5 Things to Consider Before You Begin Couples Therapy

The frequency with which inquiries show up in my practice for couples therapy is far greater than before. I receive calls daily from all kinds of couples… Married, pre-married, cohabitating, post-married, heterosexual, gay, straight, ambivalent, committed, etc. with all sorts of struggles both in and out of the bedroom. I’m not certain if the rise is due to the recognition that the divorce trend hasn’t made for better next relationships as well as having adverse effects on family integrity or if there are simply convenient and more powerful empirically based methods at the therapeutic disposal.

With the trend in marriage towards ‘our one and only’, betrayal at record producing rates (or at least our discovery methods expanded) and sex ever more on the back burner for some, people are stepping up to make meaning of their lives and their relationships. And marriage counseling can be a suitable remedy prior to opting for the more costly alternative, divorce.

Five things to consider when on the couple therapist hunt:

Not every ‘couples therapist’ is created equal.

For one, there is an abundance of practitioners who set a claim on couples therapy, whether they have a doctorate (PhD, PsyD, DSW), a master’s level degree (MHC, MFT, CSW) or, alternatively, refer to themselves as a relationship coach. In the therapy world, that is, today, considered less relevant than the notion that one has the fundamentals—training, skills, and experience to provide a service for which they proclaim. Websites promoting expertise in psychotherapy for children, addictions, couples, forensics create skepticism and require further evaluation of their training and experience. Working with children is a specialty that does not often overlap with couples, with developmental disorders, autism, and cognitive testing being a subspecialty. Peruse the ‘about’ page and if insufficient ask further questions defining their expertise. Whether a referral from a friend, college or google, you can take it a step further and scrutinize online organizations/directories because, despite that they are paid memberships and advertising, there is a qualification process for most to show inclusion, with some citing various levels of expertise. Invest in the process and do your due diligence.
Nor is every model of couples therapy created equal.

Perhaps you have heard tossed around methods of couples therapy like Emotionally Focused Couples Therapy (EFT), Gottman, Imago, Object Relations and more. While many are effective, the bottom line is that EFT has more than 20 clinical studies showing it’s efficacy; it is the most empirically based of them all. That said, I have faced many a couple who have found great solace and healing with the other assorted models at contrasting times in their lives. Although there are pieces of all that can help, it is most potent when there is a basic structure and model so that the experience is the antithesis of what Dr. Ellyn Bader, a noteworthy couples therapist herself said about couple therapy to the therapist can, “feel like piloting a helicopter into a hurricane”.
Good couples therapy is not inexpensive.

Given the above (#1, #2) couples therapy, today is not inexpensive. To enlist someone proficient requires education, training, and experience, none of which comes cheap. Done correctly it can help you not only grow your dyad but transform you as an individual as well. And if you are that far along on your downward spiral, look at the alternative financially; it is less costly than divorce court.
Couples therapy can transform not only the relationship but the individual as well.

One of the reasons I love Esther Perel, psychotherapist, and best-selling author, is because she, not infrequently, exercises a risk to speak what only others, myself included, might ponder. As such, I have heard her say that one can do couples therapy with the individual in the room and individual therapy with the couple in the room. We know, for example, with EFT for couples, as an attachment based protocol, the potential for individual growth and healing is monumental. While the alternative can also ring true, I have seen at times greater healing within the couples frame.
It’s more than a plus if your couples therapist is also a sex therapist.

When someone steps into the therapy, they bring themselves both in and out of the bedroom. Although not the sole obstacle with which they face, when engaging in an assessment of the couple, it should not go unnoticed. My personal bias… there should be no mental health professionals with at least some basic education in sexuality and for those who work with anything sexually related, like couples therapy or sex addiction, it no doubt should be more extensive. For two reasons. Why? One, to be able to speak about it. Two, to know what to ask, look for, assess and integrate if possible, or refer out. There remain qualified practitioners who maintain their own discomfort either because of the topic or because of their ignorance. Within the dyad and the frame of couples therapy, we look at sexual issues as part of the relational piece. It often is. But there are times when conflict arises due to physiological, physical, individual and spiritual issues as well; and while these will have direct ramifications to the relational piece, they may need to be addressed independently as well. For example, a man with erectile dysfunction or a woman with desire disorder; both of which most frequently maintain a relational base but might signal other etiologies as well.