There are many different approaches to marriage counseling, which may be used alone or combined with other methods by the therapist. Among the oldest is the psychodynamic approach, which attributes problems within a marriage to the unresolved conflicts and needs of each spouse. Each client's personal history and underlying motivations are central to this mode of therapy. Therapists using this approach apply the principles of psychoanalysis in their treatment; they may either treat both marriage partners individually, or treat one spouse in collaboration with another therapist who treats the other. Marriage counseling that follows a systems approach stresses the interaction between partners as the origin of marital difficulties, rather than their actions or personality. Behavior and communication patterns are analyzed as well as the interlocking roles portrayed by the couple or members of the family. Family members may be conditioned to consistently play "the strong one" or "the weak one," or such other roles as "scapegoat," "caretaker," or "clown." Although initially it may seem that only one member of a family system is troubled, on closer inspection his or her difficulties are often found to be symptomatic of an unhealthy pattern in which all the members play an active part.
Systems theory is actually an umbrella term for a range of therapies, and systems-oriented counseling may take a variety of forms, including both short- and long-term therapy. A popular individual treatment approach also used in marriage counseling is Rogerian or client-centered therapy, also referred to as humanistic therapy. Here, the emphasis is on communication and the open sharing of feelings. Through specially formulated exercises, couples work on improving their speaking and listening skills and enhancing their capacity for emotional honesty. Another widely employed mode of marriage counseling is based on a behavioral approach, in which marital problems are treated as dysfunctional behaviors that can be observed and modified. Couples are made aware of destructive behavior patterns, often by systematically recording their behavior until certain patterns emerge. The therapist then coaches them in various modifying strategies with the goal of achieving positive, mutually reinforcing interactions.
Behavior-oriented therapy also focuses on improving a couple's problem-solving and conflict-resolution skills. Marriage counselors may conduct therapy sessions with both spouses, treating one as the primary client and the other one only occasionally, while another therapist treats the other spouse. An increasing number of therapists counsel couples in pairs, with married therapists sometimes working together as a team. Theoretically, the relationship between the co-therapists is supposed to serve as a model for their clients. Marriage counseling in groups, which is becoming increasingly common, offers clients some of the same advantages that group therapy offers individuals. Sex counseling, which had previously been part of marital therapy, emerged as an independent field following the pioneering work of William Masters and Virginia Johnson in the 1950s and 1960s. Couples seeking treatment for sexual dysfunction have the option of working with a sex therapist.
Marriage counseling is usually practiced by licensed individuals with specialized training in psychology, psychiatry, and counseling, or by persons without such training, including members of the clergy. The first marriage counseling centers were established in the 1930s, and the American Association of Marriage and Family Therapy (formally the American Association of Marriage Counselors) was founded in 1942.