Therapy Tools for the Advanced Practitioner

William Doherty, Ph.D.

There’s a nasty little secret in the therapy field: Couples therapy may be the hardest form of therapy, and most therapists (even advanced practitioners) aren’t good at it. Most advanced therapists can manage sessions with challenging couples well, but they make subtler mistakes compared to new clinicians. These mistakes often go unnoticed by themselves and their clients.

Advanced practitioners’ mistakes are more about strategy than technique, more about missing the context than specific relational dynamics, and more about unacknowledged values than lack of knowledge. There are two areas of poor couples therapy by experienced therapists that stand out: working with remarried couples and working with couples deciding to work on their marriage or divorce.

Mistake #1 – Thinking All Couples are Equal

Remarried couples with stepchildren are a minefield, even for experienced therapists, because the partners almost always come with parenting issues, not just couples problems, and because many therapists miss the nuances of stepfamily dynamics. Therapists who specialize in adult relational work but aren’t skilled at parent-child therapy will fail with these families. Experienced therapists who treat remarried couples like first-marrieds usually manage the individual sessions well, but use the wrong overall strategy.

Stepfamilies are a different species, and couples in these families have to be treated with different approaches. Many experienced couples therapists still don’t know this-or even if they do know it, still lack a viable treatment model.

Beyond coparenting leadership issues, couples in stepfamilies swim in a sea of divided loyalties, which even experienced therapists sometimes miss.

Mistake #2 – Not Standing by Marriage

Experienced therapists sometimes give up on couples because of the values they hold about commitment in a troubled marriage. Some experienced therapists believe they aren’t there to save marriages, they are there to help people. No one wants to save a marriage at the cost of great damage to a spouse or the children. But the statement reflects a troubling—and usually unacknowledged—tendency to value a client’s current happiness over everything else.

One highly regarded therapist describes his approach to working with couples in this way: “I tell them that the point is to have a good life together. If they think they can have a good life together, then let’s give it a try. But if they conclude that they can’t have a good life together, then I tell them maybe they should move on.”

The ethics of market capitalism can invade the consulting room without anyone’s seeing it. Do what works for you as an autonomous individual as long as it meets your needs, and be prepared to cut your losses if the futures market in your marriage looks grim.

The Myth of Therapist Neutrality

The biggest problem in couples therapy is the myth of therapist neutrality, which keeps us from talking about our values with one another and our clients. If you think you’re neutral, you can’t frame clinical decisions in moral terms, let alone make your values known to your clients. Fragile couples are caught in a moral crucible, trying to discern whether their personal suffering is enough to cancel their lifetime commitment, and whether their dreams for a better life outweigh their children’s needs for a stable family.

A wise therapist is able to see the whole context of people’s lives, and can reflect openly and deeply on values and broader social forces influencing the profession. The philosopher Alasdair MacIntrye wrote:
In a world that seduces professionals into seeing their work as the delivery of technical services stripped of larger social context and moral meaning, the hallmark of a true profession is a never-ending argument about whether it’s being true to its fundamental values, principles, and practices.
In other words, becoming a competent couples therapist is just the first step to becoming a good one.

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Fine tune your couples therapy skills with The Neglected Craft of Couples Therapy: How to Manage Couples Sessions featuring William Doherty.

This post is based on an article originally brought to life by our partner, Psychotherapy Networker.

Click to read the full article, “Bad Couples Therapy,” written by William Doherty, Ph.D.

Topic: Families and Couples

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