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To the Editors: I am grateful to Dr. Fitzgerald for his letter because it calls attention to often-heard arguments regarding the treatment of marital partners. He repeats Dr. Sager's opinion about psychotherapists having responsibilities beyond the individual patient, and then he tells us about his clinical experience, i.e., the efficacy of conjoint therapy and the fact that many of his patients want to be seen with the spouse.
I do not believe this is the place to review the merits of an eclectic approach. This is a psychoanalytic forum. Although highly varied, papers and discussions are in the context of the psychoanalytic frame of reference, and, in communicating with one another, analysts wish to learn about psychoanalysis. Once one begins treating the family or extends his responsibility beyond the individual he is doing something besides analysis.
A patient recently told me, “The trouble with psychoanalysis is that it is not cosmological.” Perhaps this is true, but once it becomes cosmological it is no longer psychoanalysis. A treatment approach based upon a consistent theoretical framework cannot stray into other frames of reference without losing its identity: if physicists introduce ethics into their scientific edifice, although this may be an important and even vital confluence, then they are no longer functioning as physicists.
Other treatment approaches may be effective
—but how effective and in what ways deserves further study. Psychoanalytic theory can help explain the types of dynamic shifts that occur in patients treated by conjoint methods. However, when discussing the treatment of married patients and the quality of the marital relationship in terms of metapsychology, the fact that one can successfully treat such patients by nonanalytic means is not relevant.
The above does not mean that psychoanalyzing the married patient (or any patient) is a shirking of humanistic and ethical responsibilities. Again, this is not the place to defend the ef