Therapy can be dangerous to marriage

WASHINGTON, Nov. 14 (UPI) -- Psychotherapy -- even couples' counseling -- can be dangerous to your marriage.

"Let the buyer beware," said William J. Doherty, director of the University of Minnesota's Marriage and Family Therapy Program. "A dirty little secret" is that couples therapy may be the hardest form of therapy, and most therapists are not very good at it. But most discussions of marital problems occur in individual psychotherapy, "where a lot of the damage to marriage goes on."

UPI spoke to Doherty by phone from his St. Paul office, and he supplied copies of three of his articles, which form the basis of this story. Except where there is abuse or danger, Doherty tries to advocate for the marriage and support the possibility that a couple can salvage it. And he does not consider ordinary marital conflict "abuse."

He points out that working with couples inherently involves value judgments in ways that treating depression or anxiety do not. Not to have a moral framework is to have an unacknowledged one, and in mainstream American culture, that will probably be individualistic rather than relational or communitarian.

Doherty believes that divorce, unfortunately, is sometimes necessary. But it should be avoided if at all possible because it brings about permanent disability, especially when children are involved. If divorce were a medical procedure, it would be like amputating a limb -- not like cosmetic surgery - a drastic measure justified only in the most hopeless circumstances.

The therapist's attitude is important, but technique can also be crucial. "A laid-back or timid therapist can doom a marriage that requires quick CPR," Doherty writes. "If couples therapy were a sport, it would resemble wrestling, not baseball -- because it can be over in a flash if you don't have your wits about you."

A therapist's skills in joining with individuals can backfire in a second when one partner thinks he is a genius and the other thinks he is clueless or, worse, allied with the enemy.

Doherty's "How Therapists Harm Marriages and What We Can Do About It" appeared in Vol. 1, 2002, of the Journal of Couple and Relationship Therapy. In it he says two dangers face married people who seek therapy either as individuals or as couples. The first is therapists trained to deal with individuals who are incompetent in working with couples. (This despite surveys showing that about 80 percent of therapists in private practice do couples therapy.) The second danger is therapists, whether competent or not, whose individualistic value system leads them to undermine marital commitment when the marriage causes distress for the individual.

As recently as the 1950s, a tremendous amount of social stigma was attached to divorce, and therapists often saw it as a treatment failure. But with the rise of the culture of individualism in the 1960s and 1970s, the social conception of marriage changed from one based on duty to personal happiness.

The therapeutic profession moved from disapproval of divorce to "neutrality." Many therapists, especially in the context of the treatment of individuals, moved beyond neutrality, seeing themselves as "liberationists" who help people out of unhappy marriages and other commitments in their lives. "If you describe your marriage as painful for you, the therapist wants to liberate you from this toxic influence." If the client raises concern about the fate of their children, such therapists will say the kids will do fine if their parents do what they need to do for themselves.

The culture of consumerism prevailed. "And consumers are inherently disloyal." People are getting married with the idea that they can get a divorce if it doesn't work out -- like a job or a house.

Doherty found that therapists -- in clinical consultations, talk shows and self-help books -- were saying such things as, "The marriage wasn't working anymore." The implication: If it's not working, get another one.

"You deserve better," is a consumerist expression that both friends and therapists say to someone who is having trouble with a spouse. This market-oriented language is not balanced with the client's responsibilities.

Doherty writes that if therapists and marriage educators don't counter the prevailing culture, they will have hardly any influence. "Marital therapy and marriage education has to be based on moral principles about commitment, not just based on ideas about enriching your marriage and reaching your potential."

But Doherty does not want to reduce the divorce rate simply to increase number of truly miserable couples by a similar margin. "We can do both: we can reduce the divorce rate, and we can increase the percentage of people who are working out successful marriages."

Therapists undermine marital commitment in four ways, he writes: by incompetence, by being "neutral," by pathologizing the partner or the relationship, and by overtly undermining the union.

Incompetent therapists mistake working with couples as an extension of individual psychotherapy, where a leisurely, clarifying approach can be taken. "If you have a warring couple in your office, and you do not create a structure for that session, they will overwhelm you. They will repeat in the office that which they do at home."

Therapists used to dealing with individuals also focus on the problems and contributions of one partner. A man more comfortable with thoughts than feelings might find himself stigmatized. And a depressed wife who reads a lot of self-help books might find that the therapist and her husband have teamed up to treat her.

Therapists who can't handle the hot conflict of couples therapy assume that there is a lot of individual pathology going on. "So they turf the spouses off to their individual therapist colleague, or keep one of the spouses in individual therapy and send the other to a colleague. I have seen a lot of unnecessary divorces because of this scenario," Doherty writes.

Neutrality is not neutral. A consumerist cost-benefit analysis ("What's in it for you to stay? What's in it for you to leave?") masquerades as neutrality but in fact undermines the marriage. "Neutrality when somebody has promised before their community, and perhaps before their God, to be married to this person until death do them part ... is an undermining stance, not a neutral stance. And it often sides with the more self-oriented spouse." If the therapist and a client share the language of individual self-interest rather than moral commitment, it results in an alliance between the reluctant, distancing spouse and the therapist.

Doherty considers pathologizing by therapists to be particularly insidious. A client in individual therapy who complains about a spouse may be told he or she is married to someone with a narcissistic personality disorder. This leads to hopelessness. "Sometimes the therapist pathologizes the reasons you got married. For almost any marriage, we therapists can figure out what pathology fed its inception."

An individual or a couple can be made to feel that theirs is a sick relationship and anyone who would stay in it is in questionable mental health. "Let's say you see an individual therapist after your spouse has an affair, and you're thinking of taking your spouse back. You may be pathologized for your very commitment to keep trying."

And in a consumer culture, "boring" is the new pathology. "I've seen therapists get very exercised about how awful it would be to be in a boring marriage, and be quite sympathetic to why these spouses have affairs and move on to new partners."

Overt undermining takes the form of such questions as: "If you are not happy, why do you stay?" Such questions imply that the couple is fundamentally incompatible, but Doherty believes they actually reveal the therapist's fundamental inability to help. Some therapists say, "For your own health, you need to move out."

In the November/December, 2002, issue of Psychotherapy Networker, Doherty wrote: "Like attorneys who automatically fight their client's opponents, some therapists encourage clients to rid themselves of currently toxic spouses, rather than work hard to see what can be salvaged and restored. This approach may be wrongheaded, even when it comes to individual well-being. Recent research by sociologist Linda Waite has found that the great majority of unhappy spouses who persevere in their (non-violent) marriages for five years report marked improvements in their marriages, and that divorce, on average, does not make people in unhappy marriages any better off in personal well-being."

Doherty encourages couples to ask therapists to declare their value positions regarding marital commitment and avoid those whose values differ from their own.