Many people believe that successful marriage counseling is a "hit and miss" proposition. However, as a practicing psychotherapist with over 35 years of clinical experience, specializing in the area of couples therapy, I believe the majority of couples I have treated have had successful outcomes, largely because of the methodological techniques I have used.
There is a false belief among patients and therapists alike who think that resolving a couple's communication and problem-solving skills will alone improve and mend a broken relationship. Although effective communication and conflict resolution skills is a prerequisite to having a happy relationship, I have found that that there are two other steps that need to take place before one is able to focus on a couple's communication skills.
First, a thorough assessment of the relationship has to happen. This assessment cannot be done in 45 minutes or an hour. I have found that long sessions -- lasting anywhere from 3-5 consecutive hours in the beginning of a couple's therapy -- gives the couple and the therapist the necessary information and momentum to be able to grasp what the issues are (past and present) that need to be acknowledged, addressed and resolved.
I begin at the beginning when both people had stars in their eyes and when each could do no wrong. Despite the fact that we can't change history, it is very important for the couple and the therapist to identify, understand and discuss what went wrong and what events and /or behavior caused the couple to get off track. Was it the birth of the first or second child? Was the couple experiencing financial or job related difficulties? Did one or both have physical, emotional, or psychiatric problems that changed the dynamics of the relationship? Was there a death or illness in the family? Did sex become a problem? Or did the couple simply grow apart?
Secondly, I see the partners individually, in order to discover who they are as individuals. I need to know about each person's family history, their skeletons in the closet, including possible depression, anxiety and other psychiatric problems, early child sexual abuse, substance abuse and sexual or sexual orientation or gender issues. I also need to find out whether one or both are involved in extramarital affairs. And if that is the case, I would never begin couple's counseling until that issue was resolved. Namely, the affair would have to end before couples counseling could begin.
And third, if one or both people have significant psychological or psychiatric problems, these need to be dealt with first on an individual basis. It is simply not possible to treat the couple's communication and sexual problems, his affair, her depression, his addiction to pornography and cocaine all at the same time. And yes, I do both the individual and couples therapy, since virtually every couple that I have treated who needed some individual work preferred not to be referred to another therapist. Naturally, if one or both did want to work with another therapist individually, the marriage counseling would then be put on hold.
My patients understand this methodology and embrace it. When the couple and I are finally ready to meet together as a threesome, we are ready to focus on the "we" issues. I ask each person to make an agenda of issues that need to be discussed and worked through. The agenda items are then prioritized by the individuals and then and only then are they ready to learn the art of emotional communication and problem-solving. They then begin to tackle the issues one by one.
Couples are taught how to discuss and make compromises and trade-offs. They learn that the win/lose model is a disaster for marriages and are committed to learning how to reach win/win resolutions. I teach them ''how to say it," '"if to say it," "where to say it," "when to say it" and how to do this respectfully. Role play is used extensively throughout. This is very hard and painful work. And as a therapist, I am very active and directive. My model has proven to be so successful that I will not accept new patients who do not agree to this process at the outset.
There have been a small percentage of couples who I have treated who have decided to divorce. In making this decision they are aware of what went wrong. Each person is clear about what they did or didn't do that contributed to the end of their marriage. And most are then able to divorce without the rage and wrath that so frequently comes with the demise of a marriage, knowing that they at least tried to resolve their difficulties.
BUT WHAT ABOUT CONFLICT OF INTEREST AND CONFIDENTIALITY?
CASE STUDY-- MEET THE JOHNSONS
Joe, 45, and Jane, 40, have been married for five years. This is a second marriage for both. The Johnsons were referred to me by Joe's urologist for couple's counseling. When I spoke to Joe's doctor in order to rule out any medical problems, he told me that Joe's testosterone level was normal and that he could find no medical reason for Joe's lack of interest in sex. The couple had not had sex in over two years and Jane was becoming more and more depressed. Up to this point, Joe would simply not discuss this issue with his wife. When we all finally met, we were clear about their sexless relationship. The real question was why did Joe have no interest in sex and more importantly, could this marriage be saved. I intuitively knew that I would discover a wealth of information when I met with the couple individually.
JANE Jane was convinced that Joe no longer found her attractive and was concerned that he was having an extra-marital affair. Her symptoms of depression were clearly understandable under the circumstances. However, she did not meet the criteria for clinical depression. Other than the sexual issue, Jane was a very happy woman and loved her life and her husband.
JOE When I met with Joe alone the first thing that he asked me was whether everything that he told me would be confidential. I explained to him that I was legally and ethically bound to honor his privacy. Joe proceeded to tell me that he was gay and that he did not want his wife to ever know this. Although he was not sexually permissive, he did on occasion see a man who he had known for many years. Joe also told me that he loved his wife and did not want a divorce. However, he also said that he had no desire to have a sexual relationship with her. Although Joe would have one too many beers on occasion, he too seemed basically contented with his life.
THE DILEMMA If Joe had seen his own individual therapist after our initial couple's evaluation, I would never have known about his sexual orientation. I would have spent time trying to help the couple improve their sex life. I would have used the Master's and Johnson techniques and would have encouraged them to experiment with sex toys, pornography and schedule dates for sex. This would have been a complete waste of time, money and energy for everyone. Knowing what I knew, I needed to help Jane accept the fact that her husband loves her dearly, does not want a divorce, but no longer has any interest in having a sexual relationship with her. She would then have to decide whether she would continue to live in a sexless marriage or not.
THE JOHNSONS TOGETHER
Joe and Jane met together for one session after the initial visit. Joe was kind but firm. He told her that he loved her, found her very attractive physically and intellectually and hoped to spend the rest of his life with her. He also told her that the problem was his and that he would understand if she wanted a divorce. Jane told him that she needed more time to think about the situation. I never heard from either Jane or Joe again. A few years later I bumped into Jane at an event. She whispered in my ear that she had divorced Joe and was now engaged to a wonderful man. "Our sex life is great," she said.