Saturday, February 15, 2014

Does Premarital Counseling Work?

Premarital

Counseling

Boom

Good news. People still fall in love and want to marry. Couples want their marriages to last. And many are willing to invest in premarital counseling.

Bad news. Marriage rates are at an all-time low and recent divorce rates remain high. And the research on the possible benefits of premarital counseling is not impressive. See post about marriage in 2013.

Breaking news (almost). According to a Fox News story published 21 January 2014, “The Colorado Marriage Education Act would require potential spouses to complete 10 hours of pre-wedding marriage education. Twenty hours would be required for second marriages and 30 hours for third marriages, KDVR.com reported Monday.”

Why Do People Think Premarital Counseling Helps?

1. Engaged couples feel satisfied with the programs they attended. Some even think premarital counseling is fun. But some complain about the negativity when programs discuss pitfalls.

2. One review of some studies found evidence of effectiveness in 2003 (Carroll & Doherty). The authors found effectiveness for short-term gains in interpersonal skills and overall relationship quality. They offered a caution: "However, because of a lack of extended follow-up research, conclusions about long-term effectiveness remain elusive." (page 105).

3. The components of premarital counseling programs are often helpful to know. Most people can benefit from improving their relationship, communication, financial management, and problem-solving skills. Most can benefit from learning more about sexuality. And most can benefit from learning to be sensitive to the needs of other persons.
What Do We Know About 
Effective Premarital Counseling Programs?

1. We do know that relationship quality or satisfaction does not reliably improve (Fawcett & others, 2010).

2. Short-term follow-up studies of married couples find better communication skills for couples who participated in premarital education compared to those who did not (Fawcett & others, 2010).

3. One study of American Protestants found that the quality of premarital counseling predicted perceptions of its helpfulness in the short-term and long-term (Schumm and others, 2010).

But we don't know...
1. We don’t know enough to prescribe which program works with which people.

2. We don’t know how long the positive effects, if any, last for what length of time.

3. We don't know how premarital counseling programs might need to be different for couples in different categories: never married and never lived together; in a cohabiting relationship; had one or more marriage; have children; are members of a sexual minority group (e.g., same-sex, bisexual, transgender).

4. We don't know enough about programs for couples from different ethnic or racial groups.

What are some of the problems with the research?

1. Participants in premarital counseling are a select group.  Couples that agree to participate in premarital counseling are not representative of the U.S. population. Only a subset of participants in premarital counseling has participated in research studies. Most studies have not included couples in distress. Most of the participants in studies are well-educated and middle-class Americans.

2. Premarital counseling programs vary considerably. It is hard to compare programs when they use different techniques with different people for different quantities of time (few hours to more than 10 hours) and in different formats (e.g., weekly sessions, one intensive weekend). And they measure success in different ways.

3. Premarital counseling programs do not report short-term and long-term benefits of their interventions using standardized comparison measures. And even if they did report good results, how would we know that the difference between staying married and getting divorced was due to a few hours of counseling 5-10 years in the past?

4. Premarital counseling interventions that fail are not published. Studies demonstrating the lack of statistically significant effects are not in the published literature. These studies exist and can be found by looking at dissertations. There is a general bias against publishing the results of studies that fail to find significant effects.

What Might Prevent Divorce and Unhappy Relationships?

1. There are personal and couple factors that are linked to divorce.
2. There are personal and couple factors linked to happy relationships. See my previous post on healthy marriages.
3. There are societal factors linked to divorce. These may include support from secular and religious organizations, examples of marriages or similar relationships a person experiences before getting married, and attitudes toward marriage voiced by influential persons.

What are the Possible Downsides
 to Participating in Premarital Counseling?

1. One or both partners may discover problems. And they end a relationship that seemed great before entering counseling. Perceived problems may or may not have resulted in a great marriage. Counselors have their biases and may emphasize what they perceive to be a problem.

2. Counselors and other providers of premarital counseling vary considerably in their education and experience. Licensed providers usually hold a minimum of a Master’s Degree in Marriage and Family Therapy, Counseling, or Social Work. Some hold a Ph.D. in Counseling or Psychology. Some are clergy with graduate courses in counseling and extensive experience. But some clergy do not have college degrees.

3. One or both partners may be overly optimistic about their marital success. And high optimism is not necessarily productive in relationships. See post about optimism and marriage.

4. Counseling can increase financial stress. The cost of premarital counseling can be very expensive at a time when many couples are low on finances. If premarital counseling were shown be effective then it could be viewed as an investment.

5. Counseling can be harmful. Some therapies are based on scientific evidence and some are not. Lambert (2007) reported that some people do not change in response to psychotherapy. And some people in therapy deteriorate.  Before recommending premarital counseling, effective programs need to be established by longitudinal studies using large representative samples and adequate control groups. And the benefits and risks need to be established and disclosed.

 6. Some therapists produce harmful effects. David Kraus and others (2011) looked at data from 6960 patients treated by 696 therapists.  They found that therapists may be helpful in one area of counseling but actually harmful in another area. As part of their discussion, the authors concluded: “The widespread prevalence of negative treatment effects has significant public health and public policy implications (p. 272).” Although some harm is produced by unethical conduct such as sexual activity between counselors and clients, those occurrences are rare. In addition to the work by Kraus and his colleagues, other researchers have documented harmful effects of therapists. While many people do benefit from therapy, a small but substantial portion do not. You can find a summary of other research in the Kraus article.

So What Should People Do?

What people should do is a matter of opinion. I offer some suggestions but not advice. I am open to other suggestions via the comments to this post.

1. Couples, and those recommending programs to couples, should select a premarital counseling program that can at least provide evidence of helping relationships in the short-term. It is obviously better to choose a program that has at least some evidence that relationships remain improved compared to control groups at least five years after counseling.

2. Establishing mandatory premarital counseling appears premature. But funding long-term controlled studies would be a good idea. Viable candidates are likely those premarital counseling programs that have demonstrated short-term effects.

3. Counselors and organizations that offer premarital counseling should provide experimental evidence that their interventions are successful. All interventions should be similar to programs that at least demonstrate short-term success. All counselors and organizations should include research measures in their programs.

Additional posts related to marriage

Marriage under reconstruction Part 1,  Part 2 and Part 3 (healthy marriages)
Understanding love

References

Carroll, J. S., & Doherty, W. J. (2003). Evaluating the Effectiveness of Premarital Prevention Programs: A Meta-Analytic Review of Outcome Research. Family Relations, 52, 105-118.

Fawcett, E. B., Hawkins, A. J., Blanchard, V. L., & Carroll, J. S. (2010). Do Premarital Education Programs Really Work? A Meta-analytic Study. Family Relations, 59, 232-239. doi:10.1111/j.1741-3729.2010.00598.x

Kraus, D. R., Castonguay, L., Boswell, J. F., Nordberg, S. S., & Hayes, J. A. (2011). Therapist effectiveness: Implications for accountability and patient care. Psychotherapy Research, 21, 267-276. doi:10.1080/10503307.2011.563249

Schumm, W. R., Walker, A. B., Nazarinia, R., West, D. A., Atwell, C., Bartko, A., & Kriley, A. (2010). Predicting the Short- and Long-Term Helpfulness of Premarital Counseling: The Critical Role of Counseling Quality. Journal of Couple & Relationship Therapy, 9, 1-15. doi:10.1080/15332690903473044

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