Constructivist approaches to therapy that view the therapist and patient as equal participants in co-creating a new dialogue render aspects of experience invisible. What is missing is an awareness of the dominant structures in society and the dominant ways of thinking and speaking. Three key factors need to be understood: first, the way meanings are embedded in language; second, the hierarchical nature of relationships, including the therapeutic relationship; and third, the larger social context in which therapy as an institution exists. Therapy is a cultural practice of modern European-related society, which reproduces that society's gender, class, and race systems. One way a therapist can question the dominant discourses and the ways patients may be harmed by them is by use of discourse analysis. Marital conflict is analyzed using three discourses of heterosexuality: (1) the permissive discourse; (2) the male sexual drive discourse; and (3) the marriage between equals discourse. Each discourse involves reciprocal patterns for men and women, but each also favors masculine interests and needs. The case illustrates how the therapist can bring marginalized views into the therapy room and make visible the cultural narratives through which we live. Contains 27 references. (Author)