I was recently asked by some colleagues to contribute a guest column to the Science of Relationships website on the topic of how to choose a good couple therapist. When thinking about this week’s YouBeauty.com column, it occurred to me that the topic of couple therapy might be of interest to some of you. In fact, the topic of couple therapy follows nicely from my last YouBeauty.com column on “earned” attachment security. If I seek professional help to improve my relationships, how should I make the decision about who to see? Without further ado, here’s what I’ve written on how to go about choosing a (good) couples therapist.First, let me say that if your relationship is struggling and you’re thinking about couple therapy, you are not alone. Recent research indicates that approximately 3 of 10 marriages may be classified as experiencing severe “marital distress” that is qualitatively distinct from the way more happily couples experience their relationship satisfaction.Said differently, 30 percent of our marriages are in serious, high-risk territory for being really bad. By any account, that’s a lot of people. As you’ve seen time and time again on this website, relationships can be difficult to maintain and relationship quality can erode fairly quickly. As a result, many relationships are teetering on the brink of a breakup.The hopeful side of this story is that help is available. In a recent study of two forms of therapy I’ll describe below, more than 60 percent of couples who successfully completed treatment maintained clinical significant gains up to 2 years later. What does “clinically significant” mean? In essence, it means moving from being among the 3 in 10 (really distressed) couples to the 7 in 10 (relatively satisfied) couples and staying improved for over 24 months. This is a good outcome, and the lesson here is that couples treatment can work when people are engaged and motivated to change.MORE: Dr. Oz and Dr. Roizen Talk Relationship CommunicationGiven all these facts, what do you need to know about choosing a good couple therapist? First, you want to find a therapist who regularly sees couples and has clear training in working with couples.As a potential client, you also are a consumer (that is, you will pay for this service and you are entitled to shop around for the person who is best qualified to provide therapy for you). There is no such thing as “dabbling” in couple therapy, so your potential therapist must be qualified to provide you and your partner with the most up-to-date treatments based on contemporary science. Here are two initial questions to ask when you speak to a potential therapist:
- Can you tell me a bit about your professional background and training in working with couples?
- About what percentage of your practice is dedicated to working with couples?
With respect to #1, you want to find someone who has worked with couples for a long period of time and who mentions definite training experiences in couple therapy. I might answer this question with something like: “As part of my doctoral training, I received extensive experience working with couples, including spending multiple years being closely supervised while working proving therapy to couple. I took graduate classes in basic relationship science, as well as couple treatment more specifically, and I stay up-to-date on advances in the field by regularly attending continuing education sessions on this topic.”If a potential therapist merely says, “I’ve attended several workshops on couples treatment,” I personally do not believe this is enough. A good couple therapist has a history of being supervised by qualified professionals when they first learned how to do the work.With respect to #2, it is often difficult to sustain a clinical practice with couples alone, but I think most good couple therapists will devote 50 percent or more of their time working primarily with couples. There’s no hard-and-fast rule here, but you want to find someone who spends a good deal of time providing the treatment you’re interested in receiving.This is why we think of a couple therapist as a specialist and not a generalist. Analogously, if you break your ankle you want to see an orthopedist, not an internist or family doctor. It’s the same for couple therapy: Try to find someone who can explain or demonstrate why they are a specialist in this area.Next, a brief word about professional certifications. Notice that I used the broad term “therapist” and not “clinical psychologist.” I don’t believe your therapist needs to be a psychologist. A licensed marriage and family therapist will most likely have the degree of training needed to provide high quality couple therapy. In a similar vein, just because someone is a licensed clinical psychologist does not mean they are qualified to provide couple therapy. Regardless of your therapist’s degree, look for someone who has demonstrated experience and expertise working with couples.MORE: One Easy Fix to Help Your MarriageYou’ve found somehow who might be good, but what treatments will they provide? There are many different forms of couple treatment, but only a handful has good scientific support. In my opinion, you want a therapist who is up-to-date on the best scientific treatments available to you. Here’s a brief description of three basic forms of therapy:
- Behavioral (or cognitive-behavioral) couple therapy (BCT). This treatment is based on the idea that couples with relationship problems have developed behavioral patterns that erode relationship quality. The essential elements of treatment are altering interaction patterns through, for example, things like how to communicate in less destructive ways, how to interrupt and alter negative thoughts about a partner, or how to express and experience emotion in a more positive way.
- Integrative behavioral couples therapy (IBCT). IBCT is a direct extension of BCT and focuses on teaching couples ways to manage and accept irreconcilable differences in their relationship. IBCT provides couples skills for decreasing dysfunctional relationship patterns, and it also focuses teaching couples to accept and better understand their partner’s actions. For instance, when a husband learns to be accepting of his wife’s lack of affection in certain situations, he may no longer react with negativity or withdrawal, which, in turn, results in a positive (rather than vitriolic) outcome. I note that some therapists may simply say they are “integrative” when describing their practice; this does not mean they practice IBCT per se, and you should ask directly: “What do you mean by integrative?” IBCT is the most well-established form of integrative couple treatment, and simply drawing from multiple, unsupported treatments in an “integrative way” is not necessarily meaningful. It’s equivalent to saying, “I have no real theory of what’s wrong with couples, so I pull from everything and hope something will work.”
- Emotionally focused couple therapy (EFT). EFT is fairly different from the two therapies I described above. As its core, EFT is based on the idea that distressed couples have developed a problem using each other for emotional support (technically, EFT says that distressed couples “fail to use each other as a secure base”), and the treatment is based on teaching couples to identify with and connect to each other’s emotional needs. An EFT therapist does this work by helping couples explain their emotional needs to each other and to respond in new ways that deepen their emotional connect. In this way, EFT is not focused on, say, communication skills directly but is pluralistic and uses many approaches to teach couples how to deepen their emotional connections to each other, as well as how to recognize and validate their partner’s emotional/attachment needs.
QUIZ: What’s Your Attachment Style?These three treatments constitute some of the main “empirically supported” therapies for couples. When you speak with a potential therapist, you should ask him/her directly about what types of interventions he/she uses. If you’re going to spend months working with a therapist, you want to know, to the best of your ability, if they are going to deliver a treatment that is known to work well for couples. Don’t be afraid to ask what treatment your therapist will provide when he/she works with you.Where to go from here? You feel like you have decent answers to the questions above and that your therapist is well-versed in one of the treatments I’ve mentioned. What’s next? My suggestion is for you to think about the first few sessions as an evaluation of sorts. To be sure, you should invest as much energy as you can in the treatment and your therapist’s recommendations, but you also want to ask yourself if this therapist, in practice, is the best match for you and for what you think your relationship needs. These are general issues about fit, but you can consider the following questions:
- Does my therapist understand my perspective on our relationship problems?
- Do I feel connected and as if I have a good alliance with this person?
- Does my therapist seem to take sides, perhaps suggesting that one of us is right/wrong about the majority of our issues?
- Most simply, with the help of this therapist, is our relationship going to be better off now than before we started treatment with this person?
Time and again, research shows us that feeling understood by and connected to your therapist is important for a good outcome, and this is no less important in couple treatment than in individual therapy. You have the right to evaluate your therapist and make sure he/she is a good fit for you. You want to find someone you connect with and who does not take sides in your relationship disagreements. Making sure this is the case is the last step in choosing a good couples therapist.I wish you the best of luck and hope you find this advice helpful. Copyright David A. Sbarra, Ph.D., August 3, 2011