Case Study


Case Study

Questions of Gender: A therapist struggles with the clinical choices he’s made

By David Treadway

September/October 2014


Sometimes I’ve been instrumental in helping couples stay married when perhaps they’d have been happier if they’d gotten divorced. Other times, it’s been the reverse. Obviously, we all know that’s it not our job to tell our clients what’s right for them: rather, we need to create the right conditions for them to discover the answers for themselves. Frequently, however, our own reactivity shapes the messages we send and how profoundly we can influence—in unconscious and unpredictable ways—the unfolding of some couples’ lives. I feel that way about my work with Glen and Julie over a 14-year span.

An Ordinary Case

Up until my eighth session with Julie and Glen, they’d seemed to be a vanilla kind of case—a middle-aged couple with two middle-school children, two careers, busy lives, and what seemed to me a pretty sweet relationship. They came to see me because they were having a painfully mediocre intimate life: she wasn’t all that interested in sex, and he felt hurt by always being in the initiating role, with little success. For her part, Julie was gently accepting of his difficulties with premature ejaculation and seemed perhaps too willing to be the problem. In their shared sense of fragility, they were usually extra careful not to hurt each other’s feelings. Then, toward the beginning of one session, Julie dropped a bomb.

“Well, I don’t think his ‘male needs,’ as you call them, Dr. Treadway, always get expressed so normally,” she…

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1 Comment

Saturday, October 11, 2014 12:53:46 AM | posted by Mary A.
I appreciate the format of reporting and reflecting on a case, getting consultation, and integrating that to develop greater competence. I have always respected Treadway's work, and with his openness to self-reflect demonstrated here, I respect him even more. I also love the suggestion of separating the couple for a deeper exploration of their feelings surrounding the changing norms in their dynamic.