Handbook of Clinical Issues in Couple Therapy

Joseph L. Wetchler

• Publisher: Routledge
• Year: 2011
• Print ISBN: 9780415804769
• eBook ISBN: 9781136837418
• Topic: Psychologie
• Subtopic: Santé mentale en psychologie

Now updated in its second edition, Handbook of Clinical Issues in Couple Therapy provides a comprehensive overview of emerging issues that impact couple therapy. Unlike other guides that concentrate more on theoretical approaches, this invaluable resource contains the latest research and perspectives that every clinician needs when dealing with the challenging issues often found in practice. Carefully referenced, it explores a range of issues that include intimate partner violence, posttraumatic stress disorder and its effect on couple relationships, divorce therapy, remarriage and cohabitation issues, cultural issues, and couple therapist training. This insightful edited volume is suitable for a wide spectrum of readers, including couple and family therapists, counselors, psychologists, social workers, pastoral counselors, educators, and graduate students.

1

The State of Couple Therapy

RICHARD J. BISCHOFF

Contents

Introduction

History of Couple Therapy

News Flash: The Eclipse of Couple Therapy

Glimpses Into the Shadow: Practice Patterns and the Consumer Reports Study

Out of the Shadow

Research on Couple Functioning

The Development of Theories/Models Unique to Couple Therapy

Research on the Effectiveness of Couple Therapy

The Future of Couple Therapy

Reference

Introduction

Couple therapy, in its state-of-the-art form, is currently one of the most robust treatment modalities in the field of psychotherapy. But, for many, both in and out of the field, couple therapy is a sleeping giant. Many trained as therapists, including many trained as marriage and family therapists, are not fully aware of the strong empirical and theoretical base that underlies the practice of couple therapy. The purpose of this chapter is to briefly review the history of couple therapy, placing this history in the context of the broader field of mental health care, and to identify the trends and evidences that suggest that couple therapy is currently worthy of premiere status.

History of Couple Therapy

As long as there has been coupling and marriage, there most assuredly have been people who have been willing to become involved in others’ relationship problems. For many, it is difficult, and sometimes even emotionally painful, to see the unhappiness experienced by those in a bad relationship, and most people do not like to see a marriage end. So, for many, a desire to help is a natural response (if for no other reason than to just alleviate their own distress as observers). Those who select a career in the helping professions (e.g., clergy, physicians, mental health professionals, social workers, educators, lawyers) are probably most susceptible to becoming involved in others’ lives and relationship problems. So, it is not difficult to understand how the origins of couple therapy are shared among the many helping professions and not just within the mental health fields.

Modern couple therapy has its origins primarily in the marriage counseling movement of the early 1900s (Broderick & Schrader, 1981; Wetchler, 2003). This movement occurred largely outside the mental health field. It was initiated by clergy, lawyers, physicians, social workers, educators, and really anyone who became involved in couple relationship problems through their primary work. Marriage counseling, in these early days of the movement, was a part-time endeavor (Broderick & Schrader): an avocation for most. At this time, a compassionate lawyer, physician, or minister, for example, would provide advice or counsel to distressed individuals or couples with whom they were working in their capacity as professionals. In many ways, this is still happening today.

It wasn’t until the early 1930s that the first marriage counseling centers were established with professionals devoting full time attention to providing marriage counseling (Broderick & Schrader, 1981; Wetchler, 2003). Paul Popenoe founded the first of such centers, the American Institute of Family Relations in Los Angeles, California, in 1930 (Popenoe, 1992), thus ushering in the era of professional marriage counseling (Broderick & Schrader). On the other side of the United States, Emily Mudd’s Marriage Council of Philadelphia in Pennsylvania opened its doors soon after in 1932. Other centers soon followed, with each being unaffiliated with others and with the impact of each being largely local.

With the establishment of the marriage counseling centers, interest grew in marriage counseling as a full-time profession. But, because the practice of marriage counseling emerged from outside the mental health field, being a marriage counselor was generally a second profession for non-mental health trained professionals. For example, Paul Popenoe (see Popenoe, 1992) was trained as a biologist and spent his early career studying date palms. During World War I, he developed an interest in heredity and became a eugenicist and was the editor of the Journal of Heredity before developing an interest in marriage counseling. Emily Mudd (see Thomas, 1998) was trained as a landscape architect. Her interest in marriage counseling probably developed during the 1920s when, with her husband—a microbiologist—she established Pennsylvania’s first birth control clinic.

Recognizing the need to link professionals and advance the practice of marriage counseling, Emily Mudd and other like-minded professionals established the American Association of Marriage Counselors (AAMC) in 1942 (Broderick & Schrader, 1981; Wetchler, 2003). But, this did little to address the great diversity in marriage counseling practice, and with an increasing number of marriage counseling centers and marriage counselors, it was becoming harder to ignore both the diversity in practice and differences in the quality of services being provided. With no standards of counseling, there could be no consistency across treatments. Marriage counseling centers were generally being staffed by individuals whose training was in another field and whose qualifications for providing marriage counseling consisted of an interest in helping couples overcome marital distress. So, a joint committee of the AAMC and the National Council on Family Relations was appointed in 1948 to develop standards for marriage counselors (Broderick & Schrader). This was soon followed by standards for marriage counseling centers (Broderick & Schrader), which have become the precursor to the standards for training that exist today through the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE).

But, despite these attempts to provide standards for practice, the field continued to be dominated by a diverse group of practitioners during the 1950s and 1960s. Marriage counseling was still a second profession for most of those who saw their primary professional role as that of marriage counselor. Because marriage counselors came from a broad range of professional backgrounds, it was difficult to establish a profession and to mainstream marriage counseling within the mental health care field. Probably as a result of the second profession nature of marriage counseling, the practice also lacked a professional literature, which is necessary for legitimizing, advancing, and standardizing any treatment modality. Even as late as 1973, Alan Gurman lamented that the scholarship about marriage counseling lagged far behind the other mental health treatment modalities of the time. Consequently, the practice continued to reside on the fringes of the mental health care field. Even within the AAMC, most members during the 1960s identified marriage counseling as something that they did in addition to their primary professional role (Alexander, 1968). More than a primary professional organization, the AAMC was a place where anyone who was interested in providing marriage counseling, regardless of their primary professional role, could come together to associate with and learn from one another. But, without a membership base with their primary professional identity as marriage counselors, the AAMC struggled with its identity and consequently struggled to maintain a clear purpose and direction. So, the stage was set for marriage counseling to be overrun by something else that could be more easily mainstreamed in the mental health care field. That something else was family therapy.

During the 1960s, the AAMC saw an increase in its membership among those who had been trained in the mental health field (primarily psychiatry) and who were interested in family relationships. So, in 1970, to accommodate this increasing interest among its members for working with families, the AAMC changed its name to the American Association of Marriage and Family Counselors (AAMFC) (Broderick & Schrader, 1981; W. C. Nichols, 1992). Then, in an attempt to both elevate the practice of working with couples and families to the status of a treatment and to further advance the emerging profession, the name was changed again in 1978 to the American Association of Marriage and Family Therapists (AAMFT) (Broderick & Schrader; W. C. Nichols).

But, it wasn’t really until the publication of standards for training marriage and family counselors (and later, marriage and family therapists) in 1975 (W. C. Nichols, 1992) that an identity as a marriage and family therapist began to emerge. Without training standards, MFT would always be seen as a specialization practiced by professionals trained in other mental health fields. But, with training standards and the accreditation of graduate level training programs, graduate students were being trained as marriage and family therapists as their first profession and their primary training was in the practice of couple and family therapy. First profession status finally arrived and with it the professionalization of the field.

News Flash: The Eclipse of Couple Therapy

Professionalization was important to the field of marriage and family therapy, but it did not come without negative consequences for couple therapy. One of the most important negative consequences was that couple therapy became hidden; obscured in the shadow of its younger, more dynamic, and outgoing sibling: family therapy.

Although younger, the history of family therapy is similar to that of couple therapy. Both began as part-time endeavors by practicing clinicians and as second professions for many of its pioneers. However, it is in the differences in the histories of couple therapy and family therapy that we are able to understand how marriage counseling, as the older sibling, could be eclipsed by family therapy.

First, unlike couple therapy, family therapy has its origins more firmly in the mental health field. This may be due to the fact that it came on the scene later than marriage counseling, and after the mental health field was more developed. It may also be due to the fact it emerged in response to a recognition that family pathology was associated with psychological maladjustment and that most, but not all, of the family therapy pioneers were trained first as psychiatrists, social workers and psychologists. This positioned family therapy much differently from marriage counseling whose practitioners where trained first in the clergy, the law, education, and medicine and whose clients were primarily individuals seeking advice or guidance about the how-to’s of married life (Gurman & Fraenkel, 2002). So, while marriage counseling was seen as appropriate for addressing problems in living, family therapy was seen as appropriate for addressing psychological maladjustment. Consequently, many in the field did not even recognize it as a mental health treatment modality (Gurman & Fraenkel).

Second, unlike couple therapy, family therapy has its roots in research. As “the auxiliary activity of a professional whose primary commitment was elsewhere” (Broderick & Schrader, 1981, p. 4), marriage counseling developed out of the desires of well-meaning professionals to help individuals and couples understand married life and improve their marriages. Family therapy, however, developed in response to research that pointed to the role and influence of family relationships in the development and perpetuation of individual pathology. These research findings provided both the rationale and the foundation for family intervention.

Third, unlike couple therapy, theories and models were the basis for family intervention almost from the beginning of family therapy. Techniques and strategies for intervention were derived from and pertained to these theories and models, thus not only giving clinicians a conceptual framework to aid in interpreting family functioning, but also giving them a framework for how to intervene to bring about change. These models directed how and when techniques would be used and gave clinicians a common language for talking with one another about their clinical work.

Nothing like this existed for marital counseling. Manus (1966, in Gurman & Jacobson, 1986) lamented that although there were an increasing number of therapists working with couples, that the approach was “a hodgepodge of unsystematically employed techniques grounded tenuously, if at all, in partial theories at best” (p. 1). Gurman and Fraenkel (2002) explained that because marriage counseling was without a theory to guide it, clinicians turned for direction to those theories that were dominating the mental health field at the time. For those trained to work with individuals, these were the psychoanalytic theories, with object relations being the most logical choice among them (Gurman & Fraenkel; Gurman & Jacobson). But, with an emphasis on the interaction of individuals’ intrapsychic processes, the focus was still on the individual and the model gave couple therapists little practical direction about what to do in conjoint work with couples. In the late 1960s and early 1970s behavioral marital therapy came on the scene, but like object relations, it was primarily a one-dimensional adaptation of a theory originally developed to describe individual functioning and guide the behavioral modification of individuals. For those trained as marriage and family therapists, the family therapy theories were the most logical choice. After all, it was assumed that couple relationships were nothing more than just a subsystem of the family and so the family models would apply. But, this assumption turned out to be just as faulty as the one that suggested that models to guide work with individuals could be applied to relational systems because couples and families are made up of individuals. But, in the absence of alternatives, these fallacies were overlooked and couple therapy became subsumed within family therapy.

During the 1970s and early 1980s there was a proliferation of family therapy models (Gurman & Kniskern, 1981; W. C. Nichols, 1992; M. P. Nichols & Schwartz, 2007). One might think that with so many competing models, confusion and chaos would reign and the field would be diluted, but just the opposite happened to family therapy. All this interest in model development quickly propelled family therapy to star status. The fervor over model development actually advanced the field because it increased interest in it. There was always something new and there was something for everyone. In contrast, couple therapy during the 1970s—when family therapy was quickly ascending in status and recognition as an exciting new treatment modality—was still largely just a collection of techniques in search of a model or theory. To fill this gap, the models of family therapy were quickly adopted to explain couple functioning (just as models of individual psychotherapy had earlier been adapted to explain couple functioning and to guide treatment). So, marital therapy, which was already marginalized and discounted as a legitimate treatment modality, was subsumed within family therapy.

Fourth, unlike couple therapy, family therapy had charismatic and outgoing proponents of the various family therapy models. Critics descriptively compared what was happening in the field of marriage and family therapy to a religious fervor, complete with competition among various sects for followers (see Sprenkle, 2003; Werry, 1989). T...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Acknowledgments
• Editor
• Contributors
• Introduction
• 1 The State of Couple Therapy
• I Biological and Physiological Issues
• 2 Brain Biology and Couple Therapy
• 3 Couple Therapy in the Presence of Mental Disorders
• 4 What's Love Got to Do With It? Couples, Illness, and MFT
• 5 Couples Therapy and Addictions
• 6 Current State of Sexuality Theory and Therapy
• II Traumatic Issues
• 7 Conjoint Couples Treatment and Intimate Partner Violence Best Practices
• 8 Trauma and Recovery in Couple Therapy
• 9 The Field of Infidelity Past, Present, and Future
• III Divorce and Remarital Issues
• 10 Divorce Therapy
• 11 Remarital Issues in Couple Therapy
• IV Sociological Issues
• 12 Awareness of Culture Clinical Implications for Couple Therapy
• 13 Fostering Strength and Resiliency in Same-Sex Couples
• 14 Couple Therapy and the Integration of Spirituality and Religion
• 15 Feminist Couple Therapy
• V Primary Prevention Issues
• 16 One Size Does Not Fit All Customizing Couple Relationship Education for Unique Couple Needs
• 17 Premarital Counseling Promises and Challenges
• VI Training Issues
• 18 What Is Unique About Supervising Couple Therapists? One Supervisor's Beginning Answer
• Index