Increasingly, gender has become a central theme in couples treatment. This reflects our society, in which marital roles have become vague, ambiguous, and often in flux. The balance or division of labor that couples achieve is tenuous and creates tensions in which power emerges as an explicit dimension of couples' conflict. Furthermore, the abdication of formerly traditional expectations (for a man to pursue his career with wholehearted, self-sacrificing support from his wife, and for a woman to be financially secure and a full-time parent) erodes the marital bond and creates hurts and disappointments that are not easily healed. Inevitably, this broadens the scope of marital dissatisfactions commonly presented in the consulting room and requires from therapists a sensitivity to gender. This paper attempts to identify the gender differences that evolve from cultural imperatives. These differences have always been obvious, but curiously ignored in clinical work. For purposes of discussion, gender differences will be divided into internal/psychological and external/behavioral aspects. These concepts will be defined and elaborated. It is essential to underscore rather than ignore the differences, because it is through them that ultimately balance of power is achieved in the marital quid pro quo. We will illustrate Excerpts from this paper were presented at the American Family Therapy Association meeting in Montreal, 1988. The authors gratefully acknowledge the helpful comments of Henry Grunebaum,

This article presents a couples group therapy treatment approach that uses analytic object relations concepts such as transference/countertransference, projective identification, containment, and the holding environment. Object relations theory is seen as the most useful theory with which to view couple interaction because it is based on a two-person psychology and focuses on the impact of relational systems on the development of the person. This includes the idea that the person grows within the attachment to another person. Group therapy is seen as a more effective treatment approach because the group is a resilient holding environment that provides an avenue in which projective identifications can be understood and contained, power can be redefined, isolation of the couple can be decreased, and the couple's responses can become more versatile. The model described is illustrated with clinical vignettes from an open-ended couples group.

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