Marital interaction in persisting obsessive-compulsive disorders

The failure of modern behaviour therapy to relieve usefully more than 50% of severe, persisting obsessive-compulsive disorders is discussed. It is suggested that explanations for the failure of many married patients to respond to behaviour therapy can be found in their marital interaction. Where the development or maintenance of obsessive-compulsive symptoms is an alternative to overt marital conflict, it may often be counterproductive to treat the symptoms alone, since this serves to consolidate them as a displaced focus of marital dissatisfaction. Marital therapy is often unacceptable or ineffective in such cases. Five cases of persisting obsessive-compulsive disorder in married women are used to illustrate this. An innovative treatment model using spouse-aided therapy is outlined, wherein the patient's spouse is invited to take part in therapy as a co-therapist or co-agent of change.