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Dr. Lussheimer's cholarly presentation indicates the breadth of the diagnostic spectrum to be found in marital problems. I would like to focus in my paper on just one segment of the treatment of marital conflicts, emphasizing those aspects of therapeutic techniques which differ from those commonly
employed in psychotherapy and psychoanalysis.
Obviously in psychotherapy and psychoanalysis we are dealing by and large with a one-to-one relationship between doctor and patient. In every marital conflict we deal with two protagonists and oftentimes with many other individuals on the periphery of the conflict. Therefore the techniques for meeting the complexities in marital conflicts may often go beyond approaches commonly utilized in individual psychotherapy. Whether we are dealing with normal or psychoneurotic personality make-ups, these techniques have proven valuable for inclusion in the psychiatrist's armamentarium.
To begin with, I think it is important to consider the individual who first comes seeking help as the “patient.” The marriage itself is considered the central problem, but individuals closely related may be asked to participate in the therapeutic effort. This approach I have termed the “constellation approach” to marital problems,1 and in this constellation may be found the spouse, grown children, relatives, friends, business associates, the “other woman” or the “other man,” and in some cases individuals even more peripherally connected. Obviously this is a departure from the exclusively patient-centered approach which has been traditional in psychoanalytic circles in the past.
In beginning with the patient (i.e., the individual who first comes for help), the initial task is, of course, to obtain a thorough understanding of the patient and the presenting situation. The time required for this is obviously dependent upon the personality of the patient and the complexity of the problem presented. Only when the problem has been thoroughly delineated can the con