I think I have mentioned before, that I once conducted marriage therapy with only the wife, but ensured the husband was included in each session by sending him a letter after each session with his wife (see previous marriage therapy articles). This was effective, and helped me to work with the marriage even though I never saw the husband.
The second point is not so much a point to stress, as a tool. At a certain point in therapy, I usually land up asking the couple to do the following as a homework exercise: They are to visualize their perfect (surprise) evening out with their partner - from the preparations to the finale.
Use their answer as a metaphor for sex - or any other problem they may be experiencing. I once saw a couple who experienced problems largely due the fact that the woman was very private, and, although she enjoyed sex, was not yet really ready for the full intimacy of the act. She needed time, and did not like foreplay or any other behavior which "intimized" the act too much. For her, the surprise meal was one in which she had choices - she would choose her own food from the menu, and the perfect meal would not be one in which they were hidden away in a romantic and intimate corner of a restaurant. We discussed the differences in their fantasies, and at the same time, I was able to bring in some fears of hers, which she had expressed to me alone, without actually letting on that she had told me anything. I could relate everything back to the surprise dinner fantasy, and her husband understood really well.
When the couple relate their dinner fantasy, it is useful to note who takes the initiative. Relate this to the bedroom (or other major problem they have) showing how the one partner needs the other to take the initiative (or leave it to him/her) as the scenario unfolds itself. Look at who wants to serve, who wants to be served; how each partner defines romance (one might really wish for silver, crystal and all the trimmings, while the other may find that the more rugged the situation, the sexier).
