How Would You Counsel This Couple? - Situational Ethics

[jmj11]

Okay, I'm putting this question here because it reflects a real-life practice situation and I'm finding that there is a diverse opinion to the answer.

 

This came to mind last night as I was watching the show Parenthood. In the show, the senior couple (in their early 60s) faced a situation that was exactly like one a patient and her husband faced a year or so ago. I gave them one set of advice, but then their (her) counselor gave her a different opinion.

 

In the show, and in the real-life patient situation, the wife had had a brief affair with a man . . . I'll call Bob. In my patient's case it was about 4 years ago.

 

In the show, the wife, who loves art, signed up for an art class that happened to be taught by the man whom she had had an affair with. In my real-life patient situation, it was a Karate class. For both situations, the wife was taking the class as a hobby. In both situations the wife informed their husbands of the fact that the old lover was the teacher. In both situations the husband asked (with great passion) that the wife drop the class. Both (the real and the TV) husband was deeply hurt and angered by the situation.

 

So what would your advice be? I will give the two opinions that were offered to my patient and tell me which one you agree with.

[rev ronin]

Why would we be counseling this couple, rather than turf'ing them?

[primadonna22274]

We do PLENTY of counseling in primary care and specialty care. I'm willing to bet Mike does a significant bit of counseling in his chronic pain (headache) practice.

My advice: individual counseling first, then couples counseling. I've been on both sides of this equation and there is ALWAYS a reason for an affair. (Usually MANY reasons...needs not met, communication gap, personal dissatisfaction, etc.)

[rev ronin]

Right, but given how complicated the problem is, and the fact that only one spouse is my patient in this scenario, I just don't see the upside in stepping into the problem. Mind you, I'm coming from a pastoral counseling background, so the terms on which I would normally take on such counseling are substantially more advantageous to me: legal/regulatory concerns are minimized, reimbursement and billing are irrelevant, and I would have substantially more freedom to address actual issues.

[jmj11]

Why would we be counseling this couple, rather than turf'ing them?

 

In chronic pain work, 50% of my work is in counseling. There's a lot of Kleenex boxes in my office.

[meaux]

Tough one to answer really. Personally, I am not married,so where does my opinion/advice really come into play? I would definitely suggest counseling however, and I feel I would encourage the wife to continue her hobby, but take into consideration the idea of a different instructor. Regardless, I dont think there is 1 right answer here.

[ionux]

This is definitely inappropriate and not considerate of their spouse's feelings. I would pose the same situation in reverse: suppose her husband had an affair and, of all the places he could engage in his hobby, he chose the one place his former lover was the instructor. Would she believe that he had her interests at heart or something else?

 

Just my 2 cents...

[jmj11]

Maybe this discussion has gone as far as it needs to go. But I did find it interesting for several reasons. BTW, I'm not following this patient, or not least about this topic, anymore. Actually, while I remember the conversations clearly, I can't even remember which patient it was.

 

However, back when I was having this discussion with the patient, I gave her advice, which her therapist disagreed with and that's why it stood out to me. The TV show Parenthood had done a great job with the drama last night and it had an eerie resemblance to the real-life situation that I witnessed a couple of years ago. They also showed a therapist in the program who raised some questions, like my own patient's therapist.

 

The last thing that intrigued me about this scenario, was that my wife and I discussed it this morning. She is a nursing instructor and thinks like a nurse (don't mean that in a negative way, but you know . . . nursing theory etc.) and she disagreed with me as well. I will expound on the two views and see if there are any other comments, and then we can let this die.

 

My perspective: I had told the patient that 1) because it is painful for her husband and 2) because the class was for personal enrichment, not for a degree or anything like that, that it would be a loving thing to drop out and find a class taught by someone else.

 

The therapist's view (as was my wife's view and the view of the "wife" on Parenthood) was the following. The wife fulfilled her obligation to her husband by telling him about the situation. The fact that she was honest about it, proved that she wasn't hiding anything. Also, if the husband truly forgave her and trusted her (that was the issue brought up on the TV show) then he should have no problem with her attending this class with the man she had an affair with four years (on the show it's not clear when the affair happened) earlier. If the husband demands that she drops the class (on an emotional level, which the husband was doing on the show) then he is being controlling and violating his wife's boundaries.

 

I have a couple of other "Case studies" which would be interesting to discuss (but I won't). I have a patient who is married to the man whose son murdered her daughter. They met during the court case . . . started dating and, she left her husband (her deceased daughter's father) and married this man. Freud would have a lot to say about that. I also have a patient who is now living with her ex-mother-in-law, her ex-husband and her ex-husband's new girlfriend, whom he was having an affair with while he was married to my patient. I asked her if mornings around the breakfast table was a little awkward. She admitted it was. Where's Dr. Phil?

[ajnelson]

If I was the male in the situation, I sure as heck wouldn't want my spouse around the person they had the affair with. I understand there has to be trust, but there also has to be some giving up on the spouses side too...I agree with you Mike, don't think that she should drop her hobby, but switching classes would be appropriate. I can see where you are coming from with the 'controlling' argument to a point, but I don't think it really holds water in this situation.

[marilynpac]

It screams disrespect to me....on so many levels. Marriage counseling can work wonders if both parties agree to it. It sounds like hidden anger all the way. Boy Mike, you've got your hands full.

[jmj11]

It screams disrespect to me....on so many levels. Marriage counseling can work wonders if both parties agree to it. It sounds like hidden anger all the way. Boy Mike, you've got your hands full.

I don't know if you noticed, but this was a while ago and I'm no longer involved in those discussions with this patient. It was just one of my philosophical questions prompted by the tv show Parenthood. Didn't anyone else see it? I think an even more common situation is where someone wants to be best friends with an ex (husband, wife, boyfriend, girlfriend) and the present, significant other, doesn't like it. I think that can be trouble too. If they want to salvage their present relationship, they may have to sever old ones.

[marilynpac]

No, I said hands full b/c I didn't know counseling was also included in your work. Most health care providers I know refer it out...immediately.

[jwells78]

That is a difficult situation as a medical provider. I can't speak from experience dealing directly with infidelity in my patients, but in similar situations I found myself trying to remain as objective as possible, and not taking "sides." I could see a situation like that devolving into a firefight very quickly. If it were me, I would leave it to Family/ Marriage counselors and refer them to someone reputable.

 

First, because there are some great counselors out there who can really get the root of the problem and suggest treatment methods that I would never think of; second, I would feel bad if any input I gave to them resulted in a negative outcome that could in any way be attributed to my inexperience with such situations. For me, it just makes sense to stick our area of expertise and turf problems such as this.

 

Personally, and off the record- my opinion is: taking a class from a former lover = NO-GO at this station, no exceptions.

 

BTW- Parenthood is a great show.:=-0:

[acozadd]

1) The wife is lucky the husband stuck around after the cheating... If it were me I would be out the door no matter how much time I had invested into the relationship.

2) Out of all of the karate/fitness/whatever instructors out there, they HAD to pick the one that happened to be taught by the former fling? Seems suspicious and just a basic lack of common sense on the wife's part. She should be in the process of gaining back the husband's trust, not placing herself in situations that might give off the wrong impression.

 

I'd get the divorce papers ready personally :)

[jmj11]

1) The wife is lucky the husband stuck around after the cheating... If it were me I would be out the door no matter how much time I had invested into the relationship.

2) Out of all of the karate/fitness/whatever instructors out there, they HAD to pick the one that happened to be taught by the former fling? Seems suspicious and just a basic lack of common sense on the wife's part. She should be in the process of gaining back the husband's trust, not placing herself in situations that might give off the wrong impression.

 

I'd get the divorce papers ready personally :)

 

Certainly unfaithfulness is grounds for divorce. Some choose to try and salvage their marriage. We will see how the TV version (Parenthood) plays out over the next few weeks. In that (fictional) story, the husband also had a history of unfaithfulness many years previous (and maybe first).

[Magicnubs]

In my opinion, the wife should continue to pursue her hobby if it makes her happy; but staying in the class with her former lover is inappropriate for a few reasons (likely inappropriate anyway, there are so many variables and possible extenuating circumstances that no advice will suit every situation). The main reason of course is that the burden of responsibility to rebuild the trust is on the party that cheated. Also, if she really doesn't intend to continue the behavior, assuming that cheating wasn't a decision she made and stands by and was a "moment of weakness", it does not behoove her to continue to see the other party of her former affair regularly.

 

Was ending the relationship considered? Why or why not? Cheating is a sign of some serious relationship problems which may or may not be caused by incompatible personalities, goals or ideals.

 

^^^ Main point in bold.

[Magicnubs]

1) The wife is lucky the husband stuck around after the cheating... If it were me I would be out the door no matter how much time I had invested into the relationship.

2) Out of all of the karate/fitness/whatever instructors out there, they HAD to pick the one that happened to be taught by the former fling? Seems suspicious and just a basic lack of common sense on the wife's part. She should be in the process of gaining back the husband's trust, not placing herself in situations that might give off the wrong impression.

 

I'd get the divorce papers ready personally :)

My non-professional opinion is a lot closer to yours acozadd. I wouldn't be able to get past it. Trust is harder to rebuild than it is to garner and that's saying a lot.

[just_me]

ugh....if you want someone to trust you especially after being untrustworthy then you shouldnt give someone reason to not trust you

 

I do not agree with the therapist nor your wife...I feel that kind of reasoning is a cop out for being able to behave as you wish after being the one to cause problems

[jmj11]

ugh....if you want someone to trust you especially after being untrustworthy then you shouldnt give someone reason to not trust you

 

I do not agree with the therapist nor your wife...I feel that kind of reasoning is a cop out for being able to behave as you wish after being the one to cause problems

 

 

I still watch the show Parenthood, but this topic hasn't come back up. Not that TV reflects reality, but I just wanted to see how the writers handled the situation. BTW, I don't agree with the therapist nor my wife on this issue either.

[just_me]

never seen the show.....but its probably a good one

 

I still watch the show Parenthood, but this topic hasn't come back up. Not that TV reflects reality, but I just wanted to see how the writers handled the situation. BTW, I don't agree with the therapist nor my wife on this issue either.