Marriage and Couples Counseling in San Francisco
What’s the deal with marriage counseling?
Is it worth our time and money?
Does it actually work?
And is it the same thing as couples therapy?
These questions usually arise when things are getting bad. When it seems like the arguments are never going to end. When you’re doubting whether your relationship is going to last.
A friend might suggest it… “Maybe you guys should go to couples therapy.”
But for so many of us, it’s a mystery. We may have ideas about it, but we’re not sure.
In this post, we’ll dispel the myths and clear up any questions about marriage counseling. You’ll learn whether it works and how it might benefit you. Most importantly, you’ll find out what to expect, so that you don’t go into it blindly.
What is Marriage Counseling?
It’s a journey. A process that takes a little work, but ultimately pays off.
Marriage counseling is an opportunity to finally feel like you’re with the right person, for the right reasons, getting your needs met, supporting each other’s dreams.
Getting more concrete here: It’s therapy for you and your significant other. You don’t have to be married or even intend to be married. Although in-person sessions are ideal, many marriage counselors offer online therapy, with positive results.
With marriage counseling, you’ll figure out what’s dragging your relationship down. You’ll identify areas to work on together, whether that’s communicating better, reducing each other’s stress, improving your sex life, etc. This work can set you up for the long run, so you can grow and thrive together.
But it’s not only for improving things. Marriage counseling can also help with:
Finding out if you’re right for each other.
Healing from the effects of infidelity or betrayals.
Learning how to rebuild trust.
Deciding whether to stay together.
Navigating separation or divorce in the healthiest way possible. Many couples use the safe therapeutic space to ensure that a parting of ways feels thoughtful and compassionate for both.
What Marriage Counseling is “Not”
When we think of marriage counseling, we might picture TV shows or movies. Scenes where two people are yelling at the same time, trading accusations and vicious barbs. The beleaguered therapist tries to interrupt them, but it keeps going. One partner then stands up and storms out of the room.
Does that ever happen? Of course. But it’s usually much different than that. We’ll correct some of the misconceptions.
Marriage counseling is not:
A courtroom. The therapist will not serve as a judge or referee, deciding who’s right and who’s wrong. Why not? While it’s easy to slip into blaming and score-keeping, that just sidetracks you guys from getting your needs met.
A formality. If someone’s already decided to leave, sometimes they’ll agree to go to therapy, just to relieve their guilt when they actually do it. Closed off to new insights or learning, they get very little out of it.
A walk in the park. Difficult stuff comes up, ya know? Especially if you’re trying to figure out how to move past repetitive arguments. But progress is only possible when we allow ourselves to feel. Marriage counseling can help make emotions seem way less scary and overwhelming,
A place where only doomed couples go. It’s a common myth, that “If we need to go to counseling, there’s something wrong with our relationship.” Au contraire. Many couples just want to fix a problematic pattern, or just generally make their relationship as healthy as it can be.
A mud-filled wrestling pit. Unlike those movie scenes, marriage counseling is not just another place for you to argue, with the therapist as a spectator, holding a bucket of popcorn. The point is to give couples the experience of doing something different than they do at home. You’ll learn new ways to reduce tension, resolve disputes, and break those frustrating communication patterns.
Couples Therapy vs Marriage Counseling
These days, when a couple is seeking therapy, it doesn’t matter which of these two terms is used.
Sure, you can find articles claiming that there’s a difference. But any distinction derives from what marriage counseling used to be.
“Marriage counseling” was the traditional term, deriving from the 1930s, when obstetricians, gynecologists, family life educators, and clergy would give “guidance” to married couples about “proper” marital roles and values.
Since then the field has evolved, and today the term “couples therapy” is more commonly used, because it emphasizes the bond between two people. For that reason, we’ll use them interchangeably.
Does Marriage Counseling Work?
Marriage counseling is a very effective form of therapy.
One study, a meta-analysis of several other studies, found that marriage counseling helped approximately three out of four couples (Shadish & Baldwin, 2003). A more recent study in the Journal of Marital and Family Therapy showed that seven out of ten couples were positively impacted (Lebow, Chambers, Christensen & Johnson, 2012).
But there are factors that make progress even more likely:
Timing. So many couples wait too long, when the hurt and the anger is so strong that nothing’s going to reverse the slide. According to relationship expert John Gottman, on average couples typically wait six years of being unhappy to begin therapy. Six years!
The right therapist. It’s so important that the couple likes and trusts the therapist, and feels at ease. Research has shown that when both partners view the alliance with the therapist as strong, the success rate is higher (Symonds & Horvath, 2004). It’s wise to check out a therapist’s website, and see if their approach appeals to you. When making the first contact, ask if they offer a free phone consultation by phone. Notice what it feels like as you’re chatting with them. Continue to pay attention to this in the first session. If it doesn’t seem like they “get” you, politely say that it doesn’t feel like a good fit. You’re paying good money for this, and you deserve to be comfortable!
Motivation. A partner who intends to leave a relationship may agree to go, just to say they tried. Not surprisingly, it doesn’t last long. You need to be “in it to win it” (or whatever that ridiculous expression is).
The bottom line: If you’re proactive, carefully select a therapist you feel comfortable with, and keep an open mind, you’re setting yourself up for success.
Benefits of Marriage Counseling
“Couples therapy… it’s not just for saving relationships!”
Okay, not the greatest slogan you’ve ever heard... but it’s true. You might be surprised by the different benefits that couples have reported over the years:
Benefits to Your Relationship
Couples therapy can help you both:
Figure out why you’ve felt disconnected or even resentful.
Optimize conflict resolution.
Tackle perpetual problems.
Learn how to take care of each other.
Clarify roles and expectations.
Promote a healthy and satisfying sex life.
Figure out how individual factors (e.g. anxiety, depression, ADHD, trauma) impact the relationship dynamic.
Heal emotional wounds that have occurred between the two of you.
Promote security and stability.
Resolve ambivalence about commitment going forward.
Benefits to You Individually
No matter what happens, you’ll reap some definite rewards from the experience. Couples therapy can help you learn:
How to communicate in an optimal way (which you can also use with family, friends and coworkers).
How to express what you’re feeling and needing, without other people getting defensive.
How to manage emotions during painful discussions.
What type of romantic partner you’re ideally suited for.
It can help you both leverage the relationship, to:
Reduce your day-to-day stress.
Alleviate anxiety or depression.
Heal the effects of relational trauma
Support each other’s life goals.
What’s more, many clients have reported feeling fascinated by concepts they’ve learned in couples therapy. If your therapist uses brain-based techniques, you’ll pick up heaps of information. You’ll learn how our nervous systems really run the show when it comes to love. How we’re pre-wired from an early age to need space or to need closeness, and how we bring that pre-wiring into our adult relationships. It’s fascinating stuff.
What to Expect From Marriage Counseling?
By now you’re jumping up and down about starting couples therapy - super-excited, right?
Of course you’re not. It’s a new thing you’d be venturing into. The thought of talking about your private life with someone new might give you pause. You could easily be kicking back and relaxing instead. Plus, it ain’t free (well, not usually).
But it does get results. Knowing the lay of the land helps it feel less daunting.
Here’s what to expect:
An initial phone call. Most couples therapists will do a complimentary phone call, usually for 15-20 minutes. You’ll get a sense of them. You’ll tell them a little about your relationship and what you’re looking to get from the experience. You’ll want to get a sense of their approach to what you’ll be talking about. You’ll find out what their fee is, their availability, etc. You’ll agree to a time for the first session.
Some forms. The therapist may send you a few forms to fill out before getting started. It’s usually about how the process works, how the therapist protects your privacy, etc. Truly scintillating reading.
Video, for now. As you can imagine, therapy is mostly online right now. If the pandemic hasn’t done us the favor of exiting the stage by then, you’ll likely be starting over a video platform. Ask the therapist if it’s HIPAA-compliant! Certain video platforms offer end-to-end encryption of audio, video, and screen-sharing data.
Confidentiality. You probably know this already, but save for specific exceptions that you’ll be made aware of, anything you discuss in the sessions is kept confidential.
Assessment. In the first session, the therapist will likely ask a bunch of questions. Questions about your goals, what your lives are like these days, how you communicate, what seems to go wrong, etc. Before moving forward, we gotta know what we’re working with.
Metrics. “How will we know when we don’t need this anymore?” It’s a common question. Clear metrics should be established so that you’re able to track your progress.
Awkward! At first it may feel weird to talk about your love life with someone you’ve just met. But the therapist’s job is to help you feel comfortable. And to convey they know what they’re doing and can help. It’ll get easier over time.
Sex talk. Speaking of a topic some may feel reluctant talking about, therapists and their clients talk about sex all the time. It comes up when couples are aiming to improve their sexual connection. If “I have a headache” is a regular thing with you and your partner, that may be a symptom of a breakdown in communication, trust, or commitment. The point here is that a skilled couples therapist will assess whether there are issues in this important aspect of your relationship.
Skepticism. Early on, you may feel like nothing’s going to change. Especially if you and your partner have been stuck in a rut for a while. Some of what the therapist is suggesting may seem like total b.s. You may be skeptical at first; that’s totally understandable. But experimenting with something new can help break you out of that rut. This means getting you doing something differently than what you do at home. So keep that healthy skepticism, but also keep an open mind.
Insights. The therapist will likely pick up on nuances in how you and your partner interact, dynamics in your communication, patterns related to how you were both parented, how you were pre-wired in a certain way even before you ever met. It’s common to hear couples say “Oh wow, I didn’t realize that” in the very first session.
Discomfort. Something your partner has said or done may make you feel angry, upset, frustrated, etc. We’re all skilled at somehow pushing emotions away. At not feeling them when it’s not convenient to feel them. But in a relationship it’s so important for both partners to be taking care of each other, playing the role that your parents played (or should have played) when you were a child. So you’ll each be accessing emotions that you may have taken a break from for a while. That discomfort is normal. Talking about it can bring that up, and that’s perfect. Why? Because you’ll both learn how to convey it in a safe manner, in a way that gets you what you’re needing.
Humor. Not appropriate in all situations, but still… occasional lightheartedness makes the time so much easier.
Coaching. The point is to relate to each other in a new way, right? To break the repetitive cycle that you’re both stuck in. The therapist will likely prompt you to try new approaches (right then and there), and see how they work.
Things to practice. The therapy room shouldn’t be the only place where you guys are making improvement. Your therapist will likely provide you with concrete, actionable methods to practice outside of the session. If it goes awry, that’s okay… your therapist will help figure it out, and craft additional strategies going forward.
Relief. In many cases, over time the arguments will get less intense and less frequent. You’ll feel more safe just being yourselves. As you’re relating to each other in a new way, new understandings emerge. Amen.
Is Marriage Counseling Worth It?
Have you and your partner been arguing a lot? Has it been rough for a while? Has it been keeping you from getting to sleep, or distracting you during the day?
Couples therapy can change that. The money, the time and the effort can all be worth it.
Some couples might buy a book instead. There’s lots of good ones out there, and you can implement the techniques that they describe. A potential problem is that the author has never met you, and knows nothing about the unique dynamics of your relationship.
Then there are blog posts from marriage counselors. You might find this one and this one reasonably helpful.
But something written for a wide audience may not capture the unique dynamics of the two of you, such as:
Mental health concerns such as anxiety, depression, trauma, substance abuse, etc.
A pattern of criticism, defensiveness, withdrawal, or shutting down.
Parents who were dismissive of emotion, overly controlling, or emotionally abusive.
Unique factors around age, race, ethnicity, sexual orientation, gender identity, religion, etc.
Concerns around career, health, children, finances, etc.
An experienced couples therapist can tailor the experience to you.
Goals should be clearly defined at the outset. And along the way, you should be gauging progress towards those goals.
After a month or so, if it feels like the therapist doesn’t “get” you, or if something about their approach concerns you, bring it up. A good therapist would welcome the honest feedback, and modify things so that it feels better.
A final word about whether it’s worth it:
Although improving their relationship is the most common thing people get from couples therapy, regardless of whether this actually happens, you wind up taking something from the experience. Communication skills that you’ll be able to use with family, friends and colleagues. Insights about your history, your patterns, and what type of partner you should be with.
So the answer is yes.
Does Insurance Cover Marriage Counseling?
Many insurance companies do cover couples therapy. Some health insurance plans require that you go to an in-network therapist. In many places, including the San Francisco Bay Area, it can be difficult to find an in-network therapist with availability.
Other health insurance plans will reimburse for up to 60-80% for sessions with an out-of-network therapist. That gives you a much wider range of therapists to choose from. It’s a good idea to call your insurance company to ask if they cover couples therapy, and what the rate of reimbursement is for out-of-network therapists.
You’ve read this far. You want to make things better.
The next step is to schedule your complimentary 15-minute consultation phone call!
Email andrew@andrewkushnick.com to make it happen.
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Andrew Kushnick is a couples therapist in downtown San Francisco. As a former practicing attorney, Andrew’s approach is practical and concrete, using science-based and evidence-based methods. Video appointments are available during afternoons and evenings.
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References
Gurman, A. Clinical Handbook of Couple Therapy. The Guilford Press.
Lebow, J., Chambers, A. L., Christensen, A., & Johnson, S. M. (2012). Research on the Treatment of Couple Distress. Journal of Marital and Family Therapy, 38(1), 145-168.
Symonds, D., and Horvath, A. O. (2004). Optimizing the alliance in couple therapy. Fam. Process. 43, 443–455.