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Terapi Marital

Bentuk psikoterapi yang dirancang untuk


secara psikologis memodifikasi relasi antara
dua orang yang berada dalam konflik; dalam
satu paramater atau lebih; pada parameter
sosial, emosional, seksual dan ekonomi.
Tipe-tipe Marital Terapi

1. Individual therapy
2. Individual marital therapy
Concurrent therapy (masing-masing pasangan bertemu
dengan terapis yang sama dalam waktu yang berlainan)
Collaborative therapy (masing-masing pasangan diperiksa
oleh terapis yang berbeda)
3. Consecutive marital therapy
4. Conjoint marital therapy
5. Four way therapy
6. Group psychotherapy
7. Combined therapy
Conjoint Therapy
Kedua pasangan menemui satu terapis yang sama, secara
bersamaan
Having both partners treated simultaneously by the same doctor
Keuntungan:
Lebih mudah untuk menilai masalah
Terapis lebih objektif
Less subject to distortion
Pada Conjoint therapy dipandang sebagai kontinum, dimana:
Peran terapis sangat fleksibel
Sometimes directive & information-giving, at other times
completely non-directive
Observing the situation
Tahap-tahap pada proses Conjoint
Therapy
The Three Cs
1. Complaint
2. Clarification
3. Compromise

Menekankan pada mengatasi psikopatologi pada


tiap pasangan dan relasi di dalam situasi marital
Apabila psikopatologi tidak dapat mengalami
resolusi, maka dicari situasi yang memuaskan
bagi tiap pasangan seiring dengan perbaikan
komunikasi
1. Complaint
Pasien akan menceritakan keluhan-keluhannya dengan cara dan
emosi yang bervariasi mengenai pasangannya terapis mencari
clues mengenai konflik yang terjadi
Fase kritis
Klien akan mencoba membuat terapis berpihak padanya
Paling sulit untuk dilewati
Menentukan prognosis
Terapis memerhatikan (observe) & mendengarkan (listen) klien
Hindari memotong atau menginterpretasi terlalu dini
Menilai secara berkala transferens-kontertransferens
Hindari taking side/menjadi juru bicara
Menjaga keseimbangan antasa submissiondan dominant antara
pasangan
Interpretasi hanya bila waktunya tepat
2. Clarification
Melakukan eksplorasi terhadap motif-motif
conscious dan unconscious
Hal-hal yang mereka inginkan dari, dari
pernikahan, dari kehidupan, dan dari terapis
Dapat memberikan gambaran konflik internal
masa kecil yang pernah dialami
Saatnya klarifikasi dan interpretasi perilaku dan
motif pasien
Mengklarifikasi keluhan yang dirasakan, insight
interpersonal, memahami hubungan antara
keluhan dan pernikahannya
3. Compromise
Kadang tidak selalu bisa sampai tahap ini pada
akhirnya tidak terjadi kompromi antar pasangan
Kompromi terjadi ketika Muncul awareness
pada kedua pasangan mengenai ekspektasi
kepada dirinya, kepada pasangannya, dan
ekspektasi pasangan terhadap dirinya
Resolusi konflik intra- dan inter-personal
Muncul mutual respect dan acceptance
sebagai bentuk self-perpetuating gratification
Terkadang terapi tidak mencapai tahap ini,
namun perbaikan sudah tercapai
Wawancara Awal
pada
Conjoint Marital Therapy
Miles J. On marriage: Evolution of a conjoint therapy
approach | BC Medical Journal. BCMJ. 2003;45(1):204.

Couples in conflict
often have views about their spouse that are b
oth negative & inaccurate
Conjoint therapy bertujuan untuk meringankan
penderitaan sebagai konsekuensi konflik yang
muncul dalam pernikahan
Pada marital terapi biasanya

Dirujuk dokter keluarga atau rekomendasi dari klien


Umumnya tidak ada kontak dengan terapis
sebelumnya
Rujukan & rekomendasi menjadi faktor
penambah rasa percaya dari klien terhadap terapis
sehingga aliansi terapeutik semakin baik
Perhatikan surat rujukan yang disertai keterangan
awal karena terkadang dapat menyesatkan dalam
memahami keadaan sebenarnya
Wawancara awal memerlukan waktu sekitar 50
menit
Terapis menilai pasangan
Observasi dimulai sejak di ruang tunggu/ruang pendaftaran
Pengamatan terhadap tiap individu
Mulai dari penampilan, cara berpakaian, serasi atau tidak
Bagaimana sikap masing-masing pasangan
Saat menunggu, saat mendaftar
Cara duduk, cara berjalan
Interaksi yang terjadi
Pengamatan awal menggambarkan hal yang sebenarnya
terjadi
Ketika di dalam ruang periksa
Terapis membuat klien menjadi lebih relax dan comfort
Kedua klien duduk berdampingan dan berhadapan langsung
dengan terapis
Terapis melihat langsung serta memerhatikan wajah dan respon
mereka
The initial conjoint marriage therapy
interview
Question Comment
1. (To each in turn:) What is your age and In response to the initial pleasantry, is there
occupation? any evidence of a sense of humor, a very
important quality in terms of prognosis?
2. How long have you been married? Who takes the initiative?
Did you live common-law prior to How does the other partner respond to this?
marriage?
How long was the courtship? Do they disagree with each other over, for
example, the duration of the courtship, one
3. (To each in turn:) Have you been married insisting it was a year, the other 13 months?
before?
For how long? If one or both partners have been married
Did you have children? previously, the therapist will have gained
If so, what are their names and ages? some appreciation of the significance of these
Who do they live with? former spouses and the children to each of
What kind of relationship do you have the partners.
with each child?
Question Comment
4. Where do you live? Asking about the children reveals whether
Is it a house or an apartment? they are a conflict-free area where both
Do you own or rent? parents are in agreement on child-rearing,
or whether one or more of the children have
5. (To both, if there are children:) What are become pawns in the marital conflict.
your childrens names and ages?
How is their physical and mental health? These initial five question areas permit the
(To each:) Are they good news or bad therapist to get to know something about
news? the couple and allow them to assure
(To both:) Does anyone else live in the house themselves that they have a place in the
(e.g., relatives, nannies, etc.)? How old are worlda home, an occupation, children
they? which is helpful when they are on unfamiliar
(To each:) How do you feel about them? territory engaged in an unknown and very
anxiety-provoking experience
Question Comment
6. Whose idea was it to come for This is a very useful time to make a direct inquiry
conjoint therapy, and when did you about motivation by asking how each partner feels
first seriously consider it? about undertaking conjoint therapy.

The motivation of each partner is a central issue,


and is a curiously neglected area in the literature.

As I have noted elsewhere, While one or both


members of the dyad may have low motivation for
working toward a happier and more functional
marriage, they may have, in fact, very powerful
alternate motivations for seeing a therapist When
the lack of congruence between the goals of the
therapist and one or both marital partners goes
unrecognized, effective therapy may be seriously
prejudiced
Question Comment
7. Have you, as a couple, had previous Surprisingly often, one will give a positive
marital therapy? report of the outcome, the other a very
negative review, indicating a probable failure
Who with, and when? on the part of the therapist to have
established a symmetrical relationship with
How often were the visits, and how long the couple.
were the sessions?
Some support for this perception is given by
(To each:) What is your perception of the the fact that commonly these previous
outcome? interventions have been individual visits for
both, usually more for the wife, and most
commonly they have only been seen
conjointly on one or two occasions.
Question Comment
8. (To each:) As briefly as possible, what Many couples will agree about the approximate
do you see as the problem in your duration of their conflict, but wide divergences
relationship? are not uncommon.
An extreme example of this is where the wife
How long has it been a problem? says there has been a major marital problem for
10 years, and the husband flatly denies that from
his perspective there is any problem whatsoever.

Asking for a brief statement of the problem is


helpful in determining the degree to which each
partner is prepared to take some share of the
responsibility for their unhappy marriage.

This ranges from the unrealistic (and narcissistic)


acceptance of 100% of the responsibility by one
partner, to a complete denial of any responsibility
by one or both partners, and attributing the
blame entirely to the spouse.
Question Comment
9. (To each:) What do you This helps to clarify each individuals goals and provides an
hope to get out of therapy? opportunity to assess the congruence of their
expectations.
10. (To each:) What thoughts The answers can be a rich lode of information, not only
have you had about about the partners previous and current impulses to
separation? separate, hence constituting another monitor on their
motivation, but also about their reasons for not wanting
to separate.

Themes of love and commitment may easily emerge here


or, conversely, their absence, and concerns may be
expressed that have less to do with the relationship and
more to do with the partners apprehension over the
practical and emotional consequences of separation and
divorce.

Another value of this question is to allay anxiety.

A common fear of people contemplating conjoint therapy


is that the process will end in divorce. Raising the issue
directly and early is, in my experience, helpful.
Question Comment
11. (A sequence, to each:) How is Affectively sanction the expressionof negative
your partner a pain in the ass to live thoughts & feelings
with?
Focus on & assess the assets of marriage
What is the good news about your
partner? This question accomplishes a number of things.
First, it is an indication of the persons degree of
What behaviors of yours distress your comfort with hostile feelings.
partner? Second, it allows people to openly acknowledge
that they are aware of the specific behaviors that
antagonize their spouse and in so doing, take
responsibility for what they do.
Finally, this question introduces or reinforces the
fact that the couple are at warfull scale war
and it is remarkably salutary, in my experience, to
point that out to them.
Most couples are well aware that they are
miserably unhappy, usually blaming it on the
spouse, but find it genuinely surprising to
appreciate the complexity, pervasiveness, and
intensity of their struggle with each other.
Couple conflict is a complex area
The hallmark of the real professional is to able
to say I dont know
Resist the tendency to take sides
Do an evaluation of both partners for
depressive illness
Always arrange for another appointment
If you feel over your head, refer them