Choice architecture in marriage and divorce

I’ve been reading the excellent “Nudge,” by Richard Thaler and Cass Sunstein, about the power of choice architecture. Their thesis is simple: Since human beings are prone to fairly predictable errors in decision-making, the process by which individuals are guided through decisions impacts the quality of the choices they ultimately make. By expecting the kinds of errors we all tend to make, it is possible to steer people toward better choices without in any way restricting their freedom and ability to choose.

Perhaps the best example of this is financial: We predictably do not plan very well for our long-term financial health. When employees have to actively choose (an “opt-in” plan) to become part of their company’s 401(k) plan, many fail to do so. This is true even when enrolling can generate an automatic pay raise — that is, free money — via the employer’s matching contributions. When the “default” option is changed to be automatic enrollment (“opt-out”), participation increases dramatically, and more employees save what they need to for retirement.

The implications for therapy, especially couple therapy, are significant. Decisions about marriage and divorce tend to be complex, one-time (we hope) decisions that can offer greatly delayed rewards and have limited immediate feedback — exactly the kinds of decisions that can benefit from Nudging. How can we nudge people to better choices, with the hope of ultimately lowering the divorce rate?

There’s marriage education, which produces significant short-term gains on a variety of relationship measures but has scant evidence of reducing actual divorce risk over the long term. Such programs as How to Avoid Marrying a Jerk (or Jerkette) seek to help people identify red flags early in relationships, and fix them so they do not lead to great dissatisfaction down the road. But these too have limited evidence of long-term effectiveness. (Which is not to say they do not work for their intended purpose, but rather that we do not know, yet, whether they work.)

There’s also “covenant marriage,” a well-intended but rarely-used option for couples in three states (Louisiana, Arkansas, and Arizona). Covenant marriages are harder to get into, and harder to get out of, though they do include some protections for victims of abuse. However, because covenant marriage is not the default option, couples largely do not bother with it. Furthermore, as with marriage education, there is limited evidence that covenant marriage, in and of itself, reduces divorce rates. Those couples who do engage in the covenant process tend to be more religious than others, and more religious couples are less likely to divorce no matter what kind of marriage they enter into.

And then there’s couples therapy. Many couples come to therapy after years of a dissatisfying marriage, wondering about whether to stay or go. Can they benefit from a nudge? The AAMFT Code of Ethics is clear that therapists should respect the autonomy of clients in making such decisions, but a number of prominent scholars in the field have suggested that therapists be up-front about their own values around marriage and divorce. There is even a referral service specifically limited to “marriage-friendly” therapists.

Of course, if we don’t know what choice is best, the question is moot. There’s no point in nudging someone if you are not sure what to nudge them toward. In questions of marriage and divorce, though, there are some choices that are pretty clearly helpful in creating wealth and happiness:

* Marry after age 20, and before having a child. Quoting William Galston, an adviser to the Clinton White House: “You need only do three things in this country to avoid poverty – finish high school, marry before having a child, and marry after the age of 20. Only 8 percent of the families who do this are poor; 79 percent of those who fail to do this are poor.”

* Once you get married, stay married. Many couples report their marriages go through rough times. If the couple stays together through those rough times, they are extremely likely to describe themselves as “satisfied” or “very satisfied” in their marriage seven years later. More than 90 percent of couples who describe their marriage as having been in serious trouble at some point in the marriage are glad they stayed together.

* If your relationship is weakening, marriage therapy can help. Emotionally Focused Therapy and Behavioral Marital Therapy are considered the two approaches most strongly supported by research; approximately 90 percent of couples who complete EFT will experience significant improvement.

Focusing specifically on these three points, therapists can serve as choice architects, guiding clients down the ideal path without forcing clients’ hands or overstepping the therapist’s ethical bounds.

When it comes to both couple and individual therapy, processes like Motivational Interviewing, which encourage a thoughtful consideration of all of the options available prior to taking action, can be greatly improved if therapists anticipate the kinds of errors clients are likely to make in projecting themselves forward in time. One of the biggest challenges with Motivational Interviewing is precisely that we can’t know in advance how our choices will turn out. Unless you’ve been divorced before, it is very difficult to imagine the myriad ways in which divorce might affect you and your family. I’ll expand on this in a future post, about applying choice architecture to individual therapy.

MFT scope of practice across the country

The Therapist magazine ventures outside of its home state this month for a look at licensing laws for MFTs around the nation. The article is written in legalese, but it does provide some interesting guidance about the remarkable consistency in practical scope around the country, even when the specific terminology differs.

To wit: MFT scope of practice laws in all 48 states (and DC) where licensure currently exists effectively allow MFTs to engage in the diagnosis and treatment of mental health disorders. (Michigan’s law has perhaps the most watered-down language — something local MFTs are working on changing — but MFTs do diagnose and treat mental disorders there.) However, minor differences in language have allowed for some tugs-of-war with other professions about whether MFTs can independently diagnose, and what the exact limitations are on what MFTs treat. Twenty-two states and the District of Columbia include the phrase “diagnosis and treatment” in their MFT scope laws; 14 states use the word “assessment” instead of “diagnosis” in that phrase, with five states preferring “evaluation” and two states going with “identification.”

Connecticut, Iowa, and Texas do not use the word “treatment,” going instead with “management,” “resolution,” and “remediation” of disorders, respectively. Other states use words like “modify” and “enhance.”

Similarly, MFTs can (and do) provide services to individuals (as well as couples and families) in all states that license MFTs, though the law is not always explicit. In 41 states and the District of Columbia, the law clearly states that MFTs can provide services to individuals. In other states, that ability can be clearly inferred from other language.

It’s a pleasant surprise, really, that the profession is so consistent across state boundaries. A marriage and family therapist in California really should be doing the same kinds of work as an MFT in Kansas.

Gay and lesbian parents

There’s been a lively discussion over the past couple of weeks about gay and lesbian parents, stemming from comments about California’s Proposition 8 (pro | con) on the listserv of the California Association of Marriage and Family Therapists (CAMFT).

As a quick clarification, CAMFT is a state-based professional association that is entirely separate from the American Association for Marriage and Family Therapy (AAMFT) and its California Division (AAMFT-CA). I, like many folks here in the Golden State, am a member of both CAMFT and AAMFT. Neither group has taken an official position on this proposition.

Even among MFTs, or perhaps especially among MFTs, emotions run high on Proposition 8, which was approved by voters but is headed for a court battle. The proposition was written to deny marriage to same-sex couples in California. It does not outlaw civil unions, but instead is specific to “marriage.”

Commenters on both sides of this issue on the CAMFT listserv have argued that research is on their side. The Yes-on-8 side has suggested that research supports “‘traditional’ families as the best and most psychologically stable environment for children.” Those opposed point out that “traditional” families have their share of psychological instability, which is technically true but fails to address the question at hand: Do children of gay and lesbian parents fare worse in life due to their parents’ sexual orientation?

In a word, no. The research is surprisingly unequivocal. Charlotte Patterson, of the University of Pennsylvania, in a peer-reviewed 2006 article in Current Directions in Psychological Science, sums it up nicely:

Studies using convenience samples, studies using samples drawn from known populations, and studies based on samples that are representative of larger populations all converge on similar conclusions. More than two decades of research has failed to reveal important differences in the adjustment or development of children or adolescents reared by same-sex couples compared to those reared by other-sex couples. Results of the research suggest that qualities of family relationships are more tightly linked with child outcomes than is parental sexual orientation.

I don’t especially like the hedging of language in the last sentence there; just because relationship qualities are more tightly linked with outcomes than parental orientation, that does not mean that parental orientation is not linked with outcomes at all. But, looking over the article itself, that just seems to be a poor turn of phrase. Studies simply do not support links between parental sexual orientation and child outcomes.

An American Psychological Association resolution passed in 2004 (Paige, 2005) is equally clear:

There is no scientific basis for concluding that lesbian mothers or gay fathers are unfit parents on the basis of their sexual orientation (Armesto, 2002; Patterson, 2000; Tasker & Golombok, 1997). On the contrary, results of research suggest that lesbian and gay parents are as likely as heterosexual parents to provide supportive and healthy environments for their children.

Research suggests that sexual identities (including gender identity, gender-role behavior, and sexual orientation) develop in much the same ways among children of lesbian mothers as they do among children of heterosexual parents (Patterson, 2004a). Studies of other aspects of personal development (including personality, self-concept, and conduct) similarly reveal few differences between children of lesbian mothers and children of heterosexual parents (Perrin, 2002; Stacey & Biblarz, 2001; Tasker, 1999). However, few data regarding these concerns are available for children of gay fathers (Patterson, 2004b). Evidence also suggests that children of lesbian and gay parents have normal social relationships with peers and adults (Patterson, 2000, 2004a; Perrin, 2002; Stacey & Biblarz, 2001; Tasker, 1999; Tasker & Golombok, 1997). The picture that emerges from research is one of general engagement in social life with peers, parents, family members, and friends. Fears about children of lesbian or gay parents being sexually abused by adults, ostracized by peers, or isolated in single-sex lesbian or gay communities have received no scientific support. Overall, results of research suggest that the development, adjustment, and well-being of children with lesbian and gay parents do not differ markedly from that of children with heterosexual parents.

Most recently, a meta-analysis of 19 studies examining outcomes for children raised in gay and lesbian households (Crowl, Ahn, & Baker, 2008) concluded:

[P]arent sexual orientation was not a salient predictor for children’s development.

In fact, this meta-analysis found only one area of statistically significant effect from same-sex parents: Those parents rated their relationships with their children as being better than heterosexual parents rated their own parent-child relationships.

All this said, professional organizations are usually wise to avoid taking stances on specific resolutions in an election cycle. With emotions running so high on both sides, any stance the organization would take is likely to lead to members defecting. Policy resolutions, like those adopted by APA and AAMFT, seem to be the better approach.


Crowl, A. L., Ahn, S., & Baker, J. (2008). A meta-analysis of developmental outcomes for children of same-sex and heterosexual parents. Journal of GLBT Family Studies, 4(3), 385-407.

Paige, R. U. (2005). Proceedings of the American Psychological Association, Incorporated, for the legislative year 2004. Minutes of the meeting of the Council of Representatives July 28 & 30, 2004, Honolulu, HI. Retrieved December 11, 2008, from the World Wide Web at

Patterson, C. J. (2006). Children of gay and lesbian parents. Current Directions in Psychological Science, 15(5), 241-244.

Couple therapy effectively treats depression

Family Therapy Magazine, which is usually quite good, is simply outstanding this month. Highlighted by Michael Yapko’s “Skills or Pills? What MFTs Can Do Better than Antidepressant Medication,” the magazine examines some hard truths about depression, medication, and family therapy:

  • Antidepressants are no better than placebos. An extensive study of the six most popular antidepressants found that when unpublished trial data were combined with published trial data, “the benefit (of medication) falls below accepted criteria for clinical significance.”
  • Couple therapy is a promising treatment approach for depression. While more research needs to be done, Emotionally Focused Therapy and Behavioral Marital Therapy both appear to alleviate depression at least as much as individual therapy, while simultaneously improving the couple relationship.
  • Treatment for depression is very different in other parts of the world. Even other western, industrialized nations have found success in treating depression when it is de-medicalized. In other words, the whole person should be treated, not merely a set of depressive symptoms.

Perhaps most interesting — and depressing — in all of this is some discussion that therapy is winning the battle but losing the war. In other words, mounting evidence suggests that psychotherapy (and particularly systemic therapy) is a preferable treatment to antidepressants in the successful treatment of depression. Yet, the promise of relief in pill form, without substantial work, keeps Americans going back to the MD instead of the MFT. Antidepressants are now so widely prescribed that they show up in our drinking water.

If science alone will not turn the tide, what will? What do you think needs to happen to convince people that therapy is a better long-term fix for depression than pills?

Family intervention gives hope, second chances to prisoners

There’s a touching editorial in the current issue of the journal Family Process pleading for more widely-adopted systemic responses to incarceration.

It highlights a major paradox between science and practice: We know — not “suspect,” not “think,” but actually know, as much as is possible with science at any given time — that family-based programs to reduce recidivism are both clinically effective and cost-effective. But they remain in rare use. And ultimately, we all suffer: The US has the highest incarceration rate in the civilized world, one in nine young Black men is in prison at any given time, and elected officials still seek to score cheap points with a frightened populace by pledging to get “tough on crime.”

The following passage from the editorial is especially striking:

The average cost to keep a person in prison for a year in the United States is slightly over $23,000 (Liptak, 2008) – an amount that, for non-violent offenders, could easily cover tuition costs at many colleges. As but one example, the state of Arizona spends more to incarcerate Latinos and African-Americans than to educate these same populations at the state universities.

So, what is to be done? Again, there are interventions that we know will work, particularly for juvenile offenders. Among adults, educational and therapeutic programs are again known to work and to save taxpayers money. From Sen. Edward Kennedy’s (failed) 2007 Recidivism Reduction and Second Chance Act:

Recidivism for inmates who participate in prison education, vocation, and work programs have been found to be 20 to 60 percent lower than for nonparticipants. The Federal Bureau of Prisons found a 33- percent drop in recidivism among Federal prisoners who participated in vocational training.

Simply put, cries that we cannot afford such programs in difficult economic times are straw-man arguments — tough economic times should lead to greater use, not less, of programs that we know will reduce costs to the justice system without increasing crime. Family-based programs should be a part of this effort.

Why are divorce rates higher in cities than in rural areas?

Divorce rates are higher in cities than in rural areas. While many explanations for this have been proposed, a common one has been economic opportunity. City dwellers generally have higher incomes than their country counterparts, and perhaps can more easily afford to move on after a breakup.

Not so fast.

The publication of Barry Schwartz’s The Paradox of Choice led some to speculate that his thesis — in short, the more options you have to choose from, the less happy you will be with the choice you make — could apply to romantic relationships just as it could apply elsewhere. (Schwartz actually speculates a bit on this himself in the book.) In other words, city dwellers may be more likely to divorce not because they make more money, but because they have more and better alternatives to their current relationship readily available at all times. New evidence supports that idea.

In a study on speed dating, researchers found that as the size of the speed dating group increased, selections became more skewed toward just a few select participants. This happened, the researchers argue, because the daters were less willing to make tradeoffs — like accepting less physical attractiveness in exchange for greater intelligence — when presented with a greater variety of options.

Faced with too much choice, the authors argue, we resort to more crude decision-making techniques. To put it differently, it becomes all about looks. And when a choice of romantic partner is made solely on appearance, how likely is it to last?

I’m especially curious about how this applies to internet dating. Some sites go for quantity (, others for quality (eHarmony) in the matches they make. The sites that present quantity are more likely to be considered meat markets, where appearance is key. I’m led to wonder — if sought to create more lasting relationships (and thus higher marriage rates and lower divorce rates), would they actually be better served to limit the number of potential mates they show to members? Science seems to be saying yes.

A new genetic theory of mental disorders

Yesterday’s New York Times outlines a striking new theory of mental disorders. Put forward by Bernard Crespi and Christopher Badcock — neither of whom works in mental health — the theory goes roughly like this: Genes from the mother’s egg and father’s sperm compete for dominance in the offspring, in what the Times called an evolutionary tug-of-war.

A strong bias toward the father pushes a developing brain along the autistic spectrum, toward a fascination with objects, patterns, mechanical systems, at the expense of social development. A bias toward the mother moves the growing brain along what the researchers call the psychotic spectrum, toward hypersensitivity to mood, their own and others’. This, according to the theory, increases a child’s risk of developing schizophrenia later on, as well as mood problems like bipolar disorder and depression.

This is no less than a unifying theory of mental illness — a theory that puts all mental disorders onto the same spectrum. It naturally has its skeptics.

It does not account for various quirks of autism or schizophrenia, particularly the coexistence of both positive and negative symptoms found in both. Even critics, though, praise the theory for its creativity and plausability. And, though it is limited, there is some biological evidence to lend support to the theory.

Crespi’s name may sound familiar. A biologist by training, he has frequently waded into the murkier waters of sociology, focusing specifically on evolutionary influences in human behavior. In putting forward this theory of mental disorders, he teamed with Badcock, a sociologist. Family therapy has, throughout its existence as a profession, benefited from the contributions of outsiders. Psychology may now be getting a similar shot in the arm.

From the AAMFT Conference: Can you do effective therapy online?

There was much discussion at last week’s AAMFT Conference about online therapy: what it is, what the ethical standards are, and whether it can ever replace a therapy model where everyone is in the same room.

Beginning at the first question, the term “online therapy” is being used to reference a wide variety of approaches to offering therapeutic methods, from email to text messaging to online chat to videoconferencing. The most sophisticated model, offered by among others, pairs licensed therapists with clients via secure videoconferencing. Clients can use a simple webcam.

The ethical standards, while a bit more complicated, do not vary from the standards that always govern the field. They’re just harder to define and enforce. Confidentiality, for example, takes on a whole new level of importance when session data is being streamed across the internet. Furthermore, the constant accessibility that electronic communication offers — I’m rarely sans Blackberry — may create a “slippery slope” of boundary erosion through out-of-session emails, text messages, and so forth (Gutheil & Simon, 2005).

The final question is certainly the hardest: Can online therapy replace the traditional model of having all therapy participants — including the therapist — in the same room? Here’s at least some of what we seem to know so far, starting from attitudes and ending at outcomes. (Sorry for the lack of links, these are primarily restricted-access journal articles.)

  • Online therapy may bring in clients who would not ordinarily attend therapy. It’s easiest to think about this in regard to clients in rural settings, where a licensed therapist may be an hour’s drive away or more. But even in densely-populated areas, clients who believe there is a stigma associated with therapy or with their specific problem may be more willing to see a therapist online than in person (Nyazema, 2005).
  • The kids don’t like online therapy as much as you might think. In spite of strong computer literacy and great comfort in gathering information online, college students overall actually report negative attitudes toward seeking help online, and prefer face-to-face therapy (Chang, Chang, & Kim, 2002).
  • Online therapy is less dependent on therapeutic alliance. In face-to-face therapy, the quality of the relationship between therapist and client is strongly predictive of therapeutic outcome. In online therapy, there is still a connection between the two, but it is far weaker (Knaevelsrud & Maercker, 2006).
  • Online interventions work, but are rarely compared directly against face-to-face therapy. Online therapy has been shown effective in treating panic disorder, eating disorder, posttraumatic stress, and grief, and has shown promise for a range of other conditions (Rocklen, Zack, & Speyer, 2004). However, few studies have directly compared online therapy with face-to-face therapy, and those that do are by nature questionable. A therapist interacting online with a client will, necessarily, behave differently than a therapist in a face-to-face setting. Where differences exist, are they due to the computers themselves, or those related behavior changes on both ends?

I find myself continually torn about whether, and how, to advocate for the use of online therapy. As an educational tool, online interactions work well. As a therapeutic process, I’m less convinced — but that’s a “jury’s still out” less convinced, not an “I just don’t believe it” less convinced. Your thoughts are most welcome.


Chang, T., Chang, R., & Kim, N. Y. (2002, August). College students’ on-line help-seeking attitudes and behaviors. Poster presented at the annual meeting of the American Psychological Association, Chicago.

Gutheil, T. G., & Simon, R. I. (2005). E-mails, Extra-therapeutic Contact, and Early Boundary Problems: The Internet as a ‘Slippery Slope’. Psychiatric Annals, 35(12), 952-960.

Knaevelsrud, C., & Maercker, A. (2006). Does the quality of the working alliance predict treatment outcome in online psychotherapy for traumatized patients? Journal of Medical Internet Research, 8(4), no pagination specified.

Nyazema, N. D. (2005). HIV/AIDS stigma and shame: On-line psychotherapy. In N. S. Madu & S. Govender (Eds.), Mental health and psychotherapy in Africa, pp. 441-449. Sovenga, South Africa: UL Press of the University of Limpopo – Turfloop Campus.

Rocklen, A. B., Zack, J. S., & Speyer, C. (2004). Online therapy: Review of relevant definitions, debates, and current empirical support. Journal of Clinical Psychology, 60(3), 269-283.

Executive functioning: Smarter than intelligence?

I’m quickly becoming a fan of Wray Herbert, who writes the blog We’re Only Human. His posts are concise and interesting, and at the forefront of psychological science.

In a new piece for Newsweek, Herbert talks about “executive function,” a not-new concept being given new life through the educational system. It has shown promise as a method of bringing children (younger ones in particular) who otherwise may have difficulty attending to tasks up to speed in the classroom.

While apparently I attended much kinder schools than he did — I’ve never known of a kid being tagged with an antisocial personality label for simply being fidgety, as his lead paragraphs suggest — I will be particularly interested in seeing how some of these same methods work in trials as treatment for ADHD. Good stuff.

From the AAMFT Conference: The transformation of marriage

I’m in Memphis for the big AAMFT Conference, and today saw probably the best presentation in the 10-ish years I’ve been going to the thing.

I’ve always been a fan of the work of Stephanie Coontz, in particular her book “Marriage, a History: How love conquered marriage.” Today, though, rose her to another level. Racing through as much data as she could in a 55-minute speech, she covered far more ground than I can describe or even recall here, and pretty much ensured that I’ll be buying the conference recordings.
That said, she made a couple of statements that were especially notable. I’ll paraphrase as best as I can.
First, marriage as an institution is weaker than it was some decades ago. But the very forces that weaken marriage as an institution appear to also be strengthening the safety and fairness in marriage. For example: While the percentage of US residents who now say divorce is morally acceptable is at an all-time high (70%), so too are the percentages saying domestic violence and male adultery are morally unacceptable. As a country, we appear to be reaching consensus that a marriage plagued by abuse or adultery is a marriage worth leaving.
Second, parental anxiety and political hand-wringing about the time parents fail to spend with kids is probably misplaced. Yes, single mothers spend less time interacting with their children than married mothers do. But single mothers today actually spend more time interacting with their children than married mothers did in 1965. Both mothers and fathers spend more time with their kids, in fact. There is a cost: Parents only have so much time to give, and it appears that the extra time they spend with kids is coming at the expense of time alone, or more often, time with friends, neighbors, and other community influences. The very idea that the breakdown of “community” is linked to increases in parenting time is a radical one, but Coontz has the data to back it up.
She largely stayed away from politics, except to chastize both the left and the right for oversimplifying the dilemmas facing modern families and doing more posturing than working to really help families who could use it. All in all, a great presentation, and a great end to my conference. More on what I’ve seen this weekend soon.