Psychotherapy of Marital Partners: A Critique and Re-Evaluation
Authors: Mann A. M. , Lundell F. W. 
Published: April 2017

In psychiatry to-day it is becoming a common practice when a husband or wife is receiving therapy, for the other marital partner to seek help also. Theoretically this ‘concurrent’ psychotherapy should be expected to result in greater improvement to the individuals and to the marriage than would therapy of one partner only; in practice this is often not the case.

It is the authors' opinion that the whole concept of psychotherapy with marital partners requires careful and thorough re-evaluation. Note is made of, 1) the changing concepts of marriage in our society, 2) the emergence of the field of family psychiatry, 3) the broadening base of psychiatric referral, 4) the frequent occurrence of needless unsatisfactory results in concurrent individual psychotherapy of marital partners, 5) the discrepancy between the ‘ideal’ and the ‘real’ situation in this kind of therapy.

The factors involved in the unsatisfactory results of this kind of therapy may be conveniently divided into: a) problems in reference to the therapists and, b) problems in reference to the patients. Problems in reference to the therapists may be classified as follows: hierarchical problems, differences in viewpoint, transference-counter-transference phenomena, differences in skill, differences in assessment of improvement, the ‘advocate phenomenon’, and, (pervading all of the above), the problem of communication.

Each of these problems is discussed, with particular emphasis on the difficulties in communication that exist between the two treating psychiatrists and the differences in basic assumptions the psychiatrists may hold about the marital role and the duties of each partner. Problems on the patients' side of the situation are dealt with under the headings of: 1) transference-counter-transference relationships, 2) accentuation of gratification or frustrations, 3) the use of psychotherapy as a substitute for other gratifications, 4) the problem of the unwilling marital partner.

It is felt by the authors that, 1) a much more realistic appraisal of the whole concept of concurrent psychotherapy of marital partners is called for, 2) this type of therapeutic operation should be included in the general conceptual framework of Family Psychiatry, 3) consideration should be given to the marriage itself as being the therapeutic unit. The authors point out that the family doctor must be aware of some of the unconscious motivations which underlie the presenting picture in marital problems and thus be aware of his own attitudes and biases towards marriage and how these may affect his assessment of the particular marriage about which he is being consulted. It is recommended that specialized training in this type of therapeutic operation be provided in postgraduate psychiatric training programs.

In spite of the many difficulties, the authors feel that the concurrent psychotherapy of marital partners by different psychiatrists can work reasonably well provided the therapists, a) spend enough time together to make optimum communication possible, b) reach agreement on their own views regarding marriage, c) develop a working agreement on general concepts such as aggressiveness, dominance, dependency, etc., d) meet at regular intervals to work out the difficulties between them and their patients.