Brief Marital Therapy
Marital or couples therapy works somewhat differently than individual therapy in that the therapist
thinks of the couple as a whole as his or her client rather than either of the partners considered
separately. Treating the couple as the client keeps the focus of therapeutic discussion more firmly
fixed on healing the couple's troubles, and helps the therapist resist siding with one of the partners
at the expense of the other.
Marital therapy works best when both partners are physically and emotionally present. It can be
initiated by one of the partners in the absence of the other, but it cannot effectively proceed unless
both partners are willing to attend and be engaged by the process. Therapy is worth initiating even
when one partner will only attend under duress, but it is unlikely to produce useful change if the
unwilling partner remains disengaged throughout the process.
There is no single 'marital therapy'. Rather, there are different schools of marital therapy, and
therapists often pick and choose techniques from among these schools in eclectic fashion. Even so,
therapists trained in particular mental health professions will often most closely ally themselves
with schools favored by those professions. For example, social workers tend to favor techniques and
perspectives drawn from the ecologically-oriented 'Family-Systems' school, and psychologists tend
to draw on Psychodynamic, or Cognitive-Behavioral techniques and perspectives. Though it can be
fairly said that all surviving techniques and perspectives have merit, those drawn from the
behavioral school have received the most scientific scrutiny, and are consequently most
standardized, understood and evidence-based.
Marital therapy generally takes place outpatient-style in a therapist's office and is offered once per
week with each session lasting between 60 and 90 minutes. One or two therapists may be present in
the session. When two therapists are present the process is called 'conjoint' therapy. The number of
therapy sessions will vary according to the severity of the presented problems, the therapist's
training and technique, and (unfortunately) the couple's ability to pay for services. Many insurance
plans will provide partial coverage for marital therapy. Although some therapists will suggest that
significant change can be made in one or two sessions, it is more likely that between 8 to 12
sessions will be required before significant and lasting change might realistically occur. On the
other end of the spectrum, therapies that last for more than a year or so without producing results
are not likely to produce results. In such cases, troubled couples might consider working with a
different therapist with a different approach, or to rethink the viability of their marriage.
Indications
Difficulties which may include estrangement and loss of loving feelings, communication problems,
affairs, mismatched expectations, and competitive struggles to determine whose vision and goals
will dominate. Couples that have the best chance for recovery are those who are both motivated to
keep their marriage alive.
Contraindications
Couples who arrive at martial therapy with one or more partners ambivalent with regard to whether
to remain committed to the marriage, whose problems are more severe or are characterized by more
disengagement, or who are unwilling or unable to compromise are less likely to successfully work
things out. Couples who arrive at therapy with one of the partners already emotionally disengaged
from the other may be beyond help.
Concepts in Marital Therapy
Safety. First and foremost, therapists work to provide a trustworthy and safe environment which can
contain and manage couples' anger, frustration and contempt. Therapists remain neutral and do not
take sides. They maintain confidentiality and privacy. They limit angry and hysterical emotional
displays. They promote calm problem solving. In general, they provide a space in which it becomes
possible for couples to step out of defensiveness and work on problems in a productive and rational
manner.
Normalization and Reality Testing. Experienced therapists have "seen it all before" and are able to
help couples to understand when their desires and expectations (of each other and/or of themselves),
indiscretions and reactions are normal and when they are unusual, inappropriate or even abusive.
Such feedback from a relatively objective third party can provide a needed reference point which
partners can refer to during their negotiations.
Traffic Control. Conflicted couples often become easily defensive and have difficulty listening to
each other. Therapists function as traffic cops to make sure that partners take turns talking and
listening to each other, no one is shut down and unable to speak and all have a better chance to feel
listened to than would otherwise be possible.
Skills Education. Therapists teach problem solving skills which can help couples gain tools to help
them better address and manage their conflicts. Communication skills help couples to know how to
better speak and listen to each other. Soothing skills help partners to better recognize when they are
becoming defensive, and how to calm themselves so that rational dialog remains possible.
Interpretation. To the extent that the problem appears to be caused by partners' failure to understand
one another, therapists will work hard to promote communication. They teach listening skills,
promote sharing of feelings and desires that may be difficult to express and encourage partners to
repeat what their partners have said so as to demonstrate their comprehension. When necessary,
they will interpret partner's meanings so as to better promote each partner's understanding of the
other. Therapists may also point out relationship patterns that partners may not have been aware of
(for instance, if one partner attempts to treat the other as a child or as a parent) which could interfere
with their ability to relate as adult partners.
