The State of Couples Therapy in 2024…
Monday, April 8, 2024. I can assure you that uncomfortable chairs are not part of my process… LOL
Couple therapy has become a widely recognized and practiced treatment, standing out with its unique, science-based methods tailored for couples…
Studies show that most therapists (regardless of how modest their training might be) now treat couples, indicating its growing popularity.
This trend is expected to continue, with experts predicting couple therapy will experience the most growth of all therapeutic modalities in the coming years…
Three main factors have contributed to the rise of couple therapy in 2024.
Firstly, there's a high prevalence of relationship distress, with divorce rates increasing globally.
Secondly, relationship problems have a significant impact on the well-being of humans and their children, leading to emotional and physical health issues.
And lastly, modern American couples have higher expectations for their relationships and see therapy as a means to improve them…
Over the decades, couple therapy has evolved, drawing from various theoretical orientations and adapting to the needs of different couples. It now encompasses a wide range of approaches to reduce relational distress and enhance relationship quality.
Nowadays, science-based couples therapy addresses specific issues such as passive aggression, infidelity, anxiety disorders, sex addiction, neurodiversity, ADHD, and depression and caters to diverse populations, including LGBTQ couples and stepfamilies. A good, science-based couples therapist is an endless student because that’s what it takes.
Research into specialized problems, such as sex addiction and infidelity, have, to some extent, become specific areas of study and clinical competence. Limbic capitalism continues to modify it’s approach, and couples therapists need to understand the psychological allure of platforms such as Ashley Madison and Skip the Games.
The amount of helpful research just waiting to be developed into practical interventions is both humbling and staggering.
There’s no doubt about it. Research supports the effectiveness of science-based couple therapy in reducing relationship distress and improving individual well-being.
The well-established treatments are Cognitive-behavioral (Gottman), integrative (Developmental Model), and emotionally-focused therapies. Couple therapy has also been beneficial for addressing coexisting emotional, behavioral, and physical health concerns.
A key aspect of modern couple therapy is its strong foundation in relational science. This includes research on attachment, communication processes, and relationship emotional dynamics.
Additionally, neuroscience is increasingly being integrated into couple therapy, although this field is still in its early stages.
One notable trend in couple therapy is the convergence of intervention methods across different theoretical approaches. We’re all about interventions now.
Therapists often adopt a pluralistic, (some might say eclectic), or integrative approach, drawing on multiple theoretical perspectives and intervention strategies tailored to each couple's needs. Common factors and shared strategies underlie many approaches, emphasizing the importance of collaboration, empathy, and understanding in therapy.
Despite these advancements, challenges remain in the field of couple therapy.
One challenge is the potential for therapy effectiveness to diminish over time, particularly in clinical settings where treatments are less closely monitored.
Additionally, not all couples may benefit equally from therapy, and there's a need for ongoing research to understand how to optimize outcomes for diverse populations. Working with discrete, specific cohorts of couples is perhaps the greatest area of advancement in couples therapy so far this decade.
Moving forward, couple therapists must stay informed about the latest research and developments in the field.
This includes incorporating relational science and neuroscience findings into clinical practice while maintaining a flexible and adaptive approach that considers each couple's unique needs. Unfortunately, the insurance-based model present in the USA celebrates mediocrity and rewards poor training.
Despite this obvious impediment, couple therapy has still managed to evolve into a prominent and effective form of treatment, addressing the complex dynamics of intimate relationships.
With its roots in hard research and a growing emphasis on integration and innovation, couple therapy continues to play a vital role in helping couples navigate challenges and strengthen their relationships…
Understanding the Framework of Couple Therapy Sessions and Arrangements
Couple therapy's diverse approaches catering to various relationship challenges showcases remarkable shared structures.
Today, it predominantly involves joint sessions supplemented by clear guidelines for individual communication.
Typically, sessions last an hour weekly, and most methods incorporate follow-up activities like homework. The duration of therapy varies, ranging from a few sessions to several years, with the average process lasting between 3 and 12 months.
Despite the piles of research decrying brevity, the standard session frequency of 55 minutes persists, driven possibly by tradition and time and cost considerations.
Evolution of Couple Therapy Models
Couple therapy models have evolved from conception and are rooted in distinct theoretical traditions.
For instance, behavioral marital therapy has expanded into cognitive-behavioral(e.g., Gottman) and integrative behavioral couple therapy ( the Developmental Model). Similarly, emotionally focused therapies include family, individual, and couple therapy.
Psychoanalytic approaches have given way to object relations couple therapy and mentalization-based couple therapy. Other early Family Therapies, like Structural and Strategic therapies, have waned in influence, though their impact remains in contemporary approaches.
Newer forms, such as socioculturally attuned couple therapy and Acceptance and Commitment Therapy, have emerged, along with specific therapies targeting various issues or demographics. This has never happened before.
Couples are deeply embedded within societal and historical contexts, which also influence the development of various models of couple therapy aimed at addressing relationship distress and fostering individual and relational well-being.
However, the backgrounds in which these therapy approaches were formulated and therapists were trained may not fully reflect the diverse values each partner brings into therapy sessions. This raises the question: How can therapists effectively navigate therapy when values within and across couples diverge significantly?
For instance, what are the key elements for successful relationships? How much closeness or space is considered ideal? What steps should be taken when one aspect of a relationship is problematic while others are satisfactory?
Should relationships strive to fulfill all individual needs, as Finkel (2017) proposes in the concept of the "all-or-nothing marriage"?
When should divorce be considered a valid option? Additionally, how do cultural backgrounds influence expectations of successful relationships? When does effective therapy involve challenging cultural norms related to issues like gender inequality and relational violence?
Scholars like Doherty (2022) and Lebow (2014) extensively discuss the importance of aligning client and therapist values in couple therapy and how therapist values subtly shape practice. Perspectives from LGBTQ therapists and various cultural backgrounds, as noted by Addison & Coolhart (2015) and Kelly et al. (2019), offer diverse insights into this cultural discussion.
Couple therapists who are at their best remain attuned, adaptable, and responsive to the ways values influence therapy, especially in a global landscape where therapeutic models are applied across diverse populations with contrasting beliefs and customs.
The COVID-19 pandemic has undoubtedly impacted couples and couple therapy, with increased reliance on teletherapy being just one observable change (Stanley & Markman, 2020).
While the full extent of these effects is challenging to quantify, it's evident that the pandemic has led to significant increases in individual and relational stress.
Standard interventions have required adaptation to cope with these heightened stress levels and the constraints imposed by the pandemic.
Vulnerable couples, in particular, have faced more limited coping strategies and external support.
This necessitates a both a broader and deeper approach to couple therapy both during and after the pandemic, with themes akin to existential therapy becoming more prominent, as seen in other tumultuous historical periods (Fraenkel & Cho, 2020).
Incorporating Culture and Gender
Couple therapy, focused initially on heterosexual, married couples, has expanded to encompass diverse relationships and cultural contexts.
Feminist, queer, and multicultural perspectives have broadened the scope of couple therapy, addressing issues related to gender, sexual orientation, race, ethnicity, and social class. Understanding couples within their cultural and social contexts is vital for effective therapy, with adaptations necessary for LGBTQ couples, stepfamilies, and couples from marginalized communities.
Common Elements of Couple Therapy
Assessment plays a crucial role in couple therapy, involving the evaluation of emotions, behaviors, and cognitions across various levels, including individual, relational, and cultural factors. While approaches differ in their stance on normative versus individualized approaches to assessment and intervention, they universally emphasize monitoring progress and adapting therapy accordingly. Some methods advocate for detailed assessment and treatment planning, while others prioritize flexibility and organic evolution throughout therapy.
Final thoughts
High-level, science-based couple therapy has never been as effective and nuanced as it is today.
Collectively, there is remarkable sophistication in modern, science-based couple therapy.
Numerous approaches offer the integration of evidence‐informed principles with clinical wisdom in the best of the scientist‐practitioner tradition.
With an increasing foundation in relational science and evidence for their efficacy, such approaches continue to mature in their development.
While the most prominent models continue to improve with ongoing research, another emerging trend is a democratization and shared cultural understanding of what good couples therapy looks like.
It’s also my ardent desire that we start asking what effective family therapy looks like.
Good couples therapy enhances the skill sets of committed couples and families. I can help with that.
Be Well, Stay Kind, and Godspeed.
RESEARCH:
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