Assessment and selection

This is not an easy process, because there is a dearth of information about the types of couple problem presenting for treatment and on the outcome of treatment itself. In practice we select on the basis of the referral letter, resulting in allocation either to the couple therapy clinic, to an individual psychiatric clinic, or to a sexual dysfunction clinic. Some patients seem after perhaps one session to have been misallocated, and it is then possible to move them within the system to another clinic. However, this is a process which many patients find difficult to accept, and we try to do it as infrequently as possible.

Another, more subtle, form of selection occurs at the first therapy session, when the couple are in contact with the therapist, the team, and the process of therapy. In this session the therapist (see below) attempts to use reciprocity negotiation or straightforward techniques of therapy, partly as a treatment trial, and partly to see whether the couple is ready for this kind of intervention. If not, then he or she can move to a more systemic approach, or decide after a few visits that there is no future at this point in further therapy of this kind, and that something else (e.g. individual therapy) is needed ( Fig I).

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