The Behavioral Conundrum

The definition of therapy is a form of treatment of a disorder of some kind. It is the type of rehabilitation or adjustment through the process of healing. In our effort to fix what we feel to be issues or problems, we seek out therapy. Life, after all can be quite difficult and we want to know why. It is this awareness of the complexity and intricacy of life that pushes us to seek out help from a psychologist or therapist in the hopes of a remedy being prescribed. Much of therapy can be reasoned to be a desire to change an aspect of one's behavior or rather, mindfulness. It becomes even more of an interesting phenomenon when couples are brought into the discussion as two individuals rather than one are seeking to find answers to the behavioral conundrum.

Cigolla and Brown (2011) reasoned that our interest in mindfulness has increased substantially over the last two decades. The description of mindfulness is one's awareness of what is occurring in the particular moment. In essence, the conscious attention to one's present experience. One may seek out a therapist to understand this mindfulness. Argumentation has been made that in one's seeking out a therapist, that it is this mindfulness is an "encompassing and underlying [quality that a] therapist does. Qualities such as empathy, understanding, warmth and acceptance have been identified by clients as some of the most important [elements] of the relationship" (pg.709-710) between them a psychologist and/or therapist. Hence, individual therapy or even dialectical behavior therapy is more so for an individual to have the goal to learn to tolerate who they are. In contrast, marital therapy is an alliance between the couple rather than the individual and the therapist. There is an "agreement on goals and targets of change while in therapy. Both clients must [adhere] to the therapist's respective role" (Bartle-Haring et al.., 2013, pg.80). In other words, marital therapy differs from individual therapy in that an added component has entered the proverbial psychological equation and thus, the goals are different.

Another difference that has often been a common discussion in literature is the gender of the therapist. This takes on a different connotation in marital therapy as opposed to individual therapy. Where individuals do not mind the gender of the psychologist or therapist, Bartle-Haring et al. (2013) found that the degree of therapeutic change that happened in marital couples was determined often by the gender of the therapist. There was in effect, an influential dynamic at play. In two particular studies, there was reason to believe that women were more emotionally invested in marital therapy than men depending upon the gender of the therapist, while individual therapy did not have much of an effect. Data was further compounded by the interactions that took place within the therapeutic sessions (pg. 82). While those were two separate studies, it does beg the question as to how goals for treatment are decided and addressed in martial therapy versus individual therapy if there is a gender element driving the two different therapies.

Wolska (2011) stated that the central challenge for all therapists in marital therapy is understanding ways in which to improve relations between them given the arguments that often bring the couple to therapy. The therapist must unravel the marriage games, which in itself requires significant attention, as well as remaining neutral. Psychologists "involved in marital/couples therapy probably agree that these are the most difficult forms of therapy mainly because of the risk of" (pg.57) siding with one or the other. Whereas, with individual therapy, it is solely the individual and the psychologist/therapist, therefore there is no potential for appearing to take sides.

Wolska (2011) continued in discussion of addressing and deciding treatment by stating that prior to proposing any kind of treatment that consideration must be given to both parties in what they hope to attain from therapy. The usual objectives of marital therapy is to identify conflict sources; determine which partner caused the conflict and why the other is participating in said conflict; assistance in both defining and redefining the boundaries of the individuals within the relationship as well as the relationship itself and find resolution in any kind of misunderstandings. The psychologist/therapist before delving into these objectives must get a sense from the couple as to why they are there (pg.57). While individual therapy follows the same vein in terms of understanding why that individual wants, there is no twofold psychopathological knowledge needed (Cigolla & Brown, 2011).

Heitler (2010) added a different perspective entirely by dissecting couples that go to therapy alone rather than together. For the psychologist, it means examining the marriage from a less than neutral perspective since they are bound by "explicit confidentiality procedures" (Heitler, 2010). This brings into the discussion, the ethical standards. While ethics underlies therapy in general, if the psychologist is seeing individuals within a martial unit separately, the psychologist/therapist must carefully walk the waters of keeping the transactions distinctly separate. There must not be any overlap of information sharing. Additionally, if any additional therapist and/or clinical psychologists are brought into the fold, the individuals within the marital unit should be informed at the outset of treatment. The psychologist/therapist has to be explicitly cautious even if the couple acknowledges that whatever is individually disclosed can be shared (Heitler, 2010). It is in the best interest of the therapist to understand the ethical standards they are bound by before addressing the marital units’ issues and diagnosing treatment.

If a marriage and family therapist needs to be brought into the therapeutic situation, one of the key questions that often arise is who is the client? Is the obligation to the couple or to one individual or another? This question has to be asked if an additional therapist is brought into the situation because any supplementary intervention could potentially have an effect either positive or negative. This further gets into the ethics of psychology itself and presenting a vexing dilemma with regard to marital therapy. As it stands, there is not much literature guidance on the subject available. That is not to say that combination psychologist/therapist should just wing it or proceed as they wish, but rather they should consult the Ethical Principles and Code of Conduct per the American Psychological Association, which surprisingly only devotes a solitary paragraph to the matter. They hold that “"when psychologists agree to provide services to several persons who have a relationship (such as spouses, significant others, or parents and children), they take reasonable steps to clarify at the outset (1) which of the individuals are clients/patients and (2) the relationship the psychologist will have with each person. This clarification includes the psychologist's role and the probable uses of the service provided or the information obtained" (“American Psychological Association,” 2013). Ethics would suggest that approval would need to be had before any execution of detail divulgence.

There are however, several issues with that passage. First, the psychologist/therapist would have to decide on who the client is. Second, after it is decided who the client is, that does propose another issue as to the relationship the psychologist/therapist will have with the others. Thirdly, the passage does not say at what point during the combination therapy, such divulgence of information must be disclosed (Gangamma et al., 2012). While reasoning would suggest the earlier, the better, the APA does not explicitly give credence to that thought. 

Therapy is an interesting facet of psychological practice. Whether individual or marital therapy is being sought, the psychologist/therapist must adhere to certain ethical standards in their appropriation of treatment of the behavioral conundrum. While literature provides a roadmap as to how to deal with individuals versus couples, there are no implicit cornerstones in technique execution. Hence, as a result, the psychologist should be extra cautious in their therapeutic application in an effort to avoid making the phenomenon of behavior even more complex than it already is. 

References

American Psychological Association. (2013). Retrieved from http://apa.org/

Bartle-Haring, S., Knerr, M., Adkins, K., Delaney, R. O., & Gangamma, R. (2013). Trajectories of therapeutic alliance in couple versus individual therapy: Three-level models. Journal of Sex & Marital Therapy, 38, 79-107.

Cigolla, F., & Brown, D. (2011, November). A way of being: Bringing mindfulness into individual therapy. Psychotherapy Research, 21(6), 709-721.

Heitler, S. (2010, April 6). Individual versus couple therapy formats for treatment of marital problems. Retrieved from http://www.goodtherapy.org/blog/couple-therapy/

Gangamma, R., Bartle-Haring, S., & Glebova, T. (2012, November). A study of contextual therapy theory's relational ethics in couples in therapy. Family Relations, 61(5), 825-835.

Wolska, M. (2011). Marital therapy/couples therapy: Indications and contraindications. Archives of Psychiatry and Psychotherapy, 3, 57-64.