Relationship counseling

Relationship counseling
Intervention
ICD-9-CM	94.4

Relationship counseling is the process of counseling the parties of a relationship in an effort to recognize and to better manage or reconcile troublesome differences and repeating patterns of distress. The relationship involved may be between members of a family or a couple (see also family therapy), employees or employers in a workplace, or between a professional and a client.

Couple therapy (or relationship therapy) is a related and different process. It may differ from relationship counseling in duration. Short term counseling may be between 1 to 3 sessions whereas long term couples therapy may be between 12 and 24 sessions. An exception is brief or solution focused couples therapy. In addition, counseling tends to be more 'here and now' and new coping strategies the outcome. Couples therapy is more about seemingly intractable problems with a relationship history, where emotions are the target and the agent of change.

Marriage counseling or marital therapy can refer to either or some combination of the above.

The methods may differ in other ways as well, but the differences may indicate more about the counselor/therapist's way of working than the title given to their process. Both methods also can be acquired for no charge, depending on your needs. For more information about getting the care that may be required, one should make a call to a local hospital or healthcare professional.

History

Marriage counseling originated in Germany in the 1920s as part of the eugenics movement.^[1] The first institutes for marriage counseling in the USA began in the 1930s, partly in response to Germany's medically directed, racial purification marriage counseling centres. It was promoted in the USA by both eugenicists such as Paul Popenoe and Robert Latou Dickinson and by birth control advocates such as Abraham and Hannah Stone who wrote 'A Marriage Manual' in 1935 and were involved with Planned Parenthood.^[2]. Other founders in USA include Lena Levine and Margaret Sanger.^[3][4][5]

It wasn't until the 1950s that therapists began treating psychological problems in the context of the family.^[6] Relationship counseling as a discrete, professional service is thus a recent phenomenon. Until the late 20th century, the work of relationship counseling was informally fulfilled by close friends, family members, or local religious leaders. Psychiatrists, psychologists, counselors and social workers have historically dealt primarily with individual psychological problems in a medical and psychoanalytic framework.^[6] In many less technologically advanced cultures around the world today, the institution of family, the village or group elders fulfil the work of relationship counseling. Today marriage mentoring mirrors those cultures.

With increasing modernization or westernization in many parts of the world and the continuous shift towards isolated nuclear families the trend is towards trained and accredited relationship counselors or couple therapists. Sometimes volunteers are trained by either the Government or social service institutions to help those who are in need of family or marital counseling. Many communities and government departments have their own team of trained voluntary and professional relationship counselors. Similar services are operated by many universities and colleges, sometimes staffed by volunteers from among the student peer group. Some large companies maintain a full-time professional counseling staff to facilitate smoother interactions between corporate employees, to minimize the negative effects that personal difficulties might have on work performance.

Increasingly there is a trend toward professional certification and government registration of these services. This is in part due to the presence of duty of care issues and the consequences of the counselor or therapist's services being provided in a fiduciary relationship.^[7] See also alienation of affection.

Basic Principles

Before a relationship between individuals can begin to be understood, it is important to recognize and acknowledge that each person, including the counselor, has a unique personality, perception, set of values and history. Individuals in the relationship may adhere to different and unexamined value systems. Institutional and societal variables (like the social, religious, group and other collective factors) which shape a person's nature, and behavior are considered in the process of counseling and therapy. A tenet of relationship counseling is that it is intrinsically beneficial for all the participants to interact with each other and with society at large with optimal amounts of conflict. A couple's conflict resolution skills seems to predict divorce rates.^[8]

Most relationships will get strained at some time, resulting in their not functioning optimally and producing self-reinforcing, maladaptive patterns. These patterns may be called negative interaction cycles. There are many possible reasons for this, including insecure attachment, ego, arrogance, jealousy, anger, greed, poor communication/understanding or problem solving, ill health, third parties and so on.

Changes in situations like financial state, physical health, and the influence of other family members can have a profound influence on the conduct, responses and actions of the individuals in a relationship.

Often it is an interaction between two or more factors, and frequently it is not just one of the people who are involved that exhibit such traits. Relationship influences are reciprocal - it takes each person involved to make and manage problems.

A viable solution to the problem and setting these relationships back on track may be to reorient the individuals' perceptions and emotions - how one looks at or responds to situations and feels about them. Perceptions of and emotional responses to a relationship are contained within an often unexamined mental map of the relationship, also called a love map by John Gottman. These can be explored collaboratively and discussed openly. The core values they comprise can then be understood and respected or changed when no longer appropriate. This implies that each person takes equal responsibility for awareness of the problem as it arises, awareness of their own contribution to the problem and making some fundamental changes in thought and feeling.

The next step is to adopt conscious, structural changes to the inter-personal relationships and evaluate the effectiveness of those changes over time.

Indeed, "typically for those close personal relations there is a certain degree in 'interdependence' - which means that the partners are alternately mutually dependent on each other. As a special aspect of such relations something contradictory is put outside: the need for intimacy and for autonomy."

"The common counterbalancing satisfaction these both needs, intimacy and autonomy, leads to alternately satisfaction in the relationship and stability. But it depends on the specific developing duties of each partner in every life phase and maturity".^[9]

Basic Practices

Two methods of couples therapy focus primarily on the process of communicating. The most commonly used method is active listening, used by the late Carl Rogers and Virginia Satir, and recommended by Harville Hendrix in Getting the Love You Want. More recently, a method called Cinematic Immersion has been developed by Warren Farrell in Women Can't Hear What Men Don't Say. Each helps couples learn a method of communicating designed to create a safe environment for each partner to express and hear feelings.

When the Munich Marital Study discovered active listening to not be used in the long run, Warren Farrell observed that active listening did a better job creating a safe environment for the criticizer to criticize than for the listener to hear the criticism. The listener, often feeling overwhelmed by the criticism, tended to avoid future encounters. He hypothesized that we were biologically programmed to respond defensively to criticism, and therefore the listener needed to be trained in-depth with mental exercises and methods to interpret as love what might otherwise feel abusive. His method is Cinematic Immersion.

After 30 years of research into marriage John Gottman has found that healthy couples almost never listen and echo each other's feelings naturally. Whether miserable or radiantly happy, couples said what they thought about an issue, and "they got angry or sad, but their partner's response was never anything like what we were training people to do in the listener/speaker exercise, not even close.^[10]"

Such exchanges occurred in less than 5 percent of marital interactions and they predicted nothing about whether the marriage would do well or badly. What's more, Gottman noted, data from a 1984 Munich study demonstrated that the (reflective listening) exercise itself didn't help couples to improve their marriages. To teach such interactions, whether as a daily tool for couples or as a therapeutic exercise in empathy, was a clinical dead end.^[11]

By contrast emotionally focused therapy for couples (EFT-C) is based on attachment theory and uses emotion as the target and agent of change. Emotions bring the past alive in rigid interaction patterns, which create and reflect absorbing emotional states. As one of its founders Sue Johnson says,

Forget about learning how to argue better, analysing your early childhood, making grand romantic gestures, or experimenting with new sexual positions. Instead, recognize and admit that you are emotionally attached to and dependent on your partner in much the same way that a child is on a parent for nurturing, soothing, and protection.^{[cite this quote]}

Research on therapy

The most researched approach to couples therapy is behavioral couples therapy.^[12] It is a well established treatment for marital discord ^[13] This form of therapy has evolved to what is now called integrative behavioral couples therapy. Integrative behavioral couples therapy appears to be effective for 69% of couples in treatment, while the traditional model was effective for 50-60% of couples .^[14]

Relationship counselor or couple's therapist

Licensed couple therapist may refer to a pyschiatrist, clinical social workers, psychologists,pastoral counsellors, marriage and family therapists, and psychiatric nurses.^[15]The duty and function of a relationship counselor or couple's therapist is to listen, respect, understand and facilitate better functioning between those involved.

The basic principles for a counselor include:

• Provide a confidential dialogue, which normalizes feelings
• To enable each person to be heard and to hear themselves
• Provide a mirror with expertise to reflect the relationship's difficulties and the potential and direction for change
• Empower the relationship to take control of its own destiny and make vital decisions
• Deliver relevant and appropriate information

As well as the above, the basic principles for a couples therapist also include:

• To identify the repetitive, negative interaction cycle as a pattern.
• To understand the source of reactive emotions that drive the pattern.
• To expand and re-organize key emotional responses in the relationship.
• To facilitate a shift in partners' interaction to new patterns of interaction.
• To create new and positively bonding emotional events in the relationship
• To foster a secure attachment between partners.

Common core principles of relationship counseling and couple's therapy are:

• Respect
• Empathy
• Tact
• Consent
• Confidentiality
• Accountability
• Expertise
• Evidence based
• Certification, ongoing training and supervision

In both methods, the practitioner evaluates the couple's personal and relationship story as it is narrated, interrupts wisely, facilitates both de-escalation of unhelpful conflict and the development of realistic, practical solutions. The practitioner may meet each person individually at first but only if this is beneficial to both, is consensual and is unlikely to cause harm. Individualistic approaches to couple problems can cause harm. The counselor or therapist encourages the participants to give their best efforts to reorienting their relationship with each other. One of the challenges here is for each person to change their own responses to their partner's behaviour. Other challenges to the process are disclosing controversial or shameful events and revealing closely guarded secrets. Not all couples put all of their cards on the table at first. This can take time.

Novel practices

A novel development in the field of couples therapy has involved the introduction of insights gained from affective neuroscience and psychopharmacology into clinical practice.^[16] There has been interest in use of the so-called love hormone – oxytocin – during therapy sessions, although this is still largely experimental and somewhat controversial.^[17][18]

Popularized methodologies

Although results are almost certainly significantly better when professional guidance is utilized (see especially family therapy), numerous attempts at making the methodologies available generally via self help books and other media are available. In the last few years it has become increasingly popular for these self help books to become popularized and published as an e-book available on the web, or through content articles on blogs and websites. The challenges for individuals utilizing these methods are most commonly associated with that of other self help therapies or self-diagnosis.^[19]

Some resources include:

• Gottman's what makes marriage work
• The Five Love Languages - what spouses respond to.
• Please Understand Me - determining personal psychological makeup.
• Hold me Tight - 'Love demands the reassurance of touch. Most fights are really protests over emotional disconnection. Underneath the distress, partners are desperate to know: Are you there for me?
• Love & Respect - emotional needs of spouses.
• Divorce Busting - solutions for saving and restoring relationships.

Relationship counseling with homosexual/bisexual clients

See also: Homosexuality and psychology, Sexual relationship disorder, and List of transgender-related topics

"Marital Therapy" is now referred to as "Couples Therapy" in order to include individuals who are not married or those who are engaged in same sex relationships.^[20]Most relationship issues are shared equally among couples regardless of sexual orientation, but LGBT clients additionally have to deal with heteronormativity, homophobia and both socio-cultural and legal discrimination.^[21] Individuals may experience relational ambiguity from being in different stages of the coming out process or having an HIV serodiscordant relationship. Often, same-sex couples do not have as many role models of successful relationships as opposite-sex couples. In many jurisdictions committed LGBT couples desiring a family are denied access to assisted reproduction, adoption and fostering, leaving them childless, feeling excluded, other and bereaved. There may be issues with gender-role socialization that do not affect opposite-sex couples.^[22]

A significant number of men and women experience conflict surrounding homosexual expression within a mixed-orientation marriage.^[23] Couple therapy may include helping the clients feel more comfortable and accepting of same-sex feelings and to explore ways of incorporating same-sex and opposite-sex feelings into life patterns.^[24] Although a strong homosexual identity was associated with difficulties in marital satisfaction, viewing the same-sex activities as compulsive facilitated commitment to the marriage and to monogamy.^[25]

Professional associations: The American Association for Marriage and Family Therapy is the largest professional organization for relationship counseling in North America.[phone]...www.aamft.org Also, The National Registry of Marriage Friendly Therapist...www.marriagefriendlytherapists.com^[26]==

See also

• Counseling
• Counselling psychology
• Family therapy
• Interpersonal psychotherapy
• List of basic relationship topics
• Relationship Education
• Social Work
• List of counseling topics

References

1. ^ Wendy Kline, Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the century.
2. ^ Wendy Kline Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the century
3. ^ Lorna L. Hecker, Joseph L. Wetchler An introduction to marriage and family therapy
4. ^ [1] History of family therapy movement
5. ^ [2] Timeline of family therapy
6. ^ ^{a b} Nichols & Schwartz, Family Therapy: Concepts and Methods. Fourth edition. Allyn & Bacon
7. ^ Stewart v Layton (1992) 111 ALR 687
8. ^ Sternberg, J. "Satisfaction in close relationships", Guilford Press, 1997, p. 344
9. ^ Kaiser-Wienhoff Couples Direct Analysis CDA
10. ^ Gottman, J The Marriage Clinic: A Scientifically Based Marital Therapy (Norton, 1999)
11. ^ Smart Marriage Archives
12. ^ Chapman and Compton: (2003) From Traditional Behavioral Couple Therapy to Integrative Behavioral Couple Therapy: New Research Directions The Behavior Analyst Today, 4 (1), 17 -25 BAO
13. ^ O'Donohue, W. and Ferguson, K.E. (2006): Evidence-Based Practice in Psychology and Behavior Analysis. The Behavior Analyst Today, 7(3) 335- 347 BAO
14. ^ Christensen A, Atkins DC, Yi J, Baucom DH, & George WH. (2006). Couple and individual adjustment for 2 years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy.J Consult Clin Psychol. 74(6):1180-91
15. ^ Couples Therapy.The Harvard Mental Health Letter.Gale Group Inc.2007
16. ^ Atkinson, B., Atkinson, L., Kutz, P., et al. (2005). Rewiring Neural States in Couples Therapy: Advances from Affective Neuroscience.Journal of Systemic Therapies. 24 (3): 3-16.
17. ^ Resnikoff, R. (2002). Couples Therapy and Psychopharmacology. Psychiatric Times. 19 (7).
18. ^ Smith, D. Clashing couples to get a spray of love. Sydney Morning Herald May 26, 2007.
19. ^ Klein, M. Free Couples Counseling Canadian Association of Couples Counseling Oct 11, 2011.
20. ^ Couples Therapy.The Harvard Mental Health Letter.Gale Group Inc.2007
21. ^ Jerry J. Bigner (Editor), Joseph L. Wetchler (Editor), Relationship Therapy with Same-Sex Couple 2004
22. ^ Relationship therapy with same-sex couples
23. ^ Wolf TJ (1987). "Group psychotherapy for bisexual men and their wives". J Homosex. 14 (1-2): 191–9. doi:10.1300/J082v14n01_14. PMID 3655341. 
24. ^ Coleman E (1981). "Bisexual and gay men in heterosexual marriage: conflicts and resolutions in therapy". J Homosex. 7 (2-3): 93–103. doi:10.1300/J082v07n02_11. PMID 7346553. 
25. ^ Schneider JP, Schneider BH (1990). "Marital satisfaction during recovery from self-identified sexual addiction among bisexual men and their wives". J Sex Marital Ther. 16 (4): 230–50. PMID 2079706. 
26. ^ Couples Therapy.The Harvard Mental Health Letter.Gale Group Inc.2007