We have thus far treated counseling and marriage counseling as closely related to psychotherapy. Indeed, there are those who hold that counseling in general, and marriage counseling in particular, is a type of psychotherapy, or at least short-term, conscious, face-to-face psychotherapy. Others seek to differentiate the one from the other.
We can express the difference in emphasis then, by saying that counseling looks more often toward the interpretation and development of the personality in the relations characteristic of specific role-problems while psychotherapy looks more often toward the reinterpretation and reorganization of malignant conflictual elements within the personality through the relation with the therapist.
It may also be pointed out that unlike psychiatrists, psychoanalysts, and some clinical psychologists, the marriage counselor deals more often with so-called normal, average people, who, on the whole, manage their affairs quite adequately but occasionally find themselves confronted by a set of circumstances or a constellation of problems which are too much for them, either because of their own emotional involvement, or because they do not possess the necessary information or perspective to handle the situation, or both.
This view of marriage counseling problems leads to several rather important considerations. First, that the marriage counselor who is not a psychiatrist and who has no special training, though holding himself alert to evidence of abnormalities and of hidden motivations, need not always, in fact is not necessarily equipped to, probe too deeply, and should not indulge in extended analyses or attempt fundamental personality changes. In many situations requiring his professional services, he can safely deal with the problems as they present themselves on a reality or conscious level after making certain that he is not dealing with a displacement; that is, that the client is not withholding the real problem from him by substituting a different problem, perhaps one of lesser significance and importance. Second, that the marriage counselor must make certain, so far as possible, that he is not dealing with a deep-seated psychotic or neurotic behavior manifestation with which it is beyond his ability to cope. This implies that the marriage counselor should be sufficiently well trained to recognize a neurosis or psychosis when he is confronted with it. This is admittedly not always easy or certain, for there are situations which will puzzle or escape even the better-trained psychotherapist who is not especially versed or experienced in differential diagnosis. It means also that although the nonmedical marriage counselor need not be prepared to handle the deep-seated neuroses or psychoses, he should be prepared to interpret psychiatric service to his client and, where needed, to spend sufficient time to lay the groundwork for a constructive psychiatric referral. In addition, in cases where it becomes evident that the marriage produces, in Karen Horney's term, a real "enslavement for one or both partners," the counselor may have to aid the family members to as nondestructive as possible a severing of their relationship, and to a positive attitude toward the future.
The wise marriage counselor, will, of course, call a competent psychiatrist into consultation whenever it is possible if he is uncertain about the nature of the problem with which he is dealing. Similarly, the conscientious marriage counselor will take proper precautions that he does not overlook or ignore somatic factors and will refer to the medical profession whenever the situation seems to require it.
It follows that the marriage counselor can best make his important contribution by equipping himself to function not as a pseudo-psychiatrist or analyst, but as one who has made a special study of the problems and interpersonal relationships of family life: the bonds, loyalties, and conflicts; the loves, rivalries, and hostilities; the need for identification and independence, on the one hand, and the conflicting desire for independence, on the other; the wish for security and the urge for adventure; in brief, the stresses and strains involved in membership in a marriage and a family and the psychosocial factors and influences of such membership on the personality.
By way of summarizing our discussion of the differentiation of marriage counseling up to this point, it may be said that the marriage counselor should have, in addition to the necessary knowledge and understanding of the positive and negative influences on the family, special training to be able to differentiate normal from abnormal or deviant behavior mechanisms and to understand the dynamics of human motivation as manifested in the interpersonal relationships in the marriage. This requires as a minimum about the same type of psychiatric knowledge as is included in a standard curriculum for a master's degree in social work. Such knowledge, however, will no more equip the marriage counselor for involved psychiatric analyses and therapy than it does the social worker except where there has been additional and special training. And, like the social worker, the marriage counselor can handle most situations on a conscious level, being ever watchful for indications of more profound disturbances and calling upon the appropriate specialist when necessary.
The foregoing comparison of marriage counseling with social work in terms of the type and amount of psychological and psychiatric knowledge required as a minimum for marriage counseling and the level on which they can function, raises further questions about the other professions engaging in marriage counseling. This is especially true of the professions of medicine, psychology, the ministry, and social work. Some members of these professions carry their marriage counseling load as part of their daily work within their own professional activity. Others, apparently a relatively small minority of the members of these professions, recognize that marriage counseling requires specialized knowledge and skill and therefore believe that marriage counseling can be most effective and will make its best contribution to those who need what it has to offer by developing a new and distinct professional discipline. (There is a relatively large group of people doing marriage counseling without any kind of training for the work who are not members of any professional group. These people would, in all probability, deny any need for specialized training. However, since they are not members of any recognized profession we cannot be concerned with them here.)
A recent survey by Kerckhoff outlines the views of some of these professional groups. Rutledge and Bridgman, in independent studies, present the viewpoint for marriage counseling as a distinct professional discipline. These divergent points of view are being subjected to thoughtful examination and evaluation by committees of the American Association of Marriage Counselors and by individual members of the Association. The issue as to whether marriage counseling is or will become a separate professional entity or will remain a specialized aspect of various disciplines is not yet resolved and may be confidently expected to come up again and again. Whatever the merits of the varying views and however the issues involved may be determined, adequate preparation for marriage counseling, regardless of by whom it is done, is an obvious necessity.