In response to my recent post on saving relationships, the superb blogger Life in a Bind asked several questions about a therapist’s attitude toward marital problems:

As a therapist, did you find it hard not to give your view on a relationship; did you find yourself wanting someone to leave, or to stay, but being unable to say so? Did your clients reach different conclusions to the ones you were expecting or thought would be best for them? Were you frustrated if progress was so slow because your work together was undermined by a difficult relationship or lack of support outside therapy? And how do you deal with a situation where the party in therapy inevitably has more insight and self-awareness than the partner who is not, and so the entire task of resolution feels as though it is upon their shoulders? Particularly if they are the one who is ‘mentally ill’ and therefore the one ‘with the problem’?

I’ll try to answer those questions today.

Therapists certainly have opinions about a patient’s description of his or her marriage and much else. We attempt not to be judgmental, but are not indifferent to whether the reported relationship is “working.” Frank advice to stay or leave, however, is rare. Why?

• You are a therapist, not a fortune-teller. You cannot predict precisely where the chosen path will end.
• Major changes are the client’s responsibility to make. The counselor’s job is to empower the patient, not to lead him.
• The decision to end a relationship, especially in a home with children, is like walking through a pottery store and knocking over a precious vase. If you break it, you own it. The spouse who leaves will be held responsible for whatever follows from the divorce. Since severing family ties is difficult, he risks being blamed for anything that goes wrong, whether the finger-pointing is fair or not. Disapproval can come not only from the mate, but children, parents, and other relatives. Friends, too, may express or act out their unhappiness at the decision. No therapist is able to anticipate the reactions of all the people unsettled by a relationship’s end.
• One of the potential consequences of ending a marriage is regret by the individual who chooses to do so. As a rule I tried not to discourage patients from making every effort to save the union. To suggest a preemptive end (short of one coming in an abusive marriage) might leave the one who files for divorce saying “I should have tried harder” at some later time.

All that said, the counselor may still believe his patient would benefit from leaving the marriage. Yet, he must remind himself that he doesn’t know the spouse or have an unbiased description of life in the home. Were he to meet with the partner once, he still obtains only a snapshot of what is going on in the family. On the other hand, if the counselor were to attempt marital therapy, he leaves his patient without a therapist exclusive to himself.

While such efforts can sometimes produce a good result, they are complex and avoided by more than a few in the professional community because of the complexity. The spouse who has agreed to marital therapy with the patient’s therapist might question whether the doctor remains aligned with his long-time client. A new goal of treatment, to save the union, alters any continuing individual sessions.

Life in a Bind wants to know if the marital relationship turmoil can frustrate the treatment and the treater. Without question. Freud, in fact, attempted to discourage the people he analyzed from making any big changes during the course of therapy, the better to simplify the process and keep his patients on target to unravel their early life knots. Life happens, however. All sorts of external events might impede the patient’s progress: job losses, illness to the patient or his loved ones, and work-related moves, to name only three. The doctor’s task is to enable the client to stay afloat in difficult moments: if possible, to use those changes, misfortunes, and hurdles to grow in resilience and insight. The counselor learns to keep a therapeutic distance and manage his own personal frustrations.

As Life in a Bind suggests in her questions, client’s decisions are not always in line with what a therapist might think ideal. Doctors can inadvertently betray their own biases. Once again, we are dealing with someone else’s life. An experienced therapist comes to terms with this. He is not a god or a tarot card reader.

The counselor might well, however, ask simple questions of a person in relationship distress or considering divorce. For example:

• Do you still love your mate?
• What are the positives and negatives of the relationship?
• Why have you stayed until now? The latter question may evoke reasons to continue to stay or fears of ending things.
• What would be the positives and negatives of a separation or divorce?
• Are you prepared to take on the job of ending the marriage? What do you think that might be like? Have you talked to others who have been through it?

Finally, a look at Life in a Bind‘s last two questions:

And how do you deal with a situation where the party in therapy inevitably has more insight and self-awareness than the partner who is not, and so the entire task of resolution feels as though it is upon their shoulders? Particularly if they are the one who is ‘mentally ill’ and therefore the one ‘with the problem’?

First, the “identified patient” is sometimes the most insightful partner within the marriage. He or she can be a thoughtful, if unhappy person, who wants more out of the conjugal contract than the spouse who finds the current terms of the marriage tolerable. The latter might be obtuse, insensitive to the companion’s feelings, and domineering, even if he is perhaps more functional and not as troubled as his mate.

An important step in the treatment of the “identified patient” is for him to become able to shrug off the status of being a “second class citizen” or “damaged goods.” He must not, because of this “label,” accept the invalidation of his every thought and feeling. This does not mean he is permitted to inflict his dysfunction on the family, but rather to recognize he is not the only one who needs to work on himself and try to establish “a more perfect union.”

In the long-term, unless the partner Life in a Bind describes becomes enlightened, the marriage’s continuance may depend on the acceptance by the sole person in individual therapy of his or her discontent: in other words, a willingness to bear the largest part of the psychological weight of family life. While 50/50 sharing of the stress of home life is a goal impossible even to define, the sacrifice of oneself to a spouse’s vision of an acceptable marriage is a step toward personal unhappiness.

Were individual dissatisfaction the only concern, everything else being equal, a decision about continuing a relationship would be simplified. But, as they say, everything else is never equal.

If only it were.

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The top image is called “No Escape.” It is the work of Judith Carlin and comes from Wikimedia Commons.