The special assets and problems of doctors in marriage counseling

By setting themselves up in private practice or accepting salaried positions in institutions and public services, doctors undertake to help those who come under their care in general or limited fields to the extent of at least reasonable competence. Apart from their actual medical responsibilities they are expected as educated, trained and respected citizens to exert a positive influence in the community.

Whatever their ideas about marriage counseling it is as true of doctors as of ministers that they cannot avoid contact with marital disorders, or the social and professional obligation to do what they can to help in their resolution.

Many marital disorders come direct to a doctor in the first place, because the partners find him most easily accessible, and regard him as the most logical person from whom to seek advice and help. It may be a direct marital squabble which is distressing one or both to the point at which they feel the need of medical help, or even someone to talk to about it. It may go further, and one partner who has been attacked may come or be brought to a doctor for attention, or for the recording of cuts and bruises for possible litigation later. It may be that one or both partners are seeking help and advice with regard to some kind of sexual dissatisfaction or difficulty, or some apparent abnormality. A special example of this is when a wife returns home after giving birth to her first or a subsequent baby and finds herself indifferent to the sexual relationship with her husband, who has patiently waited through the final months of her pregnancy for it.

Other direct points of medical contact with marital disorders may be for such questions as family planning, especially at the time of marriage and after the first or a subsequent child, and in some cases there are differences and conflicts about this. Or there may be direct quarrels about the management of children and the doctor may be appealed to as an “umpire.” Or again there may be deep and growing suspicions by one partner about the fidelity of the other, and the doctor may be appealed to either for help in standing up to such threats, or for moral support when there seems nobody else to talk to.

There are also many indirect ways in which a doctor may come into contact with a marital conflict. Especially if the doctor is young and not well established people will often hesitate about telling him directly of their marital troubles, but may come ostensibly for help with some apparently unrelated symptom which arises from the marital disorder. For example the complaint may be of tiredness, nervousness, lack of sleep, restlessness, and the desire for a tonic, or some such nervous symptom. Or it may show itself as a “psychosomatic disorder,” such as indigestion, colitis, asthma, migraine, or certain kinds of dermatitis. In women there may be some gynecological symptom.

In more severe or prolonged cases the presenting problem may be some neurotic or even apparently psychotic manifestation, which may even reach the point of attempted suicide, either from despair or as an attempt to “punish” the partner. Of course marital disorder is not one of the fundamental causative factors of such mental illness, but it may well prove to be an influential precipitating factor, or may greatly intensify such troubles or hinder their recovery. As such it comes right into the field of medical practice.

A still less direct, but very important method of medical contact with marital disorder, may come through a third person, particularly through some trouble affecting one or more of the children. Poor health in a child without any obvious reason may open up inquiries by the doctor about the domestic atmosphere, particularly if the child is becoming increasingly nervous or “difficult.” The situation between the parents may be revealed on the other hand when a child or adolescent shows some consequence of parental neglect or mismanagement, such as when a teen-age girl is brought to the doctor for a premarital pregnancy, or a boy finds himself with prospective paternal responsibilities without benefit of marriage. Or a teenage boy or girl may have been the cause of a serious or fatal accident because of some careless and irresponsible escapade. There are all kinds of different ways in which the doctor may come into contact with marital disorder if he is awake to the possibility and ready to look into underlying causes.

It still happens all too frequently that a doctor faced with one or more of the symptoms or indirect consequences of marital disorder tends to leave the underlying causes untouched and to tell his patient that the trouble is with his “nerves” or that he “can’t find anything physically wrong.” Such a statement should be the beginning of positive investigation and therapy and not the end of it, and many opportunities of helping married people in troubles at a stage at which they are quite open to help are missed. With more general awareness of the influence of marital disorders on physical and emotional troubles, and more realization of the “curability” of many such marital disorders, this medical responsibility will be more often and more worthily fulfilled.

At this point it might be stated that there are many indications that a reasonable training in marriage counseling will not only improve the doctor’s handling of marital disorders, but will make a very great difference to the whole of his handling of people, in whatever department of medicine his work and interest may lie.

Tags: Counseling