The challenges that marriages in the present day face have increased there has been a gradual change in the family setup accompanied by family breakups and hence a great majority of people entering into marriage come in with various social problems (Berg & de Shazer, 1993).Even for those couples that had a stable childhood problems often crop up in marriages due to the different personalities and temperaments of the people that enter into the marriage. Marriage counseling is hence a very important component of psychology as it helps couples to get to the root cause of their problem and hopefully get solutions. Since the problems that married couples experience are due to their socio cultural differences and at times disorders in one of the partners the marriage counselor must examine the critical issues affecting the marriage to be able to give the couple effective guidance so that they can be able to come up solutions to their problems (Connie & Metcalf, 2009).This paper will therefore look at the assessment, diagnosis and treatment to a couple that is going through marriage problems.
Robert and Sophia is a couple in their early 30's and have been married for five years. The parents of Robert moved to the U.S. from Germany when he was 15 years old and Robert being an only child he often felt very isolated during high school and college. Sophia on the other hand is from a large Italian family that has been living in the U.S. for several generations. Sophia was abused by an uncle as a child, but was too afraid and ashamed to tell anyone and has never brought a closure to that abuse to date. Both Robert and Sophia work long hours at their demanding jobs, and often they feel exhausted and stressed at the end of the day. Typically, they drink a bottle or two of wine with dinner, and end up often arguing about the amount of time Sophia spends with her family, Robert's frequent business trips out of town, or when they should start to have children.
The turning point in their relationship came three weeks ago when Sophia discovered that Robert had an affair with a co-worker the previous summer. Robert however refuses to discuss this and only says that it was "a mistake." Robert admits he has felt unhappy in the marriage and depressed for over two years, but he does not think talking about it will help. Sophia feels betrayed and furious. For the past week she has been unable to concentrate at work, can't sleep, and feels irritable much of the time. She pleads with Robert to tell her what he needs, but he is silent and withdrawn. His drinking has increased and he is becoming more depressed. Sophia has been going through Robert's computer and mail when he is not at home, and she discovered current messages he had written to another women describing his hopeless feelings about the marriage and thoughts of suicide. Two nights ago Sophia confronted Robert with this correspondence, and she became so angry that she threw a glass at him, which shattered and cut his arm. This incident frightened them both, and they have decided to get marriage counseling.
The above is an example of a marriage that is at the verge of breakup due to accumulation of many issues that have remained unresolved for many years. The marriage therapist will need to clearly understand the issues that underline the behaviors of the couple to be able to decide on the theoretical approach to apply and help the couple. The therapy that will most probably work for them is a solution focused therapy since it will concentrate on the strengths to try and come up with a solution to their marital conflict. The psychotherapeutic change can be achieved through the Solution-Focused Therapy (Black, 2013).
The solution focused therapy is more proactive in its approach.it lays its focus on offering solutions instead of dwelling on old problematic ways of understanding or suffering due to old conflicts. It encourages the parties involved to stretch out more out to each other in their day to day interactions in an effort to get a solution. It also encourages the conflicting parties to enjoy their own unique opinions, values and attitudes and hence be able to celebrate and not hide their differences. They must also create new meanings and new ways of analyzing their old problems (Smith,2012).Under solution focused therapy the therapist must guide the couple to clarify what they feel that the problem is, the therapist should also be able to identify and respect the client’s opinion on what the problem is and the clients should be able to state how they feel the therapy will help them( Smith, 2012).In the course of therapy Sophia and Robert are encouraged to explain how they feel the therapy will help resolve the issues in their marriage. They will be guided so as to express their views on what they feel the issues undermining their marriage are. If they fail to concretely present their expected outcomes the therapist is allowed to ask leading questions that will guide their thoughts towards identifying the problem and suggesting possible solutions. Some of such a question would be “what would you wish your spouse did differently” or “If the issue between you and your partner was resolved would the two of you relate differently” These questions will help in the couple identifying the problems and also suggesting possible solutions.
The socio cultural Factors
Once together with the therapist the couple has identified their common goals the therapist can then go ahead and make use of the genogram. Genogram refers to a family tree and a deeper look at it gives the therapist a visual picture of the socio cultural environments of the clients and he can then relate them to their current behavioral manifestations(Connie & Metcalf, 2009).Robert grew up an only child and was generally a loner through high school and college. He does not attach much importance to spending time with family members. On the other hand Sophia grew up in a large family and they were close hence she is still drawn to go and spend time with them. By exploring the cultural norms the therapist will lead Robert to understand and appreciate why Sophia values spending time with her family. The therapist will congratulate and praise the couple for their bold step of seeking as this will be their common strength. When the couple share a common strength then the outcomes of the therapy are more likely to be positive(Morrison, 2014 ).The counselor should explore as many common strengths of the couple as possible. The counselor should also do extensive research in order to understand the exhibited behavior in the clients and how to remedy it.This include research on how to tackle the unresolved rape issue of Sophia, the elements of her Italian culture that may be in conflict with Roberts German culture among other issues. When the couple’s ideology differ from that of the therapist the therapist should maintain a neutral and calm approach and at all times uphold professionalism (Connie & Metcalf, 2009).For example on the sensitive issue of infidelity the therapist should allow Robert to express his opinion on the subject of infidelity and also explain why he had an affair if he admits but if he goes ahead to justify his behavior the therapist should not interject but let him be. Once he is done then the therapist can explain to him the professional take on issues of infidelity.
Ethical issues.
The counselor should also maintain outmost confidentiality of the information given to him by the couple. In case any disclosure is needed preferably it must be done with the client’s consent and the client should be protected from harm (Berg & de Shazer, 1993 ).During the therapy when a need arises for individualized sessions the couple needs to be reassured that there will be no secrets between them and hence outmost transparency must be maintained. The therapist should make the couple identify that they bear the full responsibility of making decisions that will determine the future of their marriage. He should also be sensitive to the cultural differences between the two and implore onto the couple to embrace cultural diversity and be more culturally sensitive and accommodative. The therapist’s role is to provide professional education to the couple and also expose them to the consequences and benefits of their decisions on their marriage and at no time should he persuade them to adopt his opinions (Morrison, 2014).
Before counseling can commence a comprehensive assessment should be carried out to determine the disorder that the client could be suffering from (Smith, 2012).Sophia will be examined for depression that has made it hard for her to concentrate at work, feel irritable and lack sleep. She has also shown emotional outburst .DSM-5 module will be used (Black, 2013). Robert will be examined for anxiety disorder putting into account his long periods of isolation while growing up. This will be done by administering the Beck Anxiety Inventory (BAI).He also presents with a severe case of depression and this is manifested in the feeling of hopelessness in marriage and suicide thoughts that he had expressed in his e-mails. This is determined using the Diagnostic Inventory for Depression (DID).He could also be an alcoholic and this is due to his deteriorating drinking habit. This is established by use of the Michigan Alcoholism Screening Test (McGee et al, 2005).
Treatment Plan
Problems between couples are usually due to an accumulation of unresolved issues some major others minor and hence they should be handled systematically. There are no quick fixes to marital problems (Gurman, 2008).Due to the complexity of the issues between this couple a ten week couple counseling session and four months of individualized session will be applied. The immediate goal is to improve communication between the couple and in the long run save the marriage from ending in a divorce. The issues that the couple hold in common such as Sophia’s preference to spend a lot of time with her family, time to begin a family and Robert’s infidelity can be handled during the joint sessions while the emotional issues of each of them such as the depression and suicide thoughts in Robert can be handled during the individualized sessions. The couple will also be encouraged to develop coping mechanism by asking them coping questions (Eriksen & Kress, 2006).The therapist should also check if the couple is making progress by asking questions such as “How have things changed between you two since the last session?” The suggestions that the therapists offer should be geared towards making the relationship take a healthy turn for the parties involved( Connie & Metcalf, 2009 ).Treatment is important because it helps the couple to accommodate each other and this improves communication between them and strengthen their relationship hence achieve their marital goal. In conclusion if the therapy does not resolve the issues between the couple then the therapist can refer the couple to another professional and if successful he should encourage the couple to come back for follow up therapy that is important in healing their broken marriage.
References
Berg, I. K., & de Shazer, S. (1993). Making numbers talk: Language in therapy. In S. Friedman (Ed.), The new language of change: Constructive collaboration in psychotherapy. New York: Guilford.
Black, D. W. (2013). DSM-5. American Psychiatric Publishing.
Connie, E., & Metcalf, L. (2009). The art of solution focused therapy. New York: Springer.
Eriksen, K., & Kress, V. (2006). The DSM and the professional counseling identity: Bridging the gap. Journal of Mental Health Counseling, 28, 202–217.
Gurman, A. S. (2008). Clinical handbook of couple therapy. New York: Guilford Press.
McGee, D., Del Vinto, A., & Bavelas, J. (2005). An interactional model of questions as therapeutic interventions. Journal of Marital and Family Therapy, 31, 371-384.
Morrison, J. R. (2014). DSM-5 made easy: The clinician's guide to diagnosis.
Smith, T. A. (2012). Revolutionizing diagnosis & treatment using DSM-5. Workshop presented at CMI Education Institute, Newport News Marriott, and Newport News, VA.
