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Marriage Counseling: Your Questions Answered

By Hilary Phillips, MS, LPC on November 15, 2014 | Relationship Dynamics

Q: What should we expect from marriage or couples counseling?

A: So, you’ve been considering it for a while, and you’ve finally found a therapist and booked your first appointment. Now what? Although approaches vary, generally speaking you can expect your first appointment to feel like a data dump. A chance for both partners to share their perspective of what feels icky in the relationship (what brought you to counseling in the first place) as well as sharing the history of the relationship. Oftentimes counselors will ask how you met, how many times (if ever) you’ve broken up, what have been the best times of your relationship, what have been the worst times in your relationship. What have you tried in the past that helped?

For some people all of this sharing feels great – finally someone to help us! For others it can feel like a big, fat vulnerability hangover, “I can’t believe we just met that person and told them we haven’t had sex in over a year!” These responses, and a lot of gray in between, are completely natural. Counseling is a lot like starting a new exercise program. You may not feel great at first, but if you stick with it you will get results.

Beyond the first session there are a lot of different directions your couples counseling may take. Many therapists will next ask to meet with each partner separately. If they do, they should be sharing with you their intentions for the session s as well as the rules of engagement. For example, many therapists have a ‘no secrets’ policy. If they do, they will be sure to cover this with you and allow you to clarify with any questions you may have.

If your therapist does not request individual sessions, they should be sharing with you what they would expect from the second and subsequent sessions – they may need to gather more information, they may already have a treatment plan mapped out and have an idea of what the focus will be going forward.

All of this to say…ask lots of questions. Before you schedule an initial appointment speak with the therapist – what is their approach, how do they work, and what if any model do they follow? It is important that you have a clear road map of the work that you’re doing together. You should not be an innocent bystander on this journey. You and your spouse should be active participants who know where you’re headed and why.

Q: How long does marriage counseling take?

A: This is a very common question, and unfortunately one that is difficult to answer. There are some approaches to couples counseling that can answer this question rather succinctly. For example Emotionally Focused Therapy (EFT for short) follows a model that typically takes 12 sessions to complete. Premarital counseling programs are often designed to meet for four to six sessions. However, for a lot of couples the length of the counseling process varies greatly.

A contributing factor can be how open both partners are to engaging in the process. It is not uncommon for couples to be several sessions in before the true source of dissatisfaction is finally disclosed. This goes back to the importance of rapport. It is crucial that you both feel comfortable with your therapist. The atmosphere should feel supportive, and nonjudgmental so that you both can open up and talk about what is really going on for both of you. It is like all things in life – the more you put into it, the more you are going to get out of it.

With all of that said, there are some couples who stay in counseling for years. While this is rare, it can be a great way to ‘tune up’ on an on-going basis. Speaking generally, most couples counseling lasts 6-12 sessions. If working through a crisis such as infidelity you may want to plan on 6-12 months of counseling. But again, each case is unique. Be sure to ask this question to therapists you are considering, while they most likely won’t be able to quote you an exact length of time, they should be able to share with you what they typically see with the other couples they have worked with.

Q: How much does marriage counseling cost?

A: Fees for counseling can vary greatly based on geography and setting. For a therapist in private practice, in large cities you can expect to pay $100-$200 per session. In rural areas you may pay considerably less. I have never verified it, but I’ve heard talk of one therapist in the South who charges $600 per session – yikes!

If your insurance policy covers Family Counseling you would also have the option of utilizing your insurance benefits by working with a therapist in your insurance network. Your insurance provider should have a list of in-network professionals. If your insurance policy allows for Out-of-Network benefits you may also be able to pay an out-of-network provider directly and then file for reimbursement for all of some of the fees paid. Each policy varies greatly, so do check with your insurance carrier first if you would like to utilize your benefits for couples counseling to verify what is and is not covered.

For more affordable prices, you may choose to work with an agency that offers services of a new professional or a student. While they won’t have as much experience, they will have hands-on supervision with a highly experienced individual which can be a huge benefit. If you live near a university you may inquire what options they may have to working with students or those working towards full licensure.

If needed, you may also inquire if a given therapist will consider reducing their fees (commonly referred to as Sliding Scale). Not all, but many therapists will allow client fees to be based on the client’s ability to pay. This doesn’t mean I’d rather pay less for counseling and go buy a new pair of Louboutins. This means we genuinely cannot afford to pay the full fee, but are still committed to the process and see the value in it. Some therapists in private practice have fixed overhead costs and may not be able to offer reduced fees, but it certainly never hurts to inquire if this is a necessity for you and your partner.

While you do want to make sure you are receiving quality care, you do not want counseling to feel like a hardship financially. Price will of course be an important consideration as you choose a therapist. So, don’t be afraid to have this discussion as you are choosing whom to work with.

Q: What should we look for in a therapist?

A: Hands down the most important consideration is that it feels like a good fit. Ask lots of questions. Before you schedule an initial appointment speak with the therapist – what is their approach, how do they work, and what if any model do they follow? It is important that you have a clear road map of the work that you’re doing together.

You may have variables that are personally important to you as well. For example, is it important to you that the therapist share spiritual philosophies? Does it matter to you and your partner if the therapist is married? Has ever been divorced? Have children? Does gender matter? I would recommend having an idea of what might feel like a good fit for you and then start searching based on your needs.

Some more concrete concerns will usually include geography and price as the process not feeling like a hardship is important. Couples counseling can be daunting, removing as many obstacles as possible is always a good idea.

Q: Is sex therapy different from Couples/Marriage counseling?

A: Yes, it is. A majority of sex therapists also are trained in couples and marriage counseling and well qualified to do both. However, there are many therapists who specialize in working with couples on relationship issues but are not specifically trained on dealing with sexual issues.

It is important that you and your spouse are honest with yourselves about the true nature of your issues. If problems seem to revolve around your sexual relationship it is important to work with a trained sex therapist. At a minimum you will want to ask a potential therapist what experience they have working with sexual issues, and how comfortable they are dealing with these issues.

Some states have a separate certification/license for trained sex therapists. There is also a national certification program through American Association of Sexuality Educators, Counselors and Therapists (AASECT).

The integration of emotional closeness and sexuality is a hallmark of long-term committed relationships. Therefore, it is important that sexuality is considered in your couples counseling work.