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Archives of Psychiatry and Psychotherapy, 2011; 3 : 57–64
Marital Therapy/Couples Therapy: Indications and
Contraindications
Małgorzata Wolska
Summary
The author, basing on literature and her own experiences in conducting marital/couples, presents the in-
dications and contraindications for this form of therapy for both recipients of the therapy and therapists.
Insufficient motivation to change relationships and behaviours, the threat of divorce, violence, deep emo-
tional and/or psychological disturbances in one or both spouses, the engagement of one of the partners
in a relationship outside of marriage are some of the contraindications to therapy, as referred to in the ar-
ticle. What is being elaborated on are also correct approach and characteristics of marital therapist as
well as contraindications to conduct this form of therapy. The author proposes a scheme of work with mar-
riage/couple in crisis: preliminary consultations as the basis for the therapeutic contract or relegating part-
ners to other specialists.
marital /couples therapy / indications to the therapy
INTRODUCTORy REMARKS the relationship on one hand, and on the oth-
Working with married couples/pairs in a se- er they tend to shift the blame for the crisis on
vere crisis, which threatens the stability of their the partner and at the same time expect that the
relationship, is a big challenge for therapists pri- therapist will help them by taking the role of an
marily for the reason that arguing partners, both ally, solicitor, advocate or judge. To unravel the
at the same time experiencing a sense of injustice complex marriage games and to reach sources of
and grief, give the impression that they are not conflict between partners is a burdensome task
interested in undertaking any kind of interven- for the therapist, requiring sustained attention,
tion that could elicit actions bringing them relief concentration, keeping watch over the neutrali-
and improving relations. A woman and a man ty and making sure not to follow the therapeutic
experiencing a crisis in their relationship fear work in his/her own convictions regarding the
abandonment and undertake many desperate role of women and men in a relationship.
and unsuccessful attempts to save and improve Psychologists involved in marital/couples
therapy probably would feel inclined to agree
Małgorzata Wolska: Jagiellonian University, Medical College, Depart- with the fact that this is one of the most diffi-
ment of Child and Adolescent Psychiatry, 21a Kopernika Str., Kraków, cult forms of therapy mainly because the risk of
Poland. Correspondence address: Małgorzata Wolska, Jagiellonian losing the distance and neutrality is higher than
University, Medical College, Department of Child and Adolescent Psy- in other therapeutic situations and the counter-
chiatry, 21a Kopernika Str., Kraków, Poland.
E-mail: malgo.wolska@gmail.com transferential reaction on their behalf may ap-
The article is an extension of a paper delivered at the conference pear. Frustrations caused by more often than
Marital Therapy; Couples Therapy organised by the Family Therapy not enormous difficulties in obtaining a positive
Section of the Polish Psychiatric Association, held in Kraków on change in the relationship of quarrelling part-
21–22 April 2007. ners induce the therapist to answer some fun-
This article has not been aided by any grant. damental questions:
58 Małgorzata Wolska
• Was the proposed treatment not too fast in what they also need is a therapy including the
reference to the vague, uncertain or low mo- realm of feelings? This therapy would be use-
tivation to maintain the relationship and sing ful with abandoning the fight between a cou-
up for the therapy? ple, regaining the confidence, allowing them-
• Was the pace of change proposed by the ther- selves to split piecefully and thus reaching the
apist adjusted to the needs and capacities of agreement on cases they are still forced to share.
the spouses/partners? However, such treatments are not always possi-
• Was the therapist not too passive or too im- ble in a situation of strong tension, fighting and
posing? blame-game, as demonstrated by the experience
• Did not the therapist take too much responsi- of therapists conducting family/marriage ther-
bility for the relationship between the two un- apies mandated by court order [1]. Taking this
dertaking therapy? under consideration, marital/couples therapies
Before proposing to marriage/couple an in- are proposed only to pairs who declare their de-
volvement in the therapy, the therapist should sire to maintain the relationship.
know what to propose, which means to know The main objectives of marital/couples thera-
the couples expectations, to determine the py can be defined as:
strength of their relationship, the risk of collaps- • a support of marriage/couple in identifying
ing degree, the motivation to stay together and sources of conflict;
motivation to engage in conducting of positive • a help to each partner in determining their
changes. He/she should meet the needs of each own participation in the conflict;
partner, the possibility of their implementation • a help in realisation of the mutual expecta-
as well as ability to fulfil expectations of a part- tions;
ner. Precise determination of the therapy aim • a help in defining the rules of functioning of a
adjusted to the couple’s expectations, needs and relationship, fulfilling roles, defining the lim-
emotional/intellectual capabilities of both part- its of internal boundaries (individual) and ex-
ners are important factors for positive changes ternal boundaries (separating the relationship
in therapy. Extremely important is also the divi- from the rest of the world);
sion of responsibilities: the therapist is respon- • an improvement in mutual verbal communi-
sible for the conduct of therapy, the therapist to- cation (to avoid further misunderstandings)
gether with both partners share responsibility and nonverbal communication (to make it
for achieving goals, but the partners themselves easier and more clearly to express feelings);
take responsibility for their relationship, that is, • an assistance in constructive conflict resolu-
whether to continue it or to end. tion;
• a help in deciding whether to continue the re-
DEFINITION AND GOAlS OF MARITAl/COUPlES lationship or to part (note: the responsibili-
THERAPy ty for this decision lies exclusively within the
spouses/partners).
Generally speaking the marriage/couples ther- Couples who seek therapy because of dif-
apy is a help for the partners remaining in a dif- ficulties with mutual coexistence, more often
ficult, conflicting and critical relation prevent- not only expect to improve relations and re-ap-
ing from obtaining closer intimacy and greater proximation but the confirmation that the fault
satisfaction in being together. So, instead of pro- lies with the other partner. Each partner is con-
posing a married couple in the middle of a di- vinced that he did everything that was possible
vorce a marriage therapy, the therapist should for the relationship to be good, and now is try-
undertake a divorce mediation suggesting rath- ing to shift responsibility for the problems on a
er the new organisation of life than staying in a spouse placing the therapist at his side in a posi-
realm of feelings. But here there emerges a ques- tion of an ally in the fight with a husband/wife.
tion: whether divorcing marriage which is still Eric-Emmanuel Schmitt [2] in his Little Marital
in the phase of combat (but which cannot yet Crimes writes that a relationship is as home to
be separated) only need divorce mediation or which the keys are in the hands of people. The
Archives of Psychiatry and Psychotherapy, 2011; 3 : 57–64
Marital Therapy / Couples Therapy: Indications and Contraindications 59
therapist cannot assess or advise whether the re- naires and surveys typically used at the stage of
lationship should be continued or whether the initial contact with the married couple by ther-
partners should part. He/she can only help the apists working in the cognitive approach. Not
spouses/partners to find the right ‘set of keys’ - only each spouse completes the questionnaire
if both are interested in finding them. separately, but it is also followed by reviewing
the questionnaires by the therapist and conduct-
CONTRAINDICATIONS TO CONDUCT ing individual talks with both partners [7]. Un-
MARITAl/COUPlES THERAPy der such conditions, surely it is easier to reach
things that are, for various reasons, deeply hid-
There are several specific situations in which den. But on the other hand, the question arises
we cannot propose to take care of marriage/cou- what to do if, for example, one of the spouses
ples therapy even when we are convinced that reveals that he/she has betrayed the partner at
the partners are really into it. Therapists dealing the same time asking the therapist to kept it as
with problems of marriage/couple in crisis are in a secret. Of course, the therapist cannot disclose
agreement that the therapy cannot be offered in without permission any contents of the conver-
following situations: sation but it will certainly be difficult for him/
her to lead further therapy (if at all possible) in
• physical violence between partners; a situation of inability to appeal to the relevant
• mental illness or addiction problems of one facts known only to him/her, that also hinder the
(or both) partners; achievement of positive emotional closeness of
• staying (of one or both partners) in other re- the couple.
lationships and lack of motivation to give up To the above-mentioned absolute contraindi-
one of them; cations for marital/couples therapy one may add
• undertaking (by one or both partners) the de- a condition found in the literature of the subject
cision of a divorce (regardless of whether they [5, 6] that if the disclosure of a deep, long-lasting
reported it to the court or not) [3, 4, 5, 6]. psychological conflict with only one of the part-
If during the initial consultations the therapist ners appears, the decision of continuation the
succeeds in discovering and diagnosing any of common therapy should not be taken. Instead,
above-mentioned problems, he/she can offer one the proposition of individual therapy should be
or both of the partners turning to the right peo- introduced. Crane [3] recommends not to offer
ple/institutions (eg. psychiatrist, mediator, rehab therapy or hinder it in a situation where partners
counselling, crisis intervention centre, etc.) as a want to talk about their individual problems,
means of help in solving the problem. There are rather than focus on their relationship. Howev-
however some situations where the person ap- er, it seems that one or several joint session after
plying for therapy for some reason do not tell unveiling an individual problem, is reasonable
the therapist about the most difficult problems, and could be used to motivate people with un-
such as the wife may be afraid that if she reveals resolved psychological conflict to take individ-
how her husband beats her, he will later on took ual psychotherapy, while considering together
revenge on her, or one of the partners does not whether the other partner also needs counsel-
wish to disclose that he/she remains in union ling and, if so, what kind.
with other person because of the fear of losing Here again, the therapist should act carefully
benefits, disintegration of the original relation- and thoughtfully, so as to focusing on individual
ship or accusations of contributing to the crisis. issues do not served spouses/partners as a con-
Therapist undertaking the work with marriage/ tinuation of fight over who is to blame for the
/couple in crisis should be alert and attentive, current status quo of the crisis (a person with a
but not suspicious, and pay attention to different revealed mental disturbance is more likely to be
types of behaviour and specific words that may exposed to accusations of the ‘healthier’ partner,
indicate the existence of a secret. What might be but it can also happen that the above-mentioned
helpful in the diagnosis of the problem (crisis) partner would be accused that his/her behaviour
and type of relationship is a variety of question- caused the state of the first one).
Archives of Psychiatry and Psychotherapy, 2011; 3 : 57–64
60 Małgorzata Wolska
Freeman [5] believes that therapy should be Freeman [5] is an advocate of short-term mar-
suspended or terminated in a situation where ital therapy which combines the cognitive and
after passing the initial phase (for example af- behavioural techniques as well as marital thera-
ter the third session) it is at a standstill, mean- py with crisis intervention. According to her as-
ing the partners continue to work on each other sumptions, as an indication for treatment she ac-
destructively, when they show no motivation to cepts the visible signs of crisis in both spouses
change the relationship, when they are not able or one of them. These signs of crisis are: a sense
to open in front of the therapist or they are too of hopelessness, inadequacy, increased level of
preoccupied to listen to each other, and contin- anxiety, frustration and inability to deal effec-
ue efforts to destroy each other. tively with the situation. Like other therapists,
she attaches a great importance to the motiva-
tion of both spouses, which is assessed on the
INDICATIONS FOR MARITAl/COUPlES THERAPy basis of completing tasks and undertaking var-
ious actions designed to alleviate existing ten-
After this long list of objections and contrain- sions.
dications to take up and lead marriage/couples Crane [3] believes that the therapy is possible
therapy, there arises inevitable question: when in the following situations:
and to which couples this kind of therapy can be • when both partners are trying to improve re-
offered? In the literature on marital therapy on lations between them by mastering commu-
the first place on the list of indications, the mo- nication and effective problem solving;
tivation of both partners is placed, so it is up to • when partners with negative experiences of
them to make efforts to achieve positive chang- failed relationships of their parents or their
es to their mutual relations [3, 5, 6, 7, 8, 9]. Ther- own previous relationships want to prevent
apists working with marriages in the behav- problems or to solve those that already exist;
ioural approach examine partners’ motivation • when partners, fearing the disintegration of
to change their conduct by giving them tasks to the relationship, want to prevent the accumu-
accomplish in the time between sessions. Com- lation of difficulties and to rebuild the bond;
pletion of these ‘home assignments’ would indi- • when partners want to make an attempt to
cate a good motivation to improve mutual rela- reach an agreement before taking a final de-
tions but, unfortunately, it happens sometimes cision about the divorce or separation;
that some people perform tasks in order to dis- • when partners have already committed part-
miss the allegations of their partner about the ing but wish to avoid tension or to find a so-
lack of commitment or a negative attitude, or lution to the problems existing in their rela-
to have an argument to continue fighting with tionship;
him/her, which can be expressed, for example, in • when partners want to undertake therapy as a
this way: ‘You care for nothing! You are not in- form of support with other problems solving,
volved! It is I who does everything to solve our for example marital therapy is to be a part of
problems and you just sit and wait for it!’, etc. family therapy, conducted because of a prob-
Except good motivation and among other in- lem of a child, who is about to appear.
dications for therapy, the behavioural therapists
of marital/couples problems place the following
types of problems: THE INITIAl PHASE OF WORKING WITH
• overprotection of one partner coexisting with MARRIAGE/COUPlE IN CRISIS: CONSUlTATION
emotional dependence of the other;
• jealousy combined with control, suspicion and In the first contact with a pair in crisis, when
restriction of freedom; there is general confusion and tension, proceed-
• the dominance of a partner combined with the ing according to the indications and contraindi-
lowering of the value and self esteem of the cations to therapy outlined above can help the
other, passive partner; therapist in making the diagnosis of the crisis
• mutual antagonism, blaming and emotional and problems in relationships as well as in tar-
interdependence [6]. geting, defining purpose, scope and method of
Archives of Psychiatry and Psychotherapy, 2011; 3 : 57–64
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