I recently had an interesting discussion with a panel of colleagues about the value of couples therapy. The question was this: "Can all couples, even those who are happily married, benefit from working with a skilled couples therapist?"
Some of my colleagues made interesting points about prevention and maintenance and how pre-emptive therapy may give happy couples a chance to make sure they are taking good care of their relationship. My colleague's angle is compelling. Why wait for the problem to arise? Why not nip it in the bud by working on the relationship before potential problems have a chance to surface? Clinician's often mention John Gottman's research that most couples are unhappy for years before entering therapy. Gottman likens waiting too long to seek therapy to walking around on a broken leg for years and therefore inflicting permanent damage that could have been fixed much more effectively in the beginning.
I agree that if a problem arises in a marriage, it is optimal to seek help sooner rather than later. However, achieving a happy marriage is a tremendous feat. For those who get there organically, I believe they have created something precious and important. If there is no reported problem, such as infidelity, poor communication, or loss of sexual desire, I believe a happy marriage does not necessitate a therapist's intervention.
I grew up with a surgeon for a step-father and his motto was: "If it's not broke, don't fix it." This message informs my perspective. My observation is that if both halves of a couple report that they feel happy and satisfied with their marriage, they have built something substantial and the value in seeking to tweak or modify such a union seems limited.
Where I do view universal value in some form of pre-emptive relationship counseling is during a couples' engagement, as they prepare to marry. Marriage is perhaps the biggest single decision an individual will make, and it's ramifications are extraordinary and lasting. While statistics are limited on the benefits of pre-marital counseling, an interesting study recently reported in the New York Times described significant benefits of brief counseling before or early in marriage. The study compared the CARE and PREP methods of couples counseling as well as film viewing followed by guided discussions. The CARE approach emphasizes building empathy while the PREP approach emphasizes communication skills. The film approach was extremely hands-off with minimal clinical involvement. All three groups were half as likely to separate or divorce three years later when compared to the couples who did not engage in any pre-marital intervention.