Archive for December, 2005

Alongside these valuable assets the doctor has many problems in marriage counseling which are not always easy to overcome. The first of these is time. If he is a good doctor it is likely that there will be many demands on his available time and energy, and he will see the long and recurring interviews with people in marital trouble as beyond his power from that point of view. Unless he sets out as a professional service to do such work he will generally feel compelled to refer any but the simplest of such cases to a marriage counselor. But there is still much that he can do without undue expenditure of time. It has been found by many doctors that a good training in marriage and family counseling has enabled them to use their normally available time with patients much more effectively, and that they can help many people in the earlier stages of marital disorder greatly without overspending their tame and energy.

Another problem which may hinder the doctor from effectiveness in marriage counseling is his professional orientation. The surgeon, for example, or the specialist in some limited field, may feel that he has quite enough on his mind in dealing adequately with the physical condition of his patient and keeping up with the details of his chosen field. He may feel unable to devote time or energy to any marital difficulties which may underlie or be associated with the trouble. He will generally be glad to hand over this part of the situation to someone else.

The gynecologist may deal with marital problems mainly if not entirely from the limited area surrounding any structural or functional disorders in the reproductive organs of women, and as an interested doctor he may allow himself to be drawn to some extent into the associated emotional conflicts for the purpose of helping in their resolution. But his special abilities in the more limited field are of most value in the role of consultant, where he may give invaluable service to troubled women, particularly in matters concerning apparent infertility.

The pediatrician may sometimes be drawn into marital disorders through his work with sick children, but here again, unless he has a special interest and sense of vocation for helping to deal with the disordered relationship between the partners, he will be glad to hand that aspect of the problem over to someone else.

The physician who takes the trouble to assess the deeper factors behind many so-called “stress diseases” which come under his care will inevitably be drawn into many marital disorders, which are often playing such an influential part in the trouble that no great relief will come until the marital situation has been relieved to some appreciable extent. Many physicians have an interest and considerable aptitude in dealing with the emotional factors behind the symptoms and signs of people, and do a lot of effective marriage counseling in the course of their work.

Psychiatrists are probably doing more marriage counseling than any other kind of medical specialist, because many of the troubled people who come to them for help either have marital troubles as one of the causative factors or else develop them as a consequence of their illness. As we have seen, the psychiatrist’s main field of work is in the intra-personality field, but he is in no sense limited to that. With the development of psychiatry its scope is constantly being widened and matters concerning human relationships are inseparable from any psychiatrist’s work.

There are two possible difficulties implicit in the psychiatrist’s professional role as it affects marriage counseling, apart from the inevitable problem of time. One is that people in marital difficulty are often hesitant to seek help directly from a psychiatrist because they regard his main function as concerned with the abnormal, or with the mentally ill. He is thereby denied many opportunities of helping people in marital disorder at an early stage when they are more easily and quickly relieved. The cost of a long series of counseling sessions from a psychiatrist sometimes constitutes a decisive factor in making people try to do without his help in the hope that things will somehow improve. In many cases the psychiatrist will come into contact with marital disorder through referral by a family doctor.

Another difficulty implicit in the professional orientation of the psychiatrist as it affects marriage counseling is that his work and his thinking are mainly in the intra-personal field. This is especially true of the psychoanalysts, and those who work mainly in psychotherapy with individual patients often find it necessary to reorient themselves considerably when faced with a problem which is mainly (though not generally exclusively) in the relationship field. Freudian analysts insist that a separate therapist should deal with each partner in any situation in which they both seek help, while marriage counselors take the view that they can help much more when the same counselor deals with both partners. It may be that the growing practice of “group psychotherapy” will lead to some reconciliation of these two different points of view, and that the psychotherapists will move further into the relationship area than many of them have felt able to do as yet.

The psychiatrist is an absolutely necessary resource fox marriage counselors as a consultant, as is made clear in many parts of this book. With the inadequate numbers of available psychiatrists it may be that the most efficient use that can be made of them by the community in marriage disorders will ibe in the role of consultants.

The general practitioner is another member of the medical profession who comes into contact with very many cases of marital disorder. Either he or the minister is generally the ifirst person, after the relatives, to be consulted. Many general practitioners do a large amount of effective counseling in marriage disorders and in all kinds of other situations, and develop considerable practical skill and experience in doing it. But the main problems here are again those of time and of difficulties in keeping up sufficient study in the extraordinarily diverse ^requirements of his professional role.

Unfortunately the training of most doctors does not include any real teaching or practice in matters concerning the marital relationship or in counseling in most medical schools, and even with all the difficulties of an overfull curriculum it would seem that the time is ripe for this to be carefully reconsidered.

Apart from his frequent contact with marital disorders the doctor has many valuable assets for marriage counseling. His education and training give him the capacity for looking behind symptoms to underlying causes, and for intelligent and reasoned assessment of the complex elements of problems. He gains experience with all kinds of people in situations through which he can see below the surface and understand many of their deeper feelings and motives. He knows their best and their worst qualities, and they feel better because he accepts them in spite of their less respectable selves.

People also know that the doctor will treat their revelations in the strictest confidence, and that helps them to come and to be open with him. They also feel freer to talk to him about matters which tend to be “taboo” in other conversation, such as the intimate sexual feelings and experiences; and they also know that he is equipped with resources by which they can gain some temporary relief from their distress and anxiety.

In addition they have confidence in his wisdom and judgment, and often an exaggerated confidence in the extent to which his statements and directions will be accepted and followed by others. They often appear to expect him to “convince” the marital partner of the enormity of what he is doing, as if the doctor were a super judge, but that does not seriously diminish his assets for counseling.

Yet another professional asset of the doctor is in the fact that people can seek his help without the same kind of admission of marital failure as would be involved in their going to a marriage counselor. When they feel hesitant to make any such open admission this may well be a crucial factor in the decision to seek help.

Finally it may be said that in many cases the doctor is honored by admission to the inner circle of his friendship and trust by many of his patients, and even if his help is not needed by them for marital trouble their warm recommendation and urgings will induce their friends who may be in trouble to go confidently for help to him.