Top 10 Things you should know before going to a Marriage Therapist

Couple therapy is a means of resolving problems and conflicts that couples have not been able to handle effectively on their own. It involves both partners sitting down with a trained professional to discuss their thoughts and feelings.

Below are Ten Things everyone ought to know about Marriage Therapists:

 

1. I have no business giving relationship advice.

Divorce rates for baby boomers have doubled in the past 20 years, with one in four couples over age 50 calling it quits by 2009, according to a study from Bowling Green State University released earlier this summer. Although overall figures have fallen in recent years, some estimates still put the divorce rate for all new marriages at roughly 50%. But couples looking to stave off a split may want to choose their expert help with care. Training and experience levels among purveyors of marriage advice run the gamut from never-took-Psych-101 to spent-more-time-in-school-than-your-doctor.

State-licensed psychologists, psychiatrists, mental health counselors and social workers can all offer sessions for couples, as can licensed marriage and family therapists. To earn the latter distinction, therapists are required by states to get at least a master's degree in the discipline and a passing score on a national licensing exam, followed by a set number of client hours -- from 1,500 hours in New York to 3,000 in Texas -- under the supervision of another fully licensed practitioner. But pretty much anyone can hang out a shingle as a marriage coach, relationship adviser or other uniquely labeled provider of "alternative marriage counseling" -- they just can't call the services "therapy." License or no, experts say the risk for consumers is that it's so easy to pick a provider who doesn't have the education or skills to solve their problems.

A license provides a baseline -- the client knows that the therapist has experience and education in the field, which isn't guaranteed with unlicensed providers, says Chris Van Deusen, a spokesman for the Texas Department of State Health Services, which oversees licensing. It's no guarantee, however. Couples should ask about the provider's overall qualifications, says Dr. Karen Ruskin, a Boston-based licensed marriage therapist and clinical member of the American Association for Marriage and Family Therapy. For example, an unlicensed provider might well have earned a psychology degree or completed training or certification courses in relevant areas. Pastors and other religious leaders can get counseling certifications or even qualify as a state-licensed pastoral therapist. Some licensed professionals, on the other hand, may offer services to couples as a side effort but lack marriage-specific training, she says. Plus, many of the consumer complaints about marriage therapists that Texas receives each year are linked back to therapists who are practicing despite having an expired license, says Van Deusen. Most state departments of health services maintain a database consumers can check to confirm a provider's licensing status, and to see any complaints that have been logged against him or her.

2. You're not going to make it.

Dr. John Gottman, who developed the Gottman Method of couples therapy and co-founded the Gottman Relationship Institute that certifies therapists in the method, has another claim to fame: He has said his studies in the field enable him to predict within minutes of meeting a couple whether they will eventually divorce, with better than 90% accuracy. Just don't expect Gottman (who wasn't available for an interview) or any other therapist to tell you flat out, says Dr. Dave Penner, a licensed clinical psychologist and the assistant clinical director at the Gottman institute. "You don't say to a couple, 'Too bad, you've got all the predictors of divorce,'" he says. That's not conducive to therapy, which is about changing those behaviors, he says. (Of course, telling a couple that their chances of resolution are nil would also mean they'd stop going to -- and paying for -- counseling sessions. But therapists say hiding information just to keep clients coming isn't ethical.) A 2005 Journal of Consulting and Clinical Psychology study found that five years after receiving eight months of therapy, half of couples said their relationships had improved. A quarter were divorced, and the remaining 25% were still having problems.

Couples may be able to pick up a few cues, however. A practitioner might point out that a couple has major challenges ahead, or is exhibiting some characteristics that can lead to divorce, says Penner. Expect to be called out if you're obviously coming in just to go through the motions, but not to attempt actual improvement, says Dr. Lynda Doyle, a licensed marriage therapist in Yarmis, Maine. "You can tell somebody's already checked out of the relationship," she says. "I'll tell them they can do fake therapy for another five sessions if they want, or try the real thing.

3. I like your partner better than I like you.

Over the course of trying to resolve marital problems during the '90s, John Wilder of Midway, Ga., and his then-wife saw nine different marriage therapists. None of them helped, says Wilder, who has a bachelor's degree in behavioral science and has since trained as a marriage coach. His main gripe: He contends that because the counselors didn't address problems equally, they did more harm than good.

It's not uncommon for couples to feel like their practitioner is playing favorites, and that won't help them solve any problems, says attorney Kenneth Altshuler, president of the American Academy of Matrimonial Lawyers and husband to marriage therapist Doyle. (The two say they don't refer clients to each other.) It can also make a divorce more acrimonious.

Therapists say that most of the time, any imbalance is inadvertent. With two people sharing session time, it's not easy for even an experienced counselor to split attention 50-50, says Doyle. Or one person may be more comfortable with the therapist or the style of therapy than their partner, leading to a sense of unfairness. The couple's issues can also be more weighted toward one party -- say, if one has committed adultery -- in a way that leads to a more imbalanced talk. Couples shouldn't be shy about bringing up perceived favoritism during sessions, or about asking for another referral if they feel balance isn't restored, says Doyle.

4. I've got my own baggage.

Styles can vary widely among therapists, coaches and other practitioners, and that's not something that's typically apparent by looking at their listings in the phone book or on an insurer's website, says Dr. Arshad Rahim, a vice president with physician data and review site HealthGrades.com. Traditional counseling is primarily about solving the problems, but there's also the relatively new field of "discernment counseling" that has the specific aim of helping couples decide whether to stay together or divorce. Some practitioners are more pro-marriage than others too. The therapist's personal history may also have an influence, says Altschuler. "I tell clients, you need to find out about the marriage counselor," he says. "Is that person divorced, or going through a divorce?"The best approach is a direct one: Ask them, preferably before booking an appointment.

Most of the time, though, the practitioner's approach isn't "wrong"; it's just not a good fit for the couple -- which makes the sessions unlikely to be successful, says Rahim. Even if the couple decides to go elsewhere after one session, their bill can still amount to several hundred dollars. Ruskin suggests asking for a free phone consultation before scheduling an appointment. "Ask them to describe how they feel marriage problems are resolved," she says. Wilder says many coaches also offer free in-person consultations or a money-back guarantee if the couple feels the first paid session wasn't helpful.

5. Anything you say can be used against you -- in divorce court.

Something called "therapist-patient privilege" typically keeps your mental health professional from divulging details of your private sessions in a court of law or elsewhere. But that privilege applies to one-on-one relationships, says Altschuler. "When a marriage counselor sees two people, arguably there's no confidentiality, since there are three people in the room," he says. State law on that point varies, and unlicensed experts seeing couples often have less legal standing to claim that information revealed during their sessions was privileged. (The American Association for Marriage and Family Therapy's code of ethics requires therapists to disclose any limits to clients' right of confidentiality.)

Most courts try to keep marriage counselors out of the proceedings, though, unless they are testifying to something serious, Altschuler says. Most of the cases where he's seen a marriage therapist testify focused on admissions of abuse that were made in session. It's more common that seeing a marriage counselor simplifies a divorce, he says, by helping a client figure out what they want and how best to proceed.

6. You really should've come to me before you tied the knot.

Brent Goren, a contractor, in Milford, Conn., has seen couples counselors on and off for the past decade -- nearly every time he got serious with a new girlfriend. The sessions served as a check, he says, to see if the early relationship problems were fixable and to find ways to better work through them. "I'm of the opinion that most of the people on this planet could use a little bit of practice in how to communicate better," he says.

It's becoming more common to see unmarried couples in the marriage counselors' client pool, says Radia Amari, an industry analyst for IbisWorld. Along with other mental health fields, marriage counselors have seen a drop in their client base in recent years, because even as the ailing economy has increased suffering, it has lessened consumers' ability to pay for therapy, she says. The declining marriage rate hasn't helped. In 2010, 51% of adults were married, down from 72% in 1960, according to the Pew Research Center. "Expanding to dating couples totally makes sense, because as a therapist, you have to expand your patient pools," Amari says -- although it's an expensive sounding board for consumers.

Therapists counter that the couples are smart to come in early. "It's like medicine: The earlier you can intervene, the better the outcome is likely to be," says Penner. Studies show that couples typically wait six years from the time they first encounter a relationship problem to decide to talk to a professional about it, and unmarried couples that come in are heading off potential crises before they're locked into marriage, he says.

7. This is going to hurt -- your wallet.

Hourly rates for a marriage coach or therapist can top $200, and that entire fee may be out-of-pocket. Insurers' policies vary widely. If marriage counseling is covered, it's generally limited to licensed therapists in the insurer's coverage network. Some restrict it further to psychologists and psychiatrists that provide couples counseling. But getting the bill paid may not be as simple as picking a counselor. Many plans -- including Medicare -- don't cover marriage counseling unless a physician or clinical psychologist has diagnosed one of the couple with a disorder than might benefit from counseling, says Amari. Even if it is covered, insurers often have varying policies for handling the bill. Some therapists charge just a copay; others expect patients to pay the full fee up front and seek reimbursement on their own, says HealthGrades.com's Rahim. "Some providers assume it's not much of a consideration" and don't mention their policies in advance, he says. The common result: a surprise three-figure bill for the first visit.

But there are some trends that are making couples counseling more affordable, Amari says. More practitioners (licensed and not) have begun offering sliding-scale fees after seeing a drop-off of patients who couldn't afford treatment during the recession. It's not always advertised, and it's up to the client to ask about. Plus, insurance companies are looking to provide more coverage for visiting a licensed marriage therapist, she says -- they're often cheaper than sending couples to a psychologist providing similar services, and the therapy tends to take fewer sessions to complete.

8. I'll keep seeing you as long as you keep showing up.

According to the American Association for Marriage and Family Therapy, couples undergoing counseling have an average of 12 sessions -- one fewer than the average for an individual who attends therapy sessions. But the group also found that 66% of clients undergoing marriage counseling have up to 20 sessions, and another 20% schedule between 20 and 50. (In comparison, a slimmer 11% of individuals receiving psychotherapy have more than 20 sessions, according to a 2010 American Journal of Psychiatry study.) That could make the out-of-pocket tab bigger than consumers expect.

Therapists say they can't put a number on how many sessions it'll take to resolve a problem when the couple comes in. "It could go for a few weeks, or a year or two if the issues are complex or deep," says Penner. But he says a good therapist will help the couple set goals for resolving issues over time, and scale back sessions so that eventually all they might need is a check-in every six months. Couples shouldn't be shy about asking for an evaluation of their goals and progress after a few sessions, either, to better determine how many more they might need.

9. Got an urgent emotional issue? I can fit you in next January.

In the new movie "Hope Springs," Kay (played by Meryl Streep) convinces her husband Arnold (Tommy Lee Jones) that the only way to save their 31-year marriage is to head to Maine for a week of intensive couples therapy with self-help guru and marriage counselor Dr. Bernard Feld (Steve Carell). Lucky them -- experts say that real-world couples are lucky to get an hour a week to hash out their issues with an expert. Clients say sessions are difficult to schedule, says Cheryl Reed, a spokeswoman for review site Angie's List. Complaints there often note that the practitioner runs late but still ends the session on time -- resulting in a shorter session for the money, she says, and that makes clients feel like they aren't a priority. "We see from poorly graded reports a common theme of the marriage therapist not being as engaged as the client would like," she says.

An unresponsive therapist or one that can't fit you in for regular appointments is unacceptable, says Ruskin. Consumers should expect that a good practitioner will respond to questions or calls within 24 hours, and have enough availability that they can fit you in within a week. Couples looking for a more intensive experience might ask about scheduling appointments that are longer than the standard one-hour time slot, too, says Wilder. "In an hour, you can't always get much done," he says, "but in a four-hour session, there's a lot that can be accomplished." That might also mean that couples need to pay for fewer sessions.

10. Don't leave me alone with your spouse.

Despite the name "couples counseling," it's not uncommon for a practitioner to schedule a few separate sessions for each person, or to take on one partner as an individual client as well. In reviews, however, couples often complain that the split sessions made them feel like the therapist picked a side, says Reed. It's even a contentious issue among practitioners, many of whom say it's a bad idea that can make the couple's therapy ineffective. "Your client is the couple," says Ruskin. Details divulged during individual sessions are almost always confidential, and that can put a practitioner in a tough position. For example, says Doyle, a client once stepped out in the waiting room to make a phone call, and her spouse used that opportunity to confess to having anonymous sexual encounters. Doyle couldn't say a word about it to his wife. "You become the secret keeper," she says. "You have to wait until they bring that issue up in the couples session -- and what if they don't?"

But some experts say it's better for the couple that the same therapist sees them together and individually, rather than bringing another practitioner into the mix, says Penner. "That other therapist may not be relationship-friendly, and may emphasize individual rights that could undermine couples therapy," he says. Either way, couples should approach split sessions with caution and with the understanding that relationship issues will only be discussed in the couple sessions, he says.