The New York Times, June 29, 2010, by Tara Parker-Pope  –  Does your marriage need therapy? If you’re like most people, the correct answer may well be yes, but your answer is probably no.

In most marriages, one or both partners resist the idea of counseling. Some can’t afford it, or find it inconvenient. And many view therapy as a last resort — something only desperate couples need. Only 19 percent of currently married couples have taken part in marriage counseling; a recent study of divorcing couples found that nearly two-thirds never sought counseling before deciding to end the relationship.

“It seems like we’re even more resistant to thinking about getting help for our relationship than we are for depression or anxiety,” said Brian D. Doss, an assistant psychology professor at the University of Miami. “There’s a strong disincentive to think about your relationship as being in trouble — that’s almost admitting failure by admitting that something isn’t right.”

Marriage counseling does not always work, of course — perhaps because it is so often delayed past the point of no return. One recent study of two types of therapy found that only about half the couples reported long-lasting improvements in their marriages.

So researchers have begun looking for ways (some of them online) to reach couples before a marriage goes off the rails.

One federally financed study is tracking 217 couples taking part in an annual “marriage checkup” that essentially offers preventive care, like an annual physical or a dental exam.

“You don’t wait to see the dentist until something hurts — you go for checkups on a regular basis,” said James V. Córdova, an associate professor of psychology at Clark University in Worcester, Mass., who wrote “The Marriage Checkup” (Jason Aronson, 2009). “That’s the model we’re testing. If people were to bring their marriages in for a checkup on an annual basis, would that provide the same sort of benefit that a physical health checkup would provide?”

Although Dr. Córdova and colleagues are still tallying the data, preliminary findings show that couples who take part in the program do experience improvements in marital quality. By working with couples before they are unhappy, the checkup identifies potentially “corrosive” behaviors and helps couples make small changes in communication style before their problems spiral out of control. (Typical problems include lack of time for sex and blaming a partner for the stresses of child rearing.)

“Couples won’t go to marital therapy with just the one thing that they are struggling with,” Dr. Córdova said. “So they end up struggling in places where the fix might be simple, it’s just that they themselves are blind to it.”

Not surprisingly, some therapists are creating online self-help programs to reach couples before serious problems set in. Dr. Doss and Andrew Christensen, a psychology professor at the University of California, Los Angeles, are recruiting couples at www.OurRelationship.com to study such a program.

The online study, financed by a five-year $1.2 million grant from the National Institute of Child Health and Human Development, will deliver online therapy to 500 couples. It is based on “acceptance therapy,” which focuses on better understanding of a partner’s flaws — a technique described in “Reconcilable Differences” (Guilford Press, 2002), by Dr. Christensen and Neil S. Jacobson.

The method, formally called integrative behavioral therapy, was the subject of one of the largest and longest clinical trials of couples therapy. Over a year, 134 highly distressed married couples in Los Angeles and Seattle received 26 therapy sessions, with follow-up sessions every six months for the next five years.

Half the couples received traditional therapy that focused on better communication and problem solving, while the others took part in a similar program that included acceptance therapy. Five years after treatment, about half the marriages in both groups were significantly improved, according to the study, which appeared in the April issue of The Journal of Consulting and Clinical Psychology. Dr. Christensen says about a third of the subjects could be described as “normal, happy couples,” a significant improvement considering how distressed they were at the start. (The couples who received acceptance therapy had better results after two years, but both types of therapy were about equal by the end of the study.)

The hope is that an online version of the program could reach couples sooner, and also offer booster sessions to improve results. Even so, Dr. Christensen notes that the disadvantage of online therapy is that it won’t give couples a third party to referee their discussion.

“Nobody thinks it’s going to replace individual therapy or couples therapy,” he said. “There’s generally a sense that the intervention might be less powerful, but if it’s less powerful but is easily administered to many more people, then it’s still a very helpful treatment.”

Researchers at Brigham Young University offer an extensive online marital assessment, called Relate, for couples and individuals. The detailed questionnaire, at www.relate-institute.org, takes about 35 minutes to complete and generates a lengthy report with color-coded graphs depicting a couple’s communication and conflict style, how much effort each partner puts into the relationship, and other things. The fee is $20 to $40.

Australian researchers are using the same assessment, along with a DVD and telephone education program called Couple Care, found at www.couplecare.info, to reach families in remote areas who don’t have access to traditional therapy. The Utah and Australia researchers have begun a randomized, controlled trial of about 300 couples to determine the effectiveness of the approach.

Preliminary data show that couples reported improvement, but Kim Halford, a professor of clinical psychology at the University of Queensland, St. Lucia, in Australia, said more study of long-term effects was needed.

Dr. Halford notes that as more couples meet through Web dating services, the appeal of online couples counseling may increase. “If information technology is integral to how you began your relationship,” he said, “then if therapy is required it’s not surprising that they would look to online technology.”


A version of this article appeared in print on June 29, 2010, on page D1 of the New York edition.

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