Archive for April, 2006

The personal relationship. Professor John Macmurray once described human relationships as of three kinds: instrumental, organic and personal. An instrumental relationship is one in which a person is regarded and used as an instrument, a means to an end. An organic relationship is one in which the participants are related through common membership of a group, and the purpose of the relationship is for the promotion of some sectional common interest. A trade union, a professional association and an employers’ federation are examples of this kind of relationship. A personal relationship is one that is self-justifying, it exists for its own sake, although it may fall apart if no common activity or purpose emerges to express the relationship and thereby nourish and strengthen it.

Each of these human relationships may be at the heart of a particular marriage and the bond between husband and wife may change from any one to any other of them. But in counseling we are mainly concerned, not so much with the type of relationship as such, but with the elements of marital conflict, in this case those applicable to the personal relationship. The type of relationship is here important insofar as it is an element in the conflict.

Four common types of conflicts in the personal relationship found in marriage counseling will be discussed, hostility, indifference, dictatorship and dependency. They are often interrelated with one another, but for purposes of discussion they will be dealt with separately.

Hostility is a universal human emotion and there is no human relationship into which it does not enter to some extent. Married couples who boast that they have “never had a quarrel in thirty years of marriage” have generally refused to face the inevitable hostilities. Some married couples who have gone into marriage with the “pipe dream” of the “live happily ever after” phantasy, may be deeply disillusioned by the first expression of real hostility, and may come to the impulsive conviction that their marriage is doomed. They need to be helped to the awareness that love can never be quite “100%”; that even though one may love another person deeply there are times when there is intense hostility against him. What matters most in marriage is not so much the fact of hostility but the extent to which for any reason it is threatening the stability of the marriage or injuring the children.

Hostility may show itself in all kinds of ways, disparaging criticism, belittling, sarcasm, slander, malicious actions, sulking, disloyality, twisting everything so as to put the “blame” on the other, physical violence, and other forms of mental and physical cruelty. In the marital situation the whole problem becomes so complicated by the mixture of action, reaction, and further retaliatory and protective devices as to be very difficult for anyone to disentangle. But it is not the counselor’s task to judge such issues, but rather to provide the atmosphere in which the differences and the hostilities can be openly faced and worked out by the partners if they are willing to do so.

In such working out it is important to distinguish between the “wounds” which come from direct injury; physical or mental cruelty; and those which arise from frustrated expectations which may have been unreal and unwarranted. The husband who expects another “mother” and finds himself with a “wife” may be very hostile at his wife’s failure to live up to “mother,” but he has somehow to come to terms with reality.

As we have seen previously the most important task of the counselor in handling hostility is to give it sufficient chance to be expressed by each partner in a fully accepting atmosphere; and then to work backward from the hostile feelings to the assumptions about life, about people, and about the client himself (or herself) on which the feelings may be based. In the clarification of hostility it may be that the partners will gain some insight into the distinction between acceptance of the partner’s feelings and the nonacceptance of his actions. There’s no reason to expect that all that any partner does will be acceptable to the other, but there is a vital difference between “I don’t like what you’re doing because of so and so” and “You mustn’t do that.” The first of these is a perfectly warranted expression of attitude, which does not constitute an interference with human freedom, while the second is a threat to human autonomy which is only justified when the unacceptable conduct may cause some oppression or injury to the partner or the children.

In many cases of hostility which come to the counselor the partners each accuse the other of doing something “wrong,” when in fact the conflict is often in terms of “difference” rather than “right and wrong.” The counselor can often help to clarify these conflicts by asking the appropriate question, “Is it really that your wife (or husband) is wrong in doing this or that you have quite different ideas about it?” “Is it that what seems so wrong to you may not seem wrong to your partner?” Such questions bring some fresh thought to matters and ideas which had been taken for granted. Of course there are some things that are in fact wrong in the sense that they are against the law, or that they are unjustifiably injurious to the marriage, the partner, or the children; and in such cases the offending partner may be faced with the question of the consequences or possible consequences of his actions and the extent to which the other partner will feel disposed to put up with them. In this way the conflict will at least be brought into the open, where it may be possible to deal adequately with it.

When two partners can learn to deal reasonably adequately with hostility in each other they will have reached a good level of emotional maturity, and will be able to help each other greatly in any outbursts of hostility which are always possible in marriage. It is a strange fact of experience that many husbands and wives who are able to be charming, gracious and well-behaved with everybody else are repeatedly hostile, ill-mannered, and very ill-behaved with their own partners and their children, as if their main rebellion is against the marriage and family bond, or the obligations of marriage. This may also be helped by clarification in the counseling.

The two most common sexual difficulties in men which are found in cases of sexual dissatisfaction in marriage are impotence and premature ejaculation. Each of these is generally a product of nervousness rather than of any physical or chemical inadequacy, and no hormonal treatment is likely to help unless there are definite physical indications of a glandular deficiency. Many cases of premature ejaculation gradually develop to normality if they are accepted with patience, but cases of impotence are generally of deeper origin and need some form of psychotherapy if they are to be brought back to normal. Even with this the results are not always good, especially when there is any indication of latent or overt homosexuality. Referral is generally advisable.

It is essential to give some consideration to certain apparently abnormal accompaniments of sexual intercourse, because they may well come up for discussion in counseling. It is generally felt by those who have made a special study of these that considerable latitude is essential in assessing what is permissible, as long as two fairly fundamental principles are safeguarded. The first of these is that any such sexual conduct that is distressing or distasteful to the partner should be regarded as in need of serious reconsideration, and the second is that any sexual conduct that takes the place of proper sexual intercourse is to be regarded as abnormal. If the counselor bases his handling of such situations on these two principles he is not likely to do any harm in this kind of situation. In any doubt a referral to the partners’ own doctor or to a psychiatrist is worth considering.

In any counseling with partners in sexual difficulties the counselor will generally attempt to gain some knowledge of the total background of the situation by getting some idea of the sexual history of the partners. Much of this may come out spontaneously in the stories that each of them give, but the counselor can add to this by some well designed questions when there is an opening for them. He can keep his own mental processes in an orderly sequence by working back from the present to the past. The general history of the present marriage and the sexual attitudes and methods, the number of children and of miscarriages if any, and the feelings of each about them may come first. Then the history of any previous marriages, the conduct of the courtship and engagement period and of any previous love affairs may be discussed, and an opportunity given for an account of anything that may have been a cause of deep regret or disillusionment. Then the attitude of parents and siblings and playmates at school, and the way in which the early introduction to sex was conducted may be reviewed, together with the emotional attitudes of the client to the various manifestations of sex.

The progressively frank discussion of these emotionally charged elements of the situation in the calm accepting atmosphere of counseling will often prove to be an entirely new experience for the client, and it will do much to overcome many of his bewilderments and fears and to bring a growing release from his emotional conflicts and tensions. Even when there are deeply repressed elements, which need psychotherapy if they are to be adequately dealt with, the experience of counseling will provide an important part of the therapy, and may even help the clients to a point at which they can go on developing themselves without specialist help. Much will obviously depend on how naturally and comfortably the counselor is able to handle the sexual aspects of the clients’ narratives, and counsellors need to be at ease in their own personalities in this field if they are to be adequate for the work.

Finally in this discussion of the sexual relationship it might be suggested that at its best human sexual intercourse can be regarded as a complete abandoned self-offering of each to the other as an expression of outgoing unselfish love, a re-enactment together of the partners’ “one-flesh-ness” in the marriage relationship, through which it can be progressively deepened and the partners brought to an ever closer union. If it can be accepted in this way there will be less desire to demand and more willingness to offer. There will also be more regular personal attention to the quality of love which the regular sexual intercourse seeks to express, and in this way the partners will be much more likely to grow together to greater maturity in their total relationship.

Such a “sacramental” view of sexual intercourse should be at least offered to all young people before marriage and fully discussed with them, so that they are clear in their minds about it. The satisfaction of appetite is in no way disregarded, but it is not then the primary motive for this deeply significant action, through which it is hoped to nourish and strengthen the loving bond between husband and wife; so that their union can weather all the storms to which marriage, more than ever in these days, is exposed. While ministers may well delegate the work of explaining the physical aspects of sexual intercourse, and even some of the emotional aspects of it, to doctors, it would seem that the Church has a solemn duty and an equally solemn privilege, to offer this deeper spiritual aspect of it to all candidates for marriage, and to people who may seek the counsel of ministers after marriage for any difficulty in their sexual relationships.

As we have seen the sexual and the personal relationships in marriage are closely inter-related. Disturbance of either will inevitably have some upsetting effect on the other. But the personal relationship is generally easier to control than the sexual, and even temporary personal acceptance of sexual difficulties which seem unable to be controlled or overcome by “will power” will make for a more appropriate “atmosphere” for the sexual relationship to develop into greater harmony.

One example of a controllable sexual relationship which can improve the personal relationship in marriage is in the attitude of the partners to sexual intercourse after a personal quarrel. Here is a situation in which the general attitude of men differs markedly from that of women. A man will often think of sexual intercourse as a gesture of reconciliation after a quarrel, but if he seeks to have it in this way his wife will almost certainly regard this as a deep affront to her personality. She will probably be glad to accept it after the personal reconciliation has been achieved, as an expression of their regained unity and not as a means to its achievement. If husbands can be helped to understand this they may save a great deal of misunderstanding and further conflict. Otherwise the husband will seek intercourse in good faith, and then when his wife objects, also in good faith, he will quite wrongly accuse her of obstinacy, and that will increase her resentment and the quarrel will deepen. Sexual intercourse is not appropriately regarded as a means of reconciliation, and its use for that purpose is often merely a way of escaping an honest personal apology.

Another disturbance of the sexual relationship which is quite controllable is what is termed “coitus interruptus,” the sudden drawing away of the husband before the emission of semen in an attempt to avoid the risk of impregnating his wife. This may not be related spontaneously in the counseling, at least during the earlier interviews, and it may be necessary for the counselor to ask at some appropriate point how the partners feel about family planning and what they are doing about it. This practice “coitus interruptus” is universally regarded as unwarranted and harmful to the nervous systems of both partners, and the emotional strain associated with it often shows itself in symptoms not necessarily related to the practice. It is often carried out because of ignorance, or because of diffidence about seeking proper help in family planning, and when it is revealed in counseling it is important for the counselor to suggest that the partners obtain some reliable help in family planning from a suitable clinic or from their doctor. Such a referral may lead to great improvement in the whole marital relationship.

Similar medical referral may be advisable in a number of other disturbances of the sexual relationship. The complete lack of satisfaction experienced by many women in the sexual relationship may often be helped by good medical or psychiatric attention. When it is accentuated or caused by extremely painful intercourse in young wives it needs expert help immediately or the situation will almost certainly deteriorate. In the same way when it is caused by deep fear of possible pregnancy it needs immediate help. Another cause of dissatisfaction, faulty conduct of sexual intercourse on the part of the husband, may also be helped by some appropriate advice, preferably by a doctor.

But many cases of dissatisfaction are not relieved by any of these measures, because they are due to much deeper sexual inhibitions, often the product of faulty conditioning of the wife by parents and others. There may be deep hostilities against men in general which are well hidden from the woman’s awareness, but which cause all kinds of apparently irrational and obstinately persistent sexual attitudes, such as frigidity and vaginismus, or even latent or overt homosexual attitudes. When there is any indication of such deeper disorders appropriate referral is generally advisable.

As the interviews proceed, either with the partners separately or together, certain specific questions will inevitably come up and need further clarification, and the first group of these to be dealt with are those in the inter-personal or “relationship” area. The most important aspects of the marital relationship which may come under discussion are the sexual, the personal, the parental and the social relationships, and they will be discussed in that order, after which some attention will be given to the question of what goal is being aimed at.

The sexual relationship is a very common area of marital conflict, as we have already seen in the discussion of contributory factors in marital disorders. In many cases the sexual difficulty is not immediately disclosed, but is hidden behind a “fac,ade” of personal touchiness and “unreasonableness” on the part of the wife, or apparent indifference or infidelity on the part of the husband. As the rapport becomes better the sexual frustrations or conflicts are often expressed, or the counselor may be provided with an appropriate opening for a question about either partner’s feelings about the sexual relationship. As already suggested in discussion of contributory factors it is generally impossible to consider the sexual relationship apart from the personal relationship or from the inner personality structure and “conditioning” of the partners.

Whatever the counselor’s ideas may be about the meaning and significance of sexual intercourse between human beings, it is necessary for him to listen to the feelings and attitudes of the partners about this important part of their relationship. The aim of counseling is to help them to a mutually satisfying total relationship, rather than to “educate” them “up” to any concept of it, no matter how good, that the counselor may have. For example, if the husband is constantly demanding, much will depend on whether the wife can willingly accept his demands, and if she is happy to do so there seems no justification for the counselor to suggest any other attitude unless asked to do so.

In most cases in which this subject comes up for serious discussion in counseling, however, there is enough painful conflict for a definite review of attitudes to be necessary, and this can only be done on a basis of some workable concept of the meaning and significance of sexual union. Many people have the vaguest ideas of this at the time of marriage and with the normal differences between male and female attitudes to sex they find themselves increasingly at cross purposes after marriage.

If we accept the democratic concept of the dignity of human personality and the autonomy and freedom that go with it, then it seems clear that sexual intercourse cannot properly be the subject of demand on the one hand, but that it is implicit in the marital undertaking that each partner makes a genuine effort to meet the reasonable needs of the other sexually and in all other respects. But this attempt is surely a matter for the individual conscience of each and not for decision by the other partner. In a sense it is more an obligation to the marital partnership than to the other partner, and the marriage will better be promoted and sustained when each makes a genuine effort, with any help that may be found advisable, to live up to the obligation.

Having made these observations it is perhaps necessary to go a little deeper, and to examine some of the inner feelings associated with sexual intercourse in many men and women. The feelings of men are more direct and even demanding than those of most women. Sex, to men, is often felt as a strong “appetite” which seeks gratification and “conquest.” Women have a sexual “appetite” that is less direct, and which generally needs to be “awakened,” especially at the beginning. Sexual intercourse to a woman involves considerable self-giving, the urge to which needs to be “won” by love rather than demanded by coercion or taken for granted.

Many men fail to understand that their demands for sex intercourse without setting out to win the self-giving cooperation of their wives constitute a recurring affront to their wives’ personalities, and that there are limits to the acceptance of such affronts to human dignity. Many wives in counseling make the rather sad observation, “The only time he’s ever at all affectionate to me is when he wants sex.” The use of any other person as a means to an end (in this case the gratification of an appetite) would seem to be a denial of the very ideas of human dignity and value for which mankind has been fighting over the centuries, and to which we so easily give “lip service.”

This kind of approach on the part of husbands may best be exposed for attention in counseling by “creative questioning” at the appropriate time. For example when it is brought out that a husband is regarding sex intercourse as a matter of demand, irrespective of his wife’s feelings about it, the counselor might put the question, “Then you feel that your wife should be ready to meet your needs at any time you want her to, regardless of her feelings about it?” In this way, the differing role perceptions can be brought out, and either reconciled by the partners or counseled more deeply by the counselor to elucidate the underlying elements in such attitudes, the habitual attitudes and responses, the uncritical assumptions, emotional needs, and the background “conditioning.” This may demand great patience and tact on the part of the counselor, because he is dealing with very deep and highly charged emotions and attitudes which do not lend themselves easily to change.

On the other side the wife who consistently rejects her husband’s appeals, or accepts them with hostile compliance may need help in finding out the deeper causative factors in her attitudes. Some of this feeling may arise from inept or crude methods of wooing on the part of the husband, but in many cases there are much deeper factors involved, which may well be related with the early “conditioning,” such as an unconscious hatred of men as a result of early experience with a coarse, drunken, cruelly demanding father, or with a tense repressed hostile mother.

When it appears that such conflicting attitudes between the partners extend as deeply as this and do not seem to respond to the general counseling approach it may be advisable for the counselor to consider referral of the partners for deeper psychotherapy, leaving it to the psychiatrist to decide how much therapy he should offer each of them.

While the counseling or psychotherapy is progressing and in cases where it appears that no further counseling or psychotherapy is justified or desired, some help can still be given through examination of the underlying aims of the partners in this area of their lives. Are they, for example, looking for perfect sexual union, something which seems to be beyond the reach of the majority of married couples? Do they on the other hand regard inefficiency in the performance of sexual intercourse as a reflection on their masculinity or femininity? To help the partners to “come to earth” and learn to accept, at least for the time, the best that can be obtained, even if it is not at all comparable with what they had hoped for and expected, may bring about enough release of tension to open the door to a steady improvement in the sexual relationship. This is often found in the case of recently married young people, and if they can even accept the pleasure of being together when the successful conduct of sexual intercourse is beyond their power, the situation may be kept from deteriorating while the necessary counseling and the time for adjustment can be obtained.

During the interviews with each client the counselor will be gradually gaining some perception of the type of personality shown by them. This has considerable bearing on many of their reactions to one another, and also on the essential process of building a more harmonious relationship, and as the con-selor comes to realize something of this inner personality type he becomes better able to act as a mediator between them.

The counselor may come to see how rigid or flexible either personality may be, and he may make some assessment in his own mind of whether either personality is of the introvert or extrovert type, the suspicious “schizoid,” the over-dramatic “hysteric” type, or the very particular “obsessional” type. He may see evidences of any of the neurotic, psychotic or psychopathic reaction types in one or both clients. It is not his business as a marriage counselor to make any very accurate assessment of these psychic patterns, that is a task that is often difficult enough for a psychiatrist, and much more appropriate for him to attempt than for the counselor.

The counselor, however, needs to have some awareness of the indications of these manifestations so that he can avoid persisting with a problem which needs expert professional help, and make a sensible and appropriate referral as early as possible. Such referral does not demand any accurate assessment by the counselor, but rather the belief that there are sufficient indications of such deeper elements to warrant psychiatric consultation. It is then for the psychiatrist to assess the conditions and if necessary and acceptable to arrange for the appropriate treatment.

Another important service which the counselor may be able to offer in many cases of marital disorder arising from gross incompatibility of personality type is in the helping a less deeply disturbed partner to cope with the more deeply disturbed one, whether or not under psychotherapy. Some of the indications by which the neurotic, psychotic and psychopathic personalities can be recognized have already been discussed in the section dealing with contributive factors in marital disorder, and some of the ways of helping a bewildered partner to cope with difficult situations will be dealt with in a later section. It may be emphasized that any “diagnosis” arrived at by the counselor is not stated to either client, that is not the counselor’s function. It is kept in his mind as a tentative assessment, continually open to further testing, and used to help in the counselor’s handling of the situation in his subsequent interviews with either of the partners or with both of them together.

For example, if one partner consistently dramatized everything and the other one shows perplexity at the apparent irrationality of such attitudes and responses, the counselor might help in the clarification by some such remark as, “You notice that she seems to exaggerate everything and to make far more of things than you would think appropriate. Could it be that she is somehow built that way, that that’s her nature?” When the client comes to some acceptance of that possibility the counselor might then put it to him that if she is built that way he might accept her as she is and not take her dramatizations quite so literally. There may well be some opportunity to go into the husband’s tendency to take such things so literally, and to open up for him some insight into his possibly obsessional personality, which may have been initially attracted by his wife’s dramatizations.

A more difficult problem is that of delusional manifestations, for example when a husband is deeply troubled about his wife’s completely unwarranted accusations of infidelity. Here again it is not for the counselor to make diagnoses to either of them, but rather to help each to deal with the problem from his own or her own standpoint. In the early interview with the wife, for example, he might say, “You feel sure your husband is being unfaithful, even though he denies it and you only have indirect evidence for it?” and when the counselor feels that there may be a delusional element in this he might set out to try to induce the client to have some specialist advice.

With the bewildered husband in such a case the counselor might say something like this, “You find that all your emphatic and repeated assurances of your innocence are utterly useless. Would it be worth trying to allow your wife to think and say anything she likes about you to you, and to let your life and your attitudes speak for themselves?” The counselor might add the suggestion that the most helpful attitude to his suspecting wife is that of acceptance of her feelings, however irrational they may seem, in the assumption that she can’t help having them. This “agreeing to differ” without hostility on his part may at least preserve some stability in an impossible situation while further help is being sought. This can be done without “labeling” anyone.

To summarize what has been considered so far in the interviews, we began with the establishment of rapport through the encouragement of unburdening on the part of the client and response to the expressed feelings rather than to the facts in the narrative on the part of the counselor. When the feelings have been as fully poured out as the client is disposed to do, the counselor sets out to discern, and to clarify with the client, such underlying influences as role perceptions and expectations in marriage, habitual attitudes and responses, uncritical assumptions, emotional needs, and ways of seeking their fulfilment, background personal “conditioning,” and personality type. This may go on with each client separately, often over the same period, but at certain points, and under certain conditions, it may be most helpful, with the consent of both partners, to have one or more interviews with the two of them together. This will be discussed later, remembering that it may happen at any earlier stage of the interviewing.