MARITAL THERAPY

TYPES, INDICATION, MOTIVATION, AND APPROACH

Presentan : Rozi Yuliandi
Narasumber: dr. Lies Kandou, SpKJ(K)
 MARITAL (COUPLES) THERAPY
• A form of psychotherapy designed to psychologically
modify the interaction of two persons who are in conflict
with each other over one parameter or a variety of
parameters (social, emotional, sexual, or economic).
• 12-20 sessions  psychodynamic approach may take more
sessions
 TYPES OF THERAPIES
• Individual Therapy
• Individual Couples Therapy
• Conjoint Therapy
• Group Psychotherapy
• Combined Therapy
 INDIVIDUAL THERAPY

• The partners may consult different therapies, who do

not communicate or know each other.
• The goal of treatment: to strengthen each partner’s
adaptive capacities.
• At times, only one of the partners is in treatment.
• It is helpful for the person who is not in treatment to visit
the therapist  may give data to therapist: anxiety,
irrational beliefs, conscious/unconscious attempts by
partner to sabotage treatment.
 INDIVIDUAL COUPLES THERAPY

• Each partner is in therapy:

• Concurrent with the same therapist, or
• Collaborative : each partner seeing a different therapist
 CONJOINT THERAPY
• The most common treatment method in couples
therapy
• Either one or two therapists treat the partners in joint
sessions.
• The advantage : focuses the therapeutic efforts directly on
the couple’s interactions where the problems manifest.
• Therapist : can observe the marital interactional patterns,
contradictions between overt and covert messages, and
subtle reinforcements of coercive behaviors.
Limitation : include impending divorce, in which the issues
confronting the spouses may be radically different, or
situations in which the couples have different therapeutic
goals.
 GROUP PSYCHOTHERAPY
• Allows a variety of group dynamics to affect the participants.
• Consists of 3-4 couples and 1-2 therapists.
• The couples identify with one another and recognizes that others
have similar problems.
• Each gains support and empathy from fellow group members of
the same or opposite sex.
• Couples explore sexual attitudes and have an opportunity to gain
new information from their peer groups, and each receives
specific feedback about his or her behavior (negative of positive)
 may have more meaning and be better assimilated coming
from a neutral, non spouse member than from the spouse or the
therapist.
 COMBINED THERAPY
• Refers to all or any of the proceeding techniques used
concurrently or in combination.
• A particular patient-couple may begin treatment with one or
both partners in individual psychotherapy, continue in conjoint
therapy with the partner, and terminate therapy after a course
of treatment in a married couples group.
• The rationale is: no single approach to marital problems has
been shown to be superior to another.
• A familiarity with a variety of approaches thus allows therapists a
flexibility that provides maximal benefit for couples in distress.
 INDICATIONS
• Problems in communication between partners  prime
indication.
• When individual therapy has failed to resolve the relationship
difficulties
• When the onset of distress in one or both partners is clearly a
relational problem
• When couples therapy is requested by a couple in conflict.
• Conflicts in one or several areas (such as the partner’s sexual life).
• Difficulty in establishing satisfactory social, economic, parental, or
emotional roles.
 CONTRAINDICATIONS
• When a pairing defense is so strong that both partners recoil at
the suggestion of couple therapy
• When the level of motivation is unequal or deceptive
• One or both partners really want to divorce.
• One spouse refuses to participate because of anxiety or fear
• Couple has an active relationship with someone other than the
partner—extramarital affairs
• The threat of domestic violence, history of physical abuse.
• Patients with severe forms of psychosis
 MOTIVATION
• Important to assess since the beginning and along
therapy sessions
• Assessing conflict of interest (conscious and
unconscious) that will affect therapeutic situation
• Bring the clients to understanding and clarifying both
their conscious and unconscious  increase motivation
in marital therapy
 MOTIVATION
• The primary determinant for a marital therapy is the
therapist’s awareness about motivational issue, detailed
variables analysis, also strong will and firm basic in
conducting treatment
• Find and deal with the barrier early, understand client’s
expectation to determine the appropriate approach
and focus to the issue
• Clarify to ensure the therapeutic contract with client
 MOTIVATION
1. Looking for a caretaker: seek for help due to pressures
from marriage, seek for a caring figure
2. Expiating guilt: because of leaving the marriage or having
an affair
3. Looking for an ally: sense of helplessness in front of partner
4. Looking for re-entry: ‘I am sick’ or ‘neurotic’ to get back
into marriage
 MOTIVATION
5. Response to an ultimatum
6. Avoidance of self-observation: avoidance for individual
therapy
7. Blaming the spouses: an opportunity to act out hatred and
rage
8. Being declared innocent: ‘I am not guilty’
9. Marital therapy as a career: an adjunct in marriage life, a
program, not necessarily being troubled
 FACTORS INFLUENCING
MOTIVATION

Difficulties in marriage:
• Aware about problem  sense of inability to deal with 
therapist is a possible help
• Chronicity, partner’s character, culture value for help-
seeking behavior
Sex
• Sexual dysfunction  highly motivated
• Fear for sex (conscious or unconscious)  decrease
motivation
• Restitutive  marriage reparation by compensation
 FACTORS INFLUENCING
MOTIVATION
• Anger
• Magnitude of anger and how to deal with it
• Rage and chronic anger  corrosive thus decreasing
motivation
• Unable to express anger  low motivation results in
premature termination
• Malignant force
• Extramarital interest
• Psychiatric disturbance  undiagnosed disorder
 APPROACHES
• Psychodynamic approach
• Systemic approach
• Behavioral approach
 PSYCHODYNAMIC APPROACH
• Attributes problems within a marriage to the unresolved conflicts
and needs of each spouse.
• Problems in a marriage are thought to be the result of the
unresolved conflicts and needs of each of the partners
• Each client’s personal history and underlying motivations 
central to this mode of therapy.
• Therapists apply the principles of psychoanalysis.
 SYSTEMS APPROACH
• Based on the idea that most marital problems result from the
interaction between the partners, rather than from their personal
histories.
• The roles each person plays in the marriage, as exemplified by
the behavior and communication patterns they exhibit, are
examined and analyzed.
• Although initially it may seem that only one member of a family
system is troubled, on closer inspection his or her difficulties are
often found to be symptomatic of an unhealthy pattern in which
another members play of an active part.
 BEHAVIORAL APPROACH

• Marital problems are treated as dysfunctional behaviors that can

be observed or modified.
• Couples are made aware of destructive behavior patterns, often
by systematically recording their behavior until certain patterns
emerge.
• The therapist then coaches them in various modifying strategies
with the goal of achieving positive, mutually reinforcing
interactions.
 BEHAVIORAL APPROACH
• Using the partner’s strengths to bring about positive change in
the relationship.
• Asking each partner to keep a journal, detailing things that
happened between sessions that the partner wanted to
continue to have happen.
• Inviting clients to discuss how the problems within the
marriage have influenced their lives.
• Asking partners to rate their subjective experiences on a
rating scale of 1-10, rather than using inadequate descriptors
such as “always”, “never”, or “slightly”.
• Help build a strategy for improvement based on resources
already available to the person.
THANK YOU