Step 1: Study the Fight: Implementing the Five-Step Model
Over 40% of mental health referrals involve a marital problem (Budman & Gurman, 1988), yet, curiously, we often do not seem able, or willing, to treat those couples. Each outpatient department appears to have either one or no couple specialist. We have some books to read, a conference here or there to attend, but little outcome or process data to rely upon and few unified systems of couple therapy to follow. The administrative hurdles to arrange for the therapist and the pair to meet regularly, at the same time and place, can loom large. Medical insurance may require gerrymandering to support the treatment as well, but I think the real reasons that clinicians shy away from couple therapy lie elsewhere. Oedipal inhibitions about prying into someone else’s marital and sexual relationship may well visit unconscious conflict upon the clinician, and many therapists also find it difficult to sort out and to maintain an alliance with two warring parties simultaneously.