Case 29: Marital Conflict and Couple Therapy
Vijay Pathak, Deepali Batra & Bankey Lal Dubey
This case study examines marital conflict in a couple who sought therapeutic intervention. The Somatic Inkblot Test (SIT) was administered to assess the individuals' psychological dynamics. The husband's SIT responses revealed a desire for relational preservation, alongside indications of emotional distress and social withdrawal. Conversely, the wife's responses highlighted somatic concerns, a yearning for spousal affection, and frustration stemming from incongruence between marital expectations and experienced reality. Collectively, the findings from both cases evidenced significant marital discord, characterized by emotional pain and perceived disconnection. Therapeutic interventions, incorporating both pharmacological and psychotherapeutic modalities, were implemented. Follow-up assessments within a six-week period indicated a positive shift towards improved relational harmony.
Introduction:
Marital conflict is a complex issue with profound implications for the well-being of individuals and families. Research has consistently demonstrated the damaging effects of maladaptive communication patterns on marital satisfaction. Gottman's work, for instance, has identified specific negative communication behaviors, such as criticism, defensiveness, contempt, and stonewalling, as strong predictors of relationship dissolution (Gottman, 1999). These patterns can create a cycle of negativity, eroding emotional intimacy and leading to feelings of disconnection and resentment, mirroring the dynamics observed in the case report where both the husband and wife express significant emotional pain and a lack of connection.
Furthermore, individual factors, such as past experiences and emotional regulation abilities, play a crucial role in shaping marital dynamics. Attachment theory provides a valuable framework for understanding how early childhood experiences can influence adult relationships. Bowlby's theory, for example, posits that individuals with insecure attachment styles may exhibit heightened anxiety or avoidance in their relationships, contributing to conflict and instability (Bowlby, 1969, 1988). In this case, the wife's history of childhood abuse and the husband's struggles with self-confidence are important individual factors that likely contribute to their marital difficulties.
Effective therapeutic interventions for marital conflict often address both communication patterns and individual issues. Couple therapy approaches, such as Emotionally Focused Therapy (EFT) developed by Sue Johnson, aim to improve emotional regulation, enhance empathy, and create more secure attachment bonds between partners (Johnson, 2004). Additionally, individual therapy can provide a space for each partner to process past trauma, develop healthier coping mechanisms, and improve self-awareness, ultimately fostering healthier interactions within the relationship.
The present study aims to discuss the issues among a couple having marital conflict approached for help. Both took Somatic Inkblot Test online. The findings of the SIT, and therapeutic progress have been discussed in the paper.
Case A (the Husband):
The Client, a 37-year-old Hindu married male who is currently self-employed, has been experiencing emotional difficulties related to his marital life and stagnant professional growth. These challenges have contributed to feelings of low energy, frequent impatience, and a sense of isolation. Over the past five years, he has become increasingly reserved and feels that he may be disappointing or letting down those around him. His interests frequently change, and he struggles with persistent negative thoughts, low motivation, and occasional suicidal ideation. He took the SIT online test on Feb 2, 2025.
He reports that the onset of his difficulties was insidious, with a fluctuating course, though he perceives his overall emotional and mental well-being deteriorating over time. He was diagnosed with depression in 2017 and was prescribed medication. In addition to his mental health struggles, he underwent cholecystectomy surgery in 2020, which may have further impacted his physical and emotional state.
During his childhood, he was an active child but often felt pressured by his parents to participate in sports, which may have contributed to his struggles with low self-confidence. At present he lives in a joint family and tries to be present for his parents, though he feels they may still be disappointed in him. Academically, he performed at an average level in school, maintaining neutral relationships with teachers and authority figures. He had a limited social circle and a small number of friends. He describes his premorbid personality as happy, motivated, and balanced. While he perceives himself as an assertive individual, he has noticed a significant decline in his emotional well-being over time. Additionally, he has developed a habit of frequent vaping, which may be a coping mechanism for his emotional struggles.
Behavioral observation (During assessment sessions):
He was cooperative, having adequate attention, concentration, comprehension and psychomotor activity. His interest and motivation are present with no behavioral problems. The assessment was done in one session.
Test administered:
The following tests along with clinical screening were used for the purpose of assessment-
Test findings:
1. Bender Visual Motor Gestalt Test: The test measures perceptual motor skills along with perceptual motor development and gives an indication of neurological intactness along with assessing emotional problems (Bender, 1946). As per Client’s performance on the test, he has adequate visuo-perceptual and/or visuo-motor skills.
2. The significant responses projected on the Somatic Inkblot Test are analyzed ahead using symbolic and psychoanalytic interpretation (Cassell & Dubey 1990, 2003, Dubey et al, 2019; Dubey & Dubey, 2023; Philips & Smith, 1993):
Image 1: Heart and inside heart a couple is holding each other’s hand, in a way they are falling apart but somehow managing to hold their hands tightly”. The response indicates his desire to keep relations intact with his wife. It’s a very good sign and positive indicator and I hope couple therapy will bring them together again.
Image 2: “Lord Krishna standing with crossed legs”. The crossed leg concept of lord Krishna may indicate a pleasant mood and happiness along with spiritual help to resolve his differences with his wife.
Image 3: 1. “Man carrying big heart on his shoulder” may indicate his feelings to continue his relationship even in odd situations.
2. “Cartoon with big open mouth laughing” indicates his happy mood. The “open mouth” may also indicate craving for affection, which is clear from his case history.
Image 4: “A child excited and happy to see a small teddy”, indicates his happy childhood. It’s a normal response.
Image 5: A lady in dancing pose with a big prop in air”. The response may indicate his wishful thinking to see his wife happy and in a way desire to have a happy interpersonal relationship with her.
Image 6: Man looking at the lady from behind, in assumption their heart is connected with each other”. Man looking from behind may indicate his avoidance to have eye to eye contact probably because of conflict with his wife, and “heart is connected with each other “indicate his desire and wishful thinking to have again loving relationship with his wife.
Image 8: “A hand asking for help, to be pulled out” clearly indicates his inner cry for help. This may also indicate his desire to get help from the significant family members to save his marital life on the verge of divorce.
Image 9: “Two birds kissing each other”. The response indicates his feelings to have smooth interpersonal relationship with his wife, and a sign of good prognosis.
Image 10: “Mans chest with heart divided” may indicate the feelings of separation among the couple and the conflict with his wife. “Divided heart” may also indicate his extra marital relationship with someone which the client has accepted and narrated the story of his affairs. This is also a major source of conflict with his wife.
Image 11: “Upper body of giraffe with heart garland” is a normal response
Image 13: “Man wearing black gown trying to protect two kids, he has big heart” may indicate his desire as a father to protect the life of his two children who suffer most if divorce takes place. This further indicates the bond between the father and children, a great source of unity for the family.
Image 14: “Spinal cord” is a normal response in this image.
Image 15 “Face with big ears and third eye of Shiva”. Face with big ears might be a symbol of suspicious attitude and third eye may indicate perceived aggression, which must be addressed during therapy sessions
Image 16: “Ultrasound with fetus inside mother’s womb”, is a normal response in this image.
Image 17: “Small portion of fashion model photograph”. Normally people perceive breast in this image which may indicate good interpersonal relationships with a mother or mother figure. Avoiding perceiving breast may indicate conflict and poor relationship with opposite sex. In this case the projection of disturbed relationships with wife is brought on the surface
Image 18: “Two couples talking but both have different minds” The response further projects difference of opinion among the couple which is a major source of conflict among couples. Couple therapy might be of great help in such cases where they learn to listen patiently and respect each other.
Image 19: “Man whispering into ears of other man” may indicate his suspicious attitude and paranoid ideation.
Image 20: “Couple sitting face to face exchanging words’ clearly indicates their aggression towards each other.
Image 21: “Girl trying to protect herself from the attack” may further projects active aggression to the extent of physical abuse which must be addressed during therapy session.
Image 22: “Soft heart” indicates his concern and affection towards his wife which is a positive indicator helping them to unite again.
Image 23: “Landscape with monument in between”. Male phallic part is a common response in this image avoiding perceiving this theme may indicate frustrated erotic relationship and sexual conflict.
Image 24: “Broken, venomous heart” clearly indicates their broken relationships with lots of bad feelings for each other which should be addressed during couple therapy sessions.
Image 25: “Gun with blasted barrel” has brought to the surface the theme of image 20 and 21 again in this image. Pent-up aggression is obvious among the couple which must be addressed during therapy sessions.
Image 28: “Mother hugging her child” is a normal response in is this image.
Image 29: “Man running” is a normal response in this image.
Image 30: Complete family of four- two kids’ husband and wife” is a normal response in this image. The response further projects his desire to save the family from the present crisis. It is also an indication of good prognosis in this image.
Quantitative Indices:
Human responses = 19 (50%), Animal responses = 2 (5.26%), Anatomical responses = 10 (26.32%), Sex responses = 1 (2.63%), other responses = 6, Most typical responses = 12, Typical responses = 4, Movement responses = 15 (39.47%), Depression=1, Hostility Aggression Scale = 3, Depression= 1, Paranoia = 1, Total number of Responses = 38.
The symbolism in the response may predominantly express
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Desire to hold onto the relationship despite difficulties.
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Spiritual coping mechanisms and his attempt to find inner peace amidst emotional turmoil.
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Themes of death and detachment, possibly reflecting DSH ideation and feelings of hopelessness.
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Desire for support.
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Emotional pain and possible resentment.
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Desire for a harmonious family life.
Summary & Impression:
His low animal responses may indicate withdrawal, aloofness, and loneliness, while high anatomical responses may suggest a preoccupation with somatic concerns, poor self-image, and possible hypochondriacal tendencies. Low sex responses may reflect suppressed sexual desires or deep-seated conflicts, potentially linked to marital difficulties. High movement responses highlight creativity and active engagement but also suggest inner restlessness and emotional turmoil. Symbolically, his responses express a deep desire to hold onto his relationship despite difficulties, reliance on spiritual coping mechanisms, and an attempt to find inner peace. Themes of death and detachment hint at feelings of hopelessness, while a longing for support, emotional pain, resentment, and a wish for a harmonious family life further underscore his psychological distress. The Most typical responses are 12 indicates his awareness with his surroundings and his contact with reality. He is able to manage his odd situation after therapeutic support.
Case B (the Wife):
Presenting problems:
The client is a 37-year-old married Hindu female working as a trainer. She took the SIT online test on Feb 3, 2025. She reports significant difficulty managing anger and emotional distress stemming from psychosocial stressors related to her marriage. She has a history of anger issues and has previously undergone marital therapy to address these challenges. She experiences frequent mood swings, oscillating between moments where she feels everything is fine and periods where she feels annoyed, disheartened, and betrayed. At times, she also feels vindictive. When angry, she often cries, whereas in the past, her anger manifested as outbursts involving yelling. These emotional episodes typically last for 2-3 days.
Her childhood was marked by significant adversity. Her mother was physically abusive, creating a frightening, painful, and humiliating environment. However, her mother passed away when she was 10 years old, after which she moved to her grandmother. This transition brought a dramatic change in her life, as her grandmother’s home had a lovely and peaceful environment. About 4 years after the death of her mother, she excelled academically, became an admired student, had many friends, and enjoyed a happier life. She shared a close and positive relationship with her father.
Professionally, she worked as a teacher for nine months before her marriage but had to leave the job when her in-laws fell ill. She has been working in her current role as a trainer for the past eight months.
Behavioral observation (During assessment sessions):
She was cooperative, having adequate attention, concentration, comprehension and psychomotor activity. Her interest and motivation are present with no behavioral problems. The assessment was done in one session.
Test administered:
The following tests along with clinical screening were used for the purpose of assessment-
Test findings:
1. Bender Visual Motor Gestalt Test: The test measures perceptual motor skills along with perceptual motor development and gives an indication of neurological intactness along with assessing emotional problems. As per her performance on the test, she has adequate visuo-perceptual and/or visuo-motor skills.
2. The significant responses projected on the Somatic Inkblot Test are analyzed ahead using symbolic and psychoanalytic interpretation:
Image 1:(1) “cancerous tissue”. It may indicate her constant suffering and somatic problems.
(2) “a man offering a bunch of flowers to a woman” this may indicate her wishful thinking and desire to get affection from her husband.
Image 3:“It’s a cartoon of a happy, kind, welcoming, educated man. The heart is the face reflecting kindness, arms spread welcomingly, and the cloud is his brain”. The theme of image 2 is brought back in this image. She has a picture of an ideal man as her husband who is happy, kind, educated, with welcoming attitude but her husband is almost opposite to her expectation. This is a kind of conflict with her expectation and present reality which has brought lots of frustration and anxiety in her life. The therapist must create a balance to resolve such conflict.
Image 4:“I can see a teddy bear who is sad and an icon of a stiff mother”. The response clearly projects her suffering during early childhood and deprivation of affection from her mother. Her case history confirms this.
Image 5:“A dancing lady and an apple”. This indicates her intact ego state and healthy body imagery. This also indicates a sign of good prognosis.
Image: 6:“Two ladies exchanging hearts” Two persons, a male and a female would have been a better response in this image. Since the client has disturbed intimate relationship with her husband, she has avoided perceiving a male and female.
Image 8: “A hand seeking help. Maybe he is trapped somewhere and could only raise his hand seeking help. I can see him in walls, barriers” The response clearly indicates the feelings of the wife and her projection that her husband is trapped in a situation (probably with other female which she is aware of)-and wanted her help. The therapist should deal with such situation during couple therapy sessions. Both may come with workable solutions
Image 9:“This is a picture of two animals. The Mamma mammal is feeding the baby mammal, and the baby will grow up like the mother soon. The heart at the bottom denotes love and growth with this love”. The response clearly indicates her feelings of separation and looking after her baby girl without emotional support from her husband. This also indicates her pensive mood.
Image 10:“This is a picture of two goats or horses stuck together and share a heart” may indicate her current situations where she feels trapped and has no choice but to share her feelings with each other.
Image 11: “A zebra princess with a garland of red flowers”. The response may project her wishful thinking to be looked after well by her partner
Image 12:“Dysfunctional Kidney” may indicate severe health concern with her own body or with some significant family members.
Image 13: “A magician showing some magic tricks to two kids” indicate slightly poor interpersonal relationship between father and son/daughter.
Image 15: “A flower captured black and white”. Female phallic part is the normal response in this image. Though the flower maybe the symbolic representation of female body, the black and white may indicate her low self and poor body imagery with deep rooted sexual conflict.
Image 16:“Ultrasound image of a womb showing a baby enjoying and swimming in the womb” may project her regression and take her back in time when she was in her mother’s womb, and she was feeling secure and happy without any tension. It may also indicate concern for a secure environment for her daughter.
Image 17:“Picture of a semi naked women showing her shoulder”. The response may project her desire to attract her husband and have an intimate relationship.
Image 18: “A sad woman and an angry man. Both with a negative state of mind” The response may indicate her pensive mood and aggressive behavior of her partner. It also indicates conflicting interpersonal relationships. This is a second response giving an indication of her pensive mood which must be addressed during therapy sessions. She also needs pharmacological intervention.
Image 19: “A man showing a face to the world but in real is faceless” indicates her feelings towards her husband who projects himself to be a good person, but he is not.
Image 20: “A man and a women conversing about food. Man is angry, the women trying to explain about something”. The response may indicate their conflict on a routine basis and the perceived aggressive behavior of her husband.
Image 21: “An abstract drawing with a lot of knives and sharp objects. The dark red scratching reflects anger and resentment of the artist”. The response projects severe conflict and aggression, to the extent physical abuse, which must be addressed during therapy sessions.
Image 22: “The picture denotes love. It’s confused and disoriented from outside, but it goes deeper its intense and strong and…” The response may project their concern for each other and a desire to understand each other. It is a sign of good prognosis for the couple.
Image 23: “Painting of a baby dinosaurs trying to come out of a dig” Male phallic part is the normal response on this image. However, baby dinosaurs coming out of the dig may symbolize sexual connotation and dissatisfaction with her husband. It also indicates conflict in intimate relationships.
Image 24: “Picture reflects earth which has love here and there but is trapped with negativity and diseases” may clearly indicates his disturbed interpersonal relationship and pensive mood. The theme of image 15 and 18 is reflected again in this image.
Image 25: “A cartoon image of a gun with a blast mouth after a shot” It may indicate flared-up aggression and hostile attitude which might be the reflection of her situation. In any case such aggression must be dealt with pharmacological aid and psychotherapy.
Image 26: “A dead body and footprints of the soul which just left” is a normal response in this image.
Image 27:“The soul of a fetus looking at a fetus in a womb it must enter” The theme of image 16 is brought back in this image and it indicates her regression at Fetus stage.
Image 28: “A mother lifting her child, the child wants to hug and climb up his mother’s arms”, may indicate her loving relationship with her children.
Image 30:“A happy family, end of a story, returning back”. This indicates a desire to resolve all differences and make a family again. It’s very good prognostic indicator.
Quantitative Indices:
Human responses =16 (44%), Animal responses =2 (5 %), Anatomical responses = 10 (26%), Sex responses =1, Other responses = 6, Most typical responses =13, Typical responses =4, Movement responses =15 (40%), Depression=1, Hostility Aggression Scale =4, Depression= 1, Paranoia =2, Total number of Responses =38. The Hostility and Aggression indices are more than average which indicates pent-up aggression.
The symbolism in the response may predominantly express
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A fragmented self-image, oscillating between distress and hope for reconciliation or healing.
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Her unmet emotional needs or aspirations in her marital relationship.
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Unresolved childhood trauma
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Longing for emotional connection, mutual understanding, and nurturing relationship(s).
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Longing for safety, comfort, and unconditional nurturing, possibly reflecting a desire to return to a state of emotional security and protection.
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Internalization of negative emotions and unresolved tension in her relationship.
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Identity conflict or emotional masking. It may reflect client’s perception of inauthenticity—either in herself or others—where outward appearances hide an inner void or lack of true self.
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Tensions or conflicts related to intimacy, control, or identity.
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Idealized longing for harmony, closure, and emotional fulfillment in her family life.
Conclusion of both cases and therapeutic plan:
Both individuals underwent clinical screening and the Somatic Inkblot Test (SIT).
Husband (Case A):
The husband's SIT responses indicate a desire to maintain his relationship with his wife, reliance on spiritual coping mechanisms, and feelings of emotional pain and resentment. There are also indications of withdrawal, aloofness, loneliness, preoccupation with somatic concerns, and suppressed sexual desires, potentially linked to marital difficulties. His responses also suggest inner restlessness and emotional turmoil, along with a desire for a harmonious family life.
Wife (Case B):
The wife's responses reveal potential somatic problems, a longing for affection from her husband, and feelings of frustration and anxiety due to a perceived conflict between her expectations and the reality of her marriage. Her childhood experiences of maternal deprivation are also evident. She displays a fragmented self-image, oscillating between distress and a desire for reconciliation, and expresses unmet emotional needs, unresolved childhood trauma, and a longing for emotional connection and nurturing. There are also indications of internalized negative emotions, tension in the relationship, and potential identity conflict. The wife's responses also suggest feelings that her husband is not genuine.
Relational Dynamics:
The findings from both cases point to significant relational distress. Both individuals express feelings of conflict, emotional pain, and a sense of disconnection within the marriage. The husband's avoidance of eye contact and the wife's perception of her husband's inauthenticity suggest communication difficulties and a lack of emotional intimacy. The wife's anger and the husband's potential for aggression indicate a pattern of conflict that may escalate further.
Overall Impression:
The couple is experiencing significant marital conflict characterized by emotional distress, communication problems, differing expectations, and unresolved individual issues, including the husband's depression and the wife's childhood trauma. These factors appear to be contributing to a negative cycle of interaction, impacting their emotional well-being and the stability of their relationship.
Therapeutic Applications
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Therapeutic Interventions: Both were started with individual therapy to focus on self-reflection, emotional regulation, and addressing underlying conflicts. Sessions of couple’s therapy were started under a specialist addressing relationship dynamics and improving emotional intimacy. By focusing on emotional awareness, vulnerability, and self-esteem, these therapeutic approaches are reportedly supporting them in creating more fulfilling connections and managing emotional challenges in healthier ways. Within six weeks of follow-ups report that they have achieved a better harmonious relationship.
References:
Bender, L. (1946). Instructions for Use of the Visual Motor Gestalt Test. New York: American Orthopsychiatric Association.
Bowlby, J. (1969). Attachment and loss. Vol. 1: Attachment. New York: Basic Books.
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.
Cassell, W. A., & Dubey, B. L. (1990). Manual of Somatic Inkblot test. Anchorage, AK: SIS Center.
Cassell, W. A., & Dubey, B. L. (2003). Interpreting Inner World through Somatic Imagery: Manual SIS-II. Anchorage, AK: SIS Center.
Dubey, B. L., Banerjee, P., & Dubey, A. (2019). Inkblot Personality Test: Understanding the Unconscious Mind. Sage Publications.
Gottman, J. M. (1999). The marriage clinic: A research-based approach to working with couples. WW Norton & Company.
Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. Routledge.
Phillips, L & Smith, J.G. (1953). Rorschach Interpretation: Advanced Technique, Grune, New York.