Archive for August, 2006

With so many marriages struggling with marital conflict and communication being a major cause of problems in a marriage it is no wonder that marriage counseling is in such demand.Couples often look to marriage counseling when they can no longer communicate with each other, when they are so frustrated that they no longer know what to do. Many marriages struggle for years before couples finally take the decision to do something about it, go for marriage counseling and try t…

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In this final section of a five-part series on making marriage work, Joan discovers that taking loving action on her own behalf, instead of waiting for Justin to make her happy, creates the closeness and intimacy with Justin that she desires.

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The decision of the counselor about extended counseling may often be helped by discussion of the whole case at a case conference of counselors and possibly consultants as well. His own resume of the case will clarify it in his own mind and the comments of his colleagues and some of their questions will often open up a previously overlooked aspect of the case. But ultimately the decision must be made by the counselor himself, and if he does not feel disposed to go on, it must be conveyed to the clients in terms and attitudes which will not appear “rejecting.” Fortunately this does not very often arise. Many of such clients will realize the situation and terminate the counseling on their own initiative.

If the counselor allows himself to be committed to extended counseling, there are various ways in which it can be carried out. As we have seen the counselor may often help greatly in a supportive and educative role once the main emotional components of the disorder have been sufficiently ventilated. The supportive role may be necessary for a time simply because the client may have nobody else to turn to. It may be an essential part of this extended counseling to encourage such clients to look for other resources in the community for support, such as a church, or a social or cultural or “handcraft” group, or even a part time or full time job where practicable. It is the essence of counseling to help people to help themselves and to overcome any dependency which may be unavoidable for a time.

The educative role of the counselor may also be productive for the clients in extended counseling. Education and healing cannot be separated, and even in the healing of physical illnesses the patient often needs to be educated regarding the main principles of healthy living, diet, rest and exercise, and general hygiene. Many disturbed marital partners can be helped by some good education in the principles of personal relationships, in matters concerning sexual attitudes and in problems of parenthood.

One aspect of the educational part of counseling which applies at this point more appropriately than in the earlier stages is the use of suitable literature, typewritten material, pamphlets, booklets, magazines, and books. In such cases it is often helpful to offer the opportunity of discussing anything in the literature supplied with the counselor, as referred to in a previous chapter. Lectures may also have a place in some cases, especially when they are accompanied by group discussion.

In some stubborn cases there may be an important part for some kind of group counseling, an activity which is beginning to develop more in recent years. It may include “unstructured” group discussion, “role-playing” in conflicts felt by any members of the group, including the reversal of the conflicting roles, and also “psychodrama” in which specific questions and problems as well as those experienced by members may be acted out under the supervision of the counselor or a trained therapist. It is probable that there will be a steady expansion of such methods of counseling and psychotherapy in the future.

Keywords: Marriage, Marriage Counseling, Marital Relationship, Marital Disorder, Marital Conflict

In the first place, if the counseling seems still to be proceeding satisfactorily and some progress is being made, it would generally seem right to go on and to give the situation more time to work out. Any ideas about how much time might be required are necessarily arbitrary, and as long as the clients feel that they are being helped enough to warrant continuation there would seem to be no reason for stopping. It often takes considerable time and patience for deep wounds to heal, and for some of the more “difficult” realities of the situation to penetrate sufficiently into the obstinate minds of many people to enable them to face the difficulties honestly and work through them into a new and more realistic chapter of their marital enterprise.

A second kind of situation is that in which the clients, or at least one of them, are willing to go on, but the counselor has some doubts of the efficacy of further counseling. It may be that one or both are repeating the same old complaints or making the same unreal demands, and apparently just using the counseling as an opportunity for unproductive self assertion. The counselor will of course “reflect” this back by asking appropriate questions, such as, “You’re still insisting that your wife must do what you want in this in spite of all your acceptance of her need to live according to her own conscience, and we have been into some of your background reasons for your attitude. How would you think I can help you further in this?” Or in the case of an incurably suspicious wife, “You still can’t accept his repeated assurances that he’s “playing the game” with you. How can I help you in further counseling?”

The counselor is not necessarily put off by such apparent “stalemate” situations, even when his efforts to find out why the client persists in such attitudes appear fruitless. He may be able to help the other partner to better ability to accept the unreal demands, complaints and suspicions without necessarily acceding to them, so that the partners may come better to “agree to differ” without the necessity of continued destructive and mutually distressing conflict. Time heals many things if given enough chance, and we may remind ourselves that many partners have a greater “vested interest” in staying together, even with constant quarreling, than they are ready to admit to the counselor or to each other.

A third kind of situation is that in which one partner seems to be suffering from a condition for which no treatment is likely to give any great relief. It may be that the counselor has a psychiatric report to the effect that the best that can be done is to keep the person under reasonable observation, with hospital or institutional care available if there is any “relapse” or other difficulty. People who are haunted by fixed delusions come into this category, and so do some of the psychopathic personalities. They may provide a difficult problem for the counselor, but he is often in a different situation from that of the professional psychotherapist. In dealing with the relationship rather than the intra-personal dynamics of the partners he may still be able to help some apparently “hopeless” cases to make a better job of ordinary living than he realizes, as long as either partner will cooperate with his efforts.

If the counselor allows himself to feel defeated in the face of apparently incurable psychic illness which is yet mild enough for a person to be able to live outside institutions he may deprive the sufferer of some valuable support which could make him easier to live with. He might also deprive the partner of the sick person of some greatly needed support and help in the difficult and distressing task of living with such a mentally ill person.

A counselor’s pessimism and defeatism will certainly be felt by the clients, who are then denied the uplift of spirit which would often make the difference between the success and failure of their courage and endurance. This may well be the last real opportunity such clients may have of receiving such a “spirit transfusion,” and it is one of the great strengths of good counseling that it often inspires one or both partners to face a grim and unpleasant reality after exploring all possible alternatives, and to achieve a courageous acceptance of an “incurable” partner as he is.

It is an interesting and gratifying fact of life that in some cases, when such an “impossible” partner comes to feel accepted as he is, without any more pressure on him to change, he may, by some strange perversity, begin to grow and to change. The greater their experience the more cautious marriage counselors will be in giving up hope for any marriage, and this optimistic attitude of mind will add much to their influence on their clients.

This may happen particularly in some less obviously “incurable” cases such as alcoholics, who provide their partners with many extra burdens. In most countries the most helpful organization known as “Alcoholics Anonymous” is available to help alcoholics of either sex to “stay sober,” and there are increasing clinical psychiatric facilities being developed to help them to discover and to deal with the underlying personality disorder. In most countries there is also an organization associated with “A.A.” in which the wives of alcoholics can receive much support and help in handling their difficult situations, and these bodies put out simple literature with suggestions from their experience. The partners of mentally ill people also need help of this kind, and it may be a valuable part of marriage counseling services to give such support and practical help to the partner in handling the problem so as to promote the most comfortable conditions for everyone including the children.

Keywords: Marriage, Marriage Counseling, Marital Relationship, Marital Disorder, Marital Conflict

After several interviews with one or both partners individually, some joint interviews, and possibly some referral to one or more consultants, the time may be ripe for a careful review of the situation with a view to deciding about the feasibility and value of further counseling.

Some counselors make it clear in their defining of the aims and methods of counseling in the early stages that they will give up to a certain number of interviews, and then will review the whole situation with the clients in this way. This has some value, firstly in making sure that the clients realize that their trouble may need more than one or two interviews, and secondly in making them aware that they cannot leave everything to the counselor and take little active part themselves.

In discussing the conditions which affect the decision for extended counseling and the possible ways and methods of conducting it we face a practical difficulty. Every case is essentially unique, and it is quite impossible to chart out the whole process of counseling. Even if a complete verbatim case record were taken from tape recordings it would not necessarily be of sufficient help in other cases, and it would take up much more space than would be justifiable in this book even if the author had access to any such tape recordings.

An attempt has been made so far to provide a reasonable account of the actual work of marriage counseling and to give summaries of portions of the discussion of some common problems, and we are now to consider some of the criteria and methods of extended counseling, to be decided at the time of reviewing the individual case after a reasonable amount of counseling. This can be attempted by considering some alternative situations.

Keywords: Marriage, Marriage Counseling, Marital Relationship, Marital Disorder, Marital Conflict

It is generally best for the counselor, at some appropriate opportunity in the discussion, to begin with a simple bit of information such as, “This seems to be a little outside my particular field, and I think you could be helped better in this by someone with special knowledge. How would you feel about letting me refer you for some special help in this part of the trouble?” If the client shows any hesitation about accepting the idea, he can be encouraged to verbalize his feelings on the matter, with the full acceptance of them by the counselor. When this is done the client will not be so likely to feel pushed around or rejected by the counselor, and the referral may then proceed more smoothly. It is generally much easier to negotiate a referral for the purpose of obtaining special help in a limited field (such as legal or gynecological) than in the deeper psychiatric field.

Any suggestion that either client may need psychiatric help may stir up hostility and defensiveness, especially when the partner has already said the same thing to him previously. It is unfortunate that such an idea of need for psychiatric help is still commonly regarded as a slur on a person’s character, and it is generally safer for the non-medical counselor to suggest the need for “medical help” which may be more readily accepted, and the doctor can easily recommend psychiatric help if he thinks fit. In any case it is best to refer anyone needing any kind of medical help in the first place to his own doctor.

What kinds of trouble might be referrable for psychiatric help through the client’s own doctor or some physician of his choice? In some cases the need is quite obvious. Completely irrational delusions, depression that shows any possible risk of suicidal tendencies, the over-enthusiasm that goes beyond reason and involves the risk of spending far too much or doing without sleep, which is characteristic of mania, the complete inappropriateness of feeling or action of the young schizophrenic, and any other kind of mental attitude or social behavior that may be harmful or obviously irrational. Any sexual problems which do not respond to simple counseling are also best referred in this way.

Some people show quite intense psychic symptoms such as deep moody depression at home, but seem to be able to carry on a responsible job and to get on reasonably well with their associates. In fact they can be natural and gracious with everyone else, but utterly ungracious with their marriage partner. This suggests some deep elements of hatred or jealousy, or morbid guilt, and such conditions may respond very well to more prolonged counseling. But if they do not seem to respond to some extent with the achievement of rapport they may be better referred, especially if the counselor has not had much experience.

Among the less obvious referrals we may think of the less seriously depressed people who may yet be greatly and quickly helped by special psychiatric treatment and are not helped by prolonged discussion, and the obsessed who are also more often harmed than helped by repeated discussion of their feelings and urges. We may also include the various forms and manifestations of psychopathic personality, already mentioned in the chapter on contributory factors in marital disorder. People with extreme and persistent anxiety, indecisiveness, phobias, and over concern with an incessant variety of symptoms may also be referrable when their troubles are getting in the way of marital cooperation, but it is not always necessary that neurotic trends should be dealt with unless the sufferer wishes to do something decisive about them. Neurotic elements in husband and wife may even balance one another well in marriage, to such an extent that any radical change in one of them may even injure the whole balance and bring unhappiness to both partners.

Finally among the psychiatric referrals we may include any case in which the counselor feels that in spite of the fact that a client’s statements are plausible, coherent, and sincere it is difficult to make adequate sense out of them, or possibly to decide whether there may be a delusional element in them. Such people and any which the counselor is unable to “sort out” are best referred. Anyone who develops undue dependence on the counselor should also be considered for referral.

There are some important ways in which any referral can be made most effective. It is important in the first place to give all the possibly relevant facts that are known about the client and his situation, but the counselor should be sparing about his opinions. It is also helpful to the consultant when the counselor states what has been so far attempted and with what result, and when he can give any other information about the client’s background and relationships.

The counselor should state in referring what is being requested from the counselor: appraisal for help in further counseling or further referral, or the total care and further treatment of the trouble by the consultant, with or without continuing participation by the counselor. It saves possible disappointment if the counselor does not “build up” the consultant by such remarks as “He will put you right in no time!” A simple statement that the consultant is regarded as the most suitable person from whom to seek this help is enough.

In many counseling agencies consultants have been of great help in many cases which do not necessarily involve referral of the client in person to them. They can often suggest a helpful line for the counselor to take in a discussion of the case on the telephone, which is often effective and less time consuming for the consultant. Discussions of this kind also help the consultants and counselors to come to know each other better and achieve better team work. They also provide a valuable alternative resource in cases in which the desired referral is either impracticable because of distance time or finance, or because of the unwillingness of the client to visit the consultant.

In the larger counseling agencies in some countries it has been found helpful and practical to have psychiatrists regularly visiting the counseling center for consulting purposes, and also for general supervision of the counseling work, including case conferences with the counselors and any trainees who may be invited. This again adds greatly to the total efficiency of the work and to the quality of the team work, and it will certainly become more and more the normal practice. Other types of consultant will also be brought into the visiting staff as occasion demands. This naturally makes for much smoother and more effective consultations, but it would only be practicable in counseling agencies of a reasonable size.

Keywords: Marriage, Marriage Counseling, Marital Relationship, Marital Disorder, Marital Conflict