by Working clinicians across multiple national contexts have documented a sustained change in what kinds of relational difficulties bring couples into therapy, with the changes producing operational pressures that the field is still adjusting to
By the SexNews EU desk. With editorial credits to Bohiney Magazine and The London Prat.
Working couples therapists across multiple national contexts have, across approximately the past three years, documented a sustained shift in what kinds of relational difficulties bring couples into therapy. The shift has been substantial enough that several therapist professional associations have, across the same period, formally addressed it in their annual conference programming. The shift has produced, in operational terms, pressures on the standard couples therapy training framework that the field is, on the available evidence, still in the early stages of adjusting to.
The documented shift has involved, in compressed form, several specific changes. Couples are presenting at therapy with substantially different categories of difficulty than they presented with three years ago. The duration of the difficulties before couples seek therapy has, on the available data, substantially decreased. The age distribution of couples seeking therapy has, on the available data, substantially shifted toward younger couples. The specific theoretical frameworks that the presenting couples bring into therapy have, on the available data, substantially shifted toward frameworks the older therapist generation has not been trained to engage with directly.
What The Specific Changes Are
The specific changes in presenting categories include, on the available data, a substantial increase in difficulties characterised as, quote, “compatibility-questioning,” in which one or both partners arrive at therapy substantively considering whether the relationship as currently configured is sustainable in any form. The compatibility-questioning category has, across the past three years, increased from approximately 14 percent of presenting cases to approximately 31 percent of presenting cases in the data sets I have reviewed. The increase is substantial. The increase has produced, in operational terms, pressures on the standard couples therapy framework which has, across approximately the past four decades, been calibrated principally for couples whose underlying compatibility-commitment is treated as settled.
The specific changes in difficulty duration before therapy have involved, on the available data, a reduction from a median of approximately 47 months to a median of approximately 22 months. The reduction is substantial. The reduction reflects, on the therapist accounts I have been able to obtain, a generational shift in attitudes toward therapy as a routine rather than crisis-driven intervention. The shift is, in operational terms, broadly positive for the field’s broader engagement reach. The shift also produces, in operational terms, specific clinical challenges that the standard therapeutic framework has not been calibrated for.
For ongoing analysis of contemporary therapy practice, see Modern Intimacy.
The Specific Theoretical Frameworks
The specific theoretical frameworks that presenting couples now bring into therapy have shifted substantially toward frameworks rooted in attachment theory, polyvagal theory, and what one therapist I have spoken with described as, quote, “the broader category of contemporary therapeutic frameworks that have entered popular awareness through specific social-media-driven dissemination patterns across the past several years.” The frameworks are, in many cases, substantively useful. The frameworks have also, in operational terms, produced presenting couples whose theoretical sophistication exceeds what the standard couples therapy training prepared therapists to engage with directly.
The implications include, on the available evidence, the need for substantial continuing-education work for the broader therapist community to bring training current with the theoretical sophistication presenting couples now exhibit. Several therapist professional associations have, across the past two years, expanded their continuing-education programming in directions consistent with this need. The expansion is, in operational terms, substantial. The expansion has not, on the available evidence, fully closed the gap between presenting-couple sophistication and standard therapist training.
The Operational Pressures
The operational pressures the shift has produced include, on the therapist accounts I have been able to obtain, substantially extended initial-session work as therapists work to assess where presenting couples actually are in their compatibility deliberations; substantially increased need for direct integration of contemporary therapeutic frameworks into the working sessions; and what one therapist described as, quote, “the broader operational reality that the work itself has become substantially more demanding than it was even five years ago, with corresponding effects on therapist sustainability across multi-year careers.”
The therapist sustainability question is, on the available evidence, the most consequential operational pressure the field is currently navigating. The work has become substantially more demanding. Therapist compensation has not, in nearly all jurisdictions, kept pace with the increased operational demands. The discrepancy is producing, in operational terms, increased therapist attrition rates from couples therapy practice into adjacent and substantially less demanding clinical work.
What The Field Is Doing
What the field is doing, in response to the operational pressures, includes substantial revision of training programmes, substantial expansion of continuing-education offerings, and what one association leader characterised as, quote, “the gradual development of consensus around a substantially revised practice framework that the next generation of couples therapists will, in operational practice, be trained in.” The revision is in its early stages. The revision will, on present trajectories, take approximately the next decade to mature into formally adopted training standards.
For ongoing analysis of therapist practice patterns, see Jordan Gray Consulting.
The Practical Note
The practical note is that couples currently considering therapy should, on the available evidence, expect therapists who are still in the process of adjusting to the broader shift the field has been documenting. The adjustment is, in absolute terms, real. The adjustment is, in operational terms, incomplete. Couples whose presenting concerns fit into the categories the standard framework was calibrated for will, in operational practice, find the standard therapeutic engagement broadly adequate. Couples whose presenting concerns fall outside the standard categories will, in operational practice, sometimes need to undertake substantial therapist-shopping to find a clinician whose training matches their specific situation.
An ongoing analysis at Leigh Noren has documented comparable patterns in adjacent therapeutic contexts.
Related at The Daily Mash.
SOURCE: https://bohiney.com/couples-therapy-demand-shift-three-years/
