HOW THERAPISTS THREATEN MARRIAGES
William J. Doherty
(TheResponsive Community, 7, 31-42)
Soon after her wedding Marsha felt something was terribly wrong with her marriage. She and her husband Paul had moved across the country following a big church wedding in their home town. Marsha was obsessed with fears that she had made a big mistake in marrying Paul. She focused on Paul's ambivalence about the Christian faith, his avoidance of personal topics of communication, and his tendency to criticize her when she expressed her worries and fears. Marsha sought help at the university student counseling center where she and Paul were graduate students. The counselor worked with her alone for a few sessions and then invited Paul in for marital therapy. Paul, who was frustrated and angry about how distant and fretful Marsha had become, was a reluctant participantin the counseling. In addition to the marital problems, Marsha was suffering from clinical depression: she couldn't sleep or concentrate, she felt sad all the time, and she felt like a failure. Medication began to relieve some of these symptoms, but she was still upset about the state of her marriage. After a highly charged session with this distressed wife and angry, reluctant husband, the counselor met with Marsha separately the next week. She told Marsha that she would not recover fully from her depression until she started to "trust her feelings" about the marriage. Following is how Marsha later recounted the conversation with the counselor:
Marsha: "What do you mean, trust my feelings?"
Counselor: "You know you are not happy in your marriage."
Marsha: "Yes, that's true."
Counselor: "Perhaps you need a separation in order to figure out whether you really want this marriage."
Marsha: "But I love Paul and I am committed to him."
Counselor: "The choice is yours, but I doubt that you will begin to feel better until you start to trust your feelings and pay attention to your unhappiness."
Marsha: "Are you saying I should get a divorce?"
Counselor: "I'm just urging you to trust your feelings of unhappiness."
A stunned Marsha decided to not return to that counselor, a decision the counselor no doubt perceived as reflecting Marsha's unwillingness to take responsibility for her own happiness.
Two aspects of Marsha and Paul's case stand out. First, the couple saw a counselor who was not well-trained in marital therapy. Any licensed mental health professional can dabble in marital therapy, but most therapists are far more comfortable working with individuals. When marriage problems are formidable or the course of treatment difficult, these therapists pull the plug on the conjoint sessions (involving both spouses) in favor of separate individual therapy sessions. Often they refer one of the spouses to a colleague for separate individual therapy, with this rationale: "You both have too many individual problems to be able to work on your relationship at this point." Of course, they are living together in this relationship seven days per week and have no choice but to "work on it" continually! The unspoken reason for this shift in treatment modality, especially if it occurs early in the marital therapy, is generally that the therapist feels incompetent with the case, especially in dealing with a reluctant husband who is not therapy savvy and says he is there only to salvage his marriage. This husband lacks a personal, psychological agenda. When he gets turfed off to another therapist to do his "individual" work, he balks, thereby confirming to his wife and her therapist that he is unwilling to work on his own "issues" and thereby do his part to save the marriage. The marriage is often doomed at this point, an iatrogenic effect of poor marital therapy.
The second noteworthy feature of Marsha and Paul's case is the strong individualistic and anti-commitment orientation of the therapist. Like most psychotherapists, she viewed only the individual as her client. She had no responsibilities beyond promoting this individual's immediate needs and agenda, no obligations to other stakeholders in the client's life. No doubt the therapist also viewed herself as "neutral" on the issue of marital commitment. But, as I pointed out in my book Soul Searching: Why Psychotherapy Must Promote Moral Responsibility, claiming neutrality on commitment and other moral issues in American society means that the therapist likely embraces the reigning ethic of individual self-interest. There is nothing neutral about asking a newly married, depressed woman "Are you happy in your marriage?" and urging her to trust her frightened and confused feelings. No self-respecting therapist would urge a suicidal patient to "trust your feelings about how worthless you life is," but many well-regarded therapists play cheerleader for a divorce even when the couple has not yet made a serious effort to understand their problems and restore the health of their marriage. Therapist-assisted marital suicide has become part of the standard paradigm of contemporary psychotherapy.
A postscript to this case: Marsha talked to her priest during this crisis. The priest urged her to wait to see if her depression was causing the marital problem or if the marital problem was causing the depression--a prudent bit of advice. But a few minutes later, the priest brought up the possibility of an annulment if the marriage was causing the depression. Marsha was even more stunned than she had been by the therapist.
Some marriages, of course, are dead on arrival in the therapist's office, in which case the therapist's job is to help with the healthiest possible untangling for all involved parties, especially the children. Some marriages are emotionally and physically abusive, with little chance for recovery. Some marriages appear salvageable, but one of the parties has already made up his or her mind to leave. I am not suggesting that the therapist harangue the reluctant spouse or urge an abused wife to keep her commitment in the face of debilitating abuse. Divorce is a necessary safety valve for terminally ill marriages, and in some cases, divorce is the morally responsible thing to do. (I think of a woman who discovered her husband and co-parent was a pedophile, and he would not seek treatment.) My critique focuses on the practice of therapists, many of whom lack good skills in helping couples, who philosophically view marriage as a venue for personal fulfillment stripped of ethical obligation and divorce as a strictly private, self-interested choice with no important stakeholders other than the individual adult client.
How Did We Get Here?
Marriage counseling (now termed "marital therapy" in the profession) was born in the 1930s and 1940s in an era of worry about the viability of modern "companionate" marriages. The early marriage counselors were mostly gynecologists, educators, and clergy. Of course, psychiatrists treated many distressed married people, but did not see their primary responsibility as assisting the marriage. It was not until the 1950s that marriage counselors began to work with both spouses together in one session. Prior to then, it was considered inappropriate treatment, and even unethical, to have both partners in the sessions, because this would destroy the powerful one-to-one psychological transference dynamics deemed necessary for successful treatment of the individual problems that were feeding the marital problems.
During the 1950s and early 1960s, "conjoint" marriage counseling became more widespread as therapists began to appreciate the power of working on relationship patterns directly in the session. The American Association of Marriage Counselors grew in numbers as credentialed psychotherapists joined clergy who specialized in marriage counseling. Interestingly, marriage counseling as a professional activity developed independently of "family therapy," which grew out of psychiatry's experiments with family treatment for mental health disorders. (Only in the 1970s did the associations of marriage counselors and family therapists merge into the American Association for Marriage and Family Therapy.)
Prior to the U.S. cultural revolution of the late 1960s and 1970s, many marital therapists saw their task as saving marriages. Divorce was seen as an unequivocal treatment failure. There was little recognition of spouse abuse and the ways in which a stable but destructive marriage can undermine spouses' emotional health and create domestic hell for children. The individual tended to get lost in the marriage. Early feminist critics of marital therapy were quick to point out how this treatment approach could be dangerous to a woman's health. Women were often held responsible for the problems, since family relationships were supposed to be their forte, and women were implicitly encouraged to follow the then-popular cultural value that parents should stay together for the sake of the children. In addition, some clergy counselors added a religious rationale to the support of stable marriages, to the dismay of critics who saw this as making people feel guilty before God for salvaging their mental and physical health from a toxic marriage.
Research and professional literature on marital therapy burgeoned during the 1970s during the era of skyrocketing divorce rates. Sobered by feminist critics and enamored with the 1970s cult of individual fulfillment, marital therapists largely rejected the "marriage saver" image. The 1980s brought a wealth of research studies on marital communication, marital distress, and effective treatment techniques. Marital therapists who were trained in these new techniques viewed themselves as performing a form of mental health treatment that not only helped marriages but also the individual well-being of the spouses. But on the value of preserving marital commitment if possible, the field was mostly "neutral"--which means embracing a contractual, individualist model of commitment. A decision about divorce became just like any other lifestyle decision such as changing jobs; the therapist's job is not to influence the outcome of the decision but to help people sort out their needs and priorities.
As therapists during the 1970s and 1980s experienced their own divorces and those of colleagues, they increasingly saw divorce as a bonafide life style option and a potential pathway to personal growth. The self-help books written by therapists reflected this positive orientation to divorce. In the term coined by Barbara Dafoe Whitehead in her book The Divorce Culture, therapists followed the popular culture in embracing the "expressive divorce" as an enlightened way to start a new life when the old marriage was in disrepair. Although they were concerned for the children, most therapists believed that the children would do fine if their parents did what was best for themselves. I term this "trickle down psychological economics," which works for the children just as well as the other trickle down model has worked for the poor in American society. Where We Are Today
The 1990s have witnessed marital therapy become mainstream as more professionals practice it, more couples seek it out, and some insurance companies pay for it. National political leaders make no apologies for having benefited from marriage (and family) therapy. The decade of the 1990s has also seen a movement back towards espousing the value of marital commitment and the therapist's role in promoting it. This was first seen in Michele Weiner-Davis' early 1990s work on solution-oriented therapy for highly distressed couples. She titled her training workshops, and later her popular book, "Divorce Busting." She and others began to take a deliberately pro-marriage stance, much to the dismay of established leaders in the field. Having come to a "middle" point of encouraging neither divorce nor staying together, many leaders in marital therapy saw this new pro-marriage stance as a conservative backlash against feminism and emancipated individualism. If marriage and divorce are primarily lifestyle choices, and if a bad but stable marriage is destructive for all involved, why should therapists be in the business of saving marriages?
In the 1990s, a decade of backlashes and counter-backlashes, there has also been an assault on the use of the term "marriage" among scholars and practitioners. The critique is that "marriage" marginalizes cohabiting couples and especially gay and lesbian couples. Most marital therapists, when giving professional presentations, use the term "couples therapy" or "couples counseling." The list of presentations at national conferences of marriage and family therapists contains multiple references to "couples" and scant references to "marriage." I have no doubt that the profession of marriage and family therapy (now credentialed in 37 states an independent mental health profession) would take a different name if it were being created in the late 1990s. "Family" is still okay, as long as a variety of family structures are included in the definition, but "marriage" is out because it is not inclusive.
This trend away from using the word "marriage" is unfortunate, because the term "couple" carries no connotations of moral commitment and lifetime covenant. My daughter and her boyfriend were a "couple" during their summer after high school, but the relationship did not survive their going to different colleges. Is this relationship morally equivalent to Marsha and Paul's, or to a long-married couple with children? Even if we use the term "committed couple" or "committed relationship," we beg the question of how deep and permanent the commitment. Rather than lower the bar for marital commitment by abandoning the term "marriage," why not expand the definition of marriage to include gay and lesbian couples who wish to make a permanent, moral commitment to each other? Why not make the marriage umbrella bigger without sacrificing its essential values, instead of folding the umbrella and watering down the precious moral dimension of this unique, for-better-or-for-worse human relationship? Giving Commitment Its Due
My own work has offered a communitarian critique of the individualist ethic of psychotherapy in the United States. Although the focus of this article is on marital therapy as a treatment modality, I believe that all psychotherapy for individuals who are married is, in part, marital therapy, even if only one spouse participates, because issues of personal need versus marital bonds and obligations are inevitably present in individual therapy. Furthermore, I am convinced that there is widespread and invisible harm done to marriages by many individually-oriented psychotherapists. Consider the following example:
Monica was stunned when Rob, her husband of 18 years, announced that he was having an affair with her best friend and wanted an "open marriage." When Monica declined this invitation, Rob bolted from the house and was found the next day wandering around aimlessly in a nearby woods. He spent two weeks in a mental hospital for an acute, psychotic depression, and was released to outpatient treatment. Although he claimed during his hospitalization that he wanted a divorce, his therapist had the good sense to urge him to not make any major decisions until he was feeling better. Meanwhile, Monica was beside herself with grief, fear, and anger. She had two young children at home, a demanding job, and was struggling with lupus, a chronic illness she had been diagnosed with 12 months ago. Indeed, Rob had never been able to cope with her diagnosis, or with his own job loss six months afterwards. (He was now working again.)
Clearly, this couple had been through huge stresses in the past year, including a relocation to a different city where they had no support systems in place. Rob was acting in a completely uncharacteristic way for a former straight-arrow man with strong religious and moral values. Monica was depressed, agitated, and confused. She sought out recommendations to find the best psychotherapist available in her city. He turned out to be a highly regarded clinical psychologist. Rob was continuing in individual outpatient psychotherapy, while living alone in an apartment. He still wanted a divorce.
As Monica later recounted the story to me, her therapist, after two sessions of assessment and crisis intervention, suggested that she pursue the divorce that Rob said he wanted. She resisted, pointing out that this was a long term marriage with young children, and that she was hoping that the real Rob would re-emerge from his mid-life crisis. She suspected that the affair with her friend would be short-lived (which it was). She was angry and terribly hurt, she said, but determined to not give up on an 18 year marriage after only one month of hell. The therapist, according to Monica, interpreted her resistance to "moving on with her life" as stemming from her inability to "grieve" the end of her marriage. He then connected this inability to grieve to the loss of her mother when Monica was a small child; Monica's difficulty in letting go of a failed marriage stemmed from unfinished mourning from the death of her mother.
Fortunately, Monica had the strength to fire the therapist. Not many clients would be able to do that, especially in the face of such expert pathologizing of their moral commitment. And equally fortunately, she and Rob found a good marital therapist who saw them through their crisis and onward to a recovered and ultimately healthier marriage.
This kind of appalling therapist behavior occurs every day in clinical practice. A depressed wife of an verbally abuse husband who was not dealing well with his Parkinson's Disease was told at the end of the first, and only, therapy session in her HMO that her husband would never change and that she would either have to live with the abuse or get out. She was grievously offended that this young therapist was so cavalier about her commitment to a man she had loved for 40 years, and who was now infirm with Parkinson's Disease. She came to me to find a way to salvage a committed but non-abusive marriage. When I invited her husband to join us, he turned out to be more flexible than the other therapist had imagined. He too was committed to his marriage, and he needed his wife immensely.
These illustrations should not dismissed as examples of random bad therapy or incompetent therapists. They stem from a pervasive bias among many individually-oriented therapists against sustaining marital commitment in the face of a now-toxic relationship. From this perspective, abandoning a bad marriage is akin to selling a mutual fund that, although once good for you, is now a money loser. The main techniques of this kind of therapy are twofold: a) walk clients through a cost-benefit analysis with regards staying married--what is in it for me to stay or leave? and b) ask clients if they are happy and if not, then why are they staying married? If those questions yield what appears to be an irrational commitment in the face of marital pathology, as the therapist believed to be true for Monica, then the therapist falls back on pathologizing the reasons for this commitment. It takes extraordinary conviction to weather such "help" from a therapist.
These therapist questions and observations are value-laden wolves in neutral sheep's clothing. The cost-benefit questions in particular brook no consideration of the needs of anyone else in this decision. I was trained in the 1970s to dismiss clients' spontaneous moral language ("I don't know if a divorce would be fair to the children") by telling them that if parents take care of themselves, the children will do fine. And then I would move the conversation back to the safer ground of self-interest. That's how most of us learned to do therapy years ago, and it's still widespread practice.
A Communitarian Approach to Marital Therapy
The first plank in a communitarian platform for marital therapy would be for therapists, both those who work only with individuals and those who work with couples, to recognize and affirm the moral nature of marital commitment. This stance moves therapists beyond the guise of neutrality which covers an implicit contractual, self-interested approach to marital commitment. Divorce, from a communitarian perspective, is sometimes necessary when great harm would be caused by staying in the marriage. Particularly in the presence of minor children, the decision to divorce would be akin to amputating a limb: to be avoided if at all possible by sustained, alternative treatments, but pursued if necessary to save the person's life.
The second plank affirms that personal health and psychological well-being are indeed central dimensions of marriage and important goals of therapy. There is no inherent contradiction between emphasizing the moral nature of marital commitment and promoting the value of personal satisfaction and autonomy within the marital relationship. These moral and personal elements together define the unique power of marriage in contemporary life.
The third plank is that it is a fundamental moral obligation to seek marital therapy when marital distress is serious enough to threaten the marriage. We need an cultural ethic that would make it just as irresponsible to terminate a marriage without seeking professional help as it would be to let someone die without seeing a physician.
The fourth plank holds that promoting marital health should be seen as an important part of health care, because we now know the medical and psychological ravages of failed marriages for most adults and children. And the health care system should support this kind of treatment as an essential part of health care, instead of regarding marital therapy as an "uncovered benefit."
The fifth plank concerns the importance of education for marriage and early intervention to prevent serious marital problems. We need a public health campaign to monitor the health of the nation's marriages and to promote community efforts to help couples enhance the knowledge, attitudes, values and skills needed to make caring, collaborative, and committed marriage possible. There are many well-tested courses and programs in marriage education across the country that can fill this need. And we need grass routes efforts among couples without direct reliance on professional leadership.
The sixth plank asserts that therapists should help spouses hold each other accountable for treating their spouse in a fair and caring way in the marriage. Although commitment is the linchpin of marriage, justice and caring are essential moral elements as well. A communitarian approach to marital therapy would incorporate feminist insights into gender-based inequality in contemporary marriages. It would be sensitive to how women are often expected to assume major responsibility for the marriage and the children, and then are criticized for being over-responsible. When a husband declines to do his fair share of family work on the grounds that "it's not my thing," the therapist should see this as a cop out from his moral responsibilities, not just as a self-interested bargaining position with his wife. Communitarians promote more than marital stability; they promote caring, collaborative, and equitable marital unions that are good for the well-being of the spouses as individuals.
The seventh plank is based on the prevalence of therapist-assisted marital suicide. We need a consumer awareness movement about the potential hazards of individual or marital therapy to the well-being of a marriage. Consumers should be given guidelines about how to interview a potential therapist on the phone, with questions such as "What are your values about the importance of keeping a marriage together when there are problems?" If the therapist responds only with the rhetoric of individual self-determination ("I try to help both parties decide what they need to do for themselves"), the consumer can ask if the therapist has any personal values about the importance of marital commitment. If the therapist hedges, then call another therapist. (Look elsewhere too if the therapist says that marriages should be held together no matter what the consequences.) Consumers also should be aware that many therapists who primarily work with individuals are not competent in marital therapy and thus are likely to give up prematurely on the marital therapy and the marriage itself. It is best to see a therapist who has had special training in working with couples.
Many therapists are now reconsidering their approach to marital commitment. They have been entranced by a cultural mirage about what constitutes the good life in the late twentieth century, and they are beginning to rethink their ill-begotten moral neutrality in the face of disturbing levels of family and community breakdown. A communitarian critique and reformulation of marital therapy can point the way to a new kind of marriage covenant that views moral responsibility, sustained commitments, and personal fulfillment as a garment seamlessly sewn, not a piece of Velcro designed for ease of separation. _____________________________________________________________
William J. Doherty is a Professor of Family Social Science and Director of the Marriage and Family Therapy Program at the University of Minnesota. He is author of Soul Searching: Why Psychotherapy Must Promote Moral Responsibility (Basic Books, 1995) and The Intentional Family: How to Build Family Ties in Our Modern World (Addison-Wesley, 1997). He may be reached at Department of Family Social Science, University of Minnesota, 290 McNeal Hall, St. Paul, MN 55108. www.drbilldoherty.org
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