Try Integrated Psychotherapy for Complex Issues

She married to be rescued from her family, he said.

The woman was not demented and did not have a depressive disorder or any other Axis I disorders, according to Dr. Sadavoy.

He explained her husband's diagnoses and the reasons for his behavior. “She clung to her previous explanatory models but needed to understand in an entirely different fashion that this was not willful behavior but was a brain disturbance,” he said.

They worked through her grief at the loss of the husband she once had, her lost sense of identity as a wife, her anger at his incapacity, and her fear of how she would survive by clarifying her role changes and reformulating her responses to interpersonal conflict. Dr. Sadavoy helped her to create a list of her interpersonal problems and then actively coached her in developing alternate behaviors and problem-solving skills.

At the psychodynamic level, the woman had a deep desire to be recognized as valuable and loved by her mother. They explored this in the context of her lifelong belief that “she was an alien in her own family.”

Her feelings toward her husband's personality change paralleled those toward her family when she described her husband as being coarse, ungiving, unloving, and stupid.

“If she's truly going to be able to deal with what's happening to her husband, stop being angry at him, lose some of her anxiety, and begin to actually focus on problem-solving and dealing with the issues, she has to understand somehow why she is reacting the way she is,” Dr. Sadavoy said.