Couples Therapy Essay

Couples therapy has long been centered around treating the relationship rather than the individual(s) in the relationship. Those who most generally present to couples therapy are people who are in a dissatisfactory relationship but are none the less “normal,” meaning they have no psychological disorders. But what happens when one (or both) of the individuals in therapy presents to couples therapy but also has a psychological disorder? Could couples therapy help alleviate individual problems within the context of the relationship? Could the therapist and couple work together to help both the individual dealing with the mental disorder and the couple’s relationship at the same time? A few examples have shown that it is possible to help the
individual and the couple together simultaneously. In cases where individuals have an eating disorder (Bulik, 2012), depression (Baucom, 1998) or obsessive compulsive-disorder (Baucom, 2012), they have all benefitted from a couples setting. Some of the benefits from dealing with an individual problem in a couples setting is the amount of time the individual spends with their partner, the amount of understanding the partner will gain about the individual’s disorder, and the potential for the partner to help change the individual. Often when including a partner or family member into therapy is done for one of two reasons: “(a) The couple or familial interactions are believed to play a role in exacerbating the disorder, and/or (b) the spouse or family is viewed as a source of potential support for change” (Chambless, 2012). Another reason it is important to consider the partner when talking about an individual’s psychological disorder is that the relationship is most likely going to be impacted if not impeded by the disorder (Baucom,2012). Some the most common complaints of a relationship where one or more of the partners is suffering from a mental illness are relationship discord and general relationship functioning (Whisman, 2012). As the couple learns more about the problems they are facing together they will also learn how to help each other grow in their relationship and help each other cope with the psychological disorder rather than fight it.
An example of how a partner can help with someone who is battling an eating disorder shows just how beneficial it can be to have a partner to help guide and support the individual along the way. When an individual presents to therapy with anorexia nervosa (AN) one of the first major treatment goals is to help the individual become more open about the problem they are facing, as it is often kept as a private struggle from the partner (Baucom, 2012). The next step Baucom (2012) describes is psychoeducation. In this stage of treatment the therapist makes sure that both individuals are aware of and are able to conceptualize the treatment process. This will help them be able to work as a team during treatment. The next stage is communication training (Baucom, 2012). In this stage of treatment the main objective is to establish two sets of communication skills: sharing thoughts and feelings and decision making (Baucom, 2012). The last portion of treatment for the couple is to address AN-specific issues. This is where the couple will use their communication skills to help overcome potentially triggering issues for the partner with
AN. Another example of how couples therapy can benefit an individual with a psychological disorder is when one of the partners is faced with Post-traumatic Stress Disorder (PTSD) symptoms. In Strategic Approach Therapy the therapist and couple work together to complete a three treatment phase of therapy: “a) psychoeducation about PTSD and motivational enhancement, (b) behavior exchange to improve management of behaviors that produce increasing levels of positive emotions, and (c) partner-assisted anxiety reduction to train couples to cope with exposure to increasing levels of anxiety” (Sautter, 2009). After completing this therapy the couples saw a significant drop ( with p < .01 or less in all categories) in PSTD symptoms (Sautter, 2009). Over the years there have been many new developments in types of couples therapy dealing with both relational and individual problems.
Behavioral marital therapy (BMT) focuses on a “skills oriented approach” where couples learn about basic understanding of relationship interactions and how to diffuse destructive interactions (Baucom, 1998). Insight-orientated marital therapy (IOMT) “emphasizes the resolution of conflictual emotional processes that exist either within one or both spouses separately, between spouses interactively, or within the broader family system” (Baucom, 1998). Emotion-focused therapy (EFT) which focuses on the “centrality of emotion in marital distress and in marital therapy” (Baucom,
1998). With all the different types of therapy a few considerations need to be taken when conducting therapy. 1. Effective treatment of individuals and couples requires comprehensive assessment of intrapersonal and interpersonal functioning throughout affective, behavioral, and cognitive domains across multiple levels of the family and socio-ecological system 2. Therapy will be most effective when individuals and couples are matched to treatments for which they possess prerequisite attributes and are excluded from treatments for which they are particularly ill-suited. 3. Empirical findings regarding the efficacy of couple- and family-based interventions for individual emotional, behavioral,and health problems should influence practice guidelines at the corporate level. 4. Differences in urgency of individual and relationship issues and their progression during therapy require an organizational conceptual framework for selecting, sequencing, and pacing interventions. 5. Effective treatment of difficult couples often requires therapists to conceptualize and practice in an integrative manner across diverse theoretical orientations. (Snyder, 2004).
These considerations, when followed properly, will ensure for that whichever form of therapy is being conducted, it will be done so in a befitting manner. As these studies have shown couples therapy can be quite beneficial for an individual dealing with a psychological disorder. Couples therapy allows for the partner to understand their situation more fully and gives the couple the skills to work on both their relationship as well as to help minimize any negative effects the disorder may have on the relationship.