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I changed from treating patients by individual therapy first to couples therapy and later to family therapy. I do not think family therapy is group therapy, nor do I think of couples therapy as family therapy. Family therapy involves two generations. Couples therapy is the therapeutic intervention in a well-stabilized two-person peer relationship.
Conjoint sessions, as used by Doctor Rogawski, seem to me a kind of intervention in order to decathect the setting and make ending less painful. The spouse comes in as a way of ending the one-to-one relationship. This is certainly feasible but seems strategically difficult. The therapist is, in effect, the mother-in-law of the visiting spouse and the whole triangle is grossly off balance.
My pattern is to have another therapist see the spouse; when they have established a relationship, we then move to four-way interviews with two therapists and two patients. It's difficult for the “mother” of the patient—the therapist—to be marriage counselor in his own child's marriage. I believe the dynamics of an individual are inextricably interwoven with those of his spouse, and that all movements on the part of the individual patient are preplanned by the couple. Thus it is hard for me to see how the non-patient can be an occasional visitor. If we use the spouse as a source of information to better manipulate the patient, we imply a capacity for understanding the patient's life that I don't have.
I admire the therapist acknowledging his countertransference but am dubious that it can be worked through, understood, or assumed to be controllable. The only way I can visualize this process would be first to see the
couple, then have an individual interview with each partner, and subsequently arrange alternate individual and joint interviews at frequent intervals. My preference is to see the couple from the first interview and never to see either alone. Therapy is just as effective this way as any other. Certainly I am more alive in this k