ABSTRACT
Research addressing the interpersonal aspects of depression cites marital distress as a contributing factor in unremitting depressive episodes. Adam's illness held the psychotic aspects of Diane's personality and that of the couple, distancing her from her own "madness." A psychiatric diagnosis is a powerful message, however, and may overshadow the need for the couple to also focus on themselves as a couple. Although couple therapists frequently encounter evidence of addiction and mood disorders in one or both partners engaged in couple treatment, severe mental health issues other than character disturbances have received limited focus in the analytic literature. The therapist must maintain a dual focus, examining the couple dynamic while keeping in mind the individual meaning and management of the illness. To lose track of either focal point compromises the treatment, as a destructive couple dynamic will exacerbate the illness or the illness itself can defeat the couple treatment.
