Couples Counseling / Marital Therapy

[Sushirolls]

My residency program back in the day had some exposure. One of the guiding principals was to not have dual roles of being the couples therapist and individual therapist. This was instructed by the Masters level therapists and even the psychologists.

I routinely counsel this to my patients, don't double dip and turn your therapist into your marital or vice versa.

Yet, I routinely see this over and over.

Am I antiquated and not up to date on this? Did I miss a memo?

Or is this still the case, for boundaries, don't mix these roles together. Are masters programs even teaching this anymore? I see it less so with the psychologists, partly because I just see them more often avoiding couples therapy.

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[PikminOC]

My residency program back in the day had some exposure. One of the guiding principals was to not have dual roles of being the couples therapist and individual therapist. This was instructed by the Masters level therapists and even the psychologists.

I routinely counsel this to my patients, don't double dip and turn your therapist into your marital or vice versa.

Yet, I routinely see this over and over.

Am I antiquated and not up to date on this? Did I miss a memo?

Or is this still the case, for boundaries, don't mix these roles together. Are masters programs even teaching this anymore? I see it less so with the psychologists, partly because I just see them more often avoiding couples therapy.

They now have online masters programs. So who knows what's being taught?

 

[Celexa]

My residency program back in the day had some exposure. One of the guiding principals was to not have dual roles of being the couples therapist and individual therapist. This was instructed by the Masters level therapists and even the psychologists.

I routinely counsel this to my patients, don't double dip and turn your therapist into your marital or vice versa.

Yet, I routinely see this over and over.

Am I antiquated and not up to date on this? Did I miss a memo?

Or is this still the case, for boundaries, don't mix these roles together. Are masters programs even teaching this anymore? I see it less so with the psychologists, partly because I just see them more often avoiding couples therapy.

An individual therapist might have a session or two with a family member present, while still acting as an individual therapist. The most generous interpretation is that this is what the therapist is trying to do or intending to do and the patients are sometimes misunderstanding.

You aren't wrong. The same person should not be both someone's individual therapist and their couples therapist. It is an insurmountable conflict of interest.

 

[FlowRate]

That is how I was instructed, as well. It's an obvious conflict of interest. I also see it happening all the time, as well.

I have seen something a little different where a therapist will agree to do couples counseling but has to nominally choose one member of the couple as the "patient" for insurance purposes. I wonder if that is technically insurance fraud.

I'm sure there's a wide variation but it seems like you're much less likely to get serious training in case formulation or basic psychodynamic and cognitive-behavioral techniques from Master's level therapists. I think a lot of the best LCSW's I've worked with have had to do a lot of additional therapy training after their education.

 

[Merovinge]

I do sometimes recommend an adolescent's individual therapist also do family therapy to help with the baseline power differential between the parents and the patient. Certainly does not always need to be done that way, but does make sense in some adolescent cases. I would not commend this in the population for any routine reason.

 

[calvnandhobbs68]

I do sometimes recommend an adolescent's individual therapist also do family therapy to help with the baseline power differential between the parents and the patient. Certainly does not always need to be done that way, but does make sense in some adolescent cases. I would not commend this in the population for any routine reason.

Agree, I don't think it's a terrible idea when there's clearly a family element contributing to symptoms or impairing progress with treatment pulling family in together with the patient or separately for some sessions. Many structured CBT programs for kids/adolescents have a parent component (either individual or group) as well, although this is a bit different than trying to solve relationships conflicts within the family as these are very geared towards drilling CBT concepts/techniques so everyone in the family is on the same page. Definitely shouldn't turn into actual "family therapy" though.

I think total no-no for marital therapy no matter what.

I mean I've had patient's parents tell me the kids therapist was recommending medical cannabis to their adolescent so yeah all kinds of stuff out there.

 

[smalltownpsych]

Family therapy when client is a kid is recommended. Can be either a separate or same therapist. Couples and individual? Not a good idea. I’ve done it a few times for very specific reasons, but my standard answer is a firm no.

 

[birchswing]

What's the word on the street about the Gottman Method?

I had an ex-therapist who was about as apathetic about everything as you can imagine, phoning it in. And I looked him up and he had rebranded himself as a Gottman Method marriage counselor, level 3--the level 3 part sounded like something straight out of scientology. Very out of character for this therapist to do much of anything that's pro-active or even active in any way (that's why I liked him; he was like a human house plant I could talk to and he just sat and listened). Was kind of curious what he got himself into.

 

[AcronymAllergy]

For the limited number of psychologists I know who conduct couples counseling, the consensus still seems to be advising against it except in specific situations (i.e., what smalltownpsych said). And even in those situations, the individual sessions tend to be very limited.

 

[smalltownpsych]

For the limited number of psychologists I know who conduct couples counseling, the consensus still seems to be advising against it except in specific situations (i.e., what smalltownpsych said). And even in those situations, the individual sessions tend to be very limited.

Exactly, would not do ongoing individual and couples. Recently though I had a client who was seeing a separate individual counselor who seemed to be siding with her client against me. To be honest, I was glad when they stopped seeing me. I hate feeling like I have to justify myself and what I’m doing especially when that is coming out of an unhealthy control dynamic. Reminds me of my own childhood. Ugh!

 

[ObsequiousAplomb]

What's the word on the street about the Gottman Method?

I had an ex-therapist who was about as apathetic about everything as you can imagine, phoning it in. And I looked him up and he had rebranded himself as a Gottman Method marriage counselor, level 3--the level 3 part sounded like something straight out of scientology. Very out of character for this therapist to do much of anything that's pro-active or even active in any way (that's why I liked him; he was like a human house plant I could talk to and he just sat and listened). Was kind of curious what he got himself into.

Level 3 just means they have taken the 3rd course. Sort of weird to advertise that one hasn't completed the training series.