While in graduate school, Meredith Hansen, PsyD, watched as many of her peers fell in love and exchanged vows. But not long into their marriages, she noticed many of the couples didn't seem happy. "They weren't fully depressed, but they weren't as happy as you'd expect," she recalls.
That observation led her to write her dissertation on women's expectations in the first year of marriage, and then to obtain additional training in relationship counseling. In 2009, she launched a couples-focused practice, including premarital counseling as one focus. "It seemed really important to me to help couples get set up and start off right in their marriages," says Hansen. "Talking about things in advance, getting on the same page, hearing what each other's needs and expectations are—just having those conversations, which a lot of couples don't necessarily have, is really important."
Research supports that belief. A classic 2003 study in the journal Family Relations, for example, found that couples who had completed some form of premarital counseling had a 30 percent increase in marital satisfaction compared with those who hadn't undergone such counseling.
Hansen offers her premarital counseling services in five 50-minute sessions at a reduced rate from her standard counseling sessions. She works with engaged couples on such topics as their reasons for wanting to marry, finances, in-laws, intimacy and conflict resolution.
Her practice has been successful, in part because she does work to bring clients in, promoting her services on Google AdWords as well as through public speaking and bridal fairs. She says engaged couples may feel a stigma about such counseling—fearing that premarital counseling implies that their relationship is in trouble.
Strength focused
But even though premarital couples can be a difficult clientele to reach, says Hansen, the work is an attractive career niche because the population tends to be excited about the next step in their lives. Also, such counseling employs a lighter touch than traditional couples counseling: Instead of focusing on deeper psychological issues that might be driving relationship problems, for instance, premarital counseling is more "tool-focused, skill-focused and strength-focused," she says.
Because couples are so motivated, the work also produces rapid, tangible results, she says.
"It's fun to be in on that ground level and teach them tools to help them stay excited and see the strength in their relationship, even when they are a little uncertain or scared," she says.
A lifelong journey
Susan Gamble, PsyD, also finds premarital counseling gratifying and even fun. "It can break up a day filled with clients who have anxiety, depression and conflicted relationships, with people who express love, joy and excitement," says Gamble, who devotes about a quarter of her practices in Pasadena and Murieta, California, to such counseling.
Like Hansen, Gamble offers blocks of six or 12 sessions for a fixed fee. In addition to addressing issues that couples raise, Gamble focuses on such topics as setting up a household and budget, planning a family, sex and more.
She also encourages couples to discuss how their families of origin handled holidays and vacations, helping them consider ways to intertwine their experiences to create their own new traditions.
Those most likely to seek out and pay for such services are young professionals, so she tailors her marketing strategies accordingly, offering weekend and evening hours, for example. Facebook is another good vehicle for reaching this group, she says. Engaged couples also call for a different office "look" than traditional clients, Gamble notes. Before seeing these clients, she may replace clinically oriented magazines with wedding planning magazines, for example. She also has two comfortable chairs so each person has his or her own space.
When a couple's sessions end, Gamble suggests that they return for a free "booster shot" in the same way they'd return to their primary-care physician for an annual physical. "I like to give the message that marriage is a lifelong journey, and that you sometimes need a nonjudgmental ear to help you sort out conflicts," she says.
Communication skills
For marriage counselor Susan Heitler, PhD, skill deficits often lie at the heart of couples' inability to create happy, stable, long-lasting marriages.
"Most of the couples who come to me for relationship difficulties lack sufficient marriage communication skills," the Denver-based practitioner says. "They almost all need to learn how to talk more cooperatively about sensitive issues, make important decisions in a mutual way, express their anger in nonthreatening ways, and share affection, appreciation and assistance."
To help clients build these skills, Heitler has developed a 12-session program that trains psychologists and others to provide premarital, couples and marriage workshops. The kit also includes marketing suggestions such as using radio advertising and fostering relationships with church leaders.
Undergirding all of Heitler's work is an emphasis on conflict resolution. She teaches couples to move from staking out initial positions and defending them, to cooperatively laying out their concerns and creating win-win solutions. "When couples engage in this process of collaborative dialogue and shared problem-solving instead of fighting, avoiding, dominating or compromising, they can virtually always create a plan of action that feels mutually gratifying," she says.
Heitler is convinced that relationship conflicts lie at the root not only of poor marriages, but also of many mental health problems including depression, anger, addictions and anxiety. As such, getting trained on the specifics of conflict resolution as it relates to relationship difficulties could beef up psychologists' ability to contribute to more peaceful families and a more peaceful society. "My hope is that by learning how to coach couples in the skills for a maturely loving relationship, psychologists can contribute in a major way to creating a better world," she says.
This is the second article in the Monitor series "No Insurance Required," which explores practice niches that don't involve working with insurance companies.