I take no joy in being a whistle blower, but it’s time. I am a committed marriage and family therapist, having practiced this form of therapy since 1977. I train marriage and family therapists. I believe that marriage therapy can be very helpful in the hands of therapists who committed to the profession and the practice. But there are a lot of problems out there with the practice of therapy – a lot of problems. I used to think that the best thing we could do for couples to improve their relationship and/or solve their problems was to send them to a therapist, but since we didn’t have enough therapists, then we probably need some marriage educators. It’s like saying that anybody who has a concern about their heart should see a cardiologist, but there aren’t enough cardiologists so they should see a primary care physician. Well, I have come to believe that this is really the reverse of how it ought to be, that people first need support people, mentors, other couples in their lives, and then they need marriage educators and then they need therapists–in that order. But the fact is that most people in this country, if they do seek help for their marriage problems, turn to a professional counselor or therapist, or a pastoral counselor. I think that there are many problems involved with all of these groups of counselors or helpers, so my critique here will not be only about people who work with couples, because that’s a small minority. Individual psychotherapists, many pastors and pastoral counselors also practice in the way that I’m going to be talking about today. In my view, there is nowhere that I know of, any category of counselor, that it’s safe to send a distressed married person to for therapy. It all depends on the particular counselor or therapist, many of whom are ill-prepared to help people with their marriage problems.
You’d be interested to know that, according to a national survey, 80 percent of all private practice therapists in the United States say they do marital therapy. And only 12% of them are in a profession that requires even one course or any supervised experience. Only marriage and family therapy as a profession requires any course work or supervised clinical experience in marital or couples therapy. So most people who say they’re doing this work picked it up on the side or not at all. The other thing I want to add, and as we go through this presentation today it is very important to keep in mind, is that most people who get any help from a counselor or therapist for their marital problems are seeing an individual counselor or therapist. That’s where most people go. If they are depressed, anxious, or having trouble with your life, most people go to an individual psychotherapist. And that’s where a lot of the damage to marriage goes on. The other aspect of the damage occurs when couples see a therapist together for marital therapy.
I’m going to be telling a lot of stories here, and I want to give a caveat up front. I was not in the room to hear what the therapist said in each case, and you cannot always assume a one to one connection between what somebody reports the therapist said and what the therapist actually said. However, when you hear these stories over and over from a lot of different people, including those who are not angry at the therapist, I think we can trust the gist of what we’re hearing people say that the therapist told them. And I have personally heard statements such as these from therapists in public presentations and case consultations. So, although I can’t stand behind the accuracy of behind every word in the stories, I do feel I can stand behind the patterns and the trends I will describe.
Let me begin with a story of Marsha and Paul. Soon after her wedding Marsha felt something was terribly wrong with her marriage. She and her husband Paul had moved across the country following a big church wedding in their home town. Marsha was obsessed with fears that she had made a big mistake in marrying Paul. She focused on Paul’s ambivalence about the Christian faith, his avoidance of personal topics of communication, and his tendency to criticize her when she expressed her worries and fears. Marsha sought help at the university student counseling center where she and Paul were graduate students. The counselor worked with her alone for a few sessions and then invited Paul in for marital therapy. Paul, who was frustrated and angry about how distant and fretful Marsha had become, was a reluctant participant in the counseling. In addition to the marital problems, Marsha was suffering from clinical depression: she couldn’t sleep or concentrate, she felt sad all the time, and she felt like a failure. Medication began to relieve some of these symptoms, but she was still upset about the state of her marriage. After a highly charged session with this distressed wife and angry, reluctant husband, the counselor met with Marsha separately the next week. She told Marsha that she would not recover fully from her depression until she started to “trust her feelings” about the marriage. Following is how Marsha later recounted the conversation with the counselor:
Marsha: “What do you mean, trust my feelings?”
Counselor: “You know you are not happy in your marriage.”
Marsha: “Yes, that’s true.”
Counselor: “Perhaps that you need a separation in order to figure out whether you really want this marriage.”
Marsha: “But I love Paul and I am committed to him.”
Counselor: “The choice is yours, but I doubt that you will begin to feel better until you start to trust your feelings and pay attention to your unhappiness.”
Marsha: “Are you saying I should get a divorce?”
Counselor: “I’m just urging you to trust your feelings of unhappiness, and maybe a separation would help you sort things out.”
A stunned Marsha decided to not return to that counselor, a decision the counselor no doubt perceived as reflecting Marsha’s unwillingness to take responsibility for her own happiness.
It gets worse: Marsha talked to her priest during this crisis. The priest urged her to wait to see if her depression was causing the marital problem or if the marital problem was causing the depression–a prudent bit of advice. But a few minutes later, the priest said that, if it turned out that the marital problems were causing the depression, he would help Marsha get an annulment.
Marsha was even more stunned than she had been by the therapist. The rest of the story is that they did find a good marital therapist who helped them straighten out their marriage, Marsha’s depression lifted, and they are currently doing well. They survived two efforts at what I call “therapist-induced marital suicide.”
Now Paul was a very nice guy. But he was young for his age and he didn’t know much about feelings. I didn’t know about feelings at his age either, and he was just really befuddled that his new bride was depressed all the time. I had been to their wedding six months before this and was appalled at this turn of events in therapy. How did we get here? It’s not that therapists or pastoral counselors are out to hurt people and deliberately undermine marriage.
I want to give you my version of a cultural overview, to put this problem in perspective. It was in the 1950s that people really began to pay attention for the first time, in a systematic way, to marital problems. The field of marriage counseling got started then. As we look back at the
1950s from a current perspective we see a focus on traditional marriage, with traditional gender roles, a reluctance to allow women to be in the workforce. We see divorce being viewed as a personal failing. If you remember in those days a woman was a divorcée her entire life. If she was in an auto accident, the newspaper headline said “Divorcée in Auto Accident.” A tremendous amount of social stigma was attached to divorce. Therapists often saw divorce as a treatment failure, based on personality problems of an individual. As we look back we often see that the therapist supported certain gender arrangements that society revisited later on. And in the
1950s most people who were doing any work in the marriage area were oblivious to marital violence; it was only in the 70s we began to pay attention to that problem. So, what we do in our country is, of course, swing from one kind of model to another. When the
60s and 70s came along, we had the rise of the culture of individualism, of marriage based not on duty anymore, but on personal happiness. The dark side of marriage now became apparent as we began to understand the amount of abuse that went on. The divorce rate skyrocketed, the no-fault divorce laws began to be passed in the early 1970s, and we had the Cultural Revolution in which we were liberating individuals from the traditional strictures of conventional morality. Therapists took two stances towards marriage during this era. The first stance was “neutrality” on the subject of marital commitment. In a short time therapists moved from an era in which a prominent psychiatrist in the 1950s said that he never supported a couple’s decision to get a divorce, to an era where the therapist was supposed to be neutral. A recent survey of clinical members of the American Association for Marriage and Family Therapy found that nearly two-thirds said that they are “neutral” on the subject and marriage and divorce. As a colleague said this in the press just a few years ago, “The good marriage, the good divorce, it matters not.” This was where neutrality has led us.
The other stance emerging during the 1970’s was beyond neutrality (because neutrality is not really possible anyway), to therapists seeing themselves as liberationists to help people out of unhappy marriages and other commitments in their lives. So we had the introduction of the idea of liberation from marriage, particularly when somebody sees an individual therapist. If you describe your marriage as painful for you, the therapist wants to liberate you from this toxic influence. This stance is still with us. If someone raises a concern about the fate of their children, many of us were trained to say that kids will do fine if their parents do what they need to do for themselves. What nonsense, but I used to say it.
The 1980s through the mid 1990s were a time when I believe that market values— the values of the marketplace–triumphed in American culture. Consumerism prevailed. If the 70s were the “I gotta take care of my own psychological needs” decade, the 1980s added the element of material greed. The business model invaded everywhere. I’m not against the business model in business, but look how it has invaded the professions with managed health care. And I believe that the business model, the market model, has also invaded the family and marriage in a very big way.
We have less loyalty now, in all spheres of life, then we did 20 or 30 years ago. Employers are less loyal to their employees, employees are less loyal to their employers. People are less loyal to their particular church or faith community; they shop around for the best show, the best services.
In a generation we have moved rapidly from being citizens to being primarily consumers. Can you imagine any politician now saying, without people laughing at him or her, “Ask not what your country can do for you, ask what you can do for your country?” Give me a break. It would not be believed. We moved from that to Ronald Reagan asking, “Are you better off than you were four years ago?”
So we are now primarily customers. And customers are inherently disloyal. Marriage, I believe, has been strongly influenced by this combination of the individual fulfillment culture and the consumer culture. Marriage is becoming yet another consumer lifestyle. The traditional marriage vows in some parts of the country are changed to “as long as we both shall love,” instead of “as long as we both shall live.” I think people now are beginning to see themselves as “leasing” a marriage. A counselor who works in the military told me that a number of young adults that she counsels tell her that, if they’re not sure whether they should get married, “if it doesn’t work out, we can always get a divorce.” That’s like saying, “I’m not sure if this car will last long, so I’ll lease,” and then if it falls apart, it’s somebody else’s problem. I invite you to consider the influence of the consumer culture on the culture of marriage. An example: Levi’s jeans is attempting to make a comeback after losing its trendiness. If you lose your trendiness in the consumer culture, you’re dead. Levi’s has an ad, a lavish ad across six magazine pages, featuring the ups and downs of dating couples whose relationships don’t last very long. The final page shows two female roommates, one consoling the other about a recent breakup. Just behind the two roommates, on the kitchen wall, is an art poster in Spanish that says, “My parents divorced.” The caption underneath the ad contains the take home message from Levi’s. “At least some things last forever–Levi’s. They go on.” You have to look at marketers to see what’s happening in the culture.
Another example: A New York Times journalist reported being at a wedding and hearing a woman at the wedding reception (apparently she was a relative of the groom) say in a loud voice about the bride: “She will make a nice first wife for Brian.” (Laughter.) You laugh, but is it not a pained laugh? Could you imagine if this was your daughter? This is like a first job, or a first house. When our daughter moved into a grubby basement apartment, with bugs, but one that she could afford, we said “It’ll make a nice first apartment.” Or, maybe we say “a nice first girlfriend,” when our son is a teenager–but a nice first wife?
Now therapists, like all of us, are far more absorbed in the culture than we are observing of the culture. Most of us like to think we’re counter cultural, but we’re not– we’re just swimming along in the mainstream. So I began to pay attention to the language I am hearing from therapists and in the self-help books that therapists write. This is the language that I hear from therapists now, in places like case consultation groups.
- “The marriage wasn’t working anymore.” This is saying your car not working anymore, and is it worth it after a period of time to put more money into repairs? If it’s not working, get another one.
- “It was time to move on.” That’s what we say about a job. I invested in the job, I’ve lost my creative edge, and it’s time to move on.
- “You deserve better.” This is a very consumerist saying, and friends, not just therapists, will say this to each other about a marriage. You complain about your marriage and your friend or your therapist says, “You deserve better.” That is a market-driven attitude. You put all this money into this vehicle, you deserve better.
- One well-known therapist, and social scientist, refers to “starter marriage.” Starter marriage? Now when you hear the word “starter” what do you think of… a starter home.
A starter home? a little home that you plan to leave. So you have a starter marriage.
I’m suggesting that this kind of language represents the invasion of a market, consumerist ethic into marriage, on top of the messages about individual fulfillment and satisfaction. This a powerful combination. I’m also saying that as therapists and marriage educators, if we do not counter this culture, we’re not going to have any influence at all. Which is why the 1990s version of marriage education has to be based on moral principles about commitment, not just based on ideas about just enriching your marriage. That’s where we were in the 70s, that we could enrich and improve our marriages, and that’s helpful, but it’s got to be based on moral notions now. Or it’s not going to withstand the notion that we move on to something else that’s even more enriching than our current marriage. Or if your marriage is not enrichable, then get out.
Here are some of my values about marriage and divorce. I do not believe we can or should go back to the 1950s or before. I believe that some divorces are necessary. And all major religions recognize that some people cannot live together. Not all religions say that you can get a divorce and remarry, but every major religion knows that some relationships break down. And that it is unwise for some people to continue to live together. Some marriages are dead on arrival at the therapist’s office. Some people just drop their spouse off at the therapist’s office and head out the door. I think divorce is a necessary safety valve for terminally ill marriages. I have a friend who discovered her husband and coparent was a pedophile, and he would not get help. The moral thing to do was to send him packing. So as much as I’m going to be talking about what we can do to save marriages, I think it’s important to understand that there is a dark, tragic side to marriage. But divorce ought to be the tragic exception, not the norm.
I view divorce as being like an amputation to be avoided if at all possible because it brings about permanent disability. But sometimes, an amputation is necessary. I also believe, and I think this is very important to say in response to critics of this movement (and I think that most of you, or all of you I hope, would agree with this): We can reduce the divorce rate substantially, without increasing the number of truly miserable conflicted marriages. I would not be thrilled if we reduced the divorce rate by one third and increased by one third the rate of truly miserable, highly conflicted couples. We can do both, we can reduce the divorce rate, and we can increase the percentage of people who are working out their marriages. We have to do both. This is not just a divorce prevention movement. Are you with me on this? (Applause.) I think both are important to say. And we need more data like the Australian and New Jersey studies that found that over 40% of divorced people regretted their divorce and thought it was preventable. We need to get that kind of data out.
Having stated my own values, my critique focuses on the unnecessary pain and unnecessary divorce created by incompetent therapists and by therapists who have hyper- individualistic approaches to marriage. In this view of marriage, marriage is a venue for personal fulfillment stripped of ethical obligations. And divorce is a strictly private, self-interested choice, with no important stakeholders other than the individual adult client. The result is, in my opinion, is that it is dangerous in America today, to talk about your marriage problems with a therapist. You don’t know what their attitude is. (Applause.) I don’t have any research on this, but I believe you may have a better than even chance of having your marriage harmed.
Now I’m going to talk about the most common ways that therapists undermine marital commitment. And I want to underline again: I do this for a living. I train therapists, and I think that therapy can be enormously helpful in the right hands. There are four ways that therapists undermine marital commitment: incompetent therapists, neutral therapists, pathologizing therapists, and overtly undermining therapists.
First, incompetent therapists. The biggest problem I see in this area is that most therapists are not trained to work with couples, and they see working with couples as an extension of individual psychotherapy. It is not. In individual therapy, depending on your model, you can be fairly laid back. You can be empathic and clarifying, you can even be fairly passive if you want. People will tell their story, they will feel heard, they will be helped to think through their concerns and their options. If you take that approach in marital therapy, you will fail. If you have a warring couple in your office, and you do not create a structure for that session, they will overwhelm you.
They will repeat in the office that which they do at home. A lot of therapists end a stormy session with, “Well, we’ve clarified some of the issues, haven’t we?” (Laughter.) Which means they’ve put in psychological terms the stuff that the couple knew they were doing. Um, thank you for the clarification that we are at war with each other. And these therapists offer no direction, no structure, no guidelines–under the pretense that this is being helpful. This may be helpful to some individuals in therapy, but it is not helpful to couples.
Another thing that incompetent therapists do is to beat up on one of the partners. Although women sometimes get more than their fair of the therapist’s negative attention, an under-recognized problem is that men also get seriously disadvantaged in some couples therapy. Men often come to save their marriage, not primarily to seek insight into themselves. The light bulbs have gone on: I could lose this woman, I could lose these children. I gotta shape up. When they come to a therapist who is only used to dealing with individuals, they are in trouble. The therapist begins with “And how do you feel about being here, Joe?” And Joe says “Well, I’m just here to save my marriage.” “No, Joe, that’s not a feeling.” “Well, I think it’s important that we…” “No, no, that’s a thought, Joe, that’s not a feeling.” And so Joe is not a candidate for individual psychotherapy, which to the therapist means “he’s got big time problems.” The therapist and the wife decide that both she and he need a lot of individual help. And so you try to trot him off to an individual therapist, her to an individual therapist. He doesn’t go, because he’s there to save his marriage, not to understand his psyche–which proves that he is not serious about change. Another time that therapists turf couples off to individual therapists is when the therapist can’t handle the in-session conflict. The therapist can’t handle the hot conflict, feels overwhelmed by it. This work is not easy. Jay Haley, one of the founders of family therapy, says that marital therapy is the most difficult form of therapy. The pulls, the triangles, the hot conflict that is right in the room makes it very difficult. The problem isn’t that some therapists can’t handle it, the problem is they don’t know they can’t handle it, and they assume that there is a lot of individual pathology going on. So they turf the spouses off to their individual therapists, or keeps one of the spouses in individual therapy and sends the other to a colleagues. I have seen a lot of unnecessary divorces because of this scenario. The wife can lose out in this scenario if she is to say that she has “issues.” She’ll say that she’s depressed a lot, that she’s read a lot of self-help books and knows she is co-dependent or something worse. So the therapist and the husband become co-therapists to help her with her problems. And it goes nowhere. The first problem in marital therapy, then, is incompetence, and therapists not knowing they’re not competent.
Second, neutral therapists. In the 1970s and 1980s, I was a neutral therapist on marriage and divorce. I helped people do a cost-benefit analysis–what does the individual gain and lose by staying married or getting divorced. This consumerist cost-benefit analysis disguises itself as neutral. The questions “What do you need to do for you?” and “What’s in it for you to stay, what’s in it for you to not stay?” are not neutral because they focus only what the individual sees as his or her own personal gain or loss. Neutrality when somebody has previously promised before their community, before their God, to be married to somebody until death do them part–neutrality on whether somebody can fulfill that commitment–is an undermining stance. It is not a neutral stance. And it often sides with the more self-oriented spouse. When somebody is seriously considering getting out of a marriage, listen to their language. They are often using the language of individual self-interest, not the language of moral commitment. You know, “I have needs”; “I have a right to happiness.” That’s the language. If the therapist’s language is the same, now you have an alliance between the reluctant, distancing spouse and the therapist, a collusion it undermines the marital relationship in ways that they therapist does not recognize.
An alternative to neutrality is that, except where there’s abuse and danger, to let the couple know that I will try to support the possibility that they can salvage their marriage. I am an advocate for their marriage. They can call me off but they’re going to have to look me in the eye and call me off. I’m going to try to support the possibility they can work this out, knowing that they must want it and that it is not always possible.
Third, therapists who pathologize. This is really an insidious one. You go to individual therapy, you criticize your spouse, and your therapist is likely to come up with a diagnosis for your spouse. I’m afraid you’re married to a narcissistic personality disorder. When you get a therapist giving you labels to pathologize your partner, it leads to hopelessness. Sometimes the therapist pathologizes the reason you got married. For any marriage in this room, we can get together and figure out what pathology led you to get married. This can lead to a sense of fatalism and hopelessness. You should never have bought that car to begin with. Another version is pathologizing the current relationship, telling the couple that they have no assets, that this is a sick relationship, that you are of questionnable psychological health if you stay. Let’s say you see an individual therapist after your spouse has an affair, and you’re thinking of taking your spouse back, you can be pathologized for your very commitment to keep trying.
What’s wrong with you that you are hanging in there? The therapist can highlight a one-sided sense of victimization. Now there is a lot of marital abuse out there, genuine abuse, but this word gets thrown around a lot. You can take ordinary unhappiness and conflict and transform them into the sense of being abused. You are a victim, and this then propels you out. A new form of pathology, by the way, is clients saying that they’re “bored” in their marriages. I’ve seen therapists get very exorcised about how awful it would be to be in a boring marriage. In a consumer culture, when we want stimulation and satisfaction all the time, boring is the new pathology.
Fourth, overt undermining. The most common form is provocative questions and challenges. “If you are not happy, why do you stay?” is a directly undermining question. It says “You are an idiot if you stay.” I have a student who had post-partum depressions after both of her children. She went to counselors to get help, in the process complaining about her husband for being insensitive to her emotional distress but not saying that she was doubting her commitment. Each time, at the end of the first session, the therapist said some version of this statement: “I can’t believe you’re still married.” This is an assertion of the therapist’s belief that the couple are fundamentally incompatible and that an intelligent client should run, not walk, out of the marriage. You’d be amazed at how many therapists say this kind of thing after a session or two.
What they’re really saying is that the that couple are fundamentally incompatible but that “I am fundamentally unable to help you.” (Laughter.) That’s what that means. And this plays to the distancing spouse.
Then there is undermining by direct advice. It’s against the code of ethics of the American
Association for Marriage and Family Therapy to directly tell people what they should do, either to stay married or divorced, but a lot of therapists do it. They have a different code of ethics.
They say, “I think you should break up,” “I think you may need a separation,” or “For your own health you need to move out.” In one case, a woman with a husband and ten children relapsed from her alcoholism. Her individual therapist admitted telling her that she needed to move out and have no contact with her husband or kids, for the sake of her recovery. The family therapist I talked was trying to pick up the pieces with the husband and children. Now let me show you a video from a public television series, Frontline. It was an exposé of abuses in therapy, and I’ve pulled out an excerpt on marriage. You’ll see Pat, one of the therapists, describe her approach to helping individuals who have marriage problems detach from their marriage. Then you’ll see one of her clients, followed by comments from a second therapist also named Pat. These therapists encourage cutoffs from family of origin, and also from spouses. This is a fringe group of therapists, but what you’re going to hear represents an element of mainstream psychotherapy carried to its logical conclusion of undermining marital commitment.
Scary? Very scary. This group was shut down after this expose came out, but they are back in operation, I am told. But the language that you heard is out prevalent in the world of therapy.
What can be done to make therapy less hazardous to marriages?
- We need a consumer awareness movement about the risks of sharing marriage problems with a therapist or counselor. Caveat emptor.
- Licensing boards and professional associations should have training requirements for therapists who claim to practice marital therapy.
- People considering therapy should learn to ask questions to learn about the therapist’s training and value orientation. They can ask a therapist on the phone or in the first session the following kinds of questions:
- “Can you describe your background and training in marital therapy?” If the therapist is self-taught or workshop-trained, and can’t point to a significant education in this work, then consider going elsewhere.
- “What is your attitude toward salvaging a trouble marriage versus helping couples break up?” If the therapist says he or she is “neutral,” or “I don’t try to save marriage, I try to help people” look elsewhere. (I’d also run if the therapist says he or she does not believe in divorce.)
- “What is your approach when one partner is seriously considering ending the marriage and the other wants to save it?” If the therapist responds by focusing only on helping each person clarify their personal feelings and decisions, consider looking elsewhere.
- “What percentage of your practice is marital therapy?” Avoid therapists who mostly do individual therapy.
- “Of the couples you treat, what percentage would you say work out enough of their problems to stay married with a reasonable amount of satisfaction with the relationship.” “What percentage break up while they are seeing you?” “What percentage do not improve?” “What do you think makes the differences in these results?” If someone says “100%” stay together, I would be concerned, and if they say that staying together is not a measure of success for them, I’d be concerned.
Let me say a few things in conclusion. In the late 90s the cultural tide is shifting. We’re shifting towards what I believe a better balance between individual satisfaction and moral commitment, and towards the creation of new opportunities for people to learn how to have lifelong, successful marriages. But I believe that most therapists are still behind the times. Like generals, they are still fighting the last war. The one that freed individuals to leave unhappy marriages.
They still see themselves as liberation fighters, for individual fulfillment against oppressive moral codes and family structures. That’s how I started my career as a therapist. But in the meantime the culture has shifted. The old war has been largely won. Most of us are now free to walk away from our marital commitments more easily than from any other contract in our lives.
We can always get a divorce. And we suffer relatively social stigma for doing so. But now we face the prospect of losing our ability to sustain any commitment at all. We have cut through our marital chains but ended up with Velcro. Easy to pull apart, but not strong enough to hold us together under pressure. Speaking of pressure, I think of long-term marriage like I think about living in Minnesota, in Lake Wobegon, perhaps. You move into marriage in the springtime of hope, but eventually arrive at the Minnesota winter with its cold and darkness. Many of us are tempted to give up and move south at this point. We go to a therapist for help. Some therapists don’t know how to help us cope with winter, and we get frostbite in their care. Other therapists tell us that we are being personally victimized by winter, that we deserve better, that winter will never end, and that if we are true to ourselves we will leave our marriage and head south. The problem of course is that our next marriage will enter its own winter at some point. Do we just keep moving on, or do we make our stand now–with this person, in this season? That’s the moral, existential question. A good therapist, a brave therapist, will help us to cling together as a couple, warming each other against the cold of winter, and to seek out whatever sunlight is still available while we wrestle with our pain and disillusionment. A good therapist, a brave therapist will be the last one in the room to give up on our marriage, not the first one, knowing that the next springtime in Minnesota is all the more glorious for the winter that we endured together. Thank you.