Case Study - Page 6

Author's Response

Working with couples around the possibility of opening the sexual boundaries of their relationship is complex, regardless of sexual orientation, as Jean Malpas comments. I'm grateful for his recognition that one of the unique vulnerabilities in helping clients negotiate mixed-orientation marriages is the tendency of clinicians to rush to prescriptive solutions that often impede, rather than expand, the possibilities for intimacy.

I agree with Malpas's assertion that in doing such work, it becomes essential to explore the terms of the relational arrangement. I regret that I wasn't able to do this with this couple because Rob's therapeutic alliance with me and Mia's therapeutic alliance with her therapist made couples work with either therapist impossible. In such situations, I've frequently referred couples to a third, hopefully "impartial," clinician, with whom the couple can explore the option of staying together in what they each perceive to be a more agenda-free space. Unfortunately, in this case, neither Rob nor Mia was willing to pursue this option. I still wonder whether I waited too long to offer it as a possibility.

I hope, nonetheless, as Malpas suggests, that we're beginning to challenge the social constructions of coupling, recognizing the influence of multiple, complex, and seemingly incongruous identities.

Jeff Levy, L.C.S.W., C.T.R.S., is cofounder and CEO of Live Oak, Inc., in Chicago. He's a part-time faculty member at the University of Chicago's School of Social Service Administration. Contact: jlevy@ liveoakchicago.com.

Jean Malpas, L.M.F.T., is a faculty member of the Ackerman Institute for the Family. His publications include "From Otherness to Alliance: Transgender Couples in Therapy" in Interventions with Families of Gay, Lesbian, Bisexual and Transgender People. Contact: jean@jeanmalpas.com.

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