Save Your Marriage

Save The Marriage

Lee Baucom, Ph. D. shows couples with marriage troubles a new way to save their marriage that is far more effective than any marriage counselor in this marriage course. In 4 easy-to-read modules, Dr. Baucom shows the step by step way to save a marriage that is in danger of ending any day. These show the top 5 mistakes that most people make in marriage, the REAL secrets to a happy marriage, why marriage counseling can actually HURT your marriage more, and how to move beyond your emotions into action. This module can actually have you saving your marriage in less than an hour, sometimes even 10 minutes. This book also comes with 4 bonus gifts free: Coping With a Midlife Marriage Crisis, Recovering from an Affair, 5 Rules for Fighting Fair, and an eBook written by a couple who was on the edge of divorce and the methods they used to get a happy marriage back. Marriage can be hard, but divorce is harder, on you and your children. Why risk it? Read more here...

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Implementing Treatment Dimensions of Family Therapy

In family therapy, the therapist should be cognizant of how the family arrangement and stage influence the patterns that maintain the presenting problem, and how each can affect treatment success or failure. No single recommendation can be made for each possible combination of family stage by family composition by marital status by parenting skill, and so on. Instead it is much better to examine each family as a unique composite, having its own history and belief system. By observing this belief system as expressed through behavioral patterns, the proper therapeutic intervention becomes evident for each particular family, irrespective of developmental stage. a. Tasks In-Session versus Out-of-Session. Requesting change via tasks is a hallmark of family therapy. Tasks, or requests for specific behaviors, can occur either in- or out-of-session. In-session tasks consist of directing the interaction among family members. This can consist of interaction between family subunits, or among...

Communications In Group Or Family Therapy

When therapy includes more than one individual, as in group and family therapy, clients have a right to know in advance, as part of the informed consent process, any limitations of privacy, confidentiality, or privilege affected by the presence of more than one client. For example, if a clinician is providing family therapy, will he or she keep confidential from other family members information conveyed in a telephone call from a minor son that he is using drugs, from a minor daughter that she is pregnant, from the father that he is engaging in an extramarital affair and plans to leave his wife, or from the mother that she has secretly withdrawn the family's savings and is using it to gamble Therapy involving more than one client emphasizes a major theme of this book trust. The therapist and members of a therapy group may assume that everyone involved is trustworthy. But what if that is wrong What if, for example, one of the group members is a newspaper or magazine reporter gathering...

Comprehensive Interventions

A number of cognitive-behavioral researchers have developed comprehensive interventions for children and adolescents with ADHD, which include individual skills training, family therapy, and school interventions. To our knowledge, none of these comprehensive intervention packages have been compared in their totality vis- -vis stimulant medications, contingency management, or as an adjunct intervention to the established treatments. Building on the successes and failures of the first generation of CBI for ADHD, Lauren Braswell and Michael Bloomquist (1991) developed one of the most comprehensive treatment packages for children and adolescents with ADHD. This treatment package, Cognitive-Behavioral Therapy with ADHD Children Child, Family and School Interventions, was developed based on an ecological- developmental model of cognitive-behavioral therapy to improve children's self-control. In contrast to previous treatment packages where most of the interventions focused on the child,...

The Sense of Merger and Transcendence

Lovers may go beyond a sense of joint identity, may feel that they have in fact merged. Charles Williams said, Love you I am you, perhaps echoing Cathy's famous declaration, Nelly, I am Heathcliff. Lovers play on merging their names as a symbol of soulful merging. The Duke and Duchess of Windsor, in their love letters written before their marriage, referred to themselves as WE, the W standing for Wallis

Criticisms Of Cbt With Couples And Families

The vast majority of criticisms concerning CBT come predominantly from the field of marriage and family therapy. CBT was, and in some cases still is, perceived by the other modalities as lacking depth in dealing with the underlying dynamics of family dysfunction. Moreover, CBFT is often regarded as being useful only with cases involving children who have behavioral disorders or family problems, especially when parenting issues are the focus of treatment. CBT tends to be viewed by some mental health professionals as rigid, mechanistic, and too wooden in its approach. It is also the erroneous impression of others that CBT tends to downplay affect and may be very insensitive to cultural issues in couples and family therapy. One of the other criticisms is that the more direct treatment posture of CBT has been viewed as being intrusive. For example, many of the proponents of system theory tend to view the therapist as a reflective instrument of change as opposed to maintaining a more...

Directions For Cbt In The Future

The future of CBT with couples and families appears to be very promising. The integration of CBT with other modalities of couples and family therapy is on the rise. It was actually highlighted in a recent edited text by Dattilio (1998a), in which CBT was proposed as having strong, inte-grative potential with many of the 16 different modalities of couples and family therapy featured in the text. CBT techniques and strategies are very versatile in dealing with contemporary issues of couples and families. Theoretically, because most approaches to couples and family therapy involve human intellectual communication, the majority of therapies may be said to be cognitive, or at least maintain a cognitive component. For similar reasons, most therapies can be considered behavioral as well because communication and interaction exchange is often behavioral, and all behaviors are communicative. Because the human condition also involves emotions, most psychotherapies address emotion to a...

Gender Related Social Groups

Historically, the basic unit of association was the nuclear or extended family, which existed within a village. There were no large kin-based or gender-based associations beyond these. Under Communism, concerns about privacy and safety from informants, as well as a general material scarcity and lack of funds for outside recreation, led most Czechs to associate mainly within the family or a close circle of relatives and friends. Today, the divorce rate is high, and young Czechs are marrying at a later age and are more geographically mobile than their parents' generation. Young Czechs still often socialize at least occasionally with their families, and a weekend at the family cottage (chata or chalupa) in the country is quite common, but many Czechs now comment on the erosion of the family associations which held under Communism.

Future Directions For Practice And Research

Social support can have a strong impact on the occurrence, severity, and duration of psychopathology, and friends and family should be involved in treatment if possible. This may simply involve obtaining information about patients from loved ones or educating those loved ones about depression and personality disorders. However, there is also evidence that couple and family therapy can be used to treat patients' mental health problems in addition to ameliorating relationship problems (APA, 2000 Hollon et al., 2002).

Empirical Basis Of Cbt With Couples And Families

It was not until the late 1970s that cognitions were introduced as an auxiliary component of treatment with behavioral paradigms in couple and family therapy (Margolin & Weiss, 1978). During the 1980s and 1990s, cognitive factors became an increasing focus in the couples research and therapy literature, and cognitions were addressed in a more direct and systematic way than in the other theoretical approaches to family therapy (Dattilio, 1998 Dattilio & Padesky, 1990). Similarly, behavioral approaches to family therapy were broadened to include members' cognitions about one another. Ellis was also one of the pioneers in introducing a cognitive approach to family therapy. A more progressive expression of literature on cognitive-behavior family therapy expanded rapidly throughout the 1980s and 1990s (Dattilio, 1998). Epstein (2001) has produced an excellent overview of the empirical status of CBT with couples. More recently, Dattilio and Epstein (2003) published an overview of both...

Communicating your concerns

What can you do if he doesn't seem to take your symptoms seriously You need to find another doctor. But if you initially felt comfortable with this doctor, you may want to try and salvage your relationship. To take another stab at developing a good relationship, try the following

Courtship and Marriage

In the early decades of China's post-revolutionary period, marriage required parental approval. However, by the 1980s that was changing. In China's largest cities, a new generation had come of dating age and, through their ideas and actions, had expanded the customary notions of courtship, generating new expectations and demands for emotional satisfaction within marriage. Part of this thinking suggested that if dating could provide some emotional excitement and satisfaction, marriage could do the same. In this way marriage is no longer seen as primarily a vehicle for procreation, but rather it is regarded as the primary institution for achieving happiness, contentment, and emotional security. The folk notion that love and romance could be combined within marriage is not a recent phenomenon. The two were not perceived as antagonistic or mutually exclusive, barring unfavorable circumstances. What is new is the state's legal endorsement of free choice, and thus love, as a basis for...

Smell And Sexual Arousal

Throughout history aromas have been linked with sexual response. Perfume jars were preserved in the chambers designed for sexual relations in volcanic remnants of ancient Pompeii. Ancient Sumarians used perfumes to entice women. Traditional Chinese rituals highlight the relationship between smell and affection. Hieroglyphics also relate the two. Virtually all cultures use perfume in their marriage rites. In the modern world as well, the connection is pervasive. Use of perfumes and colognes as romantic enticements are a multibillion dollar business (8). The prominence of the historical connection between odors and sex among diverse cultures implies a high level of evolutionary

Therapeutic Contexts

Clarification has a special role to play in family therapy. In dealing with the family, the therapist must be clear about the nature of the relationship to the patient and how that interdigitates with the relationship to the family and what his or her purpose and role is in each of those related contexts. Ultimately, the desire for all parties involved must be taken as seeking the well-being of the patient as connected with the better- and healthier functioning of the family system and ultimately to the benefit of all parties involved. This clarification and stance must be maintained in the face of continual pressures from all sides, on the part of both the individual patient and the family, to undermine this position, to draw the therapist into one or other trans-ferential position, and to elicit from him or her some form of countertransferential response that will serve to undermine the therapeutic alliance, destroy the therapeutic position and make him or her in-effectual as a...

Husband Wife Relationship

The average age of first marriage for females has increased to 27, and the age disparity between bride and groom has decreased. Because young couples are now much more likely to live on their own, the nuclear family has become a more significant unit. For many Iranian wives, these changes translate into a more equal relationship with husbands. However, in other cases, couples left to their own devices feel their dissatisfaction more. Divorce rates have risen.

Discuss how the differences in the core values could lead to different strategies for future product development in the

The food designer needs to be aware, in the target market, of the general consumer behaviour towards foods and eating, and how this is slowly changing with time, but also needs to recognise the sudden change. This can be caused by either new information giving an attitude change, or new foods giving the consumers some greater advantage for safety, nutrition, convenience or attractiveness. Companies that have a long-term relationship with their target consumers build up knowledge about the trends in changes of their behaviour, which is invaluable in product development.

Relative Status of Men and Women

In traditional marriage, the bride has less say than the groom. Fathers may betroth their daughters at a young age the daughters have very little choice in the matter. The men perform brideservice as the girl matures, and when she has reached marriageable age, she is more or less forced to marry her official fiance or be punished by the spirits. Many young women prefer to flee the area and or work as prostitutes to earn money to compensate the groom for his brideservice they can then marry a man of their own choosing, who is closer in age and often in the same age set. Women are also relatively free to divorce, as long as the husband is compensated for brideservice and or children remain with the husband.

Scenarios For Discussion

How might this event affect the therapy and your relationship with the client much gotten over that. Their sex life is not good. Her husband enjoys anal intercourse, but she finds it frightening and painful. She tells you that she'd like to explore her resistance to this form of sexual behavior in her therapy. Her goal is to become comfortable engaging in the behavior so that she can please her husband, enjoy sex with him, and have a happy marriage.

Description Of Treatment

Insight-oriented approaches to couples therapy emphasize recurrent maladaptive relationship patterns that develop from early interpersonal experiences either in the family of origin or within other significant emotional relationships. These approaches vary in the extent to which they emphasize the unconscious nature of these relational patterns, the developmental period during which these maladaptive patterns are acquired, and the extent to which interpersonal anxieties derive from frustration of innate drives. However, a shared focus of insight-oriented strategies are previous relationship injuries resulting in sustained interpersonal vulnerabilities and related defensive strategies interfering with emotional intimacy, many of which operate beyond partners' conscious awareness. Consequently, insight-oriented approaches to couples therapy emphasize that partners' maladaptive relationship patterns are likely to continue until they are understood in a developmental context. This...

Theoretical Bases

In its most orthodox formulation, insight-oriented couples therapy derives from object relations theory and its central tenet that the primary drive in infants is to secure attachment to the mother. From interactions primarily with the mother, infants develop internalized images of the self, images of significant others, and sets of trans actions connecting these images or objects. From an object relations perspective, maladaptive relationship patterns of adults reflect enduring pathogenic introjects that give rise to inevitable frustration when these are projected onto relationships with significant others. In a distressed marriage, partners' pathogenic introjects interact in an unconscious, complementary manner resulting in repeated disappointments culminating in persistent conflict. Consequently, the goal of psychoanalytically oriented couples therapy is helping partners to modify each other's projections, to distinguish these from objective aspects of their own self, and to assume...

Empirical Studies

Among insight-oriented approaches to couples therapy, both the emotionally focused therapy developed by Susan Johnson and Leslie Greenberg and the affective reconstructive therapy described by Douglas Snyder and colleagues have been shown to be effective in reducing couples' distress and improving relationship satisfaction. Douglas Snyder and Robert Wills compared their insight-oriented approach emphasizing affective reconstruction with a traditional behavioral couples therapy emphasizing communication skills training and behavior exchange techniques. Thirty couples were randomly assigned to each of these two treatment conditions, and 20 couples were assigned to a wait-list control group. At termination after approximately 20 sessions, couples in both treatment modalities showed significant gains in relationship satisfaction compared to the control group. The effect sizes for both treatments were approximately 1.0, indicating that the average couple receiving either treatment was...

The Anger Episode Model

Models Anger

And duration of the episode, and sets the stage for additional anger as a negative distorting filter likely to be applied to further actions by the trigger. Angry adults who are high on trait anger also report more mental health problems such as depression, anxiety, panic attacks, substance use, and marital problems, all of which have strong cognitive elements.

Additional Resources

Excerpts addressing dual relationships and multiple relationships from the standards of professional associations (with links to the original documents) including American Association for Marriage and Family Therapy American Association of Christian Counselors American Association of Pastoral Counselors American Association of Sex Educators, Counselors and Therapists American Board of Examiners in Clinical Social Work American Counseling Association American Mental Health Counselors Association American Music Therapy Association American Psychoanalytic Association American Psychological Association American School Counselor Association Association of State and Provincial Psychology Boards Australian Association of Social Workers Australian Psychological Society British Association for Counselling and Psychotherapy British Association of Social Workers British Columbia Association of Clinical Counsellors California Association for Counseling and Development California Association of...

Other Cross Sex Relationships

The closest and deepest cross-sex relationship is that between sisters and brothers. Sisters are considered sacred by their consanguinal relatives, and their brothers ardently express this. Sisters are worshipped as goddesses during the fall harvest festival, and at other religious times in devout families. In return for sacred tributes such as clothing and money, sisters confer longevity and prosperity on their brothers. Brothers are expected to take care of their sisters until their marriage, and even after, if necessary.

Initial Contact and First Session

Like other forms of psychotherapy, during the first session the objective is to join with the client and assess the problem. However, unlike other forms of psychotherapy, family therapy also begins by attempting to alter the family's perspective. Almost immediately an effort is made to dilute the idea that the presenting problem associated with an individual is encased within that person instead an attempt is made to modify beliefs so that the problem is perceived to be a byproduct of the situation that characterizes the system (i.e., environment) housing the individual. In effect, an initial objective is to have the problem viewed differently by the family. Family therapy then, especially initially, occurs through social negotiation. It involves determining what the family wants, how they see the problem, how they want it fixed relative to the assumptions and orientation of the family therapist, and how well the therapist can pull the problem away from an individual and distribute it...

Applications And Exclusions

Because family therapy does not attempt to modify a person but rather the behaviors exhibited by a system, it is generally applicable to most of the problems seen by mental health practitioners. With children and adolescents, it has been applied to problems ranging from conduct disorder to anxiety and depression. In adults, it has been applied to relationship problems, as an adjunct to the treatment for schizophrenia, depression and anxiety, modifying family reactions to medical illness, and drug and alcohol abuse. Most of the couples and families treated with family therapy, at least as described in the scientific literature, have been predominantly upper-lower and middle class, and white. In the past decade, greater emphasis has been made to apply these techniques to more diverse groups such as Asian and Hispanic populations. Because family therapy did not evolve from a psychological perspective but rather from a general systems orientation, most of the assumptions that form family...

Case Illustration

This synopsis reviews the case of a 10-year-old girl that presented with uncontrollable head shaking and humming. The condition had been occurring for about 1 year, and the parents were told that the disorder was caused by a biochemical imbalance in the brain. The child and her family were referred to the Marriage and Family Therapy Clinic after several thorough neurological examinations found no physical reason for the condition. The humming and head shaking, although reported to be uncontrollable, did not occur at school, during therapy sessions, or in situations that the child enjoyed. It occurred primarily at night, starting within minutes after the child went to bed. The humming usually increased slowly until it got the attention of the parents, who would then check on the girl, reassure her, and then leave the bedroom. This cycle continued until the child fell asleep. This case was assigned to an M.S.-level family therapist, and I was the supervisor.

Attention Deficit Disorder

Among NF practitioners there seems to be nearly universal agreement that this can be a highly effective treatment for many cases of attention deficit hyper-activity disorder (ADHD) in both children and adults. This may be especially true for cases of ADHD that involve cortical underarousal, and a growing body of research using brain imaging techniques such as functional magnetic resonance imaging (fMRI) and QEEG suggests that these may constitute the majority of cases. Relatedly, among the first and still most commonly used NF protocols for attention disorders is one designed to increase cortical activation (b or SMR amplitude) at frontal and or central (e.g., Cz) scalp sites (often with simultaneous training of decreases in 0 or a and 0 amplitude). Joel and Judith Lubar pioneered this protocol, which in its original or slightly modified form continues to be considered highly effective. Some practitioners believe that NF can be effective as the sole treatment procedure, but most...

Change in Attitudes Beliefs and Practices Regarding Gender

Courtship is more public, and marriage has become more personalized and individualized. Traditional marriage ceremonies are rare events today. Some Yapese opt for a church wedding, but, more commonly, young couples just live together. Yapese women with an education and or job are taking more of an active role in selecting a spouse or making the decision to marry at all. Consequently, the number of female-headed households in Yap has increased greatly during the last few decades. Self-reliant single mothers are on the rise in Yap, and all indications are that their numbers will increase. Brothers and sisters now talk in public, but they still avoid conversations on sexual matters. Traditional kinship terminology is giving way to a kinship system that has been Americanized. Young Yapese boys and girls are unfamiliar with the details of Yapese kin terms and prescribed behaviors associated with them. Old limitations and restrictions placed on Yapese women continue to be lifted, and the...

Patients Mental Health Rights

He following Bill of Rights was developed by several participating groups, including American Association for Marriage and Family Therapy American Counseling Association the American Family Therapy Academy American Nurses Association American Psychiatric Association American Psychiatric Nurses Association American Psychological Association Clinical Social Work Federation and National Association of Social Workers. (The participating and support groups are listed at the end, as on the Web site.)

Cultural Construction of Gender

A small number of Zapotec boys and men will move into a third-gender role, called muxe in the Isthmus. Chias (1995, p. 294) describes muxe as persons who appear to be predominantly male, but display certain female characteristics and fill a third-gender role between men and women, taking some of the characteristics of each. While muxe do not demonstrate all the characteristics associated with masculinity in Juchitn, they do not necessarily reject them. Muxe are perceived as being different from other men, but some marry and have children. Others form long-term relationships with men. An important distinguishing characteristic of many muxe is that they do women's work such as embroidery or decorating home alters, but not all do. Many are now teachers, have white collar jobs, and are involved in politics. The muxe role is not a sexual role, and while some muxe may engage in sexual relationships with other men, not all do. It is an institutionalized gender role for biological males that...

Negative Effects Of Psychotherapy

Findings from study of the progress and outcome of patients undergoing psychotherapy have resulted in both expected and unexpected conclusions. Most patients receiving treatment improve, a minority of patients remain unchanged, and contrary to the intent of psychotherapy, a small percentage of patients actually worsen as a result of, or at least during, treatment. Independent reviews of the literature suggest that some patients fail to achieve beneficial gains from treatment. Although accurate estimates of patient deterioration are difficult to make because the results of such incidents are not often the focus of psychotherapy outcome studies, estimates of patient deterioration vary between 0 and 15 . Similar to patient improvement, it appears that the phenomenon of deterioration is equally prevalent across theoretical orientations. In addition, treatment failures are reported in all client populations, treatment interventions, and group and family therapies.

Theoretical Basis

A clear and consistent message implicit in traditional psychotherapy is that the individual with the presenting problem has a core deficit. The identified client may be lacking social skills, has aberrant thinking, is develop-mentally arrested or unable to resolve internal conflicts, or has some flawed biochemical process. Irrespective of etiology, the problem is within the individual and all effort focuses on treating the assumed structural deficit within the individual. Conversely, family therapy is an interpersonal model of psychotherapy it focuses on treating the relationships between members of a delimited environment. Unlike the individual deficit model, family therapy assumes that a presenting problem reflects the inadequate quality or inappropriate structure of interpersonal relationships in which the individual resides. Moreover, family therapy assumes, a priori, that the individual expressing a symptom for the system is no more or less likely than any other family member to...

Chronic Stress and Depression 1 Animal Research

The results of studies examining immune consequences of chronic stress in humans largely parallel the findings in animals. Research across a range of chronic stress situations, including bereavement, caregiving for a relative with dementia, unemployment, and diagnosis with a life-threatening illness, reveals that stressed individuals have altered immune function in comparison with controls. In contrast to the acute stress literature, chronic stress is typically, although not always, associated with lower numbers of immune cells and weaker immune functioning. In particular, chronic stress associated with the loss or disruption of personal relationships has been shown to reliably alter immune activity. For instance, women who have been separated or divorced for less than 1 year have demonstrated poorer immune function than married women, and both men and women who reported poor marital quality had lower immune function than more happily married individuals. Research has also suggested...

Gender and Religion

Cherokees also believed in witchcraft. Witches were human beings with special powers used for evil purposes. Misfortune was attributed to witchcraft and conjurors (medicine people) were sought to counter the evil. Conjurors had a range of skills from naming a baby to resolving marital problems. The spiritual and physical realms were not separate and illnesses had spiritual causes and cures. Both men and women could be medicine people and conjure cures (Perdue, 1998).

Esther Deblinger and Melissa K Runyon

The empirical literature is more limited in terms of the treatment of children who have suffered physical abuse. However, there have been a significant number of studies that have examined the treatment of punitive parents. These studies have demonstrated the efficacy of a variety of CBT interventions with this population of parents, including child management skills training, stress management skills training, as well as a combination of these interventions (see Runyon, Deblinger, Ryan, & Kolar, in press). The research on interventions for parents seems to reflect the practice in the field which often focuses on the parents' difficulties with much less attention given to the psychosocial needs of children who have suffered physical abuse. Although a few studies have examined the treatment of children who have suffered CPA, most of these investigations were not randomized controlled trials and or did not focus on children with documented histories of CPA (Oates & Bross, 1995). In...

Functional Analytic Clinical Case Modeling

FIGURE 2 A functional analytic clinical case model (FACCM) of a Vietnam war veteran's drinking behavior and hypervigilance. Note. Using the example of the war veteran provided in the article, an FACCM can show both respondent and operant conditioning at work. An original causal variable, the combat experience, is paired with a variety of innocuous stimuli (smells, sounds, etc.) that will later remind the veteran of his combat experiences through respondent conditioning and generalization. The trauma of the combat experience leads to intrusive thoughts and recollections long after the veteran returns from the combat theater. Both environmental cues and the intrusive thoughts and recollections have the potential to elicit sympathetic nervous system activation (e.g., increased heart rate, respiration). Sympathetic nervous system activation can also reciprocally elicit intrusive thoughts and recollections (e.g., an increase in heart rate through exercise can trigger a combat memory). The...

Winnie Eng and Richard G Heimberg

As mentioned earlier, RP is an essential part of CBT for all disorders, but the strategy was initially developed for the treatment of people with alcohol use problems by G. Alan Marlatt. Drawing from research on self-efficacy, RP is based on the premise that the probability of relapse can be predicted by client's perceptions of their abilities to handle difficult situations. RP can be easily integrated into other treatments. Over the course of RP, clients are taught to identify high-risk situations and to use cognitive and behavioral coping strategies when they find themselves in such situations. Furthermore, cognitive techniques are used to help clients deal with inevitable lapses. Clients are taught to view a lapse as a one-time mistake, rather than a sign that they have failed or that they are failures. If clients come to view lapses in this way, a single lapse will be unlikely to evolve into a full-blown relapse. James R. McKay and his colleagues explored the efficacy of RP in a...

Case Examples A Anorexia Nervosa

Maintained her status quo, still minimizing her problem and not gaining additional weight. At this point, at about age 16, she was referred to an eating disorders specialist who made the following determinations (1) Patsy would benefit from the addition of a structured cognitive behavior therapy program (2) since Patsy was still living at home and highly involved with her parents, and her parents were at their wits end as to how to contend with her, family therapy was necessary (3) developmental issues concerning her earlier childhood and budding adolescence, and interpersonal issues concerning her family and social life were all pertinent and merited ongoing discussion.

Common Direction Common Fate Good Continuation

Climates, as well as to identify problems of communication, evaluation, control, decision making, tension reduction, and reintegration. Chapple's model is more abstract than Bales' system and measures only the amount of talking, overlap, and lengths of contradiction. Both Bales' and Chapple's approaches avoid any mention of communication content per se. In other theoretical approaches, however, such as the experimental method in measuring communication, the actual communication processes are inferred from measurement of the conditions and the effect of the process. Some experimental approaches may control informal social communication processes by instruction and inputs from the experimenter with outcomes measured via questionnaires or joint actions by the group members (cf., actual communication sequences in methodologies such as simulations and role-playing scenarios). Theories and studies of interpersonal communication have focused, also, on the practical aspects of communication,...

Religious and Moral Issues

Most people today, along with philosophical ethicists, religious ethicists and organized religions, generally accept the morality of contraception within marriage, often appealing to the need for family planning. While recognizing a link between marital sexuality and procreation, many concede that marital sexuality also has other significant purposes such as expressing and enhancing the love union of the partners and thereby the good of the marriage. Unlimited procreation, or at times any procreation, could be harmful to one of the spouses, the marriage itself, the good of already existing children or the needs of the broader society. Judgments about the ethical use of contraception outside of marriage depends upon one's understanding of the morality of extramarital sexual activity. As a matter of fact, many unmarried people today are sexually active. Indeed, the majority of adolescents in the United States have had sexual intercourse by the time they are nineteen years old (Demetriou...

Behavioral Observation 1 Naturalistic Behavioral Observation

Analogue behavioral observation involves the measurement of a client's overt behavior in a contrived situation that is analogous to situations the client is likely to encounter in his or her environment. Example Code marital interactions during a marital therapy session.

David Reitman and Nichole Jurbergs

As it is most commonly known, CST is used to teach problem-solving skills, most frequently to help resolve parent-adolescent and marital conflict. Because of the diversity of programs, it is useful to identify specific operations common to all CST. First, most CST seeks to promote the clear expression and reception of meaning. Effective problem-solving requires minimizing negative communication habits and speeds the process of arriving at mutually favorable solutions. By contrast, emotionally charged accusations, frequent changes of topic, and interruptions frequently impede the promotion of clear communication. CST also attempts to teach the individual how to restructure attitudes (e.g., zero-sum or all or nothing thinking) that may inhibit or derail effective problem-solving. Second, CST trains of the best known interventions for relationship problems, behavioral marital therapy (BMT), represents an application of reinforcement principles to problems encountered in romantic...

Growthactualization Theory

The G-spot and other recent discoveries about human sexuality. New York Holt, Rinehart, and Winston. Alzate, H., & Hoch, Z. (1986). The G-spot and female ejaculation A current appraisal. Journal of Sex and Marital Therapy, 12, 211-220. Davidson, J. K., Darling, C. A., & Conway-Welch, C. (1989). The role of the Graefenberg spot and female ejaculation in the female orgasmic response An empirical analysis. Journal of Sex and Marital Therapy, 15, 102-120.

Appendix Resources on Animal Welfare and Humane Education

Uate education in the life sciences by expanding partnership ventures among academic disciplines such as biochemistry and philosophy and they lead to long-term relationships among life scientists, humanists, and others. A particularly interesting and somewhat controversial feature of the institute is that it provides only vegetarian lunches to participants. The project director is Gary Comstock, Bioethics Program, Iowa State University, 403 Ross Hall, Ames, Iowa 50011. Its newsletter, Ag Ethics Bioethics, is available from the editor.

The Sealed Record Controversy

Women who relinquish their infants often suffer a profound loss and experience lifelong difficulties. Like the child, they are encouraged by society to deny and repress the feelings that accompanied giving up their children for adoption. Some studies indicate that these women never forgive themselves. Some may feel they have no right to a happy marriage and other children, while others may try without success to have other children as replacements for the one that they relinquished (Deykin et al. Millen and Roll).

Demographic Risk Factors for Depression

Other demographic risk factors that have been consistently associated with depression include a family history of depression, low socioeconomic status, and specific stressful life events (including assaults and robberies, serious marital problems, divorce, loss of employment, serious illness, and significant financial problems). Research on the role of stressful life events has also found that specific buffers may protect against the development of depression. Some of the buffers include the existence of supportive relationships, the presence of three or fewer children, employment, self-identification with a religion, and the possession of clear roles in life.

The Psychological and Social Context of Domestic Abuse

The emotional, psychological, and physical consequences of abuse must be understood in their larger context of sexism, patriarchy, and paternalistic dominance (Lerner). Gerda Lerner defined sexism as the ideology of male supremacy, of male superiority, and of beliefs that support and sustain it (Lerner, p. 240). Sexism undergirds patriarchy, the institutionalization of male dominance over women and children in the family and the extension of male dominance over women in society in general (Lerner, p. 239). A sociological study of domestic abuse in Scotland documented the connection between domestic violence and patriarchal marriage. The researchers concluded that the law, the church, economic opportunities, appeals to science or to the natural order, and social customs all promote women's subordinate status in marriage. Women find their struggle to resist domination, including violence, within marriage labeled wrong, immoral, and a violation of the respect and loyalty a wife is...

Very Low Calorie Diets and Meal Planning

Brian was seen in individual therapy for over 2 years. Family therapy was also incorporated into the treatment plan. Treatment followed the protocol described by Williamson and colleagues in 1996. Initially Brian was seen once per week in individual therapy and the frequency of therapy sessions was gradually faded to biweekly and then once per month over the course of the first year. He was seen about once per month during the second year of therapy. All components of the behavioral management program (described earlier) were used in Brian's therapy program, including self-monitoring, stimulus control procedures, reinforcement shaping, goal setting, behavioral contracting, problem-solving, meal planning, modification of physical activity, relapse prevention, and enhancement of social support. Toolbox approaches were used to individualize treatment. Behavioral therapy for binge eating was used to modify skipping meals and cognitive approaches were used to modify beliefs about the...

Description Of Treatment Processes

Emotion (in which one or more family members is highly critical and blaming of the patient), teasing, the perverse influences of competitive or narcissistic parents, parental intrusiveness and lack of respect for privacy or autonomy, and colluding with or enabling pathological behaviors in a family member. These observations have led to recognition that family assessment and family education, counseling, and or psychotherapy may be very important in treating patients with eating disorders, particularly children, adolescents, and young adult patients who may still be living at home and or be heavily involved with their families of origin. For adults in marriages or committed relationships, issues such as those described above may merit couples therapy.

Mark J Williams and Robin B Jarrett

Reinforcers, or skills deficits (Bandura, 1977 Ferster, 1973). Examples of behavioral techniques include activity scheduling, behavioral marital therapy, self-control techniques, social skills training, and stress management techniques (see Lewinsohn, Gotlib, & Hautzinger, 1998, for overview of behavioral techniques). The treatment manual entitled The Coping with Depression Course outlines strategies often used in BT with depressed adults and adolescents (Lewinsohn, Antonuccio, Breckenridge, & Teri, 1984).

Directions For Anger Management Interventions With Youth

Coercive interaction between family members. Both parents and youth clearly need to learn more prosocial conflict negotiation responses as well as better emotional control. Integration of anger management skills either with traditional parent training approaches or with strategic family therapy intervention seems a necessary extension and a way to prevent the occurrence of family violence.

Coping And Adjustment

In cognitive, affective, and behavioral domains to promote both emotion-focused and problem-focused coping. Modalities include psychoeducation, individual, group, and family therapies. Because many of the difficulties of living with a life-threatening illness and the emotional reactions that accompany these difficulties can be anticipated, cognitive-behavioral skills can be taught early in the treatment process when the patient and the family may be most receptive. This ensures that coping strategies are in place when they are needed by the patient and the family.

Empirical Basis For

Meta-analytic reviews of randomized studies show more abstinence with family-involved treatment than with individual treatment in drug abuse (Stanton & Shadish, 1997) and in alcoholism (O'Farrell & Fals-Stewart, 2001). Overall the effect size favoring family-involved treatments over individual-based treatments was classified as a medium-size effect. BCT is the family therapy method with the strongest research support for its effectiveness in substance abuse (Epstein & McCrady, 1998). Research shows that BCTpro-duces greater abstinence and better relationship functioning than typical individual-based treatment and reduces social costs, domestic violence, and emotional problems of the couple's children. Details of the following studies are provided elsewhere (O'Farrell & Fals-Stewart, 2000, 2002, 2003).

Intake Session and Inventory Assessments

Note While quantitative inventories are an important part of BMT, detailed description of the inventories is beyond the scope of this article. Briefly, however, Inventory (Inv.) 1 measures global marital satisfaction a score of 100 discriminates happy from unhappy couples. Inv. 2 measures steps toward divorce, range 0-14, a score of 4 or greater indicates significant risk. Inv. 3 measures the three named variables regarding individual function range is 0-8. Inv. 4 measures conflict potential in domestic activities happy couples average 7 total and unhappy 28 total for husband plus wife scores. Inv. 5 measures spouses' perceptions of maladaptive conflict responses, 0-8 scale happy couples average 1.35 per person, unhappy couples average 2.77. Inv. 6 measures proportion of rewarding activities each partner engages in, in five social formats. Happy couples endorse a balance of activities across all formats, including about 35 activities with spouse only. Inv. 7 measures various aspects...

Possession Religions as Worship and Tradition

Traditional people may be caught in a conflict between two different explanatory systems (Kleinman, 1980). Possession Trance linked to long-term relationships with one or more spirits involves the development of what appear to be secondary or alternative personalities. This may be seen by psychiatrists as D(issociative) I(den-ity) D(isorder), often referred to as Multiple Personality (Bourguignon, 1989b Suryani & Jensen, 1993). Bizarre behavior and speech may be diagnosed as psychotic by psychiatrists. It might be noted that Suryani herself is both a Western-trained physician and psychiatrist and a balian, a Balinese trance healer.

Sexual Orientation Theories

Advocates assert, also, that early sexual experiences and socialization (including gender nonconformity and rejection or attachment-avoidance by parents and peers) determines sexual orientation, and cite evidence showing that the frequency of different sexual orientations differs significantly from one culture to another cf., the roles played in this debate by speculations such as performativity theory (i.e., deconstruction of foundational ideas of gender sexual identity, or gender as performance Butler, 1991 Hegarty, 1997) feminist theory (i.e., the theory suggesting that gender is a major social, historical, and political concept that influences women's choices in all communities and cultures Belenky, Clinchy, Goldberger, & Tarule, 1997 Squier & Little-field, 2004 Stewart & McDermott, 2004) deviance theory (i.e., the focus on cognitive stereotypes, and perceptions of threats to society, Plasek, 1984) psychotherapeutic theory (i.e., the methods employed by therapists in treating...

Paternal and Maternal Parenting and Outcomes in Sons and Daughters

Earlier in this chapter, differences in fathers and mothers' interactions with their sons and daughters were reviewed, and it was shown that researchers have found that fathers and mothers exert a strong influence on such outcomes as youths' gender-role ideology. This section builds on those findings by briefly reviewing other consequences of maternal and paternal behavior for children's development, including self-esteem, psychological adjustment, and cognitive and academic competence. For example, Rohner and Veneziano (2001) reported on the work of Barber and Thomas (1986) who found that the cluster of conditions predicting adolescent daughters' self-esteem was different from those that predicted sons' self-esteem. Sons' self-esteem was best predicted by fathers' sustained physical contact (e.g., picking up the boy for fun and safety) and by mothers' companionship (i.e., spending time with the boy, and sharing activities with him), whereas daughters' self-esteem was best predicted...

Timothy J OFarrell and William Fals Stewart

Keywords alcoholism, drug abuse, couples therapy, behavioral contracts, communication skills training A number of early pioneers (Nathan Azrin in 1973 and Allan Hedberg in 1974) studied behavioral couples therapy (BCT) that combined a behavioral contract to reward abstinence and communication and problem-solving training to reduce relationship problems among male alcoholic patients and their wives. A second wave of researchers (Timothy O'Farrell in 1985 and Barbara McCrady in 1986) provided initial, well-controlled studies of BCT with alcoholism. More recently in 1996, William Fals-Stewart published the first study of BCT with primary drug abuse patients.

Types Of Consequences

Contingency contracting involves the distribution of rewards, penalties, and punishments via a written contract constructed between two or more parties. Contracting is often used in family therapy as a vehicle for problem-solving, but is also an excellent way of providing rewards, penalties, and punishments in a structured and agreed-on format. After a specific behavior (e.g., curfew) is defined as the presenting problem, each party (e.g., parent and adolescent) develops parameters to indicate how they would like the behavior defined and what consequences may follow its presence or absence. In the case of curfew, each party may eventually decide that 9 30 p.m. curfew on weeknights and 11 00 p.m. curfew on weekends is desirable. Both parties may then agree that adherence to this curfew time will be rewarded via continued allowance, whereas broken curfew will be met with grounding and suspension of allowance.

The Effects of Kinship on Female Status in Marriage

Regardless of the balancing effects of the marriage contract, the patriclan system strongly influences gender status. Marriage is still understood as a conceptual transfer of belonging. In addition, male authority within marriage has been enhanced by the society's acceptance of Christianity. Women routinely ask permission first of their fathers and later of their husbands when they wish to engage in some activity, whether it is a serious step such as a trip to the mainland for medical treatment or accepting a job as a wage earner outside the home, or simply taking a ride down the beach or going to visit someone in their free time. The assumption is that girls were especially under the authority of their elders and their parents, with males within the family having more authority than

Marriage Arrangements Brideprice Grooms Service and Tradition Based Marriage Ceremonies

The pattern whereby men continue to work together within their families and with their fathers, brothers, and uncles as their primary allies, while women marry away from their original support base and must develop a new support base, is illustrated best through a description of the marriage process. (This discussion of courtship and marriage is based on Jolles 2002, pp. 121-149 and Jolles and Kaningok 1991 .) Marriage itself was once arranged by senior elders, and contemporary gender concepts and living patterns reflect older patterns common in the late 1800s and early 1900s. One aspect of marriage was lineal and clan alliance. Only since the late 1960s has it become accepted for young people to marry for love. Marriages in 2002 still included a buying ceremony in which the groom's ramket (clan group) collected gifts to be presented to the bride's ramket, particularly to the members of the bride's lineage. While no strict rules of exogamy apply in the village, the two largest clans,...

Socialization of Boys and Girls

Abaluyia value sons highly men want sons to insure generational continuity of self and clan, and women want sons to insure support in their old age. However, girls are also valued for their labor and for the wealth (cattle and money) their bridewealth will bring to their family when they marry, which in turn makes it possible for their brothers to pay bridewealth so they can marry. Increasingly, daughters are also being seen as providers of support for elderly parents. Malnutrition, though fairly common, affects girls and boys about equally, seeming to be more the result of poverty and marital conflicts than gender discrimination. Until recently, people wanted a large family with many sons and many daughters. However, in the past decade Kenya's birth rate has dropped drastically (even in Maragoli, long known for its high fertility), suggesting a new ideal of smaller families in a context of some improvement in women's economic empowerment.

Clinical Ethics Analysis of Case

In this potentially suicidal and homicidal scenario the first goal is physical safety for the patient and her parents (nonmaleficence, avoiding harm to Crystal or her parents), initially by placing Crystal in jail. Additional important goals of treatment are for beneficence, helping Crystal and her parents by referral to a structured treatment program to improve Crystal's anger management, and upgrade her coping, negotiating, and prosocial interactions with family members. The program should incorporate active family therapy work. Before returning home she needs to make a contract for safety and other mutual behavior with her parents (nonmaleficence, prevention of harm). She and her parents will need to arrange for an intensive treatment program to gain insight into and find a way to change the dysfunctional family culture (beneficence), seeing to the good of the family unit. The three family members need to restore mutual respect and find a degree of...

Psychiatric Treatment

This firm understanding should engage the patient in a treatment alliance with the team. Remember that many of these patients are very polite and 'out to please you' at least superficially, and many times their initial acceptance hides deeper feelings of isolation and resentment. Psychotherapy is of help for some patients, usually accompanied by behavior modification and family therapy.

Consent for Families and Other Multiple Clients

Individual psychotherapy is only one model for providing services. Sometimes clinicians provide therapy to couples, families, or groups. Therapists must ensure that adequate informed consent and informed refusal is provided for each person and that the consent addresses issues specific to therapy when more than one client is involved. For example, what are the limits of confidentiality and privilege for material disclosed by one of the clients Will the therapist hold confidential from one family member material disclosed by another family member If one client receiving couple therapy waives privilege, does the privilege still apply to the other member of the couple

Supervised Clinical Work With Patients

Many programs offer an experiential conference to help students identify and enhance their empathic abilities and learn to listen to the way in which a patient moves from topic to topic in an unstructured interview (the associative process). These conferences were a major contribution of Dr. Lewis's model of psychotherapy education mentioned previously Learning experiences for the psychotherapist must eventually include observed and supervised therapeutic relationships involving brief and longer-term individual psychothera-pies utilizing psychodynamic, cognitive, interpersonal, and behavioral conceptual framework to organize the therapy. Analogous experiences should take place for conducting group, family, and marital therapy. The brief therapies learned should be both those that are brief because of a clinical decision to employ a focal or targeted psychotherapy and those therapies that are brief because of external limitations or constraints on the treatment relationship. These...

Cognitivebehavioral Interventions

Toseland and colleagues' (1995) intervention for caregivers of cancer patients represents the integration of problem-solving skills training with other cognitive-behavioral intervention strategies. Their intervention protocol, known as Coping with Cancer, is a six-session program combining supportive therapy, coping skills training, and problem-solving training. The problem-solving component involves training the caregivers in the use of the steps of the problem-solving process, much like those described by Nezu and D'Zurilla (1989). Within the context of a supportive therapeutic relationship, an oncology social worker helped caregivers take necessary steps to develop and implement potential solutions to three problems identified by each caregiver as being the most distressing or pressing. Adaptive coping responses to those problems were also discussed and reinforced when utilized. In sum, treatment plans consisted of the following goals reappraisal of problem situations, increasing...

Features of Marital Interaction Importance of the Marital Relationship

The expectations of spouses will also be influenced by cultural assumptions regarding the importance of the marriage. Where a culture views marriage as the primary source of emotional gratification and support in the life of an adult, men and women will bring these same hopes to their own marriage. The results of this attitude are captured in the words of an Omaha widower, who remarked that no one is so near, no one can ever be so dear as a wife when she dies, her husband's joy dies with her (Dorsey, 1884). By contrast, in societies where the marital bond is viewed as secondary to the bonds between other people, a husband and wife will expect less from their marriage. When asked about their expectations regarding marriage, men living in many different regions of India agreed that a wife provides sexual satisfaction and sons and a smoothly running household. Similarly, women agreed that husbands provided financial security, protection, and children. But neither sex looked to marriage...

Michael J Lambert and David A Vermeersch

Psychotherapy, defined within the broader context of the field of psychology, is a skilled and intentional treatment process whereby the thoughts, feelings, and behavior of a person are modified with the intention of facilitating increased functioning and life adjustment. Psychologists, psychiatrists, and clinical social workers are authorized to provide psychotherapy to children, adolescents, and adults in individual, group, couples, and family therapy sessions. Although there are hundreds of different psychotherapies that conceptualize and treat problems in different ways, most are varia

Environmental Factors

Even if the familial transmission of bipolar disorder has been well established, the concordance rate between identical twins does not approach 100 , suggesting a combined role of genetic predisposition and environmental factors 67 . A bipolar parent with recurrent episodes is often dysfunctional, neglectful or absent, and this chronic or recurrent situation can influence the child's development 35,36 . Negative family interactions, including higher expressed emotions, have been proved to be predictive of relapse in bipolar adolescents and adults 68 , but studies considering the family environment in the presence of a bipolar parent, and its effect on offspring, are rare. Conrad and Hammen 69 evaluated the offspring of bipolar mothers and found that a better outcome was associated with social competence and a healthy father. Marital discord, parental divorce, a second parent with psychopathology, and chronicity of illness were predictors of psychopathology in children of bipolar...

The Emergence of Behavioral Medicine 1950s1970s

Initially, nonpsychiatric medical professionals considered psychologists and psychiatrists interchangeable. By the mid-1970s, psychologists gradually developed an independent reputation for their unique contributions to health care. Psychologists' expertise included biofeedback training, preventive education, family therapy, and research (Millon, 1982). Yet their status was below that of their psychiatry colleagues (Stone, 1990). The psychologist's job was primarily to focus on emotional and behavioral disturbances that perplexed health care providers (Stone, 1979).

Interventions For Highrisk Children

A few intervention efforts have recently been launched, often based on the notion that shorter duration between first psychotic episode and subsequent treatment is associated with a better prognosis 95,96 . Improved access to care and increased education efforts have been shown to reduce treatment delay 95 . Other intervention options include pharmacological treatment with antipsychotics initiated during the prodromal phase or perhaps earlier. The risks of such intervention are significant children may be more prone to side effects, including dyskinesias, and need careful monitoring 97 . The benefits of administering these medications, based on the possibility that they may develop schizophrenia, would need to be carefully weighed against the potential risks. Cornblatt's data from the Hillside Recognition and Prevention Project indicates that antidepressants in combination with a mood stabilizer and or anxiolytic were as effective as antipsychotics in yielding clinical improvements...

When To See A Fertility Counselor

The counselor can assess the degree of nervous tension that you are feeling and how it's affecting your relationship with your partner and with others. The counselor can help you come to terms with realistic expectations. You'll also explore new ways to manage and cope with your stress. Friction and strain within your relationship with your partner

Robert Ostroff

Adjunctive therapy Two or more therapies used in an integrative fashion to treat an individual with mental illness. conjoint therapy Therapy consisting of two distinct treatment models (1) The treatment of two or more related individuals in the same setting, for example, couples treated in a group therapy or family therapy groups and (2) treatment used interchangeably with adjunctive therapy. In this chapter, the second meaning always applies. integrative treatment Treatment that attempts to theoretically reconcile different therapeutic approaches into a single therapeutic approach, for example, psychodynamic and behavioral. May also be used interchangeably with ad-junctive therapy. psychopharmacotherapy The use of medication to treat mental illness. This therapy is performed primarily by a psychiatrist but may also be practiced by primary care physicians, physician assistants, and advanced nurse practitioners. sociotherapy The consideration of the patient's entire social milieu as an...

Creating Power

In some approaches, the therapist may work to create specific forms of power. For example, a family therapist may assertively unbalance the equilibrium and alliances among family members. A behavior therapist may create a hospital ward or halfway house in which desirable behaviors bring forth a rewarding response from the staff (perhaps in the form of tokens that can be exchanged for goods or privileges) the power of the therapist and staff is used to control, or at least influence, the client's behavior.

Theory Development

The rational-emotive behavioral approach (REBT) to couple and family therapy places emphasis on each individual's perception and interpretation of the events that occur in the family environment. The theory assumes that family members largely create their own world by the phenomenological view they take of what happens to them. The therapy focuses on how particular problems of the family members affect their well-being as a unit. During the process of therapy, family members are treated as individuals, each of whom subscribes to his or her own particular set of beliefs and expectations. The role of the couple and family therapist is to help members make the connection that illogical beliefs and distortions serve as the foundation for their emotional distress. The cognitive-behavioral approach, while much like REBT, assumes a different posture by focusing in greater depth on family interaction patterns and underlying dynamics.

Future Research

Future research in couples and family therapy clearly needs to focus on examining the application of CBT that has been so successful with individuals. Certainly, more long-term outcome studies need to be conducted along with studies comparing CBT with other approaches to couples and family therapy. It would also be interesting to examine the various characteristics of family members and determine what might constitute differential responses to treatment as well as optimal sequences of behavior and the restructuring of schemas. It would also be helpful for comparative studies to be conducted in order to isolate the specific characteristics that make CBT effective, and also discover which components are most advantageous for integrative purpose with other modalities. See also Couples therapy, Couples therapy substance abuse

Newlywed Customs

Newlywed customs are predictably related to other aspects of courtship and marriage. Thus it is uncommon to see newlyweds treated specially in societies where males and females choose their own spouses, where husbands and wives eat together, where special houses dedicated to male activities are absent, where males do not exhibit sexual aggression, and where wives do not tend to engage in extramarital sexual affairs. Newlywed customs are present where marriages are arranged by thirdly parties, where a husband and wife eat apart, where men's houses are present so that married males eat, sleep, and or spend their leisure time away from home, where males are sexually aggressive, and where wives typically carry on extramarital affairs. Thus newlywed customs seem to represent a strategy for allowing a newly married couple some time alone under circumstances where they have had no opportunity to become comfortable with each other prior to their marriage and where, further, their married life...

Final Considerations

A major criticism of paradoxical intention and related procedures is focused on the apparent subterfuge that is sometimes employed in their administration. First, it should be noted that when administered like any conventional behavioral technique, all aspects of the paradoxical procedure and its goals are fully disclosed to the client. However, when used in other contexts (e.g., family therapy), this is not always the case. Then, paradoxical strategies, used to reduce resistance, are presented in a more obscured manner. Naturally, regardless of how the procedure is employed, the concern remains the welfare of the client or clients, and the objective is always the achievement of the therapeutic goal.

Substance Abuse

Psychotherapy is a potentially useful and cost-effective treatment for all substance abusers. It more than doubles the number of smokers who quit. Hester and colleagues performed an extensive review of treatments for alcohol abuse and found that brief interventions, social skills training, motivational enhancement, and a community reinforcement approach are all effective. Fals-Stewart found that behavioral couples therapy

Social Support

As mentioned earlier, research examining the relationship between quality of personal relationships and immune function has demonstrated consistent immu-nosuppressive effects in individuals who reported low marital satisfaction or who recently lost a spouse. Similarly, social support has been linked with physiological processes associated with risk for cardiovascular disease and cancer, and less social integration is associated with higher mortality rates from all causes. Individuals with high levels of social support have lower baseline blood pressures than those with lower levels of support, and the presence of a supportive individual has been shown to decrease cardiovascular reactivity during an acute laboratory stressor.

Therapy

(b) If it becomes apparent that psychologists may be called on to perform potentially conflicting roles (such as family therapist and then witness for one party in divorce proceedings), psychologists take reasonable steps to clarify and modify, or withdraw from, roles appropriately. (See also Standard 3.05c, Multiple Relationships.)

Premacks Principle

Contingency management procedures have been used for other clinical groups as well. For example, they have been used successfully to address persons with polydip-sia, irritable bowel syndrome, vomiting, depression, marital problems, delusional verbalization, bedtime disruptions, pacifier use, and violent behavior. In addition, contingency management has been used to increase adaptive behaviors such as oral hygiene, appropriate eating, cooperation, productivity, homework, writing, and exercise.

William A Griffin

Family therapy is a perspective of interpreting and modifying behavior. This perspective is implemented as psychotherapy in several diverse ways each according to a different set of theoretical tenets, where each tenet or cluster of tenets forms a separate model of family therapy. Although implementation varies, the multiple methods of doing family therapy derive from a single assumption Presenting problems originate from inadequate, inappropriate, or dysfunctional interper sonal relationships, and therefore should be subsequently altered using techniques that in some manner modify interpersonal relationships. The various approaches of family therapy can be trichotomized based on their respective therapeutic assumptions and techniques they are ahistorical, historical, or experiential. Each classification approach represents a general orientation toward ameliorating the problem, and within each type, various models reside. family. In addition, therapists are encouraged to share their...

Belief Structure

Depending on the specific model of family therapy, each emphasizes to a lesser or greater extent the role of beliefs and cognitions in maintaining the behavior patterns associated with the presenting problems. Consequently, the therapist seeks to simultaneously change the presenting problem, either directly or indirectly, and the cognitive perspective that necessitates the dysfunctional interactions within the environment. In family therapy, this cognitive perspective is a belief structure maintained by the family, with slight variations held among the individual family members. This family level cognitive perspective acts as a filter, determining the meaning of events, which in turn, dictate reactions to the events. De pending on the family's history and culture, events are interpreted according to beliefs held by the family. The beliefs, or myths, may be functional or dysfunctional. They may be functional in their ability to keep the family intact, and yet to the world outside the...

Medical Care

Ignorance about domestic violence and childhood sexual abuse also plagues psychotherapists, psychiatrists, and clergy who do not understand the emotional or material barriers that make leaving difficult. Often, they either blame women for remaining in dangerous relationships or they consistently ignore signs of abuse and refuse to pay serious attention to women who talk about abuse. Couples therapy often tries to assign responsibility for problems equally to each partner in the relationship, which ignores the reality of violence and the fear of the abuser that makes abusive relationships inherently unequal. Attributing responsibility for the violence to the offender, and specific treatment for the batterer in individual therapy or groups, is essential if abuse is to end. Fear of retaliation by the abuser can also prevent counseling professionals from intervening in situations of domestic abuse.

Frank M Dattilio

While Albert Ellis has written that he adapted his model of rational emotive therapy (RET) to work with couples as early as the late 1950s, little has appeared in the professional literature on cognitive-behavioral marital and family therapy prior to the 1980s. Principles of behavior modification were initially applied to interactional patterns of family members only subsequent to their successful application to couples in distress. This work with couples was followed by several single case studies involving the use of family interventions in treating children's behavior. For the first time, behavior-ists recognized family members as having a highly influential effect on the child's natural environment and were integrated into the treatment process. The cognitive approach or cognitive component to behavioral marital and family therapy subsequently received attention as providing a supplement to behavioral-oriented couples and family therapy. In addition to the work of Ellis, an...

Brian Baucom

Keywords couples, relationship therapy, behavioral couples therapy Cognitive-behavioral couples therapy (CBCT) has been evolving since the late 1960s when the first study of a behav-iorally based treatment for couples was published. The first behavioral treatments for couples attempted to increase the frequency of discrete, desired behaviors by using direct reinforcement by partners. Since that time, CBCT has been refined as couples researchers have developed a better understanding of the ways that couples function and a more detailed picture of frequent sources of distress. CBCT continues to evolve with recent interventions focusing on broadening the Early behavioral couples interventions drew heavily on reinforcement theory as well as social exchange theory. Reinforcement theory suggests that frequent, positive interactions between partners serve as reinforcers that maintain satisfying relationships and that a lack of such reinforcers is a hallmark of troubled relationships. Social...

Interventions

From its inception, the traditional interventions associated with BMT have included communication and problem-solving skills training and behavioral exchange techniques. Over the years, in many empirical studies, both interventions have been shown to be highly correlated with marital satisfaction. Although communication problem is probably the number one complaint of couples seeking therapy and most therapy approaches work on improving communication between partners in some manner, the hallmark of BMT has been direct training in skill acquisition. The therapist is likely to employ a basic communication training manual, such as We Can Work It Out, written by Clifford Notarius and Howard Markman in 1993. Throughout the course of treatment, the therapist employs any number of the following types of interventions to help couples modify their patterns of miscommunication and to acquire improved problemsolving skills didactic instruction, behavioral rehearsal, coaching and feedback about...

Resources

The Menninger Clinic of Topeka, Kansas, provides individual, marital, and family therapy, and is a major psychoanalytic training program, as well. It also sponsors educational workshops in a retreat setting in Estes Park, Colorado, for a week each July. Designed specifically for physician couples, it focuses on the problem of balancing the demands of medical practice with the needs of self and family. (Contact PO Box 829, Topeka, KS, 66601 telephone 800-288-7377.)

Virginity

In cultures for which virginity is important, a girl or her family may pay a price if she is not a virgin at marriage. In some societies, the groom or his family traditionally present money or property to the bride or her family upon their marriage. Where virginity in a bride is expected or required, the value of the gifts may be less, or they may be forfeited altogether, if the girl is not a virgin. Sometimes, a marriage is called off if the bride cannot prove her virginity. If the bride or her family have presented gifts to the groom or his family, then the gifts may be kept even though no marriage takes place. In extreme cases, the bride may be killed. At a minimum, the bride and groom may be humiliated.

Treatment Progress

At the outset both Bob and Cindy seemed motivated to improve their marriage. While admitting to some emotional ambivalence about being with wife versus lover, Bob indicated that he wanted to stay with the family and make the marriage more rewarding. He had terminated contacts with his lover. Bob and Cindy made very good early progress. In fact, with only an average amount of direction, encouragement, repeated assignments, and reinforcement by the therapists, they did quite well through the beginning stage of therapy and part way through the middle stage.

Didactic Learning

Most educational systems for psychotherapy begin with didactic learning situations in which basic concepts of psychotherapy are presented. The main mental health disciplines in which psychotherapy is practiced are psychiatry, psychology, and social work. Each of these core disciplines has a wide variety of subspecial-ties. Each provides subspecialty training in different conceptual models for psychotherapy, such as psychoanalysis, cognitive therapy, interpersonal therapy, and behavioral therapy. Each conceptual model informs therapy based on the constellation of participants in the therapeutic enterprise, such as individual, group, family, and marital therapy. What then can be considered basic concepts that should inform all psychotherapy education This chapter will proceed with the basic assumption that individual psychotherapy is the fundamental cornerstone for developing broad psychotherapy competence. Other therapeutic constellations, such as group, family, or marital therapy will...

Andrea M Chronis

Although there is some evidence to suggest that participation in parent training may improve parent stress, parenting self-esteem, and marital adjustment, parent functioning is typically not addressed in most parent training programs. This is concerning when one considers evidence suggesting that parents' personal and marital problems are associated with poorer compliance with and outcomes following parent training. These findings are not surprising given that distressed individuals often lack motivation to complete effortful tasks that require ongoing work. Therefore, it can be concluded that standard treatment for children with ADHD and behavior problems should include assessment and treatment of parental psychopathology and or marital discord, as these problems may impact parents' ability to effectively implement behavior management techniques. Relatively few studies have evaluated the incremental benefit of adding a parent enhancement component to standard behavioral parent...

Anorexia Nervosa

Gerald E Russell, Ivan Eisler, and colleagues have conducted controlled trials of family versus individual psychotherapy, starting with patients just being discharged from hospital treatment. Their results suggest that if only family therapy or individual is to be administered, for patients who are under the age of 18, family psychotherapy is of more benefit than individual psychotherapy for older patients individual therapy appears to be more favorable. In actual practice clinicians combine family therapy and individual psychotherapy depending on the patient's circumstances and needs. The critical point suggested by this research is that for younger patients, still living with and or heavily involved with their families of origin, assessing the entire family and involving the family in psychotherapeutic and psychoeducational activities is essential. Incorporating strategies based on many earlier observations of family-oriented clinicians, James Lock and colleagues have developed a...

Efficacy

Other research studies have demonstrated the efficacy of cognitive therapy for generalized anxiety disorder, panic disorder, and hypochondriasis. It has also been shown to be effective for inpatient depression, posttraumatic stress disorder, substance abuse, phobias, social phobia, marital problems, and some personality disorders. Combined with pharmacotherapy, it is effective for the symptoms of bipolar disorder and even schizophrenia.

Patient Variables

Each patient entering treatment brings a diverse array of factors when presenting to the clinician. These include, but are not limited to, a variety of psychological disorders, physical complaints, historical backgrounds, stresses, and the quality of their social support networks. Patient variables found to have a relationship with outcome are severity of disturbance, motivation and expectancy, capacity to relate, degree of integration, coherence, perfectionism, and ability to recognize and verbalize focalized problems. Therefore, patients suffering from challenging symptoms as well as relative deficits in numerous patient variable categories are likely to experience negligible improvement during treatment. For example, the borderline, alcoholic patient with suicidal tendencies who is forced into treatment, believing that most marital problems are a result of an insensitive spouse, is likely to benefit less from treatment than the depressed patient who voluntarily begins treatment, is...

Carolyn Zerbe Enns

Feminist analysis and power analysis refer to various methods for helping clients understand how unequal access to power and resources can influence personal choices and distress. Therapists and clients explore how inequities or institutional and cultural barriers may limit or complicate self-definitions, achievements, and well-being. To facilitate this process, therapists may provide information about dynamics or statistics associated with problems related to the unequal distribution of power (e.g., family violence, divorce, traditional marriage, sexual abuse). They also use open-ended questions to explore these dynamics and how clients can develop positive, personal approaches to power and relationships that empower themselves and others. Bibliotherapy, therapist self-disclosure, and psychoeducational groups may also be incorporated into feminist analysis.

Christianity

In their analysis of human reproductive cloning, Protestant scholars also seriously consider the impact that asexual reproduction may have on the societal norms of marriage, childbearing, and how humans are likely to view and value human clones. Protestants often maintain a normative Biblical view of the child as a being conceived within marriage, a gift from God, and the result of a loving relationship

Biological Basis

Primary sleep enuresis is caused by a combination of genetic, maturational, psychosocial, and endocrinological factors the relative importance of each of these varies across individuals. Anatomic abnormalities of the genitourinary system and other sleep disorders such as obstructive sleep apnea are uncommon in enuretic children although they may contribute to enuresis in some (Friman, 1995). Psychosocial factors that may contribute to or exacerbate enuresis include marital discord, parental separation, sexual abuse, and birth of a sibling.

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