Marital disorders are divided into “Marital Conflict Disorder Without Violence” and “Marital Abuse Disorder (Marital Conflict Disorder With Violence).” Couples with marital disorders sometimes come to clinical attention because the couple recognize long-standing dissatisfaction with their marriage and come to the clinician on their own initiative or are referred by a health care professional. Secondly, there is serious violence in the marriage which is “usually the husband battering the wife”. In these cases the emergency room or a legal authority often is the first to notify the clinician.
Most importantly, marital violence “is a major risk factor for serious injury and even death and women in violent marriages are at much greater risk of being seriously injured or killed” (National Advisory Council on Violence Against Women 2000). The authors of this study add that “There is current considerable controversy over whether male-to-female marital violence is best regarded as a reflection of male psychopathology and control or whether there is an empirical base and clinical utility for conceptualizing these patterns as relational.”
Recommendations for clinicians making a diagnosis of “Marital Relational Disorder” should include the assessment of actual or “potential” male violence as regularly as they assess the potential for suicide in depressed patients. Further, “clinicians should not relax their vigilance after a battered wife leaves her husband, because some data suggest that the period immediately following a marital separation is the period of greatest risk for the women.
Many men will stalk and batter their wives in an effort to get them to return or punish them for leaving. Initial assessments of the potential for violence in a marriage can be supplemented by standardized interviews and questionnaires, which have been reliable and valid aids in exploring marital violence more systematically.”
The authors conclude with what they call “very recent information”on the course of violent marriages which suggests that “over time a husband’s battering may abate somewhat, but perhaps because he has successfully intimidated his wife.”
The risk of violence remains strong in a marriage in which it has been a feature in the past. Thus, treatment is essential here; the clinician cannot just wait and watch. The most urgent clinical priority is the protection of the wife because she is the one most frequently at risk, and clinicians must be aware that supporting assertiveness by a battered wife may lead to more beatings or even death.
In some cases, men are abuse victims of their wives; there is not exclusively male-on-female physical violence, although this is more common than female-on-male violence.
Marital therapy is probably the best single thing that people in troubled marriages can do to help heal their marriages. A skilled marriage therapist offers support and intervention that can help distrusting disengaged partners to safely address their difficulties and begin the process of problem solving and healing:
- Safety: First and foremost, therapists work to provide a trustworthy and safe environment which can contain and manage couples’ anger, frustration and contempt. Therapists remain neutral and do not take sides. They maintain confidentiality and privacy. They limit angry and hysterical emotional displays. They promote calm problem solving. In general, they provide a space in which it becomes possible for couples to step out of defensiveness and work on problems in a productive and rational manner.
- Normalization and Reality Testing: Experienced therapists have “seen it all before” and are able to help couples to understand when their desires and expectations (of each other and/or of themselves), indiscretions and reactions are normal and when they are unusual, inappropriate or even abusive. Such feedback from a relatively objective third party can provide a needed reference point which partners can refer to during their negotiations.
- Traffic Control: Conflicted couples often become easily defensive and have difficulty listening to each other. Therapists function as traffic cops to make sure that partners take turns talking and listening to each other, no one is shut down and unable to speak and all have a better chance to feel listened to than would otherwise be possible.
- Skills Education: Therapists teach problem solving skills which can help couples gain tools to help them better address and manage their conflicts. Communication skills help couples to know how to better speak and listen to each other. Soothing skills help partners to better recognize when they are becoming defensive, and how to calm themselves so that rational dialog remains possible.
- Interpretation: To the extent that the problem appears to be caused by partners’ failure to understand one another, therapists will work hard to promote communication. They teach listening skills, promote sharing of feelings and desires that may be difficult to express and encourage partners to repeat what their partners have said so as to demonstrate their comprehension. When necessary, they will interpret partner’s meanings so as to better promote each partner’s understanding of the other. Therapists may also point out relationship patterns that partners may not have been aware of (for instance, if one partner attempts to treat the other as a child or as a parent) which could interfere with their ability to relate as adult partners.
Marital therapy generally takes place outpatient-style in a therapist’s office and is offered once per week with each session lasting between 60 and 90 minutes. One or two therapists may be present in the session. When two therapists are present the process is called ‘conjoint’ therapy. The number of therapy sessions will vary according to the severity of the presented problems, the therapist’s training and technique, and (unfortunately) the couple’s ability to pay for services. Many insurance plans will provide partial coverage for marital therapy. Although some therapists will suggest that significant change can be made in one or two sessions, it is more likely that between 8 to 12 sessions will be required before significant and lasting change might realistically occur. On the other end of the spectrum, therapies that last for more than a year or so without producing results are not likely to produce results. In such cases, troubled couples might consider working with a different therapist with a different approach, or to rethink the viability of their marriage.
During sessions of marital therapy, therapists help couples to work through their difficulties which may include estrangement and loss of loving feelings, communication problems, affairs, mismatched expectations, and competitive struggles to determine whose vision and goals will dominate. Couples that have the best chance for recovery are those who are both motivated to keep their marriage alive. Couples who arrive at martial therapy with one or more partners ambivalent with regard to whether to remain committed to the marriage, whose problems are more severe or are characterized by more disengagement, or who are unwilling or unable to compromise are less likely to successfully work things out. Couples who arrive at therapy with one of the partners already emotionally disengaged from the other may be beyond help.