Conjoint and Concurrent Therapies

When dealing with couples there are multiple ways to approach issues. Two of them are the conjoint and the concurrent therapies. Each of these can be applied in a sex therapy situation, and each offers its own unique approach. Though the outcomes tend to be the same, getting there will depend on the needs of the clients. This paper will compare, contrast, and describe these therapeutic approaches and the theories upon which they are founded, and provide a situation in which they would each most be appropriate.
Conjoint therapy is commonly used in family therapy. The concept underlying this approach is that it joins the two partners (the husband and wife in most instances) under a single therapeutic plan. Essentially, conjoint therapy can be used for a range of issues that impact partners in a relationship. For instance, Zitzman and Butler (2005) show that it can be used to marital therapy to address sex addiction where the husband is addicted to Internet pornography: together, the husband and wife receive the therapy and counseling needed to ensure that the partnership is able to overcome this issue and deal with it effectively and positively.
Concurrent therapy is where two or more individuals are being treated for the same issue that is affecting them but they are seen individually instead of at the same time (Nichols, 2010). This therapeutic approach is helpful in isolating the individual issues of the individual family members or relationship partners and addressing them one-on-one instead of all together in unison with the other family members or partner. It offers a more personalize approach to therapy whereas conjoint therapy offers a more communal approach.
Thus, the main difference between conjoint therapy and concurrent therapy is that in the former the two clients share the same session and receive the therapeutic intervention together at the same time. In the latter, the two are seen separately and receive the therapeutic intervention individually, one-on-one with the therapist. Conjoint is communal whereas concurrent is individual (but every member of the family or relationship is receiving the same therapy—just not at the same session). For some patients, the conjoint approach will be preferred; for others, the concurrent approach will be preferred. Conjoint therapy focuses on relationships and supportiveness. Concurrent therapy focuses on individual needs.
Hefner and Prochaska (1984) have shown that there is no significant difference in terms of outcomes when using either conjoint or concurrent therapy in marital counseling. They studied the effects of both on six different cases and found that the therapies were essentially interchangeable and did not lead to a unique outcome that could not be achieved by the other. This indicates that in spite of the main difference between one-on-one attention vs. group therapy, the outcome is the same.
Sex therapy focuses on improving sexual dysfunction for individuals or within a relationship. It depends upon determining a definition of sexual activity that is acceptable to all receiving the therapy and then working towards achieving a goal, whether psychological or behavioral, associated with the parameters of acceptable sexual behavior or sexuality. Sex therapy can include working with clients to overcome intimacy issues, addiction issues, or abuse issues.
Conjoint theories include strategic theory, experiential family theory and structural theory. Structural theory focuses on the interaction of parts within a system. Experiential family theory focuses on the idea of working out issues by role-playing and acting out parts to develop better understanding and empathy. Strategic theory focuses on solving the problems of partners or family members by working together with them all. The foundation for conjoint theory is based upon Bowen’s belief that the triangle formation of therapist at the point and the two patients at the bottom serves to provide stability in the treatment process (Titelman, 2008).
Concurrent theories include psycho-dynamic theory, which holds that marital issues stem from intrapersonal problems that can best be addressed on a person-to-person basis, because one is dealing with an individual psychology rather than with a system or social structure (Hefner & Prochaska, 1984). Cookerly’s theory serves as the basis for concurrent therapy. Cookerly found that when treated individually, partners in a relationship found their negative symptoms, such as depression and anxiety, to decrease on the whole (Hefner & Prochaska, 1984). Pyschotherapy is the key underlying theory in concurrent therapy, though cognitive behavioral therapy could also be an approach that is used in concurrent therapy.
Theory and therapy comparisons to sex therapy show that there is no wrong or right way to approach issues within a marriage or that an individual is having in relation to sex or sexuality. These issues and problems may be approached in a group with the counselor serving to provide therapy to both partners, or they may be addressed individually with the counselor seeing each partner one at a time. Conjoint sex therapy sometimes needs to be preceded by individualized sex therapy for women, according Hawton (1995). The reason for this is that women feel safer and more secure when they have obtained some assistance from the counselor before entering into a group session where they do not know what to expect and may experience anxiety or uneasiness going in blind. Thus, in sex therapy, a therapist may need to do a combination of concurrent and conjoint therapy, starting first with the former so that everyone feels comfortable with moving ahead to the latter. The first would allow any psychological or behavioral issues to be addressed, and the latter would then allows any relational issues to be addressed.
The value of conjoint therapy is that it gives the couple the opportunity to focus on their relationship and on each other instead of on themselves. The value of concurrent therapy is that it gives each person in the relationship the opportunity to focus on themselves. As Hawton (1995) notes, for most women clients it is common that they want to focus on themselves first and get themselves to a good place where they feel confident that they can begin to focus on the other in the relationship and work things out in a positive way on that end. For men, this need is not as common and it is less of an imperative for them to do concurrent before conjoint.
A situation in which there is no communication barrier between a husband and wife that is leading to hurt feelings and isolation would best be served by the conjoint approach. The two would be open to communicating together and working on their relationship together. The problem could be something like an affair or negative feelings about sexual intimacy. A situation in which there are communication barriers between partners that prevent them from being open towards one another and receiving criticism without fear is one in which concurrent therapy would be best applied. This would allow issues to be addressed individually so that there are no blow-ups due to the stress of the other partner being present and voicing dissatisfaction.
In conclusion, therapy for individuals or partners is available through the concurrent or conjoint approaches. Each has its own advantages and disadvantages and has to be discerned by looking at the clients and assessing their needs. Sometimes the best solution is to apply both, first concurrent and then conjoint to ensure that all aspects of the situation—the individual and the relational—have been addressed.

References
Hawton, K. (1995). Treatment of sexual dysfunctions by sex therapy and other
approaches. The British Journal of Psychiatry, 167(3), 307-314.
Hefner, C. W., & Prochaska, J. O. (1984). Concurrent vs. conjoint marital therapy. Social
Work, 29(3), 287-291.
Nichols, M. (2010). Family therapy concept and methods. NY: Pearson.
Titelman, P. (2008). Triangles: Bowen family systems theory perspectives. NY:
Hawthorne Press.
Zitzman, S. T., & Butler, M. H. (2005). Attachment, addiction, and recovery: Conjoint
marital therapy for recovery from a sexual addiction. Sexual Addiction & Compulsivity, 12(4), 311-337.