Marital Therapy

Indications and Contraindications for

Couples Therapy

w. Robert Beavers, M.D .*

Couples therapy may be defined as a strategy of psychotherapeutic

treatment that arranges to intervene in a committed couple's relationship.
Such a couple may be of the same sex or heterosexual, formally married or
living together; in any case, one or both have requested professional help .
The origins of this approach in psychiatry predate the development of
a systems orientation; with emotional illness then assumed to be simply an
individual phenomenon, one member of a couple would be defined by both
partners and by the therapist as ill, and the therapist would enlist the
cooperation of the partner in treating him or her.
Meanwhile, in the broader field of human relations , psychologists,
social workers, and ministers were frequently asked to do "marriage
counseling" with couples who viewed themselves as healthy but unhappy.
Experiencing problems in the bittersweet coil of an ongoing commitment,
these people sought help beyond that which might be available from family
and friends, bartenders and hairdressers.
The relatively recent development of family therapy as a body of theory
and practice has resulted in a more complex orientation to marital therapy.
The "identified patient" is redefined as a marker signaling trouble in family
attitudes and patterns. A psychotherapist can then select the family inter-
vention strategy that seems most likely to effectively alter these patterns ,
whether by seeing one person, the couple, the whole family, or by using
several of these approaches sequentially. In other words, all psychotherapy
can be viewed as family systems intervention, 3 and the choice of which
family members one sees is a most significant decision.
Any or all of these approaches (identified patient, counseling, and
interactional patterns and processes) can be used with different couples or
with the same couple at different times, depending on the problems they
present. One of the advantages of a systems view is its inherent flexibility ,
linking intervention strategies to types of problems and thus freeing
therapists (and clients) from "cookbook" methods. In most treatment
settings, the psychoanalyst analyzes, the organically oriented physician
*Clinical Professor of Psychiatry, University of Texas Health Science Center; Executive
Director, Southwest Family Institute, Dallas, Texas

Psychiatric Clinics of North America-Vol. 5, No.3, December 1982 469