Wednesday, June 22, 2005

Article: Marriage Therapy

Part of my job is to (attempt to) know everything about marriage and divorce statistics, as well as programs, laws, and other government stuff that pertains to marriage. This article is a good summary of one of the big internal debates that's going on in the "marriage community."

Hearts divide over marital therapy
By Sharon Jayson

Couples who are trying to patch up a troubled union often turn to counseling as a last-ditch effort to keep the marriage intact. That's what marital therapy is all about, right?

Not necessarily.

Most couples probably don't know that there is a long-standing debate among practitioners over whether therapists should actively try to save a marriage or whether they should remain neutral and treat the couple as two individuals for whom divorce possibly could be the best outcome.

William Doherty, a veteran marriage and family therapist at the University of Minnesota, is among those who take the marriage-saving view. He believes therapists have been too neutral, particularly since the 1970s, and have focused on the individual. He blames the period for the trend that he believes has rendered therapists so neutral that they are sabotaging marriages.

He also is among those who say that too many therapists aren't sufficiently trained to counsel couples and that the profession isn't regulated consistently, so consumers don't really know what they are getting.

So this week, Doherty is launching a therapist-finder registry called the National Registry of Marriage Friendly Therapists ( It is designed to weed out those whose skills don't meet his standards. And his list will include only therapists who sign a values statement supporting marriage and vowing to seek consultation if the therapist believes the couple is moving toward a premature divorce.

"The registry is about training and competence and about values, because most couples assume the therapist is pro-marriage, but many therapists feel they have to be neutral," he says. "The values thing comes into play when there seems to be a discrepancy between somebody's personal happiness and their commitment to the marriage."

Doherty is well respected in his field and has 30 years of clinical experience, has written several books and serves on the boards of family therapy journals. But his brainchild is stirring up controversy among his peers and probably will be much-discussed at the ninth annual Smart Marriages conference, which begins Thursday in Dallas. More than 2,000 therapists, researchers, clergy members and others will spend the next few days discussing research on marriage and marriage education initiatives.

Other counselor-finding services already exist, most notably those provided by the American Association for Marriage and Family Therapy (AAMFT) and the American Psychological Association. People use these services to find a therapist or check the credentials of someone to whom they have been referred. Michael Bowers, AAMFT's executive director, says his organization's locator service, which began five years ago, receives 5,000 hits a month.

"Word of mouth can be great if you have people you're willing to share such information with. The key thing on the Internet is to find what's reliable."

Some therapists question the need for an additional service. The fact that Doherty is calling his list "marriage-friendly" irks others, who say it suggests some therapists are biased in favor of divorce. Still others are concerned about what they see as an underlying conservative message with the name and the values statement.

"I don't know of any body of research that suggests therapists who sign a values statement are going to be better at keeping couples together than those who don't sign a values statement," says Alan Hovestadt, a professor of family therapy at Western Michigan University and AAMFT president.

And David Schnarch, who directs the Marriage & Family Health Center in Evergreen, Colo., disagrees with Doherty's assessment of his peers. "Certainly, there was a period in the '60s and '70s where there was tremendous focus on individual growth at the expense of relationships," he says. "But to position marital therapists as doing that is completely inaccurate."

These underlying differences could be brought to the forefront with Doherty's registry as prominent names line up on both sides.

Sue Johnson, a psychology professor at the University of Ottawa in Ontario who directs the Ottawa Couple and Family Institute, is among those lending support as an adviser.

John Gottman, a Seattle-based researcher and trainer and an emeritus professor of psychology at the University of Washington, refuses to be listed on this or other professional registries. He maintains that credentials alone can't determine whether a therapist can be recommended.

Johnson's backing is based on the fact that the Web site "encourages the public to be educated consumers and seek out therapists who they know support marriage."

Still, she has a few qualms.

"I assume most trained therapists are pro-marriage," she says. "It seems to me that most marital therapists don't get trained in it if they don't see value in marriage."

Still, Doherty refers to the registry as "values-oriented but not faith-based" for a reason: "This is making a statement about marriage as a lifetime relationship."

He and Kathleen Wenger, a clinical psychologist and marriage and family therapist who teaches psychology at Pepperdine University in Malibu, Calif., are co-founders of the privately owned company that operates the online registry. Unlike other therapist locators, clients of this registry will complete a post-therapy evaluation, which will appear online.

"There are a lot of people who are trained and good at this work, and there are just a lot more who are not, and the consumer doesn't know where to turn," Doherty says.

According to data from the U.S. Department of Health and Human Services, marriage and family therapy has grown from an estimated 1,800 in 1966 to almost 50,000 specialists. An additional estimated 25,000 mental health professionals also may counsel couples.

Therapists are licensed in all states but Delaware, Montana and West Virginia, where anyone can call himself a marital and family therapist.

Doherty says the bigger issue is that credentials and training vary widely between those who specialize in marital and family therapy and others in the mental health field, such as social workers, pastoral counselors, psychiatrists and psychologists, all of whom have been licensed but who may have minimal training in marriage and family therapy.

In the past 15 years, demand for couples therapy has increased just as attention has shifted toward improving relationships, Johnson says. Fifteen years ago, "you didn't have Dr. Phil on TV talking about relationships, and you didn't have all the books talking about relationships."

The therapist association estimates that slightly more than 3% of the nation's 57.3 million married couples have seen a marriage and family therapist or a mental health professional for marital problems in the past year. The average cost is about $80 for an hour's session.

Doherty's registry is free to consumers but costs $200 a year for therapists, who will each have a Web page listing their training and credentials. A copy of the license will be required before a therapist is listed.

Norman Epstein, a psychologist and professor in marital studies at the University of Maryland, is unsure whether he will accept Doherty's invitation to participate. He says he is "supportive of the goal but a little concerned about the values that could be read into it." He says he's also concerned that the registry seems to exclude committed couples who aren't legally married.

Despite an array of differences, therapists do agree that couples have a better chance of preserving the marriage if they don't wait to seek help. Often, they say couples wait years before facing their problems and seeking counseling.

"Studies show for a good number of couples, couples therapy is helpful and does improve their relationships," Epstein says. "If you get a reasonable percentage of couples who start out distressed and come out relatively happy, that's saying something."

Who's doing marital therapy?

Many types of therapists and mental health professionals do marriage counseling. State licensing and training varies by specialty:

Marital therapist: Master's degree and course work in marriage and family therapy, as well as a minimum of 1,000 hours of supervised training with clients before being licensed.

Psychologist: Ph.D. in clinical psychology from an accredited university; licensing criteria vary by state, including number of hours of course work and supervised clinical training.

Clinical social worker: Master's degree in social work from an accredited school of social work; at least two years of post-degree supervised clinical experience required for state licensing.

Pastoral counselor: Master's degree in the fields of social work, professional counseling, marriage and family therapy or psychology, as well as theological training (degree not required). Many pastoral counselors are former clergy or congregation leaders.

Advanced practice registered nurse: Master's degree in psychiatric/mental health nursing from an accredited nursing school; state license granted post-degree.

Psychiatrist: Four years of medical school, followed by state licensing. One year of post-graduate residency in a hospital. A psychiatrist-in-training spends at least three additional years in psychiatric residency learning diagnosis and treatment of mental illnesses, psychotherapy (including marital therapy) and drug and other treatments.

Sources: American Association of Marital and Family Therapy; American Association of Pastoral Counselors, American Psychiatric Nurses Association, American Psychiatric Association, American Psychological Association, National Association of Social Workers
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