Harvard Mental Health Letter

Couple therapy

Psychotherapy for two and two for psychotherapy

The problems that confront the clients and patients of mental health professionals arise mostly in marriages and other intimate relationships. Marriage and family difficulties account for about half of all visits to psychotherapists, family therapy is increasingly popular as a mental health specialty, and most family therapists work chiefly with couples. The term "couple therapy" (or "couples therapy") is gradually replacing the older "marital therapy" in order to include unmarried and gay couples.

Licensed couple therapists include psychiatrists, psychologists, clinical social workers, psychiatric nurses, pastoral counselors, and marriage and family therapists who have taken specialized courses and undergone supervised training in the field. The therapist assumes that the unhappiness of a couple amounts to more than the sum of their individual problems and symptoms. They may be concerned about emotional distancing, power struggles, poor communication, jealousy, infidelity, sexual dissatisfaction, and violence. The therapist helps them examine their lives together and decide what changes are needed. They work on eliminating mutual misunderstandings, unreasonable expectations, and unstated assumptions that perpetuate conflict.

Couple therapists make little use of psychiatric diagnosis, but they do use many of the same methods employed by individual therapists: interpreting emotional conflicts and the influence of the past; assigning exercises for behavior change; challenging beliefs; offering advice, reassurance, and support; teaching social skills and problem solving. If the relationship is moribund, some couple therapists believe that they can help the couple make a break with a minimum of recrimination, bitterness, and suffering.

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