Marriage counseling, couples or couple counseling, marital therapy and couples therapy – different names for the same thing. While the specific goals of therapy differ for different couples, couples therapy generally serves to help couples move from conflict, frustration, loneliness and confusion to greater intimacy, trust and vitality. Therapy typically begins with a focused couple evaluation. Couples therapy sessions usually include both partners but occasional individuals sessions may be included as part of treatment. Sessions are usually 50 minutes long. We may meet weekly or every other week or on a different schedule, depending on your needs and time constraints. Treatment may be short-term (5 to 8 sessions after the evaluation), longer-term, or “sequential” (a series of sessions, followed by “booster” sessions if difficulties arise in the future). If a couple is in acute crisis, I make every effort to see them on an intensive basis initially until the immediate crisis is stabilized.
Focused couple evaluation
Before therapy begins, I offer to meet with couples for a brief evaluation, designed to determine whether treatment is indicated and to quickly identify key problems, strengths and promising directions for treatment. The evaluation has four parts. I meet with both of you together for the first session; then once individually with each of you. Then all three of us meet together for a wrap-up session in which I share my impressions and recommendations for treatment and we discuss any reactions and questions you may have. The evaluation helps me understand what goes on between the two of you and within each of you. It provides an organized and reassuring structure for couples who may be in the middle of an emotional crisis. If we agree go to ahead with therapy, it helps us “set the trajectory of treatment,” sidestepping potential obstacles and pitfalls which might not be otherwise recognized.
Sex therapy is designed to help couples experiencing difficulties with some aspect of their sexual relationship. It addresses physical problems with arousal and orgasm for men and women, as well as important intangibles, including sexual preferences, excitement and intimacy. I have helped couples coping with sexual difficulties for over 20 years. While many therapists offer couples therapy, few make a specialty of it and even fewer provide sex therapy. If clients prefer to work on their sexual relationship with a female therapist, I refer them to an experienced female sex therapist in the local area and am happy to do this over the telephone.
Individual psychotherapy for adults
I spend about a third of my time working with individual clients on relationship and other issues. Some want to improve their marriages but their spouses are not (or not yet) prepared to join them in therapy. Some want help changing repetitive patterns that have sabotaged previous romantic relationships. Others want to clarify for themselves whether to continue, end or try harder to change a particular relationship. I work with individuals on a range of personal problems, including anxiety and panic, depression, compulsive behavior (such as sexual addiction), and difficulty coping with stressors and major life transitions. I am also a Certified EMDR Therapist. EMDR can be enormously helpful in promoting rapid change for a wide range of problems, both in individual therapy and in couples therapy.
EMDR (Eye Movement Desensitization and Reprocessing) is a relatively recent approach to therapy – a little over 25 years old – that can help people rapidly resolve persistent negative feelings, symptoms and beliefs about themselves, which often stem from painful or traumatic experiences. I have used EMDR successfully with a wide range of problems, including Post Traumatic Stress Disorder, fear of flying and other phobias, symptoms related to child sexual abuse, excessive anger, persistent anxiety and low self-esteem. EMDR may not be helpful for everyone; however, when it is, progress in treatment is very rapid. Research studies demonstrate that only three sessions of EMDR can be sufficient to resolve symptoms of PTSD from a single incident, such as a car accident or violent assault. For more information about EMDR, go to www.emdr.org or www.emdria.org.
Treatment for behavioral addictions
A recent modification of EMDR appears to be effective in treating addictions – intense cravings to engage in a particular behavior or consume a substance, despite serious negative consequences. Individuals feel that they, literally, cannot stop. The Feeling State Addiction Protocol (Robert Miller, www.fsaprotocol.com ) can reduce – and possibly eliminate – the cravings associated with addictions in as few as a handful of sessions. Common behavioral addictions include: sexual addictions; gambling; alcohol and drug use; compulsive shopping, eating and internet use, including internet pornography and online gaming; and repetitive re-engagement in unsatisfying or harmful relationships. The claims for this recently-developed procedure are not yet supported by scientific research, but a number of therapists who work with addictions report surprisingly effective results. I have used the procedure and been very impressed with the outcomes. I welcome questions about treatment for these or other behavioral addictions.
While many therapists practice couples therapy, few have extensive training in it. It is also widely recognized that working with couples is, in many ways, more difficult for the therapist than conducting individual treatment. Being able to discuss dilemmas associated with a particular case and more general issues that arise in couples therapy (managing secrets, handling domestic violence, working with sexual problems) with someone who has specialized in this area for three decades can help both the therapist and his or her clients. I offer consultation to agencies in western Massachusetts and elsewhere. I am available to meet with therapists for case consultation individually or in small groups – for example, when several therapists pool their resources and learn from each others’ cases.