Susan Heitler, Ph.D:
To be published in the forthcoming book
Earning a Living Outside of Managed Care: Fifty Ways to Leave Your Oppressor, Steve Walfish, ed.
I am a psychologist in private practice whose marriage therapy treatment strategy includes a heavy dose of marriage skills training. I write books for marriage therapists and for couples. I have been invited by many state therapist associations to give continuing-education workshops on conflict resolution and marriage communication as therapists need competency in these skill-sets be able to coach their clients.
In addition, based on my book The Power of Two, I have written a workbook plus a curriculum for couples’ marriage skills workshops. Lastly, I work for Torque Interactive Media which offers internet-based games and workshops where couples (and therapists) can upgrade their collaborative dialogue and conflict resolution skills.
Marriage Therapy and Education
In the 60% of my time (three days a week) that I devote to clinical work, primarily with couples, my skills-oriented treatment strategy rests on the assumption that if people knew better, they would do better. Backward-looking family-of-origin work strengthens people’s understanding of where they learned their mistaken interaction patterns. For improvement in these patterns, however, most clients need explicit skillbuilding. The three-part combo of teaching skills, exploring the family-of-origin sources of mistaken habits, and guiding couples to resolution of issues that have divided them has enabled my clinical practice to flourish free of managed care.
I focus most of the remaining 40% of my work hours on disseminating information about marriage skills to the general public and to marriage therapists. I have been particularly interested in teaching the collaborative dialogue, emotional regulation, cleaning up after upsets, and conflict resolution skills that enable couples to enjoy a harmonious marriage.
Psychologists especially need further training in these areas, given the shortage of marital skills-training offered in most psychology graduate schools. It has concerned me that by ceding the vitally important and lucrative arenas of marriage therapy and marriage education to bachelor and masters level counselors, psychology as a field has been giving away two of the fastest growing, and most gratifying, arenas of practice—and an area of skills development essential for therapists to be able to guide with virtually all of their clients, single and married.
My own interest in collaborative communication skills training began with the realization that psychotherapy is the art of helping people to resolve their conflicts. All therapists therefore need to be experts in conflict resolution. When the psychology literature did not offer this expertise, I turned to the literature on business negotiation. I began then writing articles and books to bring conflict resolution understandings to the world of psychotherapy, and then directly to couples.
Pros and Cons of Marriage Skills-Training Work
I love teaching communication and conflict resolution skills because the results are so immediate and so gratifyingly obvious. I love when couples enter a therapy session surrounded by clouds of tension and leave laughing together. I love hearing older couples in marriage workshops tell younger ones, “You are so fortunate. If we had learned these skills when we first married we would have been spared years of needless tensions.”
What is a therapist to do if clients’ insurance companies express reluctance to pay for problems that are labeled marriage dysfunction? Diagnosis the problem as depressive, angry and anxious reactions. These psychopathological states almost inevitably emerge when couples lack sufficient conflict resolution skills to prevent marriage problems. This diagnosis can then be followed by listing marriage therapy as the treatment modality.
At the same time, a second option circumvents the insurance issues by a therapist offering marriage skills workshops as an alternative to, or augmentation of, marital therapy.
The main downside of offering marriage skills workshops is the significant marketing effort necessary establish a referral flow.
Also, workshops generally need to be scheduled on non-work hours. Scheduling workshops on weekday evenings and/or weekends can intrude on the psychotherapist’s personal leisure and family time.
On the other hand, offering workshops one or two nights a week, and one weekend a month or every other month can substantially boost earnings. In addition, workshop participants sometimes want to continue to learn from the workshop leader after their initial exposure to marriage skills training, augmenting the workshop leader’s clinical practice.
Treatment choices
With regard to skills-oriented marriage therapy and skills-teaching in marriage workshops, which couples should receive which treatment?
Couples that are more acutely distressed generally need to begin immediately with therapy. In marital therapy with one couple at a time, clinicians can combine teaching communication and conflict resolution skills with helping the couple to calm and resolve their specific most pressing issues.
Marriage education courses, including Power of Two Workshops, teach skills in a group format. Marriage workshops therefore tend to be a most appropriate, as well as least expensive, option for couples who mainly need just a skills upgrade rather than help settling urgent conflicts or exploring deeply-rooted problems.
Note that a group format can be very powerful in influencing change in spouses who are reluctant to admit that their behavior might be part of the marriage’s problems.
At the same time, the two modalities are by no means mutually exclusive. Workshops and therapy can be utilized together. Marriage therapists may encourage their clients to attend a workshop to accelerate their treatment. And workshop leaders may refer couples for therapy during or after completion of the course. It therefore can be helpful to orient new clients to both options at the outset. That way you can decide together if and when each option will be appropriate.
With regard to other business aspects of these modalities, psychotherapists with strong collaborative communication and conflict resolution skills can market their skills to divorce lawyers, who tend to be a virtually untapped referral source. Divorce lawyers can refer couples who would prefer to fix rather than abandon their marriage, recent divorcees who are having difficulty letting go of the marriage, and also post-divorce couples who need to co-parent more cooperatively.
Interestingly, in terms of income potential, leading workshops actually can yield higher per-hour income than marriage therapy. One of the clinicians in our practice recently reported that a workshop with five couples–her preferred workshop size–yields more than double what she earns per psychotherapy hour. Because her hourly earnings are greater and also because her husband will be available to do childcare during the times that she teaches workshops, her plan is to continue teaching marriage education when she takes maternity leave from her clinical practice.
As I mentioned above, marketing is vital for building a marriage workshops program. Marketing can be targeted to engaged couples seeking premarital education, established couples seeking marriage enhancement, couples in therapy, as well as specific high divorce-risk groups such as empty-nesters and parents of special needs children. Marketing strategies can include flyers at ob-gyn practices, hair-dressers, gyms, and wedding dress stores, and internet or radio ads.
Learning These Skills
A psychotherapist who wants to conduct skills-oriented pre-marital or marriage therapy must first become expert in emotional regulation, cooperative communication, clean-up of upsets, and conflict resolution skills. In addition to studying books, psychotherapists can download the free articles, podcasts, and videos on my websites: TherapyHelp.com, prescriptionswithoutpills.com and watchpsychotherapy.com.
Therapists can design their own workshop course materials, or can start with one of the many existing curricula rather than by re-inventing the wheel.
The Bottom Line
A good marriage enhances life’s blessings–longer life, more happiness, health, wealth and enjoyment. Communication and conflict resolution skills play a huge role in sustaining successful marriages. Psychologists have much to learn, as well as potentially much they can earn, in this important area.
