The provocative warning comes from no lesser authority than a respected marriage and family therapist: Therapy can be hazardous to your relationship.

"A dirty little secret in the therapy field is that couples therapy may be the hardest form of therapy, and most therapists are not good at it," claims William Doherty, professor of family social science at the University of Minnesota.

Most patients who see psychotherapists for relationship problems are treated individually. But effective couples therapy demands different — sometimes opposite — approaches from solo counseling. Therapists who specialize in marriage and family issues contend that other mental-health professionals often lack experience in dealing with the dynamics of treating two partners in a troubled relationship.

For instance, therapists working with single patients often devote much of their time to simply listening. Doherty says a couples therapist can't remain so passive.

When partners bicker during their sessions, "some therapists say that's good," he said. "In fact, they could be fighting at home and not paying 150 bucks an hour."

Shopping for a therapist

Getting help to mend your marriage or relationship isn't cheap.

According to a survey by the American Association for Marriage and Family Therapists, marital therapists in private practice charge an average of $90 an hour, the typical length of a session. Although many accept sliding fees depending on your income, expect to pay at least $40 and perhaps more than $150 a session.

Referrals and resources Washington Association for Marriage and Family Therapy: www.wamft.org or Referral Line at 888-553-1228. American Association for Marriage and Family Therapy: www.aamft.org Crisis Clinic: www.crisisclinic.org or 206-461-3222 (has directory of local licensed therapists) The Gottman Institute: www.gottman.com, for quizzes to diagnose the health of your relationship.

Compared with the services available for such potentially life-threatening problems as domestic violence or thoughts of suicide, few public or nonprofit agencies offer free or low-cost marital therapy. Most health-insurance plans do not cover couples counseling, although some will if treatment involves an underlying clinical condition such as depression.

So it pays to be an informed consumer.

Several types of professionals can provide marital therapy, including psychiatrists, psychologists, licensed social workers and licensed mental-health counselors.

Be aware that your therapist's style of treatment probably will reflect his or her clinical training, said Claudia Grauf-Grounds, head of the marriage and family therapy department at Seattle Pacific University.

Psychologists, for example, tend to focus on pathology, digging for character flaws or other underlying issues, Grauf-Grounds said. Psychiatrists, on the other hand, are physicians and probably have far more training in diagnosing depression or probing for personality disorders than in conducting marital therapy.

Marriage and family therapy (MFT) is the only field that requires students to take courses in marital therapy. Licensed MFTs must hold a master's degree and have at least two years of post-graduate experience, a third of which must consist of supervised work with patients.

Seeking help from an MFT "would be the best choice, all things being equal," said Grauf-Grounds, whose department is one of only two training programs in Washington state certified by the Commission on Accreditation for Marriage and Family Therapy Education of the American Association for Marriage and Family Therapy. The other is Pacific Lutheran University in Tacoma.

Grauf-Grounds warns couples to check out their therapist's license and ask about education and credentials. She said being a "registered" counselor carries virtually no educational or training requirements.

Sources of help and what it will cost you Almost 2 million married and unmarried individuals see a marriage and family therapist. Such therapy typically lasts about 12 sessions, adding up to almost $1,100 for the average couple. Some health plans may cover couples or individual therapy if it involves treating depression or other mental disorders. A referral from your primary-care physician to a marital therapist may be required for coverage. Many companies offer counseling and therapy as part of their employee-assistance programs. This may include on-site treatments as well as a limited number of visits to a licensed therapist. Churches provide pastoral counseling, as do other places of worship. Be aware that some religious counselors may have personal bias in favor of preserving marriages.

Therapy styles

Marital therapy encompasses a range of approaches.

Thinking vs. feeling? PAIRS or PREP? Do you want to explore your family origins or would you rather focus on something more practical, like how to avoid blowups over money?

Doherty, of the University of Minnesota, says all effective marriage counseling and workshops offer clients three things: how to view problems differently (it may not be all your partner's fault); coping skills (listening instead of attacking); and hope that their relationship can be improved.

But there are widely differing philosophies about how to achieve that.

PAIRS (Practical Application of Intimate Relationship Skills), for instance, stresses emotional intimacy and confiding as the foundation for a healthy relationship. PREP (Prevention and Relationship Enhancement Program) teaches skills necessary for a good relationship, such as communication, teamwork and conflict resolution.

Imago (Latin for "image"), another approach that requires extensive training, is based on the notion that people subconsciously try to repair their childhood wounds by picking partners who remind them of their parents.

And the Marriage Survival Kit from The Gottman Institute, a Seattle-based training-and-marriage-research institute co-founded by a University of Washington professor, uses a research-based approach that identifies the traits of couples that stay together.

Grauf-Grounds says different methods may work for different people. "There is a little bit of a magic in the fit."

Most forms of marital therapy feature techniques that overlap with other methods. Several approaches have good empirical evidence of their effectiveness.

The most common is the cognitive behavioral approach. Clients learn how to see and approach issues differently, with coaching and feedback from the therapist. They learn to speak with "I" first, as in "I am worried about our finances" instead of "You are irresponsible with money."

Another method is emotion-focused therapy. This uses arguments as a gateway to explore the fears and emotions that lurk underneath. The premise is that true intimacy can be achieved only when couples open up and express their vulnerabilities ("I'm spending money recklessly because I feel lonely and abandoned").

A third approach with a good track record, as measured by the patients' own reports, is solution-focused therapy. This focuses on the times when the relationship is working and teaches couples how to expand that period. For instance, the therapist might ask when they have had constructive conversations about money ("after we put the kids to sleep") and teach them to replicate that.

Warning signs to look for in your marital therapist • Urges you to leave or stay in the relationship. The code of ethics of the American Association for Marriage and Family Therapists says clients should make the decision. • Sides with one person or displays biases about gender or cultural roles. • Ignores other serious issues in the relationship, such as spousal abuse, drug use or mental illness. • Devotes most of the session to listening to couples or allowing them to argue excessively. Couples therapists who actively structure the sessions are more effective than those who mostly sit back and listen. • Fails to set ground rules about confidentiality. If you confide in the therapist that you have had an affair, is it OK for the therapist to divulge that to your partner? • Continues therapy beyond appropriate duration. Couples therapy shouldn't continue if one or both persons aren't committed to staying together. Two-thirds of marriage and family therapy lasts no more than 20 sessions. Each session normally lasts from an hour to 90 minutes and is held weekly, with some couples meeting more frequently and others less frequently. Sources: American Association for Marriage and Family Therapists; Seattle Pacific University; Pacific Lutheran University; University of Minnesota.

But does it work?

Measuring marital therapy's success rate is necessarily subjective; it works if the clients say it worked. Charles York, professor of marriage and family therapy at Pacific Lutheran, says surveys show that about two-thirds of couples report that their relationship improved with therapy. That figure drops to as low as 40 percent when people attend marriage and family therapy without their partner.

York says marital therapy isn't just for couples who can't get along. Marriage and family therapists also can treat depression and issues stemming from drug and alcohol abuse and mental illness. In fact, studies suggest that clinically depressed women benefit just as much from couples therapy as from individual therapy.

Doherty, of the University of Minnesota, says it's crucial to find a therapist who has expertise with your particular issues. Stepparents, for instance, should look for therapists who deal frequently with remarriages.

The clients "may be doing very well as a couple, but the children may be the problem," Doherty said.

Doherty likens it to asking a physician not only "Do you treat diabetes?" but "Do you treat pregnant women with diabetes?" "That's a different animal," he says.

Yet even a first-rate therapist can't resuscitate a mortally wounded relationship. Pacific Lutheran's York, who has been a therapist for three decades and still sees private clients in addition to teaching, was divorced from his first wife after 20 years of marriage.

The couple sought help from a marriage and family therapist, but not until they were splitting up. York said the therapy helped make the divorce less painful, but said the intervention came too late.

"We had been drifting apart, very gradually, almost every day," said York, who has remarried. "It's a horrible way to say it, but some marriages are dead on arrival."

Kyung M. Song: 206-464-2423 or ksong@seattletimes.com