Psychopharmacology in couples work can be useful in all stages of therapy: 1) to control initial symptoms; 2) to improve communication; 3) to modulate biological temperaments related to personality issues; and 4) to reduce excessive stress during life transition (Resnikoff, 2001).
This article describes the value of psychopharmacology as a small, but important, part of stage-3 therapy for a high-functioning couple. The use of psychopharmacology in this case was to modify lifelong temperaments. (For more information on the use of psychopharmacology to control various temperament dimensions, please see the figure at www.psychiatrictimes.com/tempdim.html--Ed.)
"Carol" and "John" requested couples' counseling. They had been married for 16 years and had a 14-year-old child, "Daniel." Quite suddenly, John asked for a divorce. Carol was stunned and wished to preserve the marriage. The couple came to therapy to consider reconciliation. (In the following presentation, changes have been made to protect the couple's identity.)
At the beginning of therapy, John explained how he had felt rejected and angry for years and now felt better since he was ready to get a divorce and move on. He complained about the lack of attention, companionship and sex.
Carol felt on the defensive. She was upset that John would even consider breaking up the family unit. She claimed she had not realized John's complaints, in spite of the fact that he stated he had pointed out grievances for years. Although Carol thought that John lacked concern for her, she felt willing to listen now and to try to prevent a divorce. She was especially concerned about preserving the family for Daniel's sake.
I recommended a full evaluation before considering divorce, knowing that without greater awareness, similar problems and personality conflicts would likely be repeated in a new relationship. I also know from clinical experience that a marriage can frequently be the scapegoat for long-term premarital personality issues. In this case, I believed that Daniel's welfare would be best served if the marriage could be saved. Daniel came to several later sessions. He was basically well-adjusted and confirmed the dynamics of the marriage.
I presented divorce and reconciliation therapies as having many similarities, including the understanding of grievances, attachment disruptions, power and boundary dynamics, complementary personality styles, historical personality patterns, biological temperaments, and life-transition issues. If divorce occurred, therapy would focus on preventing excessive revenge or splitting Daniel's loyalty, as well as on reinforcing continued cooperative parenting. If John and Carol ended their marriage, therapy would also monitor the grieving process.
1.Cloninger CR, Svrakic DM (1997), Integrative psychobiological approach to psychiatric assessment and treatment. Psychiatry 60(2):120-141.
2.Johnson SM, Makinen JA, Millikin JW (2001), Attachment injuries in couple relationships: a new perspective on impasses in couples therapy. J Marital Fam Ther 27(2):145-155.
3.Resnikoff R (2001), Bridges for Healing. Integrating Family Therapy and Psychopharmacology. Philadelphia: Brunner-Routledge.
4.Young LJ, Lim MM, Gingrich B, Insel TR (2001), Cellular mechanisms of social attachment. Horm Behav 40(2):133-138.