Counseling Today, Cover Stories

Looking in the mirror

Jim Paterson May 15, 2009

Society has long recognized the positive impact that a sturdy adult relationship can have not only on the individuals who have united to form a couple but on the emotional health of those in the couple’s sphere of influence. These relationships help define us and, some say, strengthen our society.

For nearly 80 years, the discipline of couples therapy has strived to solidify these relationships. But today, couples therapy has come into its own with what advocates say are stronger and more successful approaches as well as a growing reputation for providing its diverse clientele with popular psychoeducational supports.

In their exhaustive 2002 history of couples therapy for the journal Family Process, Alan S. Gurman, director of family therapy training at the University of Wisconsin Medical School, and Peter Fraenkel, director of the Ackerman Institute for the Family’s Center for Work and Family, note that although couples therapy has not occupied its own place in textbooks, it has been helping couples for decades. “Couples therapy is an area of psychotherapy practice that is long on history but short on tradition,” they wrote, adding that early marriage counseling centers set up shop in the early 1930s, generally manned by other types of professionals, including clergy and gynecologists.

There have long been differing views concerning whether couples therapy should fall under the family counseling umbrella, where Gurman and Fraenkel contend it languished without notice until the 1980s, even though it was a major part of what family counselors did. Until the 1960s, nearly all couples counseling took place in separate sessions with each individual partner.

“A couple is a unique system where one can find the most intimacy, friendship and comfort, as well as the greatest hurt, so couples therapy presents very specific challenges that require special expertise and a different viewpoint,” says American Counseling Association member Mark Young, professor of counselor education at the University of Central Florida and coauthor of Counseling and Therapy for Couples. He has witnessed couples counseling gain strength as an independent counseling specialty while growing in interesting new directions. However, there is more work to be done, says Young, who is also a member of the International Association of Marriage and Family Counselors, a division of ACA.

For example, in his recent book Infidelity: A Practitioner’s Guide to Working With Couples in Crisis, ACA and IAMFC member Paul Peluso notes that unfaithfulness has not received enough attention in the field despite its prominence as a cause for marital instability. “About 55 percent of couples seeking therapy either report immediately that infidelity occurred or eventually disclose it,” Peluso says. “Ninety percent are unhappy enough in the relationship that they say it might warrant an affair. But in a 1997 study, counselors reported it was the issue they were least prepared to deal with — and the hardest one to tackle.”

Even as couples therapy grew in popularity and gained its own stature, a nagging question remained about its effectiveness. “In fact, many people believe that it has often caused relationships to deteriorate,” says ACA member Nancy Buck, a developmental psychologist and specialist in human motivation. Relationship counseling might actually appear to make matters worse because it brings to light issues that already existed, she explains. In addition, Buck points out, clients often come to couples counseling only when their situation has deteriorated beyond the point at which it can easily be repaired. Still, she says, “I think that perception (that relationship counseling can actually be harmful) is changing — and for good reason.”

Among the significant evolutions in couples counseling has been the gradual move away from encouraging individuals to clearly voice their complaints and describe their own needs in an effort to change their partner’s behavior. Most couples theory now calls for the individual to take more personal responsibility for his/her actions and level of satisfaction in the relationship.

As early as the late 1960s, Virginia Satir, who wrote several popular books about marriage, not only identified structural problems that caused marital difficulties but also noted that development of the individual’s self-actualization and self-esteem should be an overriding goal. In announcing his ground-breaking work with the late Neil Jacobson in 1997, Andrew Christensen, professor of psychology at the University of California, Los Angeles, stated that traditional couples counseling was at best helping half the clients because it was “change focused.” In a UCLA news release, Christensen said, “The pressure to change is often a barrier to change rather than a facilitator of change.” Christensen and Jacobson claimed that their new “integrative” approach was showing a nearly 90 percent success rate at the time.

“The focus of integrative couples therapy is on having couples accept and tolerate the differences that often exist between partners rather than having them try to change their spouses,” the two colleagues stated in announcing their approach.

Today, theory about the individual needing to work on his/her own issues rather than focusing on a partner’s perceived issues is both accepted and trumpeted. In its April 2009 issue, Psychology Today interviewed leading couples counselors and offered this advice to its readers: “If you want to stay in a relationship, something has to change. In all likelihood, it’s you.”

Issues of semantics and identity have often clouded this specialized area of work. For example, should it be referred to as couples counseling or couples therapy? Is there actually a distinction between the two? If so, how can it be expressed clearly so that the general public (and, for that matter, counselors themselves) understand the distinction? How does it fit into or relate to the practice of marriage counseling and family therapy?

ACA and IAMFC member Jon Carlson, Distinguished Professor of psychology and counseling at Governors State University and the author of several counseling books, offered the following view: “Counseling seems to me to be different from therapy. Counseling seems to be interested in helping a wider range of couples concerns. Counselors are concerned with prevention and education as well as remediation, while therapists focus on problems and remediation. However, the distinction between therapy and counseling does not seem to be a big deal among practitioners. The difference between marriage and couples seems to be more of a political/philosophical issue. Marriage therapy is for those who are legally bound in marriage. This seemed to discriminate against gay and other committed couples who were not legally ‘married’ but nonetheless a couple.”

Peluso adds that, today, couples counseling is more often viewed as being “unique and separate from family counseling. Prior to this, the emphasis was on family therapy, and the marriage and couples part was seen as more of an adjunct. The reality is that couples counseling deals with some complex dynamics that family therapy does not.” He acknowledges, however, that the two fields have areas that overlap.

A brief history

According to Gurman and Fraenkel, couples counseling has passed through four overlapping phases as it has stutter-stepped forward.

Phase I — Theoretical marriage counseling formation (1930-1963): Within this phase, four stages were identified — the field was born, became established, was legally recognized and began to develop its own literature and studies. Interestingly, the first marriage counseling clinical institutes emphasized premarital education, hinting at the psychoeducational-preventative efforts that are increasingly popular today.

Phase II — Psychoanalytic experimentation (1931-1966): A “rebellious” group of therapists began to experiment more broadly as the field gelled, though the focus continued to be on working with partners individually in separate sessions. “I am not primarily involved in treating marital disharmony, which is a symptom, but rather in treating the two individuals in the marriage,” wrote influential therapist C.J. Sager. Because of its link to family therapy, which avoided psychoanalytical and psychodynamic interpretations, couples therapy remained somewhat static during this phase, according to Gurman and Fraenkel.

Phase III — Family therapy incorporation (1963-1985): Pioneering therapist Jay Haley was hugely influential, suggesting that family dynamics were key to the happiness of everyone, including the primary couple. “Marriage counseling did not seem relevant to the developing family therapy field,” he said. Gurman and Fraenkel note that “Family therapy had now not merely incorporated, merged with or absorbed marriage counseling and psychoanalytic couples therapy; it had engulfed, consumed and devoured them both.”

Phase IV — Refinement, extension, diversification and integration (1986-present): The couples counseling field would develop its own identity in the 1960s but remained somewhat stagnant until the early 1980s. This period saw feminism’s and multiculturalism’s influence on couples counseling grow, as well as the roots of new approaches such as integrative therapy begin to develop.

An integrative approach

During that final phase, Behavioral Marital Therapy (BMT) developed. The therapy was based in clinical research and initially focused on couples identifying desired changes in behavior and then talking about those new actions. Couples made agreements or contracts and learned new communication and problem-solving skills. But in the mid-90s, BMT grew into what is today one of the more popular approaches to couples therapy — Integrative Behavioral Couples Therapy (IBCT), in which the concept of acceptance became a primary part of the couple’s work.

To a large degree, this new line of thinking developed because approaches based in training couples to change proved not to be very effective, particularly in difficult marriages. Gradually, self-regulation on the part of both partners to achieve mutual satisfaction in the relationship was embraced as a key component to what was increasingly called “couples counseling” rather than “marital counseling.” The name was meant to be inclusive of those who were not married but were involved in a serious relationship, particularly same-sex couples.

Kathleen Eldridge, an associate professor at the Pepperdine University Graduate School of Education and Psychology, has written about and presented on IBCT, including at the 2008 ACA Conference in Honolulu. She explains that IBCT replaces couples counseling’s former emphasis on improved behavior and new skills with “cognitive change that suggests a difference isn’t a deficiency or right or wrong in a partner; it is just a difference.” The other partner’s response, including an awareness of his or her emotions, is key.

“Based on research about couples’ ability to make behavioral changes and maintain them long term, we have learned that only about 50 percent are able to make and sustain changes after traditional forms of couples therapy. So we need to help couples learn to accept those things that are less amendable to change,” says Eldridge, a member of ACA.

However, she notes that acceptance by one partner often ends up fostering the desired change in the other partner. What’s more, she says, this change comes about “more naturally” than with traditional therapy, in which one partner typically identified a problem in the relationship, while the other partner was “encouraged” to change. “These self-motivated changes are more likely to last,” she says.

In today’s multicultural society, counselors are more likely to see partners who have very different values, tendencies and traits, Eldridge notes, so acceptance may be an even more critical component. Others have noted that multiculturalism and feminism helped change modern thinking about couples counseling because they pointed to the differing perspectives partners can bring to a relationship.

In IBCT approaches, counselors help clients learn to accept rather than criticize their partner’s behaviors, while also developing constructive communication and conflict-resolution techniques. Couples are taught unified detachment, which allows them to step back from emotional responses (particularly hard, “blaming” responses) to identify patterns and better understand their positions. The goal of the therapy isn’t necessarily to change the behavior but the response to the behavior, without always expecting complete change, Eldridge says.

Emotions are key

Another important development, Peluso says, is the attention now given to the emotions that couples in relationship bring to conflict. In particular, he credits the groundbreaking work of John Gottman as well as Emotionally Focused Couples Therapy (EFT), championed by Sue Johnson, author of Hold Me Tight: Seven Conversations for a Lifetime of Love.

On her website, Johnson says clients must “recognize and admit that they are emotionally attached to and dependent on their partner in much the same way that a child is dependent on a parent for nurturing, soothing and protection. EFT focuses on creating and strengthening this bond and identifying and transforming the key moments that foster an adult, loving relationship.”

Johnson, who recently authored an article on the approach in Psychology Today, says certain steps can transform relationships:

  • Couples must identify negative and destructive remarks to find the root of the problem and understand their partner.
  • Each partner must look beyond immediate, impulsive reactions.
  • Couples should revisit a difficult moment to provide a platform for de-escalating conflict, repairing rifts and building emotional safety.
  • Injuries may be forgiven, but they never disappear. They need to be “integrated into couples’ conversations as demonstrations of renewal and connection.” Forgiveness strengthens a couple’s bond.
  • Couples find how emotional connection creates great sex, and good sex creates deeper emotional connection.
  • Couples must understand that love is a continual process of losing and finding emotional connection; it asks couples to be deliberate and mindful about maintaining connection.

Johnson dismisses thinking that says partners’ dependency on each another is improper or shows weakness. She claims we have a “wired-in need for emotional contact from significant others” and believes that therapy can help couples find ways to meet those needs for bonding and attachment, which creates relational harmony.

Gurman and Fraenkel say EFT reconnects couples therapy to the experiential work of Carl Rogers and Fritz Perls, explaining that it “sees marital conflict and harmony as dependent upon the degree to which the marital partners’ basic needs for bonding or attachment are satisfied.”

Gottman’s approach

High praise for Johnson’s book has come from Gottman, whom several leading experts cite as the key force in modern thinking about couples therapy. “He is a must read for any couples counselor,” Peluso says.

Gottman, a mathematician by training, developed techniques for predicting whether couples will break up. These breakthrough techniques included analyzing both the literal responses and the tone of those responses in interview settings, as well as reviewing body language and facial expressions.

“The assessment process is more extensive than any other I’ve used,” says Lisa Lund, a marriage and family therapist and Gottman specialist in Santa Rosa, Calif. “I especially like the information I get from the oral history interview, where the couple shares with me the story of their relationship from the first time they met up to the present moment. I learn a lot in these interviews about how they go through life together.”

Gottman has written several books with his wife, Julie, a clinical psychiatrist who is cofounder and clinical director of the Gottman Institute, which offers seminars and various self-study guides for couples as well as in-depth training for therapists.

Like Johnson, Gottman views emotions as a primary concern, along with the patterns in a relationship. He stresses avoidance of what he calls “the four horsemen of the apocalypse” in a relationship: criticism, contempt, stonewalling and defensiveness. He also suggests that therapists help couples to identify the strengths and positive aspects of their relationship in addition to their “life wishes.”

Gottman advises couples to seek help early on in their relationship, to avoid critical thought, to soften the start-up to a difficult discussion, to accept influence from each other and to have high standards, refusing to accept hurtful behavior. He also says couples should learn to exit a disagreement and repair damage before an argument gets out of control, even backing down from a strongly held position if no harm will be done. Each of these are central ideas in his well-known book The Seven Principals for Making Marriage Work.

“In a happy marriage, while discussing problems, couples make at least five times as many positive statement to and about each other and their relationship as negative ones,” Gottman says on his website. “A good marriage must have a rich climate of positivity.”

Lund says she has more than 50 interventions at her disposal through Gottman’s approach, including labeling and replaying the “four horsemen” and replaying a fight in which the argument is slowed down and evaluated step-by-step so the participants will better understand each other and what the disagreement was really about. “What appears to be a dumb argument about taking out the trash may actually be about something else entirely,” Lund says. Using Gottman techniques, the counselor coaches the couple in speaker-listener exercises so they will learn to ask open-ended questions in a way that “deepens their understanding of each other’s gridlocked position,” she says.

Making choices

William Glasser’s Choice Theory has long been associated with individual and school counseling, but a strong contingent of counselors are also putting his ideas to work with couples. Choice Theory encourages each partner to take personal responsibility for the relationship, set aside differences and work on current issues without necessarily expecting his/her partner to change, says ACA member Kim Olver, a speaker, author and relationship coach who has worked extensively with Glasser’s theory. The theory’s emphasis on relationships as a key to happiness seems to make it a natural approach for couples counseling.

“(Glasser) says the most destructive thing in a relationship is people trying to control one another,” says Buck, a senior faculty member at the William Glasser Institute. She explains that both partners must think about whether what he/she is about to do or say will improve the relationship. “You then support those things that work,” she says. “The brain tends to focus on what is wrong, and couples have to identify what is right.”

Olver says couples must be trained to treat the relationship as a third entity that, with attention from both partners, will help to meet each of the individual’s needs. “You may think you are going to get a couple into the counseling office and get them to change, but it doesn’t work,” she says, noting that partners can only control and take responsibility for their own actions and gain real rewards internally.

As Olver explains, Glasser recommends that counselors work on couples’ “deadly” habits — criticizing, complaining, blaming, nagging, threatening, bribing and punishing — while also promoting good “caring” habits such as listening, empathy, support, encouragement and trust. Counseling begins, she says, by asking both partners if they are committed to working on the relationship. In succeeding sessions, the couple talks about ways in which their relationship is working or not working and instances in which controlling behavior tends to rear its head. Olver also asks couples to do something intentionally every day for a week to improve their relationship and then to report back about the process. This step often leads to a dramatic change in the couple’s attitude, she says.

Glasser advises counselors to get clients to “focus on what counselees can do directly — act and think,” Olver adds. This means the couple should spend less time on things they cannot do directly — namely, change their feelings and physiology. Feelings and physiology can be changed, but only if there is a change in the acting and thinking, Olver says.

Glasser says the goal of his reality therapy is to “help people reconnect” with a specific plan and to focus on the present instead of symptoms and complaints. “Encourage people to judge all they are doing by the Choice Theory axiom: Is what I am doing getting me closer to the people I need? If the choice of behaviors is not working, then the counselor helps clients find new behaviors that lead to a better connection,” Glasser says on his institute’s website. His most recent book is Eight Lessons for a Happier Marriage.

Solution-focused and brief counseling are also being used extensively today in couples counseling. Like Glasser’s therapy, these approaches focus on the present, what the couple is doing right and how the relationship can move forward rather than dwelling on past wrongs or requiring behavior changes.

When there is an affair

Another trend in couples counseling is specific work on infidelity as a primary cause of relationship problems. The causes and effects of infidelity have been more closely studied in recent years, both in serious clinical studies and in the popular media.

Peluso, whose book on the topic provides chapters by key figures in couples counseling and therapy, says many counselors acknowledge that infidelity is an issue they are ill-equipped to handle, even though studies suggest 55 percent of couples eventually report an affair has occurred in their relationship.

He believes the topic of infidelity was previously undervalued in couples counseling for a variety of reasons. First, he says, for many years, the topic was simply viewed as taboo. Counselors were also unsure of what approach to use in helping couples heal from infidelity, questioning whether counseling should be trauma-, grief- or attachment-based. In addition, many counselors remain wary of the topic’s emotional aspects. “The emotions are so raw and intense with infidelity,” Peluso says. “It really stuns a lot of counselors. It becomes difficult to offer effective counseling and maintain a neutral stance in the face of that.”

Peluso recommends that counselors recognize the underlying dynamics of infidelity and assess the reasons for its happening. He adds that responsibility for the act of infidelity rarely lies solely with the partner who had the affair.

Peluso has developed a process for working with couples confronting infidelity in their relationship. The process begins by dealing with infidelity and its effects as a crisis that must be handled with the equivalent of medical triage, treating the vital concerns and stopping further damage. The partners must then decide whether they can still live together and how they will discuss the issue. Other steps include minimizing the damage and guiding the couple beyond their bitterness over the affair. This involves getting the couple to recognize that the act of infidelity is not the primary issue; rather, it is evidence of greater issues within their relationship that they must address.

Throughout the process, the counselor must be forceful, Peluso says. “The people involved are overwhelmed, and they want strong guidance from a counselor,” he says, adding that firm direction provided by a professional is often key to the relationship’s survival and future success.

Learning the art of the relationship

Society has long recognized the positive impact that a sturdy adult relationship can have not only on the individuals who have united to form a couple but on the emotional health of those in the couple’s sphere of influence. These relationships help define us and, some say, strengthen our society.

For nearly 80 years, the discipline of couples therapy has strived to solidify these relationships. But today, couples therapy has come into its own with what advocates say are stronger and more successful approaches as well as a growing reputation for providing its diverse clientele with popular psychoeducational supports.

In their exhaustive 2002 history of couples therapy for the journal Family Process, Alan S. Gurman, director of family therapy training at the University of Wisconsin Medical School, and Peter Fraenkel, director of the Ackerman Institute for the Family’s Center for Work and Family, note that although couples therapy has not occupied its own place in textbooks, it has been helping couples for decades. “Couples therapy is an area of psychotherapy practice that is long on history but short on tradition,” they wrote, adding that early marriage counseling centers set up shop in the early 1930s, generally manned by other types of professionals, including clergy and gynecologists.

There have long been differing views concerning whether couples therapy should fall under the family counseling umbrella, where Gurman and Fraenkel contend it languished without notice until the 1980s, even though it was a major part of what family counselors did. Until the 1960s, nearly all couples counseling took place in separate sessions with each individual partner.

“A couple is a unique system where one can find the most intimacy, friendship and comfort, as well as the greatest hurt, so couples therapy presents very specific challenges that require special expertise and a different viewpoint,” says American Counseling Association member Mark Young, professor of counselor education at the University of Central Florida and coauthor of Counseling and Therapy for Couples. He has witnessed couples counseling gain strength as an independent counseling specialty while growing in interesting new directions. However, there is more work to be done, says Young, who is also a member of the International Association of Marriage and Family Counselors, a division of ACA.

For example, in his recent book Infidelity: A Practitioner’s Guide to Working With Couples in Crisis, ACA and IAMFC member Paul Peluso notes that unfaithfulness has not received enough attention in the field despite its prominence as a cause for marital instability. “About 55 percent of couples seeking therapy either report immediately that infidelity occurred or eventually disclose it,” Peluso says. “Ninety percent are unhappy enough in the relationship that they say it might warrant an affair. But in a 1997 study, counselors reported it was the issue they were least prepared to deal with — and the hardest one to tackle.”

Even as couples therapy grew in popularity and gained its own stature, a nagging question remained about its effectiveness. “In fact, many people believe that it has often caused relationships to deteriorate,” says ACA member Nancy Buck, a developmental psychologist and specialist in human motivation. Relationship counseling might actually appear to make matters worse because it brings to light issues that already existed, she explains. In addition, Buck points out, clients often come to couples counseling only when their situation has deteriorated beyond the point at which it can easily be repaired. Still, she says, “I think that perception (that relationship counseling can actually be harmful) is changing — and for good reason.”

Among the significant evolutions in couples counseling has been the gradual move away from encouraging individuals to clearly voice their complaints and describe their own needs in an effort to change their partner’s behavior. Most couples theory now calls for the individual to take more personal responsibility for his/her actions and level of satisfaction in the relationship.

As early as the late 1960s, Virginia Satir, who wrote several popular books about marriage, not only identified structural problems that caused marital difficulties but also noted that development of the individual’s self-actualization and self-esteem should be an overriding goal. In announcing his ground-breaking work with the late Neil Jacobson in 1997, Andrew Christensen, professor of psychology at the University of California, Los Angeles, stated that traditional couples counseling was at best helping half the clients because it was “change focused.” In a UCLA news release, Christensen said, “The pressure to change is often a barrier to change rather than a facilitator of change.” Christensen and Jacobson claimed that their new “integrative” approach was showing a nearly 90 percent success rate at the time.

“The focus of integrative couples therapy is on having couples accept and tolerate the differences that often exist between partners rather than having them try to change their spouses,” the two colleagues stated in announcing their approach.

Today, theory about the individual needing to work on his/her own issues rather than focusing on a partner’s perceived issues is both accepted and trumpeted. In its April 2009 issue, Psychology Today interviewed leading couples counselors and offered this advice to its readers: “If you want to stay in a relationship, something has to change. In all likelihood, it’s you.”

Issues of semantics and identity have often clouded this specialized area of work. For example, should it be referred to as couples counseling or couples therapy? Is there actually a distinction between the two? If so, how can it be expressed clearly so that the general public (and, for that matter, counselors themselves) understand the distinction? How does it fit into or relate to the practice of marriage counseling and family therapy?

ACA and IAMFC member Jon Carlson, Distinguished Professor of psychology and counseling at Governors State University and the author of several counseling books, offered the following view: “Counseling seems to me to be different from therapy. Counseling seems to be interested in helping a wider range of couples concerns. Counselors are concerned with prevention and education as well as remediation, while therapists focus on problems and remediation. However, the distinction between therapy and counseling does not seem to be a big deal among practitioners. The difference between marriage and couples seems to be more of a political/philosophical issue. Marriage therapy is for those who are legally bound in marriage. This seemed to discriminate against gay and other committed couples who were not legally ‘married’ but nonetheless a couple.”

Peluso adds that, today, couples counseling is more often viewed as being “unique and separate from family counseling. Prior to this, the emphasis was on family therapy, and the marriage and couples part was seen as more of an adjunct. The reality is that couples counseling deals with some complex dynamics that family therapy does not.” He acknowledges, however, that the two fields have areas that overlap.

Jim Paterson is a writer, editor and school counselor living in Olney, Md. He is a frequent contributor to Counseling Today. Contact him at jamespaterson7@gmail.com. Letters to the editor: ct@counseling.org.