Couples, Couples Therapy, marriage, Marriage and Family Therapy

How to Choose a Marital or Couples Therapist

marriage therapy

People routinely contact me for recommendations for marriage or couples therapists.  I have discovered that the large majority of the population has absolutely no idea how to discern the differences among mental health professionals, so I’m hoping to shed some light on the topic of choosing a marriage or relational counselor.

Couples therapy is difficult.  In my experiences both as a therapist and as a therapist supervisor, the cases that are regularly the most challenging are those involving the couple unit.  I recall the cover of a popular periodical publication for therapists from a few years ago with the question, “Who’s Afraid of Couples Therapy?” emblazoned across the cover, alluding to the common knowledge that couples generate a tremendous amount  of emotional complexity in therapy (you can access the reference here: http://www.psychotherapynetworker.org/magazine/recentissues/2011-novdec).

The pace in couples therapy can be rapid and potentially shiftier than individual therapy, or even family therapy.  The structure with three people in the room creates a potential triangulation of relationships if not constantly managed.  The emotional intensity in the room generally potentially exceeds any individual therapy sessions.

Couples come with history and read each other instantly in ways that may leave the therapist confused or a step behind.  Therapists are perhaps never required to think on their feet more than when dealing with couples, requiring relentless improvisation in managing the dynamics while staying on task.  One reason I enjoy couples therapy so much is that it is never boring.

I can only speak from my own experience, but I have devoted much of the last three decades to investigating and practicing couples therapy, and have had ample opportunity to work with couples professionally and to practice therapeutic principles in my own almost three-decade long marriage.  My ongoing clinical supervision of students and therapists exposes me additionally to an increased variety of couple cases.  I have strong opinions about how I would personally choose a marriage therapist.  Even in the very best case scenarios, marital therapy is incredibly challenging and predicting outcome is impossible because the two members of the couple impact outcome to such a large degree.

Following are some things I would do were I to choose my own couples counselor:

  1. Ask how much of this therapist’s practice represents marital or couples cases. Specialization makes a difference in the mental health profession, just like it does in the medical profession.  The reality is that the more time you spend on perfecting your skills with particular cases, the better you become at treating those cases.  I would want my counselor to be seeing couples on an ongoing basis.
  2. Inquire about this therapist’s specific training and experience in working with couples. Please do not be afraid to ask this question.  There are no laws preventing licensed mental health professionals from calling themselves “marriage counselors,” as long as they meet the state guidelines for their professional licenses.  Specialties are mostly self-monitored.  One of my former professors completed a study comparing family therapy educational and clinical work hours requirements across professions (accessed here: http://www.tandfonline.com/doi/abs/10.1080/01926187.2010.513895#) and licensed marriage and family therapists (LMFT) generally have several times the amount of education and experience in working with marriages and families.  That being said, any professional can specialize in relationship therapy through continuing education opportunities, so you cannot just assume someone’s training or competency based solely on their professional degree or license.  I know professionals who are LMFTs to whom I would not refer couples, and I know psychologists and social workers to whom I would refer couples.  Ask your counselor exactly what specific training and experience they have had in working with couples.
  3. Ask where the therapist was originally trained and look up the training requirements for that facility. The important thing to know here is that some training programs monitor and view student therapy more carefully than others.  Some programs require sessions to be videotaped and/or provide two-way mirrors to therapy rooms so students therapists can be watched live.  Some programs don’t require any of this, and in those cases, it is more difficult to discern therapeutic skill.  When I am supervising students or associates, the ones that are not afraid to bring me videotape or have the capability to be viewed live are getting better supervision by far.
  4. Ask how long this therapist has been specialized in couples therapy. Length of time practicing doesn’t always equal better couples therapy.  Some more experienced therapists stop studying, learning and perfecting their clinical skills and may be performing outdated therapies.  I have seen some marriage and family therapy students exhibit more skill at couples therapy than some seasoned professionals.  At the same time, becoming a skilled couples therapist does require experience, so this is just one factor to consider along with the others listed here.
  5. Ask about the therapist’s preferred model of couples therapy. If the therapist doesn’t operate from some kind of theoretical model, that can be a problem.  For example, some models of therapy see emotion as salient while others may ignore emotion.  Some models of therapy are empirically validated while others are theoretically informed but not validated.  Some models are harder to perfect.  If the therapist calls him- or herself “integrative,” or “eclectic,” meaning that they might combine models, don’t be afraid to ask more about their interventions and how they think change occurs in marriages.  If they can’t articulate this, it may be a warning sign.  I would personally want my marital therapist to be able to articulate and defend their theory and practice of change.
  6. Ask how trained the therapist is in their preferred model of treatment. Some models have a track for specialized certification.  While this doesn’t guarantee competency, it can mean that the therapist has had more training and may be more skilled in that model.  Some models require more intensive supervision than other models, so this is a factor as well.  Certification in one model may be more meaningful than in another model.
  7. Ask if this therapist is licensed and check the licensing board website. This seems obvious, but we live in a day and age of a proliferation of “relationship coaches,” who some clients assume are licensed therapists when they are not.  Some of these coaches may help people, but it is not a profession which is regulated.  I have personally witnessed extremely unethical behavior by some “coaches,” for which licensed therapists would lose their licenses.  However, in an unregulated profession, there is no recourse.  I have had many clients assume that a “coach,” was a licensed therapist, and they are actually quite different.

Finding a competent marriage or couples therapist with whom you resonate can be a challenge.  Don’t be afraid to call several therapists.  Be wary of therapists who oversell themselves or of those who can’t articulate hope for the marriage.  I had a couple once tell me they went to a marriage therapist who told them they had a “10% chance of success,” and it left them feeling hopeless.  This is simply inaccurate (and not extremely strategic on the part of the therapist), since there is no algorithm for accurately predicting outcome.  Client variables represent too much of the equation to be able to accurately predict success.  Overwhelmed therapists who don’t know how to skillfully handle couples can unwittingly send a message that the couple needs to divorce prematurely.  Therapist hopelessness or lack of confidence can be an indicator that the clients are simply overwhelming the skill level of the therapist.

I once had a potential client call me and ask about my model of therapy, and I was absolutely thrilled to tell him what model I use and why, based on my experience and education as both a therapist and supervisor.  He threw a few names out of other therapists and asked me to tell him why he should come to me and not them.  I told him that I couldn’t tell him to come to me instead of them because I wasn’t privy to what they actually do in their marital sessions, and that they might actually be more appealing to him, since therapy is such an interpersonal and unique experience for everyone.  I told him that I could only accurately talk about what I do, and that maybe he could call the other professionals and just decide for himself after talking to all of us.  I never know how I’m going to be perceived by any client.

Above all, if you are wanting professional help for the most important relationship in your life, I would suggest that you do at least as much research in finding one as you would in purchasing a new vehicle.  Therapists are all very different and it’s worth doing your homework.

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