Understand counseling relationship from the beginning

I have been seeing a therapist for a couple of months. I really like my therapist. I'm learning about myself, my past, and getting stronger, changing some behavior. I think I'm ready to include my husband in couples counseling. But, when I asked my therapist, she gave me two referrals. I was all the way home before I realized I was surprised and almost feeling a little hurt. Why isn't my counselor seeing us? -- P.L., Las Vegas

We counselor/therapist types tend to be of an ilk. Put 100 of us in a room, and you can usually get us to agree straight down the line on some basics. We think hitting children is wrong. We think marriages are worth fighting for. We think most divorces won't resolve what people hope the divorce will resolve. Et cetera.

But, regarding your question, I can't get three therapists to agree! Counselors' opinions and practice are all over the map on this issue. With some counselors, you can "mix and match." Pieces and parts. You can have a handful of individual sessions, then bring in your spouse for marriage counseling with the same counselor. Then, bring the whole family in. Or individual children or teens. One by one, in dyads, or en masse.

I only know my practice, and my prejudices on this issue lean toward rigid. Occasional exceptions, yes, but not often.

I would have done what your therapist did. Here's why:

When an individual wife or husband comes to see me, and, if in that first session the presenting issue or predominant conversation is about the marriage, I will ask questions such as: "Does your (spouse) know you're here today? ... If not, what are the reasons you withheld this information? ... Why isn't your spouse here? That is, did you invite the spouse and he/she refused? Tell me how the two of you together decided for only one of you to be here to talk about the marriage."

And then, of course, the question I've been sidling toward: "Should your spouse be here?"

Then I give my speech, polished and canned over all these years ...

I am available to you as an individual counselor, a marriage counselor or a family counselor, but, with rare exceptions, I will not assume two or three of those roles concurrently. An important question in forging an effective therapeutic relationship is "Whose counselor am I?" If I'm blurry on this, then the work might get blurry. Maybe even provocative. If my fiduciary commitment is to you the individual, then I'll never meet your spouse. Your spouse will never know, from me, that I'm your therapist, let alone the content of sessions or the scheduled times. On the other hand, if my fiduciary commitment is to the marriage, I won't keep individual secrets for either party. Just try calling me between sessions to "rat on" your husband about drinking again! You'll find that our next session together starts with me acknowledging that phone call out loud in words.

If you have five to six sessions with me, it creates the potential for a conflict of interest. Or the perception of one by the spouse-come-lately that is added to the work later. Your husband has the right to feel an ownership in the therapy. Not to spend several sessions wondering if, in the five to six individual sessions, you and the therapist have forged and are enjoying a therapeutic relationship in which he will always be behind.

And, if there was no other reason for me to pound this prejudice into interns and practicum students, it's this: Try doing a handful of sessions with a couple. Then blithely agree to meet with one of them alone who, in that session, tells you about the affair with the redhead across town. Gulp! Great -- try to juggle those competing confidentialities.

Individual counseling is not the same as couples counseling. Each is its own craft. I think your therapist did the right thing. She wasn't rejecting you. She was serving you faithfully.

Steven Kalas is a behavioral health consultant and counselor at Las Vegas Psychiatry and the author of "Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing" (Stephens Press). His columns also appear on Sundays in the Las Vegas Review-Journal. Contact him at 227-4165 or skalas@reviewjournal.com.