Marital therapy when a symptom is presented by a spouse

This paper proposes that hierarchical incongruities in a marriage can occur when a spouse develops a symptom in an attempt to balance the division of power in the couple. A cycle is described in which the couple deals with the dominance of one spouse over the other by alternately focusing on a marital issue, on a spouse's symptom, or on a child's problem. The task for the therapist is to organize the couple so that power and weakness are not centered upon symptomatic behavior, the division of power is balanced, and the couple is organized in a congruous hierarchy. Two case examples are presented and paradoxical and straightforward therapeutic techniques are described.