In my practice as a psychotherapist specializing in major depression, I have found an increasingly large number of cases when depression is more of a marital problem than a clinical problem.

Many women present with depressed and angry mood, feelings of hopelessness, inadequacy, self criticalness, shutting down with withdrawal from family and friends, loss of motivation, avoidance, lack of joy and pleasure in everyday living, insomnia or hypersomnia, feelings of fatigue, loss of interest in sex, and suicidal thoughts. These symptoms meet the clinical criteria for major depression.

When we have been able to engage their husbands in therapy, with an improvement in communication, having date nights without the children, emotional support, physical intimacy, nonsexual affection, and working together as a team in managing the tasks of everyday living, many women have been able to reduce or eliminate their antidepressant medications as well as have their symptoms of depression dramatically improve.

In the Bible Ephesians 5:25-33 clearly describes God's intended role for the husband and 1 Corinthians 13:4-7 clearly describes that the husband's love can be the best prescription for his wife's depression.

Mark presented to therapy being on the verge of divorce due to pornography. His wife felt hurt, degraded, devalued, and compared to other women. There was a deterioration in their communication, companionship, emotional support, and nonsexual affection. His wife had feelings of being betrayed and used as an object for Jim's sexual gratification. She discontinued physical intimacy. In therapy Jim committed to total abstinence from pornography.

Whatever we immerse ourselves in and whatever we feed, grows and becomes stronger. Whatever we starve, shrinks and dies. Jim "threw off" pornography and "put on" immersion in a spiritual relationship, reading the Bible, praying, and initiating daily devotionals with his wife. Despite this change he continued to have lustful thoughts of women, even while attending church. Through Biblical Therapy he was able to cognitively reframe women as someone's wife, mother, sister, and/or daughter. He "threw off" lustful thoughts and "put on" praying for godly wives, loving mothers, loyal sisters, obedient daughters, and that all women would have salvation.

A couple asked me, since I have been doing couples therapy for over 30 years, why some couples seem to have a wonderful relationship, while others have constant struggles, conflicts and arguments, and end in divorce.

My observation is that couples who do not get along view marriage as a 50-50 proposition. On the surface this sounds right, with equality and fairness. 50-50 is a better model for divorce. It is a terrible model for relationships. A 50-50 attitude promotes keeping score, doing only as much as the other does, and/or responding in the same manner as one's partner. At the root of most divorces is selfishness.

A better model for relationships is 100/100. One measure of love is the degree to which we are willing to inconvenience ourselves for the other. This relationship model: Is initiated by the most mature partner, is based on being a servant rather than a consumer, is based in grace and forgiveness rather than fairness, is based on compassion rather than having to be right. The perfect model of love is Jesus. After studying and conducting marital/relational therapy models for over 30 years, I have not discovered a manual better than the Bible. Please forward this to family, friends, and those who you care about who may be going through relational difficulties.

I have been seeing an increasing number of couples in the age range 20s - 50s, who have serious sexual problems or the absence of a sexual relationship. So, what's up with that? The Bible states that God created men and women to be sexual, to enjoy sex, and to have sex on a regular basis. Oh yeah, so finally some of you are getting out your Bibles for the first time

So here is the recipe for a damaged sex life: Premarital sex with multiple partners, pornography, and/or extramarital affairs. When individuals enter into a marriage, having prior sex partners, there is no longer anything special or sacred about their physical intimacy. With the use of pornography one's partner frequently feels compared and devalued. When there is an extramarital affair there is extreme damage to trust, with anxiety, depression, anger, and frequent arguments for years after the affair has ended.

For you young people, here is a recipe for great sex throughout most of your adult life: Be sexually pure until marriage, have only one sex partner, your spouse. Have good nonsexual affection such as good communication, companionship, emotional support, and spiritual connectedness with your spouse.

Nicole grew up with a father who abused alcohol and drugs, was unpredictable, at times paranoid and violent. Afterward he would break down into tears and seek hugs, kisses, and affection. Mother was passive, needy, disorganized, and undependable. Nicole would be severely punished/abused if she cried, smiled, or at times even spoke. She grew up being hyper-vigilant and highly aware and perceptive of her father's facial expressions, body language, emotions, and his needs, in an attempt to escape violence.

After several therapy visits she adopted Romans 5:3-4 as her Life Verse. Despite a high level of anxiety, fear, damaged self-esteem, and lack of self-confidence, she used her survival skills to develop a high level of sensitivity and empathy for others. She has become involved in promoting peace and nonviolent communication.

Nicole has adopted a sense of humor, being thoughtful, supportive, witty, empathetic, and caring towards others. She now perceives her childhood traumas as a training ground that developed her character, strength and perseverance, and spirituality. She now feels like a tool, although an imperfect tool, that can be used by God to further His agenda.

When Tom went to social events he would withdraw and isolate from others. Since childhood he had feelings of shyness and that he was in people's way and under their feet. Tom was given the experiential assignment of writing an autobiography. Tom's father was a carpenter who worked out of their home-based carpentry shop. Tom's father was very busy remodeling people's homes and building fine cabinets.

Tom had no memories of he and his father ever riding bikes, going camping, playing ball, or his father ever coming to any of Tom's school events. When Tom wanted to spend time with his father, he would go to his father's workshop and would usually be met with the statement "Shoo, You're in my way and under my feet". After developing this insight, when Tom would begin to develop feelings of being in people's way and under their feet, he became aware that these feelings were not coming from other people, but coming from the DVD that had his father's voice and that was playing within Tom head.

Tom chose the Biblical life verse Jeremiah 1:4-8. He began to give other people the benefit of the doubt and after approaching them, Tom developed a sense of feeling welcome and welcoming others. After several subsequent social experiments Tom's feelings of being in the way and underfoot left him and have never returned. Tom has since become more actively involved in serving his church and in developing his social support system.

Whether or not you are a believer in Christianity, Jesus provides the best model for how couples should conduct themselves in a relationship. In doing marital therapy for over 30 years, I have found no better relational model in sociology, psychology, clinical social work, or in marital or family therapy.

In order to love as the Biblical model of love commands, we are to be imitators of Jesus, and not always cling to our own rights. When we love like Jesus, it brings new life into relationships, and heals damaged relationships. The love of Christ is manifested in the following characteristics: Love is always sacrificial, there is a cost, it is inconvenient, it is not based on our feelings. It is initiated by the one who is the most emotionally and spiritually mature. It is based in grace and forgiveness rather than in fairness or equality.

Love originates from a servant's heart, not from a consumer's heart. Love is always other-centered rather than self-centered. It is more focused on giving rather than receiving. It is unconditional, it does not keep score, is empathetic, and compassionate.

When we are the receivers of Christ's love and forgiveness we are not to keep these to ourselves, but to let them flow through us that we may be grace filled and forgiving towards others. The Bible states that the words that flow from our tongue are an overflow of our heart. In order to love like Christ, we must first be filled with Christ's love.

I have been seeing an 18-year-old teenage girl in therapy who was sexually molested at the age of 13. She was lonely, both parents busy with their careers, and no close peer relationships. She would go to the municipal pool/recreation center where an older female teen offered her candy, car rides, presents, and eventually introduced her to alcohol and sex.

When client began therapy she was depressed, anxious, and angry. She professed that she was gay. As therapy progressed she developed sexual orientation confusion and thought that perhaps she was bisexual. Today she has a boyfriend, a good peer social support system, more involvement with her family, and is very clear that she is heterosexual.

In my clinical experience I have found that there are many roads that lead to a gay lifestyle. Some of my gay clients knew that they were gay since their pre-teens, in the absence of any sexual experience. Perhaps born gay? Some were drawn into a gay lifestyle through sexual molestation by an older same-sex neighbor, babysitter, teacher, relative, coach, church leader, or some other authority figure. Some became involved in a gay lifestyle through experimentation and the pursuit of hedonistic pleasures through use of alcohol, drugs, and bisexual experiences.

As my 18-year-old female client looks back at her own history, she is angry realizing that she was vulnerable due to feeling alone, and that her perpetrator "was all that she had" for the attention and affection she so desperately craved. Some "gays" are really lost heterosexuals.

In couples therapy I frequently hear wives saying that they do not feel loved by their husbands, and husbands saying that they do not feel appreciated or respected by their wives. Husbands and wives frequently have different love languages. These may include words of affirmation and encouragement, doing chores or acts of service, giving individualized personal gifts, physical intimacy, quality time, etc.

A husband may be loving his wife in a way he would like to be loved, but in a way that she does not feel loved. I have found it therapeutically powerful for wives to define for their husbands when and how they feel loved, and when and how they feel unloved, and for husbands to share with their wives how and when they feel appreciated and respected, and how and when they feel unappreciated or disrespected.

Secular views of marriage see relationships as a 50/50 proposition. This is a better model for divorce than it is for marriage. This model is grounded in a culture of equality and fairness, however, is a terrible model for marriage and may lead to keeping score, doing only as much as the other person does, and/or responding in the same manner as one spouse. It also encourages a consumer mentality towards marriage. Biblical instruction regarding loving and serving one spouse are commandments. They are not optional or conditional, they are not grounded in one's own feelings, and they are not based on the behavior demonstrated by the other in the relationship.

A better model for marriage sees relationships as a 100/100 proposition. Our spiritual lives and our relationship with God affects our relationship with other people. We should first focus on becoming holier, then focus on our relationship. The best thing we can do for our marriage is to work on our relationship with God and the condition of our own heart.

The emotional pain of an extramarital affair is one of the most enduringly painful experiences an individual, couple, and family can go through. The spouse victimized by the affair typically goes through years of asking questions in order to make sense of the experience in order to prevent or control the affair from ever happening again; will unfavorably compare themselves to the other party to see if they were not as attractive, sexy, interesting, nice...; will re-experience unwanted intrusive thoughts, and mood swings; have unanticipated triggers resulting in severe anxiety, panic, depression, anger...; and not like the change in their own personality and who they have become.

The individual who had the affair will experience feelings of guilt, shame, and embarrassment every time the topic comes up; will attempt to avoid any discussion of the affair and will respond with explosive anger to avoid these feelings; and may even bail out of the marriage.

The families and children on both sides of an affair are typically torn apart, take sides, and act out emotional turmoil. If you are considering an affair DON'T. When God created his rule book, the Bible, he did not intend to restrict our joy and pleasure in living, but to save us from ourselves and the emotional and relational pain of bad choices. If you have already had an affair and are in the midst of pain, conflict, and despair, there is hope and healing.

I have encountered an increasingly large number of couples in my therapy practice who are extremely stressed out. One mother shared with me that she dreads waking up every morning. When the alarm goes off she begins a frantic day of getting the children up, fed, off to school or day care, rushing off to work, husband up and out earlier to work, dealing with the stress of the work day, planning what to have for dinner, speed home while on the cell phone, fixing dinner, not finishing dinner in order to get the children to sports at different locations, dropping one off at soccer another at baseball, while dad is taking one quite a distance for the traveling team, rushing home to do laundry for tomorrow, getting the kids to bed, being so exhausted that she has to go to bed in order to start another frantic day all over tomorrow, and trouble falling to sleep due to racing thoughts and dreading waking up the next morning.

Most of us would agree that there are a lot of GOOD activities to get involved in, educational, recreational, church, civic, social...etc. Couple's therapy focused on dropping many of the GOOD things in their lives, and to reorient the family from child-centered, to marriage/family-centered, with some marital date nights, leisurely family dinners, walks, bike rides, and family/extended family game nights...which they now refer to as the BEST

Learning the art & skill of Active Listening and empathetic responding are powerful tools in relational therapy. Active Listening, rather than passive listening, is a skill that can be developed in order to learn more about one's partner, child, coworker, or others. The presenter should be instructed to make "I" self-disclosure statements, avoiding attacking the other with "You" statements.

The presenter should express how they think, feel, and what they need or desire about one specific issue. The active listener should not only sit quietly, but put their agenda on the shelf behind them. If the listener does not do this, they will most likely be contemplating their rebuttal rather than listening. After the presenter is through expressing their position, the active listener should be able to give a report, rather than a commentary on the presenter's position.

All of us see through our own lenses and hear through our own filters, which inclines us to listen in a commentary style. The active listener needs to check out with the presenter the accuracy of the listener's understanding. The skill of being an active listener/reporter can be mastered. The goal of therapeutic communication should not be to push our view or agenda on the other until they relent, but to learn something new about the other person

Once each individual has accurately heard the other, and have new information about each other, then they can go about the business of serving each other. Empathetic responding should be grounded in a servant's heart and radical other-centered love. James 1:19 My dear brothers and sisters, be quick to listen, slow to speak, and slow to get angry. Active listening and empathetic responding can avoid many a needless argument.