Conflicts in marriage frequently come about because of disagreements having to do with the couple's rules for living together, especially regarding how each is to treat the other. Who sets the rules is often another area of conflict, as are incompatible rules. For example, a wife insists that her husband stop being a "mama's boy" and demeans him for being dominated by a woman; yet it is she who seeks to dominate her husband by insisting that he be more domineering.
In marriage therapy (and also in family therapy), therapists encounter a great deal of resistance to change on the part of their clients. (Alas, so do all other therapists!) A main reason for resistance is that, in a marital relationship or family system, change in one member's feelings and behavior will tend to affect another's, often in unsuspected ways. Change disturbs the established balance of their system, a balance that does serve some purposes.
Jane Dowland, for example, went to see Dr. Carlton because of her husband's depression. Phil had lost his job and now spent most of his time at home, feeling sorry for himself and collecting unemployment benefits. Jane was easily upset and felt terribly insecure. Dr. Carlton recommended that Phil accompany Jane to the next session. After seeing Phil, Dr. Carlton referred him to a psychiatrist, who was able to treat Phil's depression effectively in four months' time with medication. Jane, however, continued to feel severely (and perhaps even more) anxious, although Phil's symptoms were now under control and he was back at work.
Dr. Carlton recommended marriage therapy to Jane and Phil. They saw Dr. Carlton once a week for three months. It became clear to Dr. Carlton, and eventually clear to Jane, that without realizing it she had used Phil's depression as an excuse for her own anxiety so that she could evade responsibility for herself. She came to realize that she had been unable to resolve her own conflicting needs—whether to have children in spite of Phil's disinterest in children or whether to commit herself to developing a career.
Treating Phil's depression led Jane to become aware of her own problems. The balance in their relationship was changed by therapy: Jane found out that Phil's depression was really a problem that served a purpose for her—without it, she needed help for herself.
Because of the complex, interwoven nature of a marital relationship, it is often difficult to separate the problems each partner may experience. One partner's symptoms may mask the other's problem. Or, one person's problem may be perpetuated by the other's behavior, interfering with the resolution of the problem. Further, each partner may encourage distress in the other as a result of differing expectations concerning rules of living together and who sets them.
FAMILY THERAPY
In family therapy, the "identified patient" is seen as but a symptom, and the system itself (the family) is viewed as the client.
Vincent D. Foley, Current Psychotherapies
Very often, one family member is labeled the one with the problem, the one who is "sick." When the family decides to enter therapy, it is usual for family members to feel troubled, scared, and confused. They realize that something is wrong, but they are uncertain about what is amiss and don't know what to do. The usual response to this perplexity is to push the "identified patient" forward—usually a child who is "the problem"—and try to make him or her the focus of treatment.