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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
This demonstration represents a special approach to working with married couples where one or both spouses are considering divorce and are ambivalent about working to salvage their marriage. ("Marriage" here can be defined broadly to include couples who have made a public life-long commitment, regardless of gender and legal marital status.) Often these couples have not tried couples therapy, given it a serious effort, or have not seen a competent marriage therapist. (Many therapists treating couples lack training and experience in this challenging modality.) Absent domestic violence, other forms of abuse, or bad faith on the part of one of the partners, Dr. Doherty sees his role as holding onto hope for demoralized couples and encouraging them to make a major effort to salvage their marriage. His approaches are based in value considerations (a lifetime marital commitment should not be withdrawn without an all-out effort to sustain it) and pragmatic considerations (many people who end a marriage go on to repeat the same pattern in subsequent relationships). There is also poll data from a variety of sources showing that 40% or more of divorced people regret their divorce and wish they had worked harder as a couple to save their marriage. Dr. Doherty rejects the idea that therapists should be "neutral" about the decision to divorce (as if the decision were about changing jobs), and he believes that therapists can respect clients' autonomy while first exploring the possibility of restoring the marriage to health. In practical terms, Dr. Doherty invites each partner to focus on what he or she can change in him- or herself to be healthier and make the relationship better, and he steers them away from focusing on what the other partner can or cannot do to change. Dr. Doherty sees the couple together and each spouse separately—the couple together in order for him to see how they interact, and each one separately to help each to make an independent assessment and decision. (The agreement calls for a summary at the end of each session of what was discussed in the individual parts; if someone is having a secret affair, he will not force disclosure but will not begin marriage therapy until the affair is ended.) He focuses the sessions on whether to carve out a period of time (usually six months) of serious effort in marriage therapy, with divorce off the table. With this approach, Dr. Doherty contends that "marriage therapy" does not begin until the couple and therapist are all working on the goal of improving the marriage; prior to this decision, they are doing assessment and decision making counseling. Otherwise, ambivalent spouses can claim that they "tried therapy" even though they stayed on the fence until the other person bailed out of the process. Focusing the decision on whether to try a course of therapy is more realistic than asking the clients to make a permanent decision on whether they want to stay married. In other words, the commitment Dr. Doherty seeks is to the therapy, rather than to a lifetime of marriage. He continues with a process of conjoint and separate conversations until there is a decision on whether to proceed with marriage therapy. Usually this occurs within several sessions. The most common presentation is one partner leaning "out" of the marriage and the other wanting to preserve it. In that case, Dr. Doherty uses the same format but the conversation with the "in" spouse focuses on self-care, being constructive at home, and using this crisis as a wake-up call to make personal changes in a healthy direction. Dr. Doherty does not use this approach when there is serious risk of abuse. |
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