The issues that prompt couples to go to marriage counseling - money, sex, children, in-laws and the waning of love - have remained much the same over the decades. But marriage therapy itself? Now that's changed a great deal.
Consider this advice from the 1950s. In a column called "Making Marriage Work," Clifford Adams wrote of a woman who saved her marriage by purposely losing to her husband at cards and by pretending ineptitude at household tasks.
"Occasionally, she even invented troubles for him to cope with (replacing a good fuse with a dud, fraying a lamp cord to produce a short) so he would feel needed," wrote Adams wrote in the Ladies Home Journal.
Women were encouraged to give "a helpless smile and a shrug of the shoulders," said Stephanie Coontz, who excerpted Adams' column in her book "Marriage, a History: From Obedience to Intimacy, or How Love Conquered Marriage."
None of this, of course, would be the kind of advice a young woman with a troubled marriage might expect to receive in therapy today. The focus is now on the relationship, rather than on what the wife might do to accommodate - even trick - her husband.
"The real secret for success is having the couple realize that everything they do is connected between them," said Barbara Lynch, a professor of marriage and family therapy at Southern Connecticut State University. "I ask them: What is the purpose of you two being together?"
To help them see their relationship, she asks them how others would describe their marriage.
"When they tell me they have irreconcilable differences, I tell them that most happy, satisfied couples have at least six," said Lynch. "You don't break up a marriage because of irreconcilable differences. It's what you do with them that makes the difference."
Today, marriage therapy is very much accepted. Hundreds of thousands of couples receive therapy each year, and the majority of couples do benefit, according to most research.
Looking back over how marriage therapy evolved since the early part of the last century tells a lot about changes and expectations for men, women and their marriages.
The first centers for marriage counseling began in Europe in the 1920s and were actually more about eugenics, according to Rebecca Davidson, a visiting fellow at the Princeton Center for the Study of Religion, who is writing a book on the history of marriage counseling.
"They did offer counseling for emotional problems," said Davidson, but "they were most concerned with better breeding."
One of the early adherents of eugenics in the U.S., Paul Popenoe, opened a clinic in Los Angeles in 1930. At the time, Davidson said, there was a lot of concern that white women who were going to college were delaying marriage and, therefore, having fewer children.
Popenoe, Davidson said, was "interested in encouraging what he would consider the right kind of people to get married and have more children."
His clinic sterilized the "unfit" and offered marriage counseling. His work influenced the Nazi government's sterilization program. However, by World War II, Popenoe's work had steered away from eugenics and focused on marriage counseling. He eventually became well known as the writer of the Ladies Home Journal column "Can This Marriage Be Saved?"
Another major contributor to today's marriage therapy programs were family service welfare agencies that provided a myriad of services to families, including marriage counseling. The clergy, too, provided much of the early marriage counseling.
In 1942, the American Association for Marriage and Family Therapy was founded.
However, these mid-century counseling efforts were very different from what happens today.
"Until recently, marital therapy was not about helping two different individuals negotiate their needs and accommodate their wants," said Coontz, who is also director of research and public education at the Council on Contemporary Families. "It was about helping two people - a man and a woman - adjust to the expected stereotypes. There was a sort of one-size-fits-all model of marriage. The husband does this; the wife does this; this is how you will be the happiest if you can accept the gender roles prescribed for everyone."
If a couple were experiencing difficulties, it was assumed to be an "adjustment problem." And usually it was the woman who did the accommodating. The message to women through the '50s, Coontz said, was "give in."
With the sexual and feminist revolutions of the '60s and '70s, marriage therapy changed dramatically.
"Counselors became much more aware that they were dealing with two individuals, each of whom has a whole spectrum of needs and feelings," said Coontz. "The problem then becomes for the counselor: how to deal with keeping a marriage together vs. meeting the individual needs of spouses when those things don't seem to line up."
Davidson said that counselors began to leave aside the old stereotypes of what a wife does vs. what a husband does.
"In broad strokes, the transformation we are talking about is going from talking about adjustment," said Davidson, "to talking about self-actualization."
Today, there is a much greater sensitivity in marriage counseling to how work, substance abuse, mental illness and medical problems can affect a marriage. "I think counselors are much more sophisticated," said Davidson. Also contributing to the flourishing of marriage therapy - and to the pressure on marriage - has been the diminishing role of extended families and the vanishing of supportive neighborhoods and communities.
"The invention of the idea that you ought to find all your satisfaction and love in marriage immediately required the invention of the marriage counselor," said Coontz. As a result, marriage counseling, Coontz said, has really taken off in the last 20 to 30 years.
Today, couples have an array of therapeutic choices, ranging from options that focus on behavioral techniques, to improving communication, to emotion-focused techniques, to others that zoom in on early childhood experiences.
"Everybody is searching for the holy grail in marriage therapy, and there isn't one," said Lynch.
Dan Wile, an Oakland, Calif., psychologist and author of "After the Fight," says most therapists develop their own styles. His style is what he calls collaborative, and it involves trying to help withdrawn or warring couples establish a more intimate, collaborative conversation about their problems.
If one partner makes an angry statement, Wile said, "I try to translate it into what they would be saying if they were in a more collaborative mood. I try to jump-start an intimate, collaborative conversation."
"If they come in with a big problem, some of which are unsolvable, it can be discouraging. I just try to get the most elegant, intimate conversation about the unsolvable problem."
The idea, he said, is that this tenor of conversation offers the best chance to look for solutions, to commiserate about the problem.
While many of the issues couples bring in to discuss haven't changed much over the years, there are a few new twists. Dual-income couples - too busy with children and careers to spend time on their marriage - have increased in number, while there are fewer lonely, isolated at-home wives married to workaholic husbands.
And the couch-potato television-obsessed husband is being replaced by the web-addicted guy who in some cases may be downloading pornography.
Matt Mutchler, associate clinical director of the Humphrey Center for Individual, Couple and Family Therapy at the University of Connecticut, said it is important for couples to understand they are communicating, even if it seems they are not.
"They come to therapy because they say they aren't communicating," said Mutchler. The wife is trying to talk to the husband, but he's glued to the television or the computer.
Mutchler explains to them, "He's communicating."
Many men worry that if they come to therapy, the therapist will side with their wife, said Mutchler.
"A good therapist is someone who sides with both partners from time to time," said Mutchler, "recognizing the validity of what each has to say and looking for ways to make them stronger."