SALT LAKE CITY — If you’ve been in couples therapy for nearly two decades, does that mean you have a great therapist, or an ineffective one?
That’s a question raised by the recent revelation of pop singer Pink, who credits 17 years of couples therapy for keeping her marriage intact. "It’s the only reason we’re still together," she said in an interview with "Today" show co-host Carson Daly.
Pink, whose real name is Alecia Beth Moore, didn’t say who her therapist is or how often they meet, but the length of time she and her husband have been in counseling significantly exceeds that of the typical married couple who seeks help.
Marriage counseling typically lasts six months or less, and some mental health professionals say that the longer counseling goes on, the less effective it is.
"Couples counseling often makes problems of resentment worse by focusing on what the couple resents rather than their ability to improve, appreciate, connect, and protect," said Steven Stosny, a therapist in Washington, D.C., and the co-author of "How to Improve Your Marriage Without Talking About It," among other books.
But others note that the needs of every couple are different, and long-term counseling can help couples weather the diverse problems that come up in different stages of life. Also, couples who face a significant challenge together, such as the loss of a child, are going to need more help than couples who are unhappy because they don't feel their needs are being met.
“A couple that loses a child is at a very high risk of divorcing,” said Vanessa Bradden, a licensed marriage and family therapist in Chicago.
With no set standards about how long therapy should last, couples are left to work it out with their therapists, which can be especially challenging if they've seen no improvement.
In the past, some researchers have concluded that the success rate of traditional marriage therapy is abysmally low, with separate studies showing lasting improvement in anywhere from 11 percent to one-half of couples. Relationship expert John Gottman, in his 1999 book "The Marriage Clinic," concluded that about 35 percent of couples experience "clinically significant, immediate changes" after therapy but that 30 to 50 percent of them relapse after a year.
Success rates vary, however, according to the methods used by the therapist, and a new approach developed in the 1980s — emotionally focused therapy — is reported to have success rates approaching 75 percent. Moreover, most Americans have positive opinions about their experiences with counseling, according to a 2018 report from the Barna Group.
It's unclear how many Americans are currently in couples counseling, but the industry is growing. According to the Bureau of Labor Statistics, the number of marriage and family therapists is projected to grow 23 percent by 2026, "much faster than the average for all occupations."
Whether your marriage needs a tuneup or a complete overhaul, people like Pink and former first lady Michelle Obama say an objective third party can be helpful. Mental health professionals note, however, that the qualifications of people offering couples counseling vary widely, and when interviewing potential therapists, how long you should expect to be in treatment is one of the questions you should ask.
Pink, who has two children with motocross racer Carey Hart, said on Today that she and her husband are both children of divorce, which is one reason they sought couples therapy even before they were married.
"We come from broken families, and we had no model for, 'How are we supposed to keep this family together and live this crazy life?' And there’s no book that says, ‘Here’s how to do this.’ So we go to counseling, and it works."
The two have been married for 12 years, though they were famously separated twice. (Her 2008 hit "So What?" was based on their troubles.)
Michelle Obama has seemingly had a less volatile marriage, but when her children were young, she and her husband, the future president, went to couples counseling, which she last year called "a turning point" in their marriage.
That was also the experience of Christine Burke, a mother of two and writer in Bethlehem, Pennsylvania, who has been seeing a therapist with her husband for more than two years.
Burke, who has written about the experience on the blog Scary Mommy, said there was no infidelity or other crisis that put her marriage in trouble, just that “our lives were a mess.”
She was hesitant at first, but her husband convinced her to give it a try, saying, “If marriage therapists were in the business of breaking people up, they’d be out of business.”
Even after warming to therapy — she loved that the therapist told her to think of him as a coach — Burke said that initially she didn’t want anyone to know that she and her husband were in therapy; she wrote about the experience under a pseudonym and wrote “meeting with accountant” on the family calendar when it was therapy time.
That changed when her daughter asked, “Mom, are we having financial problems?” And Burke said she decided to be open about the therapy because so many people were writing to her in appreciation, saying they were struggling in their marriages, too.
When she and her husband first entered therapy, Burke said, she was determined that the sessions not be a time for her and her husband to complain about each other non-stop. “I was not going to go to a therapist’s office and sling mud. We could do that in the family room for free. I wanted us to go back and find the ‘kind’ in our relationship. That was the goal,” she said.
And Gottman, who with his wife, Julie Schwartz Gottman, founded The Gottman Institute to help sustain relationships, has noted that a couple's initial goal for therapy often affects whether the counseling is successful and how long it takes.
In 2012, New York psychotherapist Jonathan Alpert ignited a controversy with an essay he wrote for The New York Times in which he said many people in long-term therapy don't need it.
"It doesn’t take years of therapy to get to the bottom of those kinds of problems. For some of my patients, it doesn’t even take a whole session," Alpert wrote, citing a 2010 study published in the American Journal of Psychiatry that said 42 percent of people in psychotherapy use 3 to 10 visits for treatment and just 11 percent have more than 20 sessions.
The article infuriated many mental health professionals who charged that Alpert took an inflammatory stance to help sell a book and could have influenced people who need long-term therapy to drop out, but Alpert has not backed down.
"With couples counseling, it's probably even more true," he said in an interview with the Deseret News.
However, Alpert said that in the case of Pink, who has not publicly said how often she sees her therapist, the couple could be going sporadically, essentially as "maintenance" for the marriage, which would be different.
"The big concern is dependence" when couples are in long-term therapy, he said. "That they can't problem-solve on their own."
Likewise, Laura Heck, a licensed marriage and family therapist in Salt Lake City, cites the Chinese proverb, “You can give a man a fish and feed him for a day, or you can teach him to fish and feed him for a lifetime.”
“I’ve always thought my job is to make myself obsolete,” said Heck, who is one of 350 therapists certified by The Gottman Institute. “I’m always looking for an out.”
Heck said in her first session with clients, she asks them, “When are you going to know when it’s time to fire me?”
“Setting the tone that I'm trying to make myself obsolete sets the standard that I don’t want to see you in a year, I don’t want to see you in two years. I’m here to give you the tools so that you can manage your relationship without me. I don’t want you to become dependent on the relationship.”
Heck said the longest she’s worked with a couple is about three years, and that she has “fired” couples who weren’t making progress. In cases like that, the couple may have conflicting goals — one partner wants the marriage to last, the other wants out. “You have to have two willing participants who want to grow and change and participate.”
Heck does not dispute studies that suggest about half of couples in therapy separate or divorce anyway. But she says that some of those separations occur because most couples wait too long to seek help. “Couples on average wait six years past the point of pain before seeing a therapist,” Heck said. “Within that six-year mark, that’s where a lot of bad behaviors can wear down the relationships and cause resentment.”
Some couples enter therapy married on paper, but “divorced in their minds,” she said.
Questions to ask
Bradden, the marriage and family therapist in Chicago who also works with the American Association for Marriage and Family Therapy, said the association has no official guidelines for the time couples should be in therapy because “each one is coming in for something different.”
Therapy after infidelity, for example, is much different from premarital counseling.
The way to evaluate whether therapy should be ongoing, she said, is to ask, “Are we really doing therapy?”
If you are checking in and setting goals and making progress, then it’s a valid treatment. “If you’re just spinning your wheels and nothing is happening, then you have a problem,” she said, adding, “I am not against maintenance, but what maintenance looks like is not every week."
When considering a therapist, couples should ask how how long it will be before they can reasonably expect to see progress. But an extremely short period of time isn't necessarily the right answer, either.
“Seeing a therapist once, twice, three times is just not going to do anything for your relationship” if it's in serious trouble, Heck, in Salt Lake City, said.
What couples do with what they learn, however, might.
Burke and her husband, for example, have now moved from regular therapy to maintenance, and now see their therapist for a “tuneup” every few months. They make the session the beginning of a “date night,” and they go out to dinner after each session to discuss what they learned and enjoy being with each other.
The most important thing when looking for a marriage therapist, however, is not the length of time you will be in therapy, but whether or not the therapist is on the side of the marriage, not one partner or another, according William Doherty, director of the Marriage and Family Therapy Program at the University of Minnesota.
"That's not the most common belief among many therapists out there," he said.
In addition to marriage and family therapists, couples therapy can be offered by psychologists, psychiatrists, social workers or self-proclaimed life coaches.
“The bulk of therapists who are doing this work are not trained and are not necessarily competent,” Doherty told NPR. A therapist may be highly trained and effective with individuals, for example, but without specialized training on working with couples, may struggle to make progress with a couple determined to fight.
In Utah, a marriage and family therapist is required to have a master's degree or doctorate and meet other standards that include 4,000 hours of supervised training, at least 500 hours of which are in couple or family therapy with two or more clients participating.