Book Review
Psychotherapy
How’s Your Marriage? A Book for Men and Women. Michael F Myers. Washington (DC): American Psychiatric Press; 1998. 240 p. US$29.95.
Reviewer rating*: Good
Review by Karl M Tomm, MD FRCPC,
Cynthia A Beck, MD MASc FRCPC
Calgary, Alberta
As suggested by its title, this book is a guide to committed relationships and is primarily intended for a lay audience. Written informally in the first person, it invites partners to evaluate the strengths and weaknesses of their relationship and to consider what could be done to enhance it. In the introduction, Dr Myers outlines his credentials as a practising psychiatrist and marital therapist, lending credibility to his comments.
The book’s first 7 chapters are generally structured around common themes in relationship difficulties. The copious case vignettes in these chapters and throughout the book form the basis of the material and illustrate concepts nonjudgementally, making it accessible to readers with no background in the field. Dr Myers offers particular suggestions for specific types of relationship problems—suggestions grounded in common sense knowledge and understanding of relationship dynamics.
Chapter 1, on communications, is a gentle introduction to the topic. It provides concrete guidelines for more effective communications. Chapter 2 discusses the life cycle and its effect on partnerships. Chapter 3 discusses sexual problems, beginning with a definition of sexual difficulties and proceeding to list several common factors that affect sexual intimacy. In chapter 4, the author discusses extramarital relationships, including the reasons for their occurence and their effects on the primary relationship. In particular, he explores the distinction between extramarital sex (in which there is no emotional investment) and extramarital affairs (in which there is emotional investment, with or without sex). Chapter 5 discusses excessive alcohol use, its recognition, its effect on the couple, and importantly, what to expect if a physician is consulted. This chapter also mentions dual-diagnosis issues (for example, alcohol abuse with comorbid psychiatric disorders). Chapter 6 deals with psychiatric illness and marriage. It points out misconceptions about mental illness and discusses the complex interplay between marital difficulties and psychiatric disorders and their treatments. Some simple and practical suggestions are offered for common situations. Chapter 7 discusses “the role of children in marital disharmony.”
The rest of the book focuses on consequences of marital difficulties and treatments for them. Chapter 8 offers a nonjudgemental discussion of separation and divorce. Chapter 9 proposes some simple steps to help relationships that readers can take on their own, such as reading about marriage and speaking with friends. Chapters 10 to 12 discuss marital therapy, with a view to helping partners decide whether they should seek professional help and what they can expect if they do so. One strength of this section is that it demystifies marital therapy.
Throughout the book, the focus is mainly on heterosexual relationships, although same-sex relationships are also mentioned. The book is rich in examples of common relationship problems and draws the reader’s attention to warning signs. For instance, Dr Myers points out that “it is especially serious if you find yourself withdrawing, retreating into silence and withholding your feelings and affection from your spouse.” A sound, recurrent admonition throughout the book is for couples to “keep talking.” The author also advises partners to transform their criticisms of each other into respectful requests. He is sensitive to the relevance of gender issues in contributing to relationship difficulties. In addition, this book contributes what many “self-help” books on relationships do not: a strong acceptance of the reality of mental illness, its impact on relationships, and the need to seek treatment from a professional.
This book is a practical and easily read introduction to relationship issues for couples who have not been in marital therapy. It may be best suited for those deciding whether to seek professional help for relationship difficulties: once couples are seeing a therapist, they have generally moved beyond the scope of this book. Unfortunately, its basic level, although necessary for the general public, makes it less valuable for psychiatrists and marital therapists or their patients and clients. For example, the explanations of different approaches to marital and family therapy are oversimplified. There is no mention of emotion-focused therapy, narrative therapy, and solution-focused therapy—important developments within marital therapy that are rapidly gaining in popularity. There is also no discussion of the inadvertent marital complications of individual therapy with a single member of a couple; namely, the risk of increasing the distance within the couple relationship. Probably owing to space restrictions, the descriptions of specific mental illnesses, their treatments, and treatment side effects are also quite limited. For instance, Dr Myers does not mention that the side effects of some psychotropic medications can affect intimate relationships by altering sexual functioning. Moreover, although there is a brief appendix listing “Suggested Readings,” there are no text references or footnotes. As such, we think this book is more appropriate for the general public than for psychiatrists or their patients in therapy.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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