What Everyone Needs to Know About Successful Marriage Therapy
And why some people will never be helped by any therapist.
What makes marriage therapy successful? Does it solely depend on the therapist you choose? I believe couples should be aware of what they should look for and what is required of them.
To that end, almost one year ago, I had a random idea: what would I need to do to help couples achieve better outcomes? In my analysis, I discovered that there are four reasons couples don’t get the results they would like to have in marriage therapy:
1. They Drop Out of Therapy Too Soon
Research shows the average couple only goes to marriage therapy three to five times, and 20–40% drop out after 2 sessions. The overall dropout rate is between 30 and 60 percent.[1]
Couples don’t seem to realize how much there is to learn and how much work it takes to understand the dynamics of having a healthy relationship with themselves and others. They may get 10 percent better, at first, then decide things have improved enough, therapy is expensive and sometimes stressful, or they have a busy period of things going on, drop out for a while, and don’t make it a priority to return.
Many had expected rapid improvement or thought therapy should be like piano lessons, and you get better every week and have a recital in the spring, and when they didn’t get a quick reward, they stopped. Therapy can also be emotionally uncomfortable, sometimes one person feels the therapist is not supporting their side, and another common reason is one spouse has already secretly decided to leave and were going only to check a box to avoid and minimize criticism. How many times have I heard a divorced person say, “We went to marriage therapy, but it didn’t work,” when the truth is one or both people in the couple didn’t want to do the work? Too many.
2. One Person Is Highly Motivated, While the Second Person Is Not
This is a big one. Most of the time, it is the woman who is fighting for a higher-quality partnership and subconsciously designates herself as the relationship manager. They often seek in relationships things higher up on Maslow’s Hierarchy of Needs,[2] such as greater emotional intimacy or a more equitable relationship. Women buy 70 to 80 percent of all self-help books, most likely because of this.
Men are socialized differently from women. They hear cultural and sociological micro-messaging such as suck it up, handle yourself, don’t be weak, don’t need help, figure it out. My theory is that while men would love to be doted on and adored, they aren’t likely to ask their wives to go to therapy with them to get more affection. Many have an attitude of, “Things could be better, but at the same time, I am OK as is.” One word I hear from men more than any other is an admission of fearing failure. Asking for marriage therapy might be tangible proof that they are a relationship failure, though I know no marriage therapist or any average person who would ever think that.
3. Severe Mental Disorders in at Least One Person
Probably 20 percent of the population has serious mental disorders like narcissism, borderline personality disorder, histrionic or obsessive-compulsive personality disorders, untreated or mismanaged bipolar disorder, attention and hyperactivity issues, and more. Another issue is untreated complex trauma that prevents a person from becoming an emotional adult.
Many of these are permanent brain disorders and cannot be cured, but sometimes can be managed. They are defined by a person’s inability to see things differently, to blame others, and to accept responsibility. They often have zero ability to hear anything remotely negative about their own thoughts, premises, and behaviors, and once a therapist starts diving into those dysfunctions, it will cause them so much rage and anxiety that they will refuse to continue, usually demonizing the mental health professional on the way out the door.
4. The Therapist Wasn’t a Fit
Most therapists are qualified to help, but we have different personalities and approaches to our work.
You wouldn’t give up on dating after going out with fewer than 5 people, but part of going to therapy is finding someone you like, trust, and have rapport with. Many couples go to one or two, and when they don’t find the right one, they assume marriage therapy isn’t for them. Big mistake. Be patient. Find the right fit.
The People Who No Therapist Can Help
First, the population I work with, and the people I refer to here, are high-functioning, successful people. They have careers, families, and are living their lives, but some have such severe complex trauma or mental disorders that they have extreme difficulties that show up mostly in their interpersonal relationships. That is where the tire meets the pavement in mental and emotional health: at home.
Working with difficult people with these disorders is the bane of most therapists’ existence. In graduate school, I remember some budding therapists saying, “The crazier the better, bring it,” but for most of us, the opposite is true. Indeed, the first question I hope to ask, if there is an exit interview when we die, is, “Why did there have to be personality disorders?”
People who have them typically got that way due to a series of genetics, personality, temperament, and the environment they grew up in. If the immature behaviors causing them problems are trauma-related, they are usually fixable, because the person is willing to look within, as painful as that may be in the beginning.
If they are personality-disorder related, it is a chronic issue of false perception that can only be managed, but the perception problem will never go away. When I say ‘perception problem,’ consider they are always right, never wrong, they know what’s best, they are the authority, and don’t you dare try to teach them anything, because they don’t need it.
Part of how I know the difference is that with the personality-disordered people, no matter how I approach a conversation, they will not accept that they are a serious part of the problem and resist any and all negative scrutiny like a growling dog.
People suffering only from complex trauma are usually able to understand that what they were doing was dysfunctional and work to change it.
Since I work in marriage crisis management, I see quite a few couples who have been everywhere else and have nothing left to try. Coming to see me, they tell themselves, is the last stop before divorce. And in a majority of these situations, the main reason they cannot be helped is that one person is one of those who will not accept responsibility for their part in the marital nightmare. They have a history of firing therapists after therapists as soon as the scrutiny turns in their direction.
One of the most fascinating things about what I do is how many people I work with love or hate me. When someone tells me I was a godsend, I say to myself, “Don’t get too sure of yourself, Becky, remember the client who told you yesterday that you are the worst person in the world.”
Maybe I am the worst. Maybe I am both? Maybe I am neither?
“My husband is scared of you,” I hear sometimes.
“He says he’s not coming back,” I also hear.
“He says you won’t even listen to his side.”
The difficult people who won’t be helped have called me a quack, inept, a train wreck, and unethical. I have been accused of being involved in malpractice, in need of therapy myself, and some say I should be reported to the counseling board, though I see people solely as a life coach these days. I can’t recall, over the past 20 years, even one of those people being a woman.
So, What’s Going On?
It could be that I am a woman with undeniable credentials. It could be, that if I am correct that they are acting immature and dysfunctional, and what the person is doing is misguided, then it might have to be true.
I have done everything possible to be qualified and prepared to help my clients with the most powerful therapeutic tools available. Why? Years ago, when I was a journalist writing about relationships, my articles were criticized for lacking the proper credentials to speak with authority on the subjects.
One of my best friends at the time was an anchor at the local NBC affiliate, and she often had me as a guest on her morning television show to talk about relationships. One day, she said, “People keep calling and complaining that you don’t have credentials. Could you just get a mail-order degree or something so I can shut them up?”
“Hell no,” I said. “If I am going to get a degree and credentials, it will be done the hard way, so that I never have to hear about not being qualified again.” And so, I went to graduate school for five years, got my doctorate, and have spent over $150,000 since then getting trained by world experts in trauma, addiction, relationships, attachment, hypnosis, energy healing, and more.
Then add over 20 years of experience working with individuals and couples.
With all of that, I “see things” everywhere I go. I can easily discern dysfunctional behaviors, phrases, and negative patterns in less time than it takes an Olympic sprinter to complete the 100-yard dash, and time and experience usually prove me right. My brain is attuned to noting it all.
My intuition, education, and experience have become astute processors of information, relationship dynamics, and patterns, and so if I tell you that you are misguided in any way in your relationship, it will be difficult to turn the tables on me as the one who is incorrect, yet people do it all the time. In fact, I have had plenty of clients who think they know more about how to fix and heal their relationship than I do, many throwing Google research in my face as if what they read there was spoken by Jesus himself. Consider your sources, people, if you don’t want to get shot down.
So, You Want to Work With Me?
Some of the difficult people I work with purposely sought out the most qualified person they could possibly find. And when that person with that level of training tells them that they are a large part of the reason their relationship is on the rails, they may not have the ego strength to handle it. It takes some sense of confidence in yourself to be able to weather negative observations; another term for that is ego strength, and people with personality disorders are not capable of it.
A person with little or no ego strength has extremely low self-esteem and covers it with false bravado. If anyone comes near the cover and tries to remove the false persona, they implode.
Time and time again, couples come to me telling the story that the wife is the reason the marriage is on the brink of disaster, only to find that the husband was the real problem all along.
Most women I work with are ready and willing to take full ownership of their part in the marriage breakdown, and they are eager to keep the marriage together and, in most cases, grow and change. But when I start poking around in the relational bushes and start finding evidence of extreme immaturity, control, or serious personality disorder in the man, his reaction will be to hurl insults and threaten to burn me on a stake.
It’s on those days I wonder if it’s time to retire.
“I am so glad that he found you to be our therapist, Becky,” the wife says, “because if I had been the one to find you, he would be blaming me, too.”
Early warning signs that we are trending in the direction of therapeutic hopelessness are defensiveness, deflection, rage, being combative and prickly, and shutting down, an aversion to talking about the past, minimizing the stories in which they emotionally harmed their spouse, saying they feel attacked, and a keen interest that I spend the exact same amount of time talking to your wife as I do you.
“Why are you spending so much time talking to me? I’m not the only problem, you know. Seems to me you think I am.”
Perception failure alert.
In an example like this, a person is making up what he thinks I said rather than working with what I actually said. He decides that since I am mostly talking to him (since I can only talk to one person at a time), I must be thinking only he is the sole problem, which, on its face, is ridiculous, but this is what I deal with time and again.
It is almost never one person’s fault that a marriage breaks down, but many times, one person is the primary obstacle or problem child, and but for their extremely dysfunctional actions and reactions, things would have been pretty workable.
I guess everyone wants to think that a marriage in trouble has to be blamed equally on both people, but it usually doesn’t work that way.
When a confident and highly trained therapist tells you news about your thinking and behaviors that aren’t that great, it’s never fun. But for those who have toxic shame, weak egos, and a head full of insecurities, it is their worst nightmare come true; they cannot emotionally handle not being the superb person in their head they thought they were, and they almost always lash out, then make their dramatic exit.
“My husband ran through the house yelling your name and screaming that we just wasted X amount of dollars on your services. He refuses to come back.”
Thank you. Next.
The Program That Forces Couples to Stick to the Process and Not Run Away
As I pondered how couples could achieve more powerful, lasting results, I wondered how I could create a plan that addressed the most controllable reasons therapy hasn’t worked for them. The one thing no therapist can control is the personality disorder issue, and whether there is trust and rapport.
I decided to create a marriage crisis management intensive that lasts for two months, including at least 13 sessions and daily messaging with me on the Voxer app. There, I can coach, teach, and address any and all concerns along the way. It has been a game-changer. And the kicker, they must pay for all of it in advance, and it is nonrefundable.
I added that piece to make sure couples stick with it, no matter how hard it gets. The prices are high enough that they will be forced to take it seriously.
We meet first in a 90-minute marriage crisis consultation so they can get a feel for me and how I work. If we both think we could work together, I will send them a proposal and contract, and then we begin the process of a no-nonsense, get-to-the-bottom-of-it marriage examination, and hopefully repair. Couples must learn the basic skills of having a healthy interaction with their spouse. How to handle disagreements, what proper boundaries are, and how to take a break when things are intense and return to the conversation later.
If one of the partners has a personality disorder, they likely won’t make it through the entire 8 weeks; they will either drop out or get kicked out for disrespectful behavior. This is after signing a contract with me that requires them to act respectfully or risk being asked to leave. If their partner wants to, I will continue working with them individually for the rest of the time they contracted for, and they will need it as the conversation turns to how to live with an impossible person. Or not.
These conversations are usually relieving for the remaining spouse, as they begin to realize they have been caught flat-footed in most of their arguments. They begin to see the patterns more clearly and realize that they have been victimized. They begin to grow, gain confidence in what is their fault and what isn’t, and clearly see both sides of the equation. They will no longer tolerate their dominant spouse running the show.
So far, the intensive programs have been a great success. 80% of the couples make it all the way through the eight weeks and continue working with me afterward. 20% of the time, I end up working with just one spouse. I’m still seeking ways to improve how we can lead a spouse to success. Since I can’t force them into a relationship school, this may be the best way for now.
References
[1] See the sources below.
About one-third of couples terminate therapy prematurely. Doss, B. D., Simpson, L. E., & Christensen, A. (2004). Why do couples seek marital therapy? Professional Psychology: Research and Practice, 35(6), 608–614. doi.org/10.1037/0735-7028.35.6.608. This paper discusses attrition and references previous work showing that approximately 30–35% of couples terminate treatment before completion.
Dropout rates commonly range from 30% to 60%. Lebow, J. L. (2012). Couple and Family Therapy: An Integrative Map of the Territory. Washington, DC: American Psychological Association. Lebow summarizes the literature and notes that premature termination rates in couple therapy frequently fall between about 30% and 60%, depending on the population and how dropout is defined.
Many clients attend only a few sessions. Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329–343. doi.org/10.1093/clipsy.9.3.329. This paper isn’t specific to couples therapy, but it demonstrates that many psychotherapy clients attend only a small number of sessions, and meaningful improvement generally increases with additional sessions.
Couple therapy effectiveness and attrition. Snyder, D. K., Castellani, A. M., & Whisman, M. A. (2006). Current status and future directions in couple therapy. Annual Review of Psychology, 57, 317–344. doi.org/10.1146/annurev.psych.56.091103.070154. This review discusses both effectiveness and the challenge of premature termination in couple therapy.
[2] Maslow, A. H. (1943). A Theory of Human Motivation. Psychological Review, 50(4), 370–396. Full text here. Abraham Maslow proposed that human beings are motivated by a hierarchy of needs. Before people can focus on higher-level goals like self-esteem, personal growth, and reaching their full potential, they must first have their basic physiological and safety needs met. Once those foundational needs are reasonably secure, people naturally seek love and belonging, followed by esteem, and ultimately self-actualization — the desire to become the best version of themselves (Maslow, 1943, 1954).
WORKING WITH ME
I’m Dr. Becky Whetstone, a licensed marriage and family therapist and America’s Marriage Crisis Manager®. I’ve spent nearly 30 years with people at the worst moment of their marriage.
I work with clients everywhere by Zoom. If something in this post hit close to home, here’s where to start.
My book: I (Think)I Want Out: What to Do When One of You Wants to End Your Marriage — Read the whole framework, in order, at your own pace.
Appointment: 90-Minute Marriage Crisis Consultation — Bring me your situation. You’ll leave knowing what stage your marriage is actually in and what to do next.
Relationship University — Live classes and a private community for people who’d rather understand relationships than keep guessing.
Quiz: What Stage Is Your Marriage In? — A free 10-question quiz.
Note. Becky is an Amazon affiliate and may receive a small percentage if you purchase a book from her links, at no extra cost to you.
