THINGS YOU SHOULD KNOW ABOUT MARITAL OR RELATIONSHIP THERAPY

Studies have shown that problems in our closest relationships affect the quality of our lives more than many other types of problems. Despite their impact, finding safe outlets for resolving relationship problems may be difficult due to the need to respect the privacy of our partners and our families, and the potential overlap between relationship problems and some of our own deepest fears, insecurities, and conflicts. For these reasons, many people turn to professionals for help. Due to the sensitivity and complexity of many relationship problems, choosing a competent, licensed psychologist is very important when taking the step of seeking assistance.

Generally, marital or relationship therapy is best conducted as a couple. However, sometimes one or both partners may need further evaluation, referrals, or treatment before marital therapy can be productive. This is sometimes done before marital or relationship therapy, but can also occur at the same time. In most circumstances, a therapist should not serve both as an individual and a marital therapist for the same couple.

What Problems May be the Focus of Marital or Relationship Therapy?

Marital and relationship therapists may treat a variety of couples’ issues such as interpersonal conflicts, communication problems, and parental decision-making. When a couple presents to therapy seeking couples’ counseling, the “patient” is the couple, rather than one or the other of the partners in the relationship. The goal of counseling is to help the couple find ways to improve their relationship, resolve conflicts, and stay together in a positive and mutually satisfying way. In some cases, when a couple decides to end their relationship or to divorce, a therapist may be called upon to help the couple to separate in a productive and respectful way.

In addition to working with couples, relationship therapists may also work with patients presenting with more individually-oriented concerns, such as dating dilemmas, the impact of a partner’s depression or low self esteem on relationship functioning, finding a balance between the demands of work and those of maintaining a close relationship, and adjusting to a recent divorce. Counseling may also involve helping individuals who have behavioral or psychiatric difficulties that may impact the quality of relationships, such as depression, bipolar disorder, post-traumatic stress disorder, social anxiety disorder, and others.

What kind of training does a marital therapist have?

Therapists who work with marriages and relationships have specialized training and experience working with couples or individuals presenting with relationship concerns. Individuals seeking such services should ensure that they are seeing a licensed provider. In most states, licensed Psychologists must have doctoral-level training (either a Ph.D. or Psy.D.), as well as over 4,000 hours of internship and residency training and experience.

While treatment approaches may vary from psychodynamic, interpersonal, solution-focused, systems, behavioral, and cognitive-behavioral, most relationship therapists use a combination of approaches depending on the characteristics of the individuals and the problems they are working with. Therapists who specialize in relationship counseling typically have had advanced training in relationship theory and research, family systems interventions, relationship adjustment issues, and parenting issues, as well as normal and abnormal psychology. Some therapists also have training in applications of attachment theory, and certifications in special areas, such as pre-marital preparation programs.

In addition, some therapists have experience in special types of relationships such as employer-employee relations. They may be called upon to consult in business settings, employee assistance programs (EAPs) or to help individuals negotiate more favorable job situations.

Are there any important things to consider before choosing a marital or relationship therapist?

Psychologists and other therapists working with relationships or marriages may commonly be referred to as marital therapists. Since there is overlap in the types of professionals that provide marital or relationship therapy, in addition to ensuring you are dealing with a licensed provider, asking about specific training or experience working with couples, marital or relationship issues is strongly recommended.

To approach the task of improving marriages and relationships, successful therapists must have well-developed diagnostic and therapeutic skills. Diagnostic skills involve an ability to analyze normal and abnormal patterns of behavior, to consider cultural and family issues, and to identify problems such as mood or personality disorders that can interfere with marital and other types of adjustment. Therapeutic skills involve being able to provide both reassurance and challenge to individuals and couples as they explore the roots of different relationship problems, as well as the ability to creativity tailor interventions to a particular individual or couple.

Working with relationships can be more demanding than other forms of therapy, since relationship therapists must integrate information from two or more individuals, or information across a variety of settings, such as home and work, so selecting a licensed, qualified, and competent clinician is especially important.

What can I expect in the initial phase of marital or relationship therapy?

The goal of the first few sessions is generally twofold: to obtain a comprehensive assessment of medical, social, and psychological background factors, as well as to assist the patient(s) in deciding which type of therapy (e.g. individual as opposed to couples therapy), if any, is appropriate to address the presenting concerns.

In addition to assessing the situation, determining needs and coming up with a plan for therapy, time is also devoted to establishing a relationship in which a patient(s) feels safe in communicating their concerns. Efforts are also made to agree upon the treatment plan, clarify what each party is committed to doing, and establish therapeutic as well as relationship boundaries for the course of the therapy.

The process of thorough assessment involves examining the personal, family, social, medical, psychiatric, relationship and situational factors that contribute to how we interact with, relate to, and love one another. This process is not unlike individual therapy, in that the initial stages are comprised of gathering history, situational and personal information.

As information is gathered, the therapist and couple begin to formulate and test their understanding of the impact of various strengths and weaknesses on the relationship. In the early stages of therapy, the therapist may proffer hypotheses and may check out any underlying assumptions about patient’s individual and collective perspectives on their relationship.

What is the typical length of treatment for marital or relationship therapy?

Often initial sessions are scheduled weekly. As the relationship improves, sessions may be spaced out bi-weekly. Generally, most marital or relationship therapy runs a course of between two months and twelve months. While the length of therapy will vary depending on the issues being addressed, the average duration of marital therapy is six months. Solution-focused therapy to address one particular problem in a relationship may take as few as six (50-90 minute) sessions.

Some therapists offer “block therapy,” which is a series of extended sessions (one and a half to three hours in length) that are booked over consecutive days in order to enable clients to do in-depth work in a concentrated time. For some patients, an effective approach is to commit to concentrated bursts of therapy for 3-6 sessions at a time with breaks of a few weeks between sessions as needed over a longer period of time. Many couples feel that establishing a relationship with a competent marital therapist whom they can consult with as needed over the course of their marriage has been critical to their relationship success.

Can I assume that what I share in marital or relationship therapy will be kept confidential?

Federal laws involving HIPAA, psychological and mental health information and alcohol and drug treatment protect information that is shared with licensed psychologists or licensed mental health providers. Additionally state statutes, administrative rules and professional ethical guidelines such as those promulgated by the American Psychological Association also regulate the release of information. Most medical and psychological offices explain confidentiality issues in a HIPAA document as well as in patient service agreements.

There are common exceptions to psychotherapist-patient confidentiality. The most common exceptions involve claims where an individual is asserting their mental health as an issue in judicial proceedings, cases of child abuse, and cases of immediate risk of serious harm to self or others.

Marital therapy poses some special challenges in terms of confidentiality of records. Some therapists keep notes about both relationship partners in one file, while others may keep separate files. Keeping separate files is advantageous if there are future requests by an individual for their records.

Issues of confidentiality should be discussed openly at the start of counseling. Concerns about confidentiality are an important reason to see a licensed Psychologist or other licensed providers, since communications have protections by state and federal statutes. Bring up any questions you have.

Will Insurance Cover the Cost of Therapy?

Insurance may often cover individual therapy services for a patient diagnosed with an adjustment disorder, depression or other mental health condition which may impact relationships, physical or occupational functioning. Insurance will often cover the majority of the cost of a diagnostic assessment, which involves arriving at a diagnosis and formulating a treatment plan. Co-pays and deductibles vary by insurance company and can be verified by calling your insurance provider.

On the other hand, marital therapy is not often covered by health insurance plans, though a limited number of sessions are sometimes allocated by employee assistance programs (EAPs). While the cost of professional services is a consideration, marital therapy often consists of a modest number of sessions and the costs should be considered in the context of the potential benefits to the marriage, or the cost associated with a decision to dissolve the relationship.

Issues related to fees or billing should be discussed openly at the start of counseling.

Photo by Jack Caputo