Referral should take place after mutual agreement between the patient (who is complaining) and the doctor. The purpose is to obtain a specialist opinion, or investigations or treatment not available from the referring doctor. Reluctance or even resistance will be encountered if the patient has been sent by another person, such as the partner, for treatment, when they do not perceive that they have a problem (as with Mr S.). It might be possible to suggest to a partner that the patient complaining will need the assistance of that partner in the therapy, thus engaging their interest at the outset.

However, if the doctor insists on referring both partners when only one is complaining, there may be serious difficulties for the therapist to whom the couple are referred. Both partners need to accept an adult and responsible role during therapy. The therapist offers interpretation and suggestions about changes, but it is up to the individuals to make use of them. More often, a therapist, whether using cognitive therapy, behavioural techniques or psychotherapeutic interpretations, will empathize with the person who seeks help for the problem. A partner who has not acknowledged that he or she has a problem is much harder to engage in therapy, and may opt out by not attending either physically or mentally, or even undermining therapeutic endeavours in a subtle fashion.


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