Back in the 1970s, as boomers like me came out of grad school and flooded the field, the big challenge to the mainstream tradition of psychodynamic orthodoxy was posed by the family therapy gurus like Salvador Minuchin, Virginia Satir, and Carl Whitaker. Their version of therapy seemed like a thrill-a-minute joyride in comparison to the staid predictability of therapy-as-usual. They welcomed the loud, messy, and revealing stuff that happened when real, highly imperfect families got together. As the polemicists of the family movement like Jay Haley argued, this was exactly the reality that individual therapists, lost in their tidy theories, were missing about troubled relationships and what was needed to change them. The authors in this issue resemble those family therapy pioneers in their willingness to rock the boat and exhort their colleagues to reconsider their basic clinical assumptions, including why so many still concentrate on individual treatment, rather than more challenging modes of therapy.
One thing that’s clear from every article in this issue: couples therapy is hard work. As Ellyn Bader and Peter Pearson point out in their lead article, “Facing Our Fears,” “couples therapy can feel like piloting a helicopter into a hurricane,” and most therapists are “unprepared for the degree of hostility, bitterness, distrust, and occasional homicidal rage” they encounter. In fact, according to them, clinicians are resistant to doing couples therapy for a simple reason—it makes them nervous. But individual therapy can be detrimental to clients because it “too often leaves [them] ill-prepared to take on the gritty, emotion-charged real world of a troubled relationship.” By avoiding the often bitter acrimony of couples work, therapists are choosing their own comfort over their clients’ best interests. After all, therapists like being nice, compassionate people—being Ninja Therapist isn’t usually what they signed up to do.
This issue’s contributors aren’t just convinced that therapists should do more couples therapy, but that risk-taking and turning up the heat in the therapy room is the key to having real therapeutic impact with couples. In “Removing the Masks,” David Schnarch offers the decidedly unsentimental view that the most respectful way to help clients grow up and improve their marriages isn’t by endlessly soothing their wounded inner child, but by challenging them to pull themselves up by their own psychic bootstraps. Similarly Terry Real, in “A Matter of Choice,” espouses a more confrontational, truth-telling approach with couples to help spouses unearth the inner adult buried beneath the self-centered infant personae they generally present to each other. Finally, Bill Doherty argues in “In or Out?” that from the moment a couple enters the therapist’s office, it’s the clinician’s responsibility to cut through their ambivalence to determine whether both partners are true “customers.” This means assessing whether or not they’re willing to make a full-bore commitment to a reconciliation plan that’ll either save the marriage or leave the spouses (and the therapist) convinced that all facets of the decision to divorce were fully considered.
It’s clear from this issue that couples therapy isn’t easy. It requires more energy, more hands-on, minute-to-minute involvement, and—in the final analysis—probably more guts than other kinds of therapy. Whether it leads to more effective therapy, however that’s defined, is an empirical question that remains to be answered. What’s sure is that therapists who take on this kind of work aren’t going to be just strolling amiably along through their sessions.