Marriage and Family Counseling Pennsylvania

Advanced Counseling and Research Services offers marriage, couples and family counseling across Pennsylvania, in person at our Lancaster office or by secure telehealth, which also reaches clients in Florida. We are a psychotraumatology practice, and that shapes two things about how we do this work: we screen for safety before we put two people in a room together, and we ask whether something that happened — to one of you, to both of you, or to the family — is driving the pattern you are stuck in.

Like the other pages on this site, this one tells you what the research does not support as well as what it does. If you have already tried couples or family therapy and it did not help, the section on real-world results is the part worth reading.

What People Describe

• The same fight, with the same opening line, ending in the same silence
• Feeling more like flatmates or co-managers than partners
• One person pursuing the conversation, the other withdrawing from it — and both calling it the other's fault
• An affair, or a discovery, that neither of you knows how to get past
• A teenager who has stopped talking to anyone except through a closed door
• A stepfamily in which everyone is polite and nobody feels at home
• Co-parenting after a separation, with the children carrying messages
• A family that changed after something happened, and has never talked about it

Who We See

Every kind of couple and every kind of family. You do not need to be married, and you do not need to fit anyone else's picture of what a family looks like.

That includes married and unmarried couples, same-sex couples, couples before marriage and couples many decades in, remarried and blended families, co-parents who are no longer together, parents and their teenage or adult children, adoptive, foster and kinship families, and households where several generations live under one roof. Sessions can include whoever is part of the problem and part of the solution — sometimes that is two people, sometimes it is five, and sometimes part of the work happens with one person on their own.

The Honest Numbers on Couples Therapy

The good news is real. A 2020 meta-analysis in the Journal of Consulting and Clinical Psychology pooled 58 studies covering 2,092 couples and found that couple therapy produced large improvements in relationship satisfaction, along with gains in communication, emotional intimacy and how partners behave towards each other. Couples placed on waiting lists did not meaningfully improve on their own, and the gains in therapy were generally maintained at follow-up. Couples who started out most distressed tended to improve the most — which is worth knowing if you are wondering whether you have left it too late.

Now the part most pages leave out. A 2020 review in the Annual Review of Clinical Psychology estimated that 60 to 80% of distressed couples benefit in controlled trials, but that effects are weaker in ordinary practice and fade after treatment for about half of couples. Studies of couples therapy as it is actually delivered in the community consistently find smaller effects than the trials — one recent line of research in Germany and Switzerland found that fewer than 40% of couples improved in a clinically significant way and roughly half stopped early. Researchers call this the efficacy–effectiveness gap.

Two limits on those numbers, stated plainly. The 2020 meta-analysis included only opposite-sex couples, so its findings for same-sex couples are an extrapolation rather than a measurement. And much of its headline result compares couples with themselves before and after therapy, which tends to produce larger numbers than comparisons between a treated group and an untreated one.

What that means: couples therapy works, the trials are encouraging, and how it is delivered matters a great deal. We would rather you started with an accurate expectation than a marketing one.

What Closes the Gap

A 2016 paper in the Journal of Marital and Family Therapy looked at why couples therapy in practice underperforms couples therapy in research, and its recommendations are specific enough to hold a practice to. Three of them shape how we work.

Settle what you are there for. Some couples come to improve the relationship. Others come because at least one of them is deciding whether to stay in it. Those are different pieces of work, and a great deal of stalled couples therapy is one partner doing the first while the other is quietly doing the second. We ask at the start, separately, and we do not assume the answer is the same for both of you.

Assess each person, not only the relationship. Depression, trauma, drinking, or a history neither partner has fully told the other can all sit underneath a relationship problem and keep it running.

Measure whether it is working. We check progress, and whether the therapy itself is working for both of you, as we go — rather than waiting for one of you to stop turning up.

Why We Talk to Each of You Alone First

Joint sessions assume that both people can speak freely in the room. When one partner is afraid of the other, that assumption fails, and couples therapy can make things more dangerous rather than less.

Professional guidance on this is consistent in one respect: when there is violence, intimidation or control in a relationship, each partner should be assessed separately, not in front of the other, and joint therapy is generally not advised where one person is being controlled or harmed. What the guidance is less settled about is the smaller group of couples where there has been conflict that escalated but no pattern of fear or control — some researchers argue that carefully screened joint work can be safe for them, and others remain cautious. We take the cautious reading.

So before any joint session, each of you will have a chance to talk to a clinician on your own. If what emerges is that one of you is not safe, we will not continue with couples work as though nothing had been said. We will help the person at risk find specialist support — including the domestic violence services listed on this page — and talk about what kind of help, if any, is right for each of you separately.

The same principle applies to a few other situations that tend to stall joint work: an affair that is still going on, active substance misuse, or a crisis in one person that needs attention first. None of these rules you out. They change the order of things.

We will also explain, before your first joint session, how we handle something one of you tells us privately. That is worth knowing in advance rather than discovering later.

When Trauma Is in the Relationship

Not every relationship problem is trauma, and a practice that told you otherwise would be selling you its own specialty. But trauma very often lives in relationships, and it is the part of the picture that general couples counseling tends to miss.

Sometimes it belongs to one partner — a history of childhood trauma or an attachment injury that shows up as panic when the other person goes quiet, or as shutting down when they get close. Sometimes it arrived from outside: a job that exposes one of you to things most people never see, which is why we work with first responders and their families, or the aftermath of a death, an accident or an illness. And sometimes the injury is between you. The discovery of an affair is not a clinical diagnosis, but many people describe reactions to it — intrusive images, checking, a sense that the past has been rewritten — that look a great deal like the aftermath of other shocks, and it helps to treat them with that seriousness rather than as a communication problem.

What this changes in practice is the sequencing. If one partner's PTSD or complex trauma is driving the conflict, joint sessions aimed only at communication tend to help while you are doing them and slide back afterwards. That is when individual trauma processing — for that partner, alongside or before the couples work — belongs in the plan. There are also conjoint treatments designed specifically for couples where one partner has PTSD, with trial evidence behind them; if your situation calls for a protocol we do not deliver, we will tell you so.

When One of You Is Depressed

Low mood and relationship distress arrive together often enough that people reasonably wonder which to treat first. The best summary of the evidence is a 2018 Cochrane review comparing couple therapy with individual therapy for depression. Both improved depressive symptoms to a similar degree. Couple therapy did better at improving the relationship itself. The review's authors rated the studies as low quality and were careful not to draw firm conclusions — but where the relationship is a large part of the problem, their reading was that couple therapy is a reasonable choice.

In practice that often means both: individual work for the person who is struggling, and joint sessions for the relationship that is carrying the weight of it. Our pages on depression and anxiety cover the individual side.

Family Therapy — What the Evidence Covers, and What It Does Not

Family therapy has a broader evidence base than most people realise. Alan Carr's successive reviews in the Journal of Family Therapy have found support for family-based and systemic approaches — used alone or as part of a wider treatment plan — for a wide range of problems in young people, including conduct and behaviour problems, anxiety, depression, grief, self-harm and eating disorders, and, for adults, relationship distress, mood and anxiety disorders and adjusting to chronic illness. An earlier review of 20 meta-analyses by Shadish and Baldwin estimated that the average family in therapy ended up better off than about 71% of families in comparison groups.

The honest qualification is that much of that evidence belongs to specific, structured programmes — particular forms of parent training, or family-based treatment for adolescent eating disorders, for example — often delivered by specialist services. “Family therapy works” is true in general and does not mean every family approach works for every problem. If what your family needs is a specialist programme we do not provide, we will say so and help you find it rather than offering a general substitute.

Where we fit best is the family that is carrying something: a traumatic event, a loss, a parent's trauma history showing up in how the household runs, a blended family that has never really merged, or a teenager whose behaviour makes more sense once you know what they have been through.

When Children Are Part of the Work

Two things are worth knowing before a family session that includes children. First, children often say things in therapy that they have not said at home, and part of our job is to make that safe for them without turning the session into a verdict on a parent. Second, like every licensed clinician in Pennsylvania, we are required by law to report reasonable suspicion that a child is being abused or neglected. We would rather you heard that from us now than found it in the paperwork later. It is not a reason to avoid bringing your family in; it is part of why a family can trust the room.

Family therapy is also not a custody evaluation, and we are not the right people to decide questions for a family court.

The Cost — and Getting Everyone Through the Door

Two practical barriers usually stand between a couple or family and a first appointment. One is money, and insurance treats relationship work differently from individual therapy. The other is that not everyone involved is equally ready to come.

On money: health insurance in the United States is built around diagnoses held by one person. Relationship distress on its own is recorded under codes that most plans do not treat as a medical necessity, so couples counseling is often not covered as such, while family sessions may be covered when they are part of treating a diagnosed condition in one family member. Plans differ, and the only reliable answer is your own plan's. We will not record a diagnosis that is not accurate in order to get a claim paid — that protects you as much as us. What we accept is on the fees and insurance page, and a Good Faith Estimate means you know the cost before you commit. If the household has no coverage or income has dropped, Medical Assistance — Pennsylvania's Medicaid programme — covers mental health care through Behavioral HealthChoices; you can apply at compass.dhs.pa.gov or call 1-866-550-4355. Pennie, at pennie.com or 1-844-844-8040, is the state's official marketplace.

On readiness: it is very common for one partner, or one parent, to be the one who makes the call while the other is sceptical, embarrassed or convinced it is pointless. That is not a reason to wait. The first conversation is ten minutes and free, whoever makes it, and you can use it to ask how to start when not everyone is on board yet.

• Domestic Violence Services of Lancaster County — part of Community Action Partnership. 24-hour hotline 717-299-1249, emergency shelter, counseling and support groups, and a legal center. Free.
• National Domestic Violence Hotline — 1-800-799-SAFE (7233), text START to 88788, or chat at thehotline.org. 24/7, confidential, with safety planning and local referrals.
• ChildLine (Pennsylvania) — 1-800-932-0313, answered 24/7 by trained specialists, for anyone concerned about the safety of a child. TDD: 1-866-872-1677.
• 988 Suicide & Crisis Lifeline — call or text 988, or chat online. Free, confidential, 24/7/365. Spanish: dial 988 and press 2. Veterans can press 1.
• Lancaster County Crisis Intervention — 717-394-2631, 24 hours, at 750 Eden Road.

• Crisis Text Line — text PA or HOME to 741741, free and confidential, 24/7. HOLA for Spanish.
• SAMHSA National Helpline — 1-800-662-HELP (4357). A free, confidential, 24/7 treatment referral and information service in English and Spanish, including for families affected by a loved one's substance use. Referral and information, not counselling.
• NAMI HelpLine — 1-800-950-NAMI (6264), Mon–Fri 10am–10pm ET, for one-to-one support and information, including for family members. NAMI is explicit that it is not a crisis line.
• PA 211 — dial 211 or text your zip code to 898-211 for help with housing, utilities, food and more — often the practical pressure underneath a family's conflict.