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Chapter: Essentials of Psychiatry: Couples Therapy

What Is “Couples Therapy?”

Marital or couples therapy can be defined as a format of intervention involving both members of a dyad in which the focus of interven-tion is the problematic interactional patterns of the couple.

What Is “Couples Therapy?”

 

Marital or couples therapy can be defined as a format of intervention involving both members of a dyad in which the focus of interven-tion is the problematic interactional patterns of the couple.

Couples therapy is distinguished by the peer relationship of the participants, the ever-present question of commitment, and a need carefully to attend to gender issues. In general, even behaviorally focused couples therapy must attend particularly to the feeling level with the goals being positive feeling between the partners and more reasonable behavior.

 

It is important to understand that when considering dif-ferent types of psychotherapy – individual, group and family therapy – “couples therapy” is considered as a subtype of “family therapy”. Further, we should make explicit the obvious: a couple is an example of a “family” (broadly defined).

 

Currently, there are various models and strategies for treating couples. Each may emphasize different assumptions and types of interventions. Some therapists prefer to operate with one strategy in most cases, whereas others intermix these strategies, depending on the presenting problem and the phase of treatment. At times, the type of strategy used is made explicit by the thera-pist, whereas in other instances it remains covert; irrespective of whether a therapist specializes in one or another approach or is eclectic, some hypotheses will be formed about the nature of the couple’s difficulty and the preferable approach to adopt.

 

Therapists may choose one school or another based on their training or their personality. For example, a very organized and di-rective person would probably prefer cognitive–behavioral methods, while a person who prefers long-term emotional intensity over prob-lem-solving might gravitate to experiential models. Individuals and families as well may prefer some ways of working over others.

With the therapeutic focus on one person, the emphasis is of-ten on the individual’s perceptions, reactions and feelings, and also on the equality of status between the individual and the therapist; when two people are the operative system, attention is directed to interactions and relationships. Therapists who think in terms of a unit of three people look at coalitions, structures, and hierarchies of status and power. The number of people actually involved in the interviews may not be as important as how many people are involved in the therapist’s way of thinking about the problem.

 

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