Consumer Report: Marital therapy - How to choose a therapist to save your troubled marriage by Matt Sanders a Relationships and Intimacy Consultant currently practicing in Tucson, Arizona and Solana Beach, California. Matt has an M.S. Social Sciences and Psychology, M.S. Family Studies and Human Development and is a Licensed Substance Abuse Counselor in Arizona. Matt’s primary focus is on couples, family trauma and recovery, men’s issues, anger and depression. Contact Matt: 858-366-2104.

Part 3 of 3 in a series on hiring and managing professionals to help you find and care for your relationship.

Individual Goals
Most people don’t realize when they sign up for couple’s therapy, that strong emphasis will be on watching each other do individual therapy. Initially, some therapists will prefer to see the couple separately to establish some goals and guidelines for the sessions. An important issue that the therapist should discuss, in some form or another is:

Does each person have their own goal that involves their own personal development?

The most common and insidious problem with an individual’s goal is when it depends primarily upon the other person ‘changing’.

A married woman once told me during an initial session, ‘I just want him to stop criticizing me’. I asked, ‘And what if he decides not to stop?’ She stared accusingly at me, then said slowly, ‘I don’t know’. I’d really have to think about that’.

What she meant was, she was going to have to negotiate with herself and get back to me.

The immediate goal of her individual therapy in the session shifted from him stopping the criticism to her deciding how she would handle it if he didn’t. It hadn’t occurred to her that her satisfaction in the relationship might have been based more upon her choice than his behaviors. Of course it would have been nice if she did not feel criticized in her marriage, but much of that depends upon the expectations she had of herself in the marriage. Before entering a session with your partner, ask yourself what you would like to change within your own thought processes, feelings and behaviors that would benefit the relationship. Get your therapist’s help on this if it is not offered up front. This small exercise can help you with the often emotionally charged moments that occur between intimate partners. It reminds us in critical times that even as the couple’s goal has set the room spinning, our own goal is always within our grasp.

Couple Goals
Is the couple trying to save the relationship, dissolve the relationship amicably, deepen intimacy, resolve a specific crisis, increase communication, all of the above or something else? More importantly, do the people in the relationship know the goal(s) and, for that matter, agree on the goals?

Often, when couples see a therapist, they shock one another with the fact that the outcome they want from therapy is different than their partner’s. It's easy to imagine the feelings involved when each person is asked to say what they want and one person responds ‘ let’s save us’, while the other says ‘I’m done with us’. I can remember distinctly a situation where the male in that equation responded, “I can’t believe you want a divorce” His wife's reaction was, “I’ve been trying to tell you that for the past year” He stared incredulously, “I thought you said that because you were mad at me….” Welcome to session #1 folks.

The therapist’s primary job is to acknowledge these differences in a way that doesn’t judge. Therapist fairness is what the couple will come to count on, though each partner may at some time ask the therapist to pick a side. Therapists are supposed to practice in a way that refuses to do this and devotes energy toward helping each person hear the most difficult of messages.

Keep in mind-The therapist is generally there to:

1. Witness and help articulate the goals and the progress made.
2. Hold the structure and let the participants know when rules are broken, when goals are being sabotaged, or new goals might be established.
3. Provide a safe place for vulnerability and healing.

Client-Therapist Match
Client involvement in their own progress aside, the client therapist match is, quite honestly one of the most important aspects of a successful counseling experience.

Two issues come to bear quickly in an initial therapy session. Is your therapist competent in the areas you want to address and, most importantly, do you like your therapist. If you don’t like their style, you’re likely to mistrust them no matter how competent, and you are less likely to show for sessions. More often than not, the couple disagrees on whether the therapist is going to work for them.

Some things you may discover while deciding if the therapist is a match:

1. Choosing the therapist simply becomes another power struggle for the marriage. (If you like the therapist, then I hate him/her)
2. One or both of the clients discover, “this is going to be more work than I thought” so they quit therapy altogether and blame therapy in general.
3. One person is there for the ‘gesture of trying’ but does not intend to continue.
4. One (or both) feels the therapist is biased against them or in favor of the other.
5. The couple feels the therapist has their own agenda and imposes goals

Issues of Expertise and Credential
Checking credentials is easy enough. In this State information can be found with the California Board of Behavioral Health Examiners: www.bbs.ca.gov This site is also helpful to consumers because there is access to prior disciplinary actions taken against professional therapists by the Board. This is public information and may be useful when trying to find someone to help with steering toward your relational outcomes.

In addition, various publications and resources exist in San Diego. The Therapist Directory of San Diego (www.sandiegotherapists.com) provides an overview of the therapist’s degree, certification, and specialty (sometimes with a picture and short bio that describes the style/philosophy).

Just as an aside, many counselors build a practice (and a reputation) on previous client referrals and not formal advertisement. Asking a trusted friend if they recommend a therapist is usually helpful, but sometimes too vulnerable. It can be good to practice the notion that being vulnerable sometimes gets you where you want to go.

Medications and Therapy
If one or both are on medication, interview therapists that have some background on meds. That means consider someone with psychiatric training or with explicit experience with the medications you are using. Although it’s not a requirement, it is likely to increase the integrity of the sessions.

These days, Medical Doctors like your Primary Care Physician are able to prescribe psychotropic medications to treat depression, anxiety, fatigue etc. It is critically important for a therapist to have this information and to have some experience dealing with the issues/side effects that can arise with such medications.

For example, some antidepressants have been shown to actually contribute to episodic depression when taken in ways other than prescribed. This kind of information is valuable to every interaction that the couple could have and it gives a the therapist insight that is equally important to other information like: are you sleeping well, eating well, stressed at work, overwhelmed with parenting, using alcohol/other drugs?

Couple Goals Vs. Therapist Expertise
This issue was briefly addressed in earlier sections of this article. But, here is an example of goals and therapist expertise that might help you see the connection between your goals and the therapist’s background.

Imagine the goal has become ‘dissolve the relationship amicably’, it may be obvious to choose someone with experience in marital conflict/divorce. Additionally, look for someone who has expertise in treating anger, depression and grief as these relate to divorce recovery. A final note would be to seek a therapist who has had training with the effects of divorce on children if the couple is in the difficult position of establishing guidelines for co-parenting.

Matching Philosophies/Religious Beliefs
For both good and bad reasons, religious and/or spiritual beliefs are strong indicators for most couples when matching with a therapist.

For example, if you know that your religious beliefs are a large part of your relationship orientation, then finding a therapist who understands your belief system is fundamentally a good idea. However, couples will sometimes substitute a church elder/minister/priest for a therapist. This can result in sessions becoming more focused on either venting (complaints about the other partner) or performing (convincing their minister that everything is ok). Couples that have tried to seek spiritual counsel have often found it helpful and supportive, yet the behavioral changes can sometimes be short-lived. In part, due to the style of church based or spiritually oriented counseling, issues such as the dynamics of the relationship, prior individual trauma/betrayal, or family of origin disclosures remain undiscovered. In such cases, mutual empathy (which is foundational to tolerance and forgiveness) can remain under-developed. So, the positive changes prescribed by the counselor may not last long enough to be fully trusted by the couple. In choosing a spiritual counselor, look also at professional credential as a way to connect your spiritual path with the day to day patterns of thoughts and feelings that set scripts for behavior. You’re going to have to trust your therapist to guide with something other than good advice.

Which Reminds Us…
Ultimately, but not surprisingly, choosing a therapist may come down to one last question, do you both like Ms./Mr. Therapist? Sounds superficial, but just as love can approximate the level of our commitment; like often indicates how much we trust others. And, as you may already know, we don’t change well without trust.

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I picked out my son's name when I was twelve years old. I wouldn't meet his father for another 6 years. During my pregnancy I imagined my son as a sort of "man kit." I thought that I would create this little person who would become the kind of man I wanted to have in my life. The moment Alex was born I knew I had been wrong. Even his name, though I did use the one I'd picked out years before, changed in Kindergarten. He decided he was someone other than the person I'd thought he would be. continued >