Expanding the treatment system from the individual to the couple or family carries with it some unique challenges and fundamental clinical dilemmas for the marital and family therapist. Marital and couple therapy is explored with a focus on the dilemmas that dyadic relationships bring to the treatment context. The couples central relationship dynamic is discussed as a way of distilling the sources of disharmony in an intimate relationship to the emotional concerns most relevant to treatment. The dilemma of therapeutic technique that is omnipresent in all forms of couple therapy is the distribution of the therapists confrontation and support among the partners. This issue is elucidated in light of the role that the therapist occupies within the family and treatment hierarchies. Finally, the dilemmas involving the balance of relational power in the couple, the attribution of responsibility and blame, the question of family loyalties, and the balance of therapeutic art in an age of science and empirically validated treatments are also examined. (Contains 80 references.) (Author/GCP)