Wednesday, July 28, 2010

Marriage Therapy

In addition to training as an individual psychotherapist I was formally trained as a marriage therapist. The leading schools of marriage therapy in that day were Communications, Structural and Strategic Therapy. What was most significant though was that the training and approach to couples was wholly different from the approach to individuals.

Indeed it was recognized early that psychotherapists who were trained in individual therapy and tried to use this approach in marriage therapy were more likely to break up a marriage rather than restore it to functioning capacity.

As a simple example marriage therapists learned not to dwell on the past but focus specifically on the present. In individual therapy a lot of focus and emphasis is on the past, reviewing it and learning from it. In marriage therapy this can be devastating in the way that such review of the past served to 're traumatize' people suffering from PTSD. In the treatment of PTSD specific approaches had to be developed to address this potential. Marriages were routinely traumatized by untrained and inexperienced therapists who themselves might well not even have addressed the very specific 'countertransference' issues which further contribute to marriage break down in therapy.

Once a therapist enters the 'family system' the experience in terms of transference and counter transference (how therapist and patients experience this relative to their own past experience of family) changes the whole 'caboodle'. A couple may be behaving in a dominant submissive manner but the therapist may become either the 'co parent' to one of the patients or be perceived by the patients together as the 'child' or become the 'stupid wife' or any number of archetypal subconscious presentations. Therapists coming from dysfunctional families and marriages themselves can 'act out' their own dysfunction (and commonly do) in the marriage they're supposed to be 'helping'.

Because of just these facts finding a good marriage therapist is often next to impossible in what has colloquially called our 'divorce culture'.

First, make sure the marriage therapist has been formally trained in 'marriage therapy'. Check their credentials. Marriage therapy is more like surgery than massage. A lot of counseling is 'safe' because its educational and ego massaging. Marriages are volatile and suffer greatest from therapists who 'take sides'.

When I trained as a marriage therapist and family therapist I was literally grilled on the need to be 'impartial'. This 'impartiality' had to be able to withstand being in the presence of a sadist and a masochist. The tendency of social workers who I trained with is to 'rescue' mother and children from 'abusive' father. This is accepted when the social worker is essentially playing 'mommy' to 'big daddy' government and assisting the 'big daddy' law and order system. Those same social workers who trained beside me knew months later that 'adults are volunteers' and only 'children are victims' . It was counter transference and "identification' that was at work when a person 'allied' with one or the other 'adult' in the system. Indeed the minute a therapist 'allies' with one or other of the couple they are covertly destroying the marriage.

Training in marriage therapy is all about recognising 'covert' and 'overt' aggression and seeing how the individuals are playing 'roles' they've learned and that as commonly the masochist has sought out the sadist as vice versa.

The role of the therapist is to help the couple progress to a higher, less unhealthy, less destructive form of functioning. Much of the training of formal marriage therapy is the same as ambassadors use in diplomacy. And commonly the therapist is like an ambassador between two 'clans' or two 'family of origins' with whatever way each individual wants to solve disagreements having worked just fine for their extended blood line in the past. In fact anthropologists like sociologists are more likely to make better marriage therapists than traditional psychologists trained so dominantly as they are in individual psychology versus social psychology.

The miserable failure of so many psychologists and counsellors in the area of marriage therapy actually opened the field to lawyers who are often doing less damage by using 'mediation therapy' techniques to resolve couples differences. Mediation as such focuses on the present and starts from a position of equality like any 'business negotiation'. Mediators are less at risk of 'choosing sides' and doing the damage this causes however mediators like judges and lawyers lack the training in their own family dynamics so commonly bring their own dysfunctional family issues to the 'mediation'.

Over the years I've reflected a lot on this principally because I was divorced and had marriage and individual therapy in the process and left doing marriage therapy for a number of years after I was divorced because I was aware of the 'covert aggression' that I naturally carried and how I could 'act out' this potentially till my own 'grief' was resolved a year or two later.

With that I would say that the second most important thing to look for in a marriage therapist is that they are married ideally. The best marriage therapists I have known and the best marriage therapy I've seen has been done by couples. These couples have either been married themselves or separately married. The key feature is that they believe in marriage. Over and over again in my individual therapy practice I encountered individuals who described being in marriage therapy and I would ask and they routinely did not know anything about their therapists 'marriage'.

Marriage therapy is unlike individual therapy in this regard. It's very like Addiction Counselling in that in Addiction counseling it is normal and appropriate to ask the counsellor if they are sober and if so how long. This doesn't mean that only 'sober' therapists make good addiction counsellors but rather that the question is appropriate. In individual therapy following on the psychoanalytic tradition there was tremendous 'secrecy' about the therapist and this indeed served the 'therapist'. It was entrenched at times with 'boundaries' and so called 'professionalism' but the fact remained that in every small town everyone knew if not everything a whole lot more than the dictates of 'urban boundaries' and 'urban professionalism' talks suggested were necessary for good results. Therapeutically small town and country results were commonly equal and at times superior to the results seen in large urban centers suggesting that much of cloaking served other agencies than specifically the process of therapy. Where it was once 'wrong' to ask a surgeon if he had done a procedure before the good surgeon today will openly tell how many such procedures they'd done and what the success rate was.

So ask your therapist if they're married and probably best to find another one if they hedge and haw. Further specifically ask if they are divorced how long their marriage was.

Another principal way for therapists to break up marriage is to apply the thinking of a first year marriage to a 10 year marriage problem. It's well recognized today that marriages grow as individuals so that the 30 year marriage may have an argument about a 7 year itch problem but the solution is wholly different than what might be appropriate for a 7 year marriage. I've been married roughly 10 years twice. There are 'developmental' challenges that occur in marriage like the developmental stages in childhood development. I have no idea how a couple of 20 years marriage would best resolve a problem. Marriage is like education. My 10 year marriage is like one phd. The person with 50 years marriage is like a person with 5 phd in marriage. I feel comfortable with helping people with 5 years or less marriage because they really are like undergraduates in this sense. But I've learned that problems I encountered in first year medical school may look the same today but are wholly different for me to address in some ways as a specialist with many years education and experience than I would as a first year student. That's the same with long term marriage. They have short cuts and codes and all manner of complexity that I'm humble enough to recognize is beyond my capability as a divorced therapist. I might take it on if I was marrried and had a partner therapist and an elderly married mentor but otherwise I 'd think wisely it was too advanced and complex for me and I would have a greater likelihood of doing damage.

The thinking that evolved in modern marriage therapy was the first baby of a marriage was the marriage itself. I raised a 10 year old. In the process I learned what 1 year olds need etc. Postmodern marriage therapy says simply too that a marriage was working and would probably have worked until some event overwhelmed its capacity to cope. There's no room for 'retrospective falsification' in evidence based marriage therapy. If a marriage gets five years of travel distance it's a robust marriage but it may not be able to 'cope' with the mountain ahead. This followed the recognition that even the best marriages rarely survived the death of a child well. The sense of a marriage's 'coping skills' working for a particular stage of development is the same here as in individual development. If we looked at teen agers the way untrained therapists looked at adolescent marriages we'd tell them all "they should never have married'. Just like we might tell a mother 'you'd better take that bad acting teen ager and stuff it back where it came from because that sure looks like a mistake to me."

Finally delivering babies I was trained that the only real success was when mother and child survived. In marriage therapy I was trained that the only real success was for the marriage and individuals to survive. If the marriage died I didn't consider it a success.

One of the principal threats to marriage were the individual therapists who broke up the marriage and then spent 2 years doing individual therapy with one of the 'wounded'. The conflict of interest here is profound.

Counsellors and lawyers have together contributed a great deal to this 'culture of divorce' and couples with marriage problems would be wise to shop carefully. Marriage therapy does work. It's amazing how much it can help. Over the years I saw some 80% of marriages come to me and colleagues who untreated would likely have ended in divorce but with therapy continued on.

Marriage is a 'vehicle' of relationship. It's always being 'repaired' like our own bodies are self healing and often need pit stops. In the past, before the nuclear families, parents and grandparents and aunts and uncles helped marriages. All that was when the culture was a 'culture of marriage'. Today we are living in a culture of 'individualism' and there is real benefit for couples to get help in therapy.,

The research of GOTTMAN and his LOVE LAB is a good place to start. It's not the end all and be all but today it really does provide hard data that supports the benefits from therapy with trained marriage therapists. Other important names to know are Virginia Satir, Minuchin, Erickson. As well there is a marvelous series called 'marriage enhancement' put on commonly by religious organisation.

- Posted using BlogPress from my iPhone


Anonymous said...

your a braver man than me

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