Couple therapy with parents whose youngest daughter had a psychotic episode: impairment of a child and marital conflict.

An 18-year-old girl developed a withdrawn state with suicidal ideas. The therapist gave 8 sessions of conjoint family therapy, with her parents and two sisters. In the course of conjoint therapy, she became psychotic and some structural features of the disturbed family system seemed to get more rigid. The therapist therefore, changed the therapeutic modality from conjoint therapy to couple therapy with her parents. During the sessions of couple therapy, the therapist tried to help her parents gain an understanding of his or her respective family of origin. The girl, as a result, got through the psychotic state and her condition stabilized. The author discussed the following points: 1) The girl's symptoms were understood to be the result of chronic tension between her parents, and disappeared when her parents became involved with their couple therapy. 2) Each parent transmitted many unresolved issues in the context of his or her original family to their nuclear family. 3) In couple therapy, when the marital conflict is so great, the couple tend to involve the therapist in triangulation. Therefore, it is very important for the therapist to keep himself in a position of distriangulation with the couple.