January 21, 2018

Choosing a Couple Therapist: Considering Credentials and Approaches

In a well-known Consumer Reports survey (1995), respondents were asked to rate their experiences with mental health services. Those who had received individual therapy were overwhelmingly satisfied with the results – over 90%. But those who had engaged in couple therapy were far less satisfied – only about 50% felt positive about the experience. There are various reasons for these results. For one thing, most couples wait too long to begin couple therapy, so it’s also not unusual for couples to come in as a last ditch effort to save the relationship, when one or both partners has one foot out of the marriage. In fact, John Gottman’s research showed that the average amount of time between a couple first considering therapy and starting it is about 6 years. However, training also plays a key part. While graduate programs in mental health do a good job of preparing professionals to work with individuals – the coursework and practicum are tailored to it – the same can’t be said of couple therapy.

Couple – Specific Training

Did you know that the vast majority of mental health practitioners do at least some couple therapy, and yet many have had little formal training in how to do it? Most graduate programs in the mental health field don’t require coursework in couple therapy as part of their degree requirements. (An exception to this is the Marriage and Family Therapy program (MFT) which, as the name implies, concentrates on training in couple and family therapy.) And yet couple therapy is notoriously difficult. The pace of sessions and the complexity of issues, such as addictions, trauma, affairs, mood disorders, etc. and their impact on relationships – and vice versa – can challenge the most experienced and confident therapists.

For those trained in social work, psychology and related fields, the usual way of obtaining specialized training in couple therapy is through post graduate training programs and/or the certification process set out by various therapy approaches, such as Emotionally Focused Therapy, Gottman Method Couple Therapy or Imago Relationship Therapy. These can be fairly demanding programs in terms of theory and supervision and help prepare a therapist to work successfully with couples. They also make it easier to find someone trained in a specific approach.

What’s in a Name?
Lots of mental health professionals work with couples. All of the following disciplines work with couples and can be licensed in Illinois. I’ve included both the degree and the licensing title that allows for independent practice.

* Social Workers (MSW or PhD, licensed as LCSW)
* Psychologists (PhD or PsyD)
* Masters level counselors (M.A., M.S. or M. Ed., licensed as LCPC)
* Marriage and Family Therapists (M.A, M.S. or PhD, licensed as LMFT)
* Pastoral Counselors (MDiv, licensed as LCPC)
* Psychiatrists (MD)

These disciplines vary by the amount and sometimes the type of training needed to obtain a degree, but in order to be licensed to practice independently all require a graduate degree and a period of supervised clinical practice. There is a lot of overlap in the training, but each has its own strengths and traditions. Some of these titles are “protected”, meaning that, for instance, no one can legally call himself a social worker without having obtained a degree in social work. ‘Marriage Therapist’, however is not a protected title, so anyone can use it or a similar title.

Approaches to Couple Therapy
As with individual therapy there are many ways of working with couples, far too many to adequately describe here. According to marital researcher Alan Gurman in his highly regarded Clinical Handbook of Couple Therapy(2008), the major categories include:

* Behavioral – such as Cognitive-Behavioral
* Humanistic – such as Emotionally Focused Therapy
* Psychodynamic – such as Object Relations
* Social Constructionist – such as Narrative
* Systemic – such as Structural
* Integrative – such as Insight-Oriented Marital Therapy

Most other approaches not listed here either fall into one of these categories or combine elements of two or more of them. In fact, integrative models that combine features of several of the models have flourished in recent years, perhaps because of the complexity of understanding and creating change with couples.

What About Effectiveness?

With so many options, how in the world does one make an informed choice? You can start with what you know and like, or maybe an approach you’ve read about. You could also look at what the research says about effectiveness. Jay Lebow, in the September 2006 issue of Psychotherapy Networker, “Scoreboard for Couples Therapies”, reviewed the recent research and concluded that “there are now four empirically supported methods of practice for which positive outcomes have been demonstrated: Behavioral Couples Therapy, Emotionally Focused Couple Therapy, Integrative Behavioral Couple Therapy, and Insight-Oriented Marital Therapy.” This doesn’t mean that other approaches won’t work for you– just that they haven’t so far demonstrated their effectiveness in research trials. It also helps to know that the best predictors of a positive outcome have less to do with the specific approach the therapist uses and more to do with the therapeutic relationship, namely, how you get along with the therapist. A strong alliance between therapist and clients, agreement about treatment goals, and ongoing monitoring of progress toward those goals are consistently tied to good treatment results. In other words, whether  you feel a connection with the therapist and see him as a reliable guide as you do the often strenuous work of improving your relationship.

… to be continued.