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Dear Dr. Robert,

My wife and I have been married for six years. I am 34, and she is 29 years old. For the first year or so we were happy together, but then we began arguing, at first about small things, but then more and more about important matters. The arguments gradually got worse until we seemed never to have a single day without a fairly bitter fight. Our sex life suffered terribly since my wife says she cannot be interested in making love with someone who obviously dislikes the way she is, so now we fight about that too.

Seven months ago we began couples therapy with a local counselor who was recommended to us by a friend of my wife. We see her twice a week, so by now we have had at least fifty meetings with her. These are expensive and time-consuming, but I would be willing to pay the price, both in money and time, if I thought the therapy was helping, but it isn't. This counselor seems to do little more than listen to us talk about our complaints, and this has gone on and on now for, as I say, fifty hours or more. She makes almost no recommendations to us, and the ones she makes seem to do more harm than good.

When I complained to her last week, she told me that "these things take time," and told me that given the amount of discord in our marriage we should not expect quick results.

I am beginning to suspect that this counselor is not helping us, and may even be making things worse. What would you advise?

R.W. New York, N.Y.

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Dear R.W.

Thank you for your question which I think will be helpful to many people since this is a very common experience in therapy, particularly couples therapy. Unfortunately, there are many incompetent people claiming to be able to help couples to resolve their relationship problems. One reason for this is that anyone can claim be be a "counselor," regardless of training or qualifications. Another is that the "counselor" can always blame failures on the incompatibility of the couple while taking credit for whatever successful outcomes might arise.

Without having seen your counselor at work, or at least having more details, I cannot say for certain that she is unqualified, but your report of having put in over fifty hours of therapy without feeling any better makes me suspicious. Usually, there is some improvement, both in the way couples regard one another, and in the way they communicate with each other, after between 5 and 10 hours of effective therapy, sometimes sooner.

You did not give details about the kind of therapy your counselor is providing for you, and this is vitally important. Many approaches to counseling couples have proven to be either ineffective or downright counterproductive. Often these are approaches used by untrained, self-styled "counselors, or counselors working within religious traditions such as pastors and priests who use the hammers of obligation and scripture to try to force the couple into compliance with some kind of "spiritual" ideal, but some well-trained psychologists, who should know better, also fail to approach this kind of work in the right spirit and with the right tools.

In my experience, there is only one really effective approach to couples counseling, and it has nothing to do with giving advice, teaching so-called "communication skills," or offering verses from the Bible or other religious texts. Now, some couples simply should not be together, and no amount of counseling, no matter how effective, can improve that kind of relationship. which, as I see it, is destined to fall apart. But if a couple has some reasonable foundation for a relationship, the approach that often can bring sanity and happiness to their lives together is based on a kind of depth analysis (that is, consideration of childhood experiences in ones family of origin) of both parties to the relationship.

In other words, the psychotherapist will work with each person in turn to try to discover what "old tapes" are being reenacted in the present day context of the relationship. This has two great benefits. In the first place, it gives the person being analyzed a new perspective on his or her complaints, showing that they really are not the fault of the partner. And, at the same time, the partner, witnessing the old pain of his or her mate, learns to feel much more sympathy and tolerance for the behaviors that before seemed so annoying.

This approach does not always work, but often it does, and only a few hours of therapy should be sufficient to demonstrate that it is working.

A recent article in the New York Times approached this topic in a useful way, and I take the liberty of quoting it below.

Be well.

From The New York Times, April 19, 2005:

Married With Problems? Therapy May Not Help

Each year, hundreds of thousands of couples go into counseling in an effort to save their troubled relationships.

But does marital therapy work? Not nearly as well as it should, researchers say. Two years after ending counseling, studies find, 25 percent of couples are worse off than they were when they started, and after four years, up to 38 percent are divorced.

Many of the counseling strategies used today, like teaching people to listen and communicate better and to behave in more positive ways, can help couples for up to a year, say social scientists who have analyzed the effectiveness of different treatments. But they are insufficient to get couples through the squalls of conflict that inevitably recur in the long term.

At the same time, experts say, many therapists lack the skills to work with couples who are in serious trouble.

Unable to help angry couples get to the root of their conflict and forge a resolution, these therapists do one of two things: they either let the partners take turns talking week after week, with no end to the therapy in sight, or they give up on the couple and, in effect, steer them to divorce.

"Couples therapy can do more harm than good when the therapist doesn't know how to help a couple," said Dr. Susan M. Johnson, professor of psychology at the University of Ottawa and director of the Ottawa Couple and Family Institute.

One couple, in Boonton, N.J., saw two marriage counselors over 13 years.

"One therapist hurt our marriage and actually a caused our separation," said the husband, Jim, who did not want his last name used out of concerns for his privacy.

"She told my wife, 'You don't have to put up with that,' " referring to his battle with alcoholism, he said.

To be sure, many couples credit counseling with strengthening their marriages. And therapists say that they could save more marriages if couples started therapy before their relationships were in critical condition.

"Couples wait an average of six years of being unhappy with their relationship before getting help," said Dr. John Gottman, emeritus professor of psychology at the University of Washington and executive director of the Relationship Research Institute in Seattle. "We help the very distressed couples less than the moderately distressed couples."

In the last few years, efforts to find ways to save more marriages and other long-term relationships have increased.

With an experimental approach called integrative behavioral couples therapy, for example, 67 percent of couples significantly improved their relationships for two years, according to a study reported in November to the Association for the Advancement of Behavior Therapy.

Instead of teaching couples how to avoid or solve arguments, as traditional counseling techniques do, the integrative therapy aims to make arguments less hurtful by helping partners accept their differences. It is based on a recent finding that it is not whether a couple fights but how they fight that can destroy a relationship.

Especially encouraging, all of the couples in the study were at high risk of divorce. "Many had been couples therapy failures," said Dr. Andrew Christensen, a professor of clinical psychology at the University of California, Los Angeles and the lead author of the study.

But some experts who were trained as couples therapists have now become so disillusioned that they question the value of couples therapy in any form. They say that couples are better off taking marriage education courses - practical workshops that teach couples how to get along and that do not ask them to bare their souls or air their problems to a third party.

Two large nationwide marriage education programs, Practical Application of Intimate Relationship Skills and the Prevention and Relationship Enhancement Program, offer such workshops.

"When I was a practicing therapist, I was like a judge listening to each partner tell why the other was ruining the marriage," said Diane Sollee, a former couples therapist who founded Smartmarriages, a clearinghouse of marriage education programs. "There was a lot of crying. Marriage education classes are more empowering."

Developed several decades ago mainly to prevent marital problems in newlyweds or engaged couples, marriage education programs are now attracting couples who have not been helped by couples therapy but who want to try one last thing before deciding to divorce.

How effective these programs are is unclear.

Some studies indicate that couples who take marriage education classes have a lower divorce rate than couples who do not take the classes.

But Dr. Gottman, who uses marriage education workshops and couples therapy, has found that workshops alone are insufficient for 20 percent to 30 percent of couples in his research. These couples have problems - like a history of infidelity or depression - that can be addressed only in therapy, he said.

Couples therapy, also called marriage counseling and marriage therapy, refers to a number of psychotherapy techniques that aim to help couples understand and overcome conflicts in their relationship.

It is conducted by psychologists, psychiatrists and social workers, as well as by marriage and family therapists.

Three types of couples therapy have been found to improve people's satisfaction with their marriage for at least a year after the treatment ends.

The oldest approach, developed more than 20 years ago but still widely used, is behavioral marital therapy, in which partners learn to be nicer to each other, communicate better and improve their conflict-resolution skills.

Another, called insight-oriented marital therapy, combines behavioral therapy with techniques for understanding the power struggles, defense mechanisms and other negative behaviors that cause strife in a relationship.

With each method, about half of couples improve initially, but many of them relapse after a year.

A relatively new approach that studies have found highly effective is called emotionally focused therapy, with 70 to 73 percent of couples reaching recovery - the point where their satisfaction with their relationship is within normal limits - for up to two years, the length of the studies.

Dr. Johnson, who helped develop emotionally focused therapy in the 1990's, said that it enabled couples to identify and break free of the destructive emotional cycles that they fell into.

"A classic one is that one person criticizes, the other withdraws," she said. "The more I push, the more you withdraw. We talk about how both partners are victims of these cycles."

As the partners reveal their feelings during these cycles, they build trust and strengthen their connection to each other, she said.

Surprisingly, Dr. Johnson said, until emotionally focused therapy came along, therapists were so intent on getting couples to make contracts to change their behavior that they did not delve into the emotional underpinnings of a relationship.

"It was like leaving chicken out of chicken soup," she said.

Dr. Johnson's latest research, completed in January, included 24 of the most at-risk couples, people who were unable to reconcile because their trust in each other had been shattered by extramarital affairs and other serious injuries to their relationship.

"These injuries are like a torpedo," she said. "They take a marriage down."

The study found that after 8 to 12 sessions, a majority of the couples had healed their injuries and rebuilt their trust.

Most important, these gains lasted for three years. "It's very satisfying to know that we can make a difference with these couples and that it sticks," Dr. Johnson said.

Alice, a library program coordinator in Honesdale, Pa., credits her couples therapy, which focused on emotional issues, with getting her and her husband to reunite after a yearlong separation.

"The marriage counselor brought us back together," she said.

Alice, who did not want her last name used out of privacy concerns, said an important catalyst for their reunion was the therapist's asking each to think about the ways that the other person wanted to feel appreciated and loved. Gradually, she said, she has come to see that her husband's needs were different from her own.

"Going back to this exercise is one thing that has gotten us through hard times," she said.

Researchers have begun to identify which qualities in a couple make for a lasting relationship. The findings challenge some common assumptions - that couples who fight a lot are beyond help, for example.

Over more than two decades of videotaping and analyzing the behavior of happy and unhappy couples, Dr. Gottman has found that all couples fight and that most fights are never resolved. What is different between happy and unhappy couples is the way they fight.

The happy couples punctuate their arguments with positive interactions, he said, like interjecting humor or smiling in fond recognition of a partner's foibles. The unhappy couples have corrosive arguments, characterized by criticism, defensiveness and other negative words and gestures.

Of course, even the happiest of couples can get nasty sometimes. But Dr. Gottman has found that as long as the ratio of positive to negative interactions remains at least five to one, the relationship is sturdy. When the ratio dips below that, he says, he can predict with 94 percent accuracy that a couple will divorce.

Dr. Gottman says that couples therapists can use this information to help keep couples together. "You can't just teach a couple to avoid conflict," he said. "You have to build friendship and intimacy into the relationship. If you don't, the relationship gets crusty and mean."

But not all marriages are salvageable, therapists say. "Some people are fundamentally mismatched, and they can't benefit from therapy," Dr. Gottman said.

Others - beyond the scope of couples therapy or marriage education programs - are people with personality disorders and relationships marred by violence and intimidation.

"We have nothing to offer them," he said.

Couples therapy is designed to be relatively short term: 26 weeks or less.

"The vast majority of my patients do better after 5 to 10 sessions and are satisfied. The cycle of blaming is interrupted," said Dr. John W. Jacobs, a psychiatrist in New York and author of the 2004 book "All You Need Is Love and Other Lies About Marriage."

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