The Disordered Couple

By Berger, Joseph | American Journal of Psychotherapy, Summer 1999 | Go to article overview
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The Disordered Couple

Berger, Joseph, American Journal of Psychotherapy

JON CARLSON, Psy.D., ED.D. AND LEN SPE.RRY, M.D., PH.D., EDS.: The Disordered Couple. Brunner/Mazel, New York, 1998, 342 pp., $38.95, ISBN 0-87630815-9.

The original contribution of this book is that it focuses on couples where one or both partners has a diagnosable Axis 1 or Axis 2 DSM IV disorder.

The sixteen chapters in this book mostly follow a standard format. They begin with a theoretical background reminding us of the diagnostic criteria for the condition(s) being discussed in the chapter. Then, there is a review of the psychological factors that may have brought these two people together, the marriages they make, and the problems that emerge. An approach to treatment is presented, and most chapters conclude with a case illustration.

In situations where one partner has a prominent Axis 1 disorder, even though both partners are seen as a couple, the emphasis seems to be on helping and supporting that person who is usually clearly identified as "the patient." But where one or both partners have an Axis 2 personality disorder, there is less emphasis on the diagnosis of one or both individuals. Instead, more prominence is given to the personality characteristics and deficiencies that led to them becoming a couple in the first place, understanding how their problems arose during the marriage, and helping repair some of the deficiencies so that life can become more livable for them.

The quality of the chapters varies considerably.

In "Panic Disorder and Agoraphobia," Carter and Schultz offer a cognitivebehavioral (CBT) approach that appears very superficial and never seems to get to grips with the real issues.

They tell us about a young man who first experienced a major anxiety attack while smoking marijuana, just after finding out that his parents had separated. Although the history indicates a recurrent theme of anxiety attacks that occur

at times of incidents that resemble a maternal abandonment, the authors appear to have made no effort to help the patient make that important connection.

Freeman and Oster outline a more detailed CBT treatment in their chapter on relationships. Though there are a number of useful clinical insights, there are also some techniques that may be unhelpful, manipulative, or demeaning.

In an unusual chapter, Dimitroff and Hoekstra remind therapists that the religious values and practices of patients must be respected. But they make a statement at the end of their chapter that may stir up again those concerns that had been voiced in the past about therapists imposing their own religious or antireligious ideologies on their patients.

Harman, Waldo and Johnson emphasize that in helping couples with sexual problems communication appears to be the key element. It is surprising that 30 years after Kohut the self-psychologists still seem to have the need to explain the whole theoretical basis of self-psychology.

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