Chapter 34. Couples and Family Therapy

Eva C. Ritvo, M.D.; Ilan Melnick, M.D.; Ira D. Glick, M.D.
DOI: 10.1176/appi.books.9781585623402.302891



"Research in many medical fields shows that families have powerful influences on health that are equal to or surpass other risk factors and that brief family interventions increase health and decrease the risk of relapse in chronic illnesses. Research in psychiatry affirms that family interventions reduce the rate of relapse, improve recovery, and increase family well-being."

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FIGURE 34–1. Genogram.In the sample genogram shown, an overall family map has been constructed to graphically describe the identified patient, identify the other members of the family (including age, gender, and relationship to identified patient) and where they live, and highlight important and/or stressful family events (here, "divorce" of both parents).
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TABLE 34–1. Characteristics of functional families
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TABLE 34–2. Outline for family evaluation
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TABLE 34–3. Strategies for beginning family therapy
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TABLE 34–4. Mediating goals of family therapy
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TABLE 34–5. Final goals of family therapy
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TABLE 34–6. Strategies for attaining mediating goals of family therapy
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TABLE 34–7. Guidelines for interviewing couples
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TABLE 34–8. Assessment of sexual problems
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TABLE 34–9. Mediating goals of couples therapy
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TABLE 34–10. Final goals of couples therapy
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TABLE 34–11. Therapist strategies in focused, active treatment of marital discord
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TABLE 34–12. Indications for sex and marital therapy
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Couples therapy can be defined as a format of intervention involving both members of a dyad in which the focus of intervention is the problematic interactional patterns of the couple. The focus of couples therapy is on the dyad and its intimate emotional and sexual aspects.

Family therapy is a psychotherapeutic intervention in which family members beyond the primary dyad are involved, including parents, children, and even extended family members, if they share in or are part of the pathology. The goal of family therapy is to assist the family in more successfully achieving their goals and establish gratifying ways of living and interacting as a family unit.

Family therapists need, and should use, an integrated model.

In this chapter we encourage the integration of a variety of techniques, depending on the particular problem and personalities of the family or couple.

Periods of dysfunction are inevitable in any long-term marital relationship. The clinician should always ask how having a child has changed the nature of the relationship.

The therapist must teach intimate communication (focusing on how to explore difficult issues and increase empathy).

Gender differences in needs and communication often make marital problems more complex.

The job of the therapist is to ascertain as well as possible the etiology of the problem and to choose the most effective therapy, whether medical, individual, or relational.

Individuals almost always have more interesting sexual lives than one imagines; they will be more likely to discuss them in individual sessions than with their spouse or partner present.

In general, when sex is not part of a marriage over a long period of time, the relationship has less vitality and life.

Prince and Jacobson's (1995)Prince and Jacobson's (1995) review suggested that medication plus marital therapy is better than individual therapy alone.

Our decisions about who should be treated and by whom depend more on the characteristics of the couple and how they function than on the particular diagnosis or problem area. The bias of the couple or individual must also be taken into account.

In general, a family secret should be disclosed if it is seriously affecting connections between people, poses danger to a family member (e.g., sexual abuse), or shapes family coalitions and alliances.

The therapist can collect and organize historical data through the use of a genogram, a three-generational family tree depicting the family's patterns regarding either specific problems or general family functioning.


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CME Activity

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Sample questions:
When offering couples therapy to a cohabiting rather than married couple, the therapist is advised to be informed of some of the characteristics of this type of coupled relationship. Which of the following statements concerning cohabiting couples is true?
Divorce is common in many societies, and management of divorce dynamics is a common charge for the couples therapist. Which of the following statements regarding divorce is false?
To further the goals of developing increased capacity for emotional experience and enhanced interpersonal skills, the couples therapist may use all of the following techniques except
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