they want the therapist to "fix it" now! it makes our jobs very difficult.
March 4, 2012 at 10:10 a.m.
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David

Chicago

I'm half of a gay male couple. My partner and I had a great experience in couples therapy. We went fairly early in a our relationship for about 18 months to work through some daunting differences. The work not only saved our relationship but helped it flourish. Perhaps we were just lucky. Yet, I think both of us were really willing to give it a go -- even though I was highly skeptical at

the time that our differences could be bridged. Maybe a couple's mutual willingness is a key success factor.
March 4, 2012 at 10:10 a.m.
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clare

MN

Hmmm... I thought that part of good training for therapists involves supervision and learning to deal with all those unpleasant, unresolved issues and feelings that bubble up in the course of those nasty sessions- so that they can stay on track on and be effective. One of the most disconcerting subjects, as regards to couples therapy, involves those individuals who counsel couples but have been unable to maintain a marriage themselves... anyone unable to follow the prescription that they dispense to others is probably either doling out the wrong prescription or lacking the very skills that they purport to inculcate in others. Personally, I would trust and enlist the aid of the good-natured couple who lives across the street and been married for 45 years, over that of a therapist who cannot sustain a marriage for him or her self. There's proof in the sustained achievement of mutual repect, compassion, and admiration.
March 4, 2012 at 10:01 a.m.
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Kay

Indiana

My parents did couples counseling, enough to get them over rough spots and allow them to keep their marriage going long past when it would have otherwise ended. the result is that their children grew up in the middle of a cold war, with an incredibly angry mother, with our only up-close example of a marriage as one in which passive-aggressive and snark were the norm. I have no idea why people, esp women (and I am one), think it is better to stay together for the sake of the children. I DO understand the economics of divorce, but there is nothing at all wrong with ending a relationship that isn't working - even if there are children involved and even though it is painful. Why CAN'T that be the goal? My

mom, now remarried almost as long as she was married to my father, still says that she didn't want a divorce. This is crazy to me. I do not understand the obsessive need to stay in at all costs. If I was a therapist dealing with these dynamics, I'd be very stressed indeed.
March 4, 2012 at 9:52 a.m.
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frank

providence, ri

Couples therapy changed the dynamic of my former marriage. The therapist so obviously favored me that it became embarrassing. I would give long sound explanations of why my former wife was driving me insane and she would be her passive-aggressive self and say almost nothing. The therapist, of course, then shut me up, giving her space, but my former wife never said more than two words, so eventually he gave up and we had less and less to say. I decided to quit since things had gone no where but the lasting change was that I decided that if the therapist couldn't get her to talk about her resentments and version of correcting things, I certainly couldn't by badgering her. So I stopped talking. I gave up. On some superficial level this helped things for many years, nothing exploded outright, but what we then had was an abandoned marriage which merely took much longer than it should have to disappear. Did the therapist help? No. I had married a woman who was interested in having, basically, children. Nothing much else. So, I would amend the above article -- it's not really about things festering even, marriages fail before they start. And modern women may merely want children, not husbands. The stat about 59% of women under 30 having children outside of marriage bears this out.
March 4, 2012 at 9:52 a.m.
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12

American Abroad

Near Munich, Germany

I wish there had been more social support of our marriage when my husband's occasional overindulgence in wine quickly (during a high stress period in his worklife) became full-blown alcoholism, complete with blackouts. When he started an affair with a barmaid where he had begun to go drinking while I was

still at work (without ever even once saying he was unhappy with our marriage), mutual friends knew about his betrayal, but no one told me. No one talked to him. No one asked him if he had thought about this. None of them did anything but lie to me and cover up his affair and then later his and his barmaid's plotting to take as much property and money from me as possible. This was so unlike my husband that several friends feared he had a brain tumor! When acquaintances finally told what he was doing, I tried to find help from local therapists but there was no one who worked to help people in situations like mine, where one spouse had suddenly changed dramatically and wanted out, but the shocked, betrayed spouse wanted to see if their marriage could be saved. He was a good husband for a decade; he seemed to be in a huge crisis and wasn't himself. I wanted my husband back; I'd have tried to fix things. I didn't discover until too late about therapists like Michele Weiner-Davis (divorcebusting.com), who work hard to help couples save marriages. She helped two of my friends and her books saved the marriage of my neighbors. Seek a pro-marriage coach if this happens to you!
March 4, 2012 at 9:51 a.m.
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RN

NYC

What exactly did you expect a therapist to do to stop your husband from being a rampant alcoholic with blackouts? Other than involuntary committment, how would anyone stop a grown man from consuming alcohol and cheating on his wife?
March 5, 2012 at 12:12 p.m.
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native mnhattanite

New York

I fee that this article is poorly researched and the sources quoted do not cover a broad geographical base. (mainly California and the Midwest). Furthermore, the article is too brief, too 'glib', and discuss 'old' theories and therefore is not qualified to address this important topic. I do hope this reporter, or another one, will pick up the 'thread' of this article and write a thoroughly researched,

balanced piece on couple or individual therapy. I do agree that there are many therapist who are not qulaified or trained or licensed in this area. This may be one of the biggest problems. But it is similar in other fields, including medicine, teaching, law, and also finance.
March 4, 2012 at 9:49 a.m.
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Lee

Moosehead Lake

Couples therapy for me was a complete joke. The therapist sided with my husband who was acting like a jealous freak and validated some very bad behavior of his. It was surreal and thinking back (this was 20 years ago) I realize that the therapist was an idiot in over his head, woefully unqualified, who probably thought he needed to side with the guy who was paying the tab.
March 4, 2012 at 9:49 a.m.
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Rudolph

New York, NY

A rather incomplete article. Next time include statistics of the marriage and divorce rate of such therapists. I bet you 10/1 that their marriage rate is less, and the divorce rate and anger in the divorce process much higher that the US average.
March 4, 2012 at 9:49 a.m.
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Rudolph

New York, NY

Also a fast way to solve the problem is to force husbands the same pills we give 6 year old kids now so they concentrate better at school (i.e. stop day dreaming, looking outside the window, etc.) - will do wonders in terms of loosing all interest in short-dressed ladies on the subway.
March 4, 2012 at 11:00 a.m.
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Margaret Kim Peterson

King of Prussia, PA

Have I missed something, or has there thus far been no mention, in the article or among the commentators, of the branch of professional mental health that deals directly with relationships and families, namely, Marriage and Family Therapy (MFT)? Not that good couples/family counseling can't be found with professionals who hold other credentials (I've had great experiences with several LCSWs--Licensed Clinical Social Workers), but all MFTs are trained to work with couples and families, whereas mental health professionals who hold other credentials aren't necessarily thus trained.
March 4, 2012 at 9:47 a.m.
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Joel Bergman

New York, NY

I have trained many marital and family therapists over the past 40 years, and there is no guarentee from my perspective that therapists with MFT degrees are better trained or more effective than professionals holding other degress like MSW, PhD, or MD. So, buyer beware. If you like your therapist and begin seeing change quickly, you are with the right therapist for you. If you don't like the therapist or see change after a few sessions, change therapists. ASAP.
March 4, 2012 at 3:35 p.m.
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Dr Joel Berg,am

New York, NY

I totally disagree with Margaret. I have been training couple and family therapists for over 40 years, (14 years as Senior Faculty at the Ackerman Institute for Family Therapy), and find that there is no guarentee between being a trained MFT and doing effective couple therapy. My students at Ackerman were mostly MSW, PhD and MD seeking addiitonal training in couple therapy, and they did fine without the MFT. Buyer beware. If you like your therapist and begin seeing change in the marriage, fine. If not, get out and fine another therapist who will be mroe helpful.
March 4, 2012 at 3:35 p.m.
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David

New York

Joel Bergman completely distorts Margaret's comment. He is supposed to be a sensitive therapist and he can't even understand the basic logic of her comment. She never said there was a guarantee. She only stated two basic items: 1) she asked for confirmation that there had been no mention of MFT and 2) she stated that all MFTs are trained to work with couples and families whereas other professionals aren't necessary so trained. These are rudimentary points. She even stated that she had had good experiences with other professionals. Then Dr. Bergman jumps in and announces that he "totally disagrees" with something that Margaret never said.
March 5, 2012 at 12:12 p.m.
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Shawdddy

Atl

My wife and I had terrific results from a husband wife team in Seattle, the Gottfried Institute. They have developed a very scientific-method derived approach. It is very scientific - and very intuitively clever. We had previously been a part of the horrific dynamic described where one of the couple members (me) was felt alienated by the therapist and the other developed an allegiance. The process naturally broke down. My wife's perseverance allowed us to be divinely led (my view) to Gottfried. Life is richer than ever. I am so looking forward to the rocking chairs on the porch.
March 4, 2012 at 9:47 a.m.
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Shelley

San Francisco
RECOMMEND

I believe you are referring to Gottman, not Gottfried.


March 4, 2012 at 3:35 p.m. 3

Stephen J

New Haven

I certainly agree that couples work is stressful - and that many supposedly wellqualified therapists aren't very good at it. (It was never my long suit, so I did very little of it.) When I was in training, we were taught a standard strategy for conjoint family therapy. When you have two or more family members present, you need two therapists as well. This helps in several ways. First, you aren't outnumbered as badly. Second, if one therapist is being cast as the ally of one partner, then the other can compensate for this. Third, the two therapists can work together in a strategic way - signalling to one another like a tag team, if you like - and model a more effective partnership to the couple. It's still stressful, but at least you aren't alone in there!
March 4, 2012 at 9:47 a.m.
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Anonymous

New York, NY

I was in a family therapy session with two therapists and two family members. Both of the therapists started to act as the ally of the other family member, so I left that therapy completely. There were two therapists and two family members but the two MDs started to gang up on me. This happened even after I told these therapists that my father had been diagnosed with Narcissistic Personality Disorder by my previous therapist and that relatives and others had problems with my father, they dismissed my comments at the beginning. I know that doctors change their minds, so I was supposed to keep proving myself to them, but it was tiring; I had already presented a fair amount of evidence; and why should I trust doctors who ignored a lot of evidence? I find psychiatrists are too often contrarian just to see if the patient really means what they are saying. It's exhausting and leaves me feeling worse than before I entered therapy.
March 4, 2012 at 8:59 p.m.
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MDK

NJ

If this article is journalism, perhaps the snarky and editorial comment "(Great, right)" should have met the red pencil.
March 4, 2012 at 9:46 a.m.
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BobCMe

Portand Me

Six years before seeking help? The bitterness of six unhappy years will always be there and I doubt that any kind of counseling is going to help.
March 4, 2012 at 9:46 a.m.
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Faith

Ohio

Couples Therapy was one of the most loathesome, ineffective and hauntingly remorseful experiences of my attempt to save my marriage. Maybe me and my ex-spouse just got stuck with the biggest dud out there.
March 4, 2012 at 9:45 a.m.
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SG

St. Louis, MO

The best advice we got was from my wives aunt, who is a doctor, and believed that "Marriage is a 20-year institution. People were never supposed to live so long together." While this might be a bit negative, it provides for no-fault divorce or separation as a possible and realistic goal of marriage without guilt or anxiety. After which both parties are free to live the next phases of their lives. After all who has ever kept a best friend for 20 years after spending every day together intimately?
March 4, 2012 at 9:45 a.m.
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11

woody3691

new york, ny

Having gone through couples therapy I can say that it's useful as a strategic or tactical maneuver to end a destructive, dysfunctional relationship. Often the therapist isn't let in on this secret by the fed up partner. So they struggle trying to find a middle ground so the couple can continue their failed relationship. What is difficult for many people to do is to end a bad relationship, no matter how sincerely they want out. So they seek the aid of a third party to mediate their separation. They want someone to pass judgement that this relationship is hopeless. All of the strategies the therapist employ for honest arguing is wasted energy. It's surprising that therapists aren't more attuned to the simple reality that two people in love don't need any help. It's when the love is gone or was never there that the therapist can assist in a rapid and less painful split.
March 4, 2012 at 9:45 a.m.
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Minerva19

Rockland, Maine

i have to agree with you and that is not a bad role for a really good therapist. Therapists should not underestimate their ability to help a toxic relationship end well especially if there are children involved. People often lack basic skills in how to treat one another, fight respectfully, not bully, bite your tongue before going personal. There is much to learn and much to teach.
March 4, 2012 at 10:55 a.m.
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julie Roberts

San Francisco, California

I have found working with couples to be deeply engaging and sometimes frustrating . Over the years I realized what frustrated me was how difficult it was for each of the two members of a couple to find the psychological space to be present for the other person, which usually was because they were so engaged in defending themselves or wanting the other to respond to them. To address this issue, I spent the last few years designing an on line process that I thought would help. Its called Truceworks.com

I wanted each person to have a space to express themselves and how they were feeling but also to learn and have create the space to pay attention to the other persons needs and feelings. I developed the interactive process to simulate communication patterns that encourage relatedness ; both to re- create the developmental/relational needs that exist in forming an attuned attachment, but more generally to allow space for each person to relate to their own feelings and to those of the other. It is a written process so that the escalation that can occur in face to face therapy , hopefully, is not so likely to happen. It is not a substitute for face to face couple therapy, but something to use as an adjunct, or can be used independently to learn to communicate more effectively. I have used the ideas that the website has developed in my work with couples and they seem to be very useful. Julie Roberts MFT San Francisco
March 4, 2012 at 9:44 a.m.
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herbivore

West Chester PA

From past experience with couples therapy, you have many practioners in the field that are frankly unqualified. And just as a doctor finds it difficult to be proficient in all fields of medicine, I think psychologists should also have an advanced credentialing process to help weed out faulty practioners, many without any specific training, and to help consumers identify effective practioners. To now know that the underlying therapies are equally untested, I'd say your field needs some type of oversight beyond what it receives now. I guess that is why many feel they wasted their money, time, and energy on this often recommended therapy.
March 4, 2012 at 8:14 a.m.
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Kevin Lyness

NH

Try looking for Licensed Marriage and Family Therapists, who have specific training for working with couples.
March 4, 2012 at 9:51 a.m.
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Dave Trindle

New Hope, PA

Managed Care is a large part of the problem. It's nearly impossible to make a living as a therapist. As a result, virtually every therapist includes "relationship counseling" in their list of services so they can get as many clients as possible. Yet they may see only the occasional couple. They miss the point that Couples Marriage Counseling is not a modified form of individual therapy. It is an entirely different art. Don't go to a generic therapist. Find one whose primary practice and training is Couples Therapy. Before you go to a therapist, ask them if they are basically a full time Couples/Marriage Counselor. This doesn't guarantee they will be good, but at least you're shopping in the right aisle... I am a Marriage Counselor and I have commented elsewhere on this terrible, distorted article. Marriage Counseling Works! It saves marriages. It brings people closer. It saves families. It brings more joy into family life, and greatly reduces the pathological stress that permeates our society. If it's not working for you, then find another counselor. It's worth the effort. It certainly was in my case.
March 4, 2012 at 3:35 p.m.
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Tam

Austin, TX

I'm so sorry to see the misuse of the word "theory" in this article: Most psychological theories about change are just that, theories, Dr. Pinsof says. In science, a theory is an explanation that is well supported by empirical evidence. The theory of evolution is one good example. The theory of plate tectonics is another. I find myself wishing that Dr. Pinsof had said "Most psychological explanations about change are not yet theories, they are really just hypotheses at this point." But I'm a dreamer! The use of the everyday meaning of "theory" in a discussion about what some

people consider science can contribute to the confusion that often arises when science is discussed in public discourse. Maybe we need another term for the everyday use of "theory". Any nominations?
March 4, 2012 at 8:13 a.m.
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Lynn

New York
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Guess
March 4, 2012 at 9:46 a.m. 1

Kevin Lyness

NH

When I teach therapy, I always try to use the term "models of therapy" rather than "theories", as this term seems to be a better fit.
March 4, 2012 at 9:51 a.m.
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Geneva, NY

One underlying assumption in this article is that the primary goal of couples therapy is keeping a marriage/relationship together. This is not always true. There are times when separation/separation is the best solution even for the children. Relatively conflict free relationships of separated parents may be better for everyone, including children. Janna MSW
March 4, 2012 at 8:10 a.m.
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Ken

Cherry Hill, New Jersey

My own experience as a therapist suggests that couples therapy has been one of the least gratifying and least successful of the things I have done. People are set in their ways and, if they are going to change, it usually stems from their individual determination, not because of something that has happened in the relationship. The couple is in crisis, but that does not mean that both are at a

point in their lives to change. That said, I have also thought a lot about what it means for therapy, any form of therapy, to "work." I am often awed by feedback I sometimes get to suggest that something I said or did which may have seemed incidental or of which I was unaware had a big impact on someone's life.. I've also been struck by how, one of the most powerful signs that therapy has worked lies in the "no shows." This has caused me to abandon a concept from my training, "resistance." If a person fails to come or call and abruptly stops therapy, I always keep in mind this may be a sign that the treatment was a success. I've sometimes gone to my doctor with a problem, been given a treatment and a follow-up appointment. What do I do if the treatment works? I don't come back. Hopefully, I'm courteous enough to call and cancel. So what does it therapy to work? Cure the person? Correct the problem? Have an influence on that person's life? This is worth consider when we ask if the intervention worked. Kenneth Goldberg, Ph.D. www.drkengoldberg.com.
March 4, 2012 at 8:10 a.m.
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Anonymous

New York, NY

Isn't it more likely that the no-show was due to a patient losing patience with the therapeutic process? When I skipped therapy sessions it was due to me finding them to be a waste of my time and money, not because I felt like therapy had cured my problems. When I felt like therapy had helped me, I told the therapist directly and I asked to start thinking about a new issue. I kept attending therapy when I thought the therapist was helpful. If I was going to conclude therapy because my problems had been cured, I would have thanked the therapist. That never happened.
March 4, 2012 at 9:08 p.m.
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RN

NYC

I once asked my psychiatrist from whom I received excellent psychpharmacolical management for anxiety whether some short-term talk therapy would be warranted. He does not practice psychotherapy. He remarked that he was the wrong person to ask. In fact he did not

believe in any form for someone like me that would be paid for by insurance. Furthermore, when I asked why he opposed therapy, he said something to the effect that..."Who wants to live that way, going to sessions twice a week for years?" He was right! It may have been an incidental remark to him, but for me it was permission to NOT delve into my drivel!
March 5, 2012 at 12:12 p.m.
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SBH

Chicago, IL

This article highlights some of the issues that come up when discussing couples therapy. There are two issues I feel warrant the focus of attention when further examining this therapy. First is the point raised by Doss; couples often wait too long before seeking treatment. The field of mental health is similar medicine in that untreated illnesses only worsen over time. Too often we try to preserver through overwhelming difficulties often due to stigmas surrounding therapy. Failing to properly and appropriately seek professional help, when needed, often seals the fate of a relationship. The other point raised, mentioned the best treatments are based in attachment theory. From my studies in graduate school in psychology, this conceptualization has a strong backing in theory, and is gaining a backing in research, particularly with child rearing and the relationship between the parents and the child in infancy. Many relationships we have with others are not always healthy in the sense that we (or they) are unable to view the "other" in a genuine manner constructed of individual and separate needs and priorities. We often see people in the manner we wish or believe them to be, rather than as the whole individual they are. For couples with relational issues, this opaque view of the other may be a precipitating factor, which once enough evidence (e.g., behavior) has been observed to challenge the idealized version we have implanted in our mind, an increase in distress occurs.
March 4, 2012 at 7:36 a.m.
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JFierstein

Phoenix

Thanks to the contributors of the article for validating what I feel at times as a couples therapist. The idea that the average couple is unhappy for six years before seeking couples counseling is disconcerting, although probably accurate. If couples could be more proactive in seeking treatment, it would make a big difference. I think younger couples are getting counseling earlier, because they don't want to make the same mistakes of their divorced boomer couples. As a counselor for men and couples in Phoenix, AZ, I work to make men feel comfortable in a setting that is quite often foreign and alienating to them. If men can find the benefits of counseling, and relate to their therapist in a meaningful way, they're less likely to want to quit, and less inclined to be "dragged" back to counseling week after week. Check out my blog on men, men's issues and couples tips at www.phoenixmenscounseling.com.
March 4, 2012 at 7:36 a.m.
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Faith

Ohio

And how much effort do you spend on ensuring your female patients in couples therapy are comfortable and want to come back? I'm not a therapist but if I were, I'd rethink any attempt at generalizing what an individual feels about anything, whether based on gender or whatever else. I can imagine it's next to impossible to keep bias, stereotyping, and the therapists' own life experiences out of the responses, reactions, and assumptions a therapist can make. Each one of your patients will be unique regardless of your preconceived notions.
March 4, 2012 at 9:46 a.m.
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JFierstein

Phoenix

@Faith: I spend a lot of time ensuring my female patients come back, actually. Although my focus is with men, the sessions are very non biased, and I try to communicate caring, empathy and warmth to both

parties. My client is the relationship or marriage, but my point is that sometimes men feel more alienated from the beginning. It's usually women who call me because they think I'll be able to provide that kind of setting for their guy, which is usually their primary concern for successful couples counseling.
March 4, 2012 at 10:58 a.m.
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RN

NYC

That your client is the relationship or marriage is figurative at best. There are no such entities as relationships or marriages. There are only individuals livig lives together.
March 5, 2012 at 12:12 p.m.
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Chickenlegcrew

NYC

If my couples therapist claimed he needed to be a "ninja," I would fire him on the spot. What an embarrassing thing to say. Why not go teach Tae-Bo at Chelsea Piers while you're at it? Couples therapy saved my marriage. Our therapist didn't practice martial arts on us; rather, he gave us the tools to express our feelings to each other in a nonthreatening way and get to the roots of some of our problems. My wife and I wanted to stay together and work out our conflicts. That's the most important factor, I think, in whether a couple benefits or not from therapy.
March 4, 2012 at 7:35 a.m.
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Kaleo

Kaneohe, HI

First the Times prints nonsense about the physical and sexual dangers of yoga; now it paints a negative image of couples therapy? What's next?

No skilled therapist is ever passive. Nor does s/he keep saying "uh-huh." Moreover, couples do not usually seek to change the other person. Often, they really do want to improve their relationship. Working with couples is not easy but it is nowhere as stressful as this article makes it appear.
March 4, 2012 at 7:35 a.m.
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Diana

Charlotte, NC

I just finished grad school for Counseling, and YES, all they wanted me to say was "uh-uh, tell me more about that... What does that mean to you? How do you feel about that?" And then do a recap of what the client just said. I'm not kidding! They threatened to flunk me because I wouldn't do just that. I'm drawn to couples counseling and I'm glad to hear that passive stuff doesn't work, because it doesn't work for me.
March 4, 2012 at 3:35 p.m.
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William R. Cumming

Reedville, VA

Well did this for five years with my therapist--male-- and her therapist--female- and I thought it worthwhile as to insights from both and even some from wife. Each paid his/her own way. End result no marriage.
March 4, 2012 at 7:35 a.m.
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Dave Trindle

New Hope, PA

I never allow my clients to yell at each other or disrespect each other or disrespect me in any way. The key to marriage counseling (and marriage) is, first and foremost, respect. Respect is the foundation. You cannot have love without respect. My job is to apply a structure and set of rules to the dialogue where couples can express their most difficult emotions in a safe, gentle and

respectful way. The structured dialogue method was developed by Harville Hendrix, author of "Getting the Love You Want." It is a pleasure to a joy to provide this kind of counseling. I love my job, and I am not stressed out. There is a website called GettingtheLoveYouWant.Com that will locate a trained therapist near you. They use a dialogue method. And, believe me, there is no yelling. I am continually seeing married couples fall in love again and it is a beautiful thing. My experience is that it is successful 80% of the time (excluding couples with addictions, physical abuse, or mental illness, in which cases, the underlying problems must be dealt with first before starting Marriage Counseling). I wish more people knew about it. I first learned about it 20 years ago when my wife and I were lucky enough to find a couples counselor using a structured dialogue approach. We continue to use the dialogue in our marriage, as needed, 20 years later. As a result, my moments of greatest fulfillment and joy are with my wife (close second are grandchildren)...David Trindle, LPC, Marriage Counselor
March 4, 2012 at 7:34 a.m.
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justjojo

washington

Interesting article. When I sought out a marriage therapist 17 years ago, I was desperate to save my marriage. At the time my husband was having an affair and I was devastated at home with a 2 year old. I saw our therapist as a savior, as someone who was going to see our mess from an objective perspective and help us find a way to reconstruct the relationship. In the end, it was a very disappointing experience and when I had had it one day and right in the middle of the session announced that I would be leaving my husband and taking my son with me, she did nothing... In the end, my marriage didn't survive the therapy. I had really hoped for much more engagement on her part because I really WAS lost and needed help. Sometimes I wonder if we would have survived if she had been less a therapist and more a mechanic. The only thing I do know is that I put a couple thousand dollars in her pocket for naught.
March 4, 2012 at 7:33 a.m.
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Rosie Red

Cinti

I had the exact same experience. The therapist covered himself by saying at the very beginning, "Our goal will not be to save your marriage necessarily , but, if it can't be saved, to at least make its ending more orderly." That should have been a clue. You have no chance of attaining something that is not your goal.
March 4, 2012 at 8:09 a.m.
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Stephen J

New Haven

For naught? I don't know. You started out desperate to save a marriage with a man who seems to have started an extramarital affair while you were nursing a baby - probably feeling helpless and needy. In the end, you got out. Maybe the therapist in question could have moved things along faster, but the ending sounds appropriate - unless your partner had been really ready to make some changes, no intervention would have had much of an impact on him. I hope you have found happiness since, and that your son or daughter is a thriving young adult.
March 4, 2012 at 9:47 a.m.
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Neal Jettpace

Indianapolis, IN

"Maybe the therapist in question could have moved things along faster, but the ending sounds appropriate - unless your partner had been really ready to make some changes, no intervention would have had much of an impact on him." -- Stephen J And no intervention would have also saved justjojo a couple of grand, with exactly the same outcome. That's the entire point here.
March 4, 2012 at 3:35 p.m.
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