Family therapy and psychosomatic illness

The author suggests that clinical experience has developed to the point where the question can be asked, “Is a specific psychosomatic illness responsive to a specific type of family therapy?” Examples such as structural family therapy in childhood diabetes, asthma, pain, and anorexia nervosa; cognitive family therapy in adult chronic pain; and marital group behaviour modification in adult obesity, chronic pain, and myocardial infarction, are critically reviewed. The evidence suggests, but does not yet prove, that specific types of marital and family therapy may be effective in a few specific psychosomatic problems, a useful adjunctive therapy in some psychosomatic problems, and that family assessment is helpful in the management of all psychosomatic problems.     

The impact of an 8-day intensive treatment for adolescent panic disorder and agoraphobia on comorbid diagnoses

Previous research findings have shown positive effects of cognitive-behavioral therapy for primary anxiety disorders as well as for nonprimary, co-occurring anxiety disorders. In this study, we analyzed data from an existing randomized controlled trial of intensive treatment for panic disorder with or without agoraphobia (PDA) to examine the effects of the treatment on comorbid psychiatric diagnoses. The overall frequency and severity of aggregated comorbid diagnoses decreased in a group of adolescents who received an 8-day treatment for PDA. Results suggest that an 8-day treatment for PDA can alleviate the symptoms of some specific comorbid clinical diagnoses; in particular specific phobias, generalized anxiety disorder, and social phobia. These findings suggest that an intensive treatment for PDA is associated with reductions in comorbid symptoms even though disorders other than PDA are not specific treatment targets.     

Deterioration in Marital and Family Therapy: Empirical,Clinical, and Conceptual Issues

Recent empirical evidence of deterioration during both nonbehavioral and behavioral marital and family therapy is presented. While the frequency of patient worsening in marital-family therapy does not appear to exceed that previously found for individual psychotherapy, the acceptability of the evidence for negative effects in the treatment of systems may be greater than that which exists for individual treatment. After examining the empirical evidence of negative effects in family therapy and some of the factors that influence their occurrence, the authors discuss some conceptual issues relevant to a definition of worsening in marital and family therapy and present some methodological guidelines for the assessment of deterioration in therapy with family systems. It is concluded that the study of deterioration processes in family therapy may aid the understanding of family change processes more generally.     

Individual,Marital, and Family Therapy

Two therapists have recently suggested that marital therapy is either a shadow of individual therapy (Robert Harper) or eclipsed by family therapy (Jay Haley). We offer an apologia for marital therapy. We suggest that empirical evidence shows that it works. Further, clients often request it and resist a redefinition of marital concerns as individual or family problems. Finally, people value a focus on the marriage because (a) it blends individual rights and communal responsibilities and (b) it is the only voluntary relationship between dyads with the family. We conclude that marital therapy, when requested and appropriate, is legitimate and effective.     

Killing Two Birds With One Stone: Exposure Simultaneously Addressing Panic Disorder and Obsessive-Compulsive Disorder

Massed exposure has gained acceptance as an effective method to treat anxiety disorders. When using this intervention in patients presenting with more than one anxiety disorder, specific treatment options need to be discussed. Should exposure be applied in sequential order for each of the comorbid disorders? Or can exposure sessions also be designed to simultaneously target both problem areas? We report on the cognitive-behavioral treatment of a 28-year-old woman with obsessive-compulsive disorder (OCD) and severe panic disorder with agoraphobia (PDA). A series of behavioral experiments based on prolonged exposure was planned. Due to the fact that avoided situations elicited both agoraphobic and contamination fears, we decided to combine exposure for PDA and OCD to optimize therapeutic transfer. Twelve sessions of this exposure resulted in a long-term reduction of both PDA and OCD symptoms. The case illustrates that two comorbid conditions can be effectively combined under one therapeutic rationale. Capabilities and limitations of the method and implications for current theoretical debates on exposure therapy are discussed.     

The Effects and Effectiveness of Marital Therapy A Review of Outcome Research

The literature on outcome research in marital therapy is reviewed. Issues considered include the nature of outcome criteria, the need to establish a base line against which to measure improvement, and therapeutic effectiveness as a function of treatment type and time-in-therapy. The overall improvement rate across a heterogeneous collection of patients, therapists, and treatment modalities was 66 per cent, suggesting, conservatively, at least a moderately positive therapeutic effect in light of the judgment that “spontaneous” rates appear to be much lower in marital than in individual therapy. Evidence of deterioration in marital therapy also was discovered. No support was found for the contention that co-therapy is more effective than treatment of the couple by a single therapist. The needs of future research in the outcome of marital therapy are discussed and possible fruitful directions for such investigations suggested.     

THERAPIST DEFENSIVENESS AND MARITAL THERAPY PROCESS AND OUTCOME

Abstract

This study examined the effect of couple socioeconomic status (SES); pretherapy marital adjustment; and therapist, husband, and wife defensiveness during the third session of marital therapy on posttherapy marital adjustment. Participants were 22 therapists and 88 couples. Each therapist treated 4 couples, 2 from the middle SES level and 2 from the lower SES level. Path analyses revealed that for husbands higher marital satisfaction before therapy was associated with higher adjustment at the end of therapy, but defensive therapist behavior during therapy was associated with lower posttherapy adjustment. A similar pattern was found for wives, but this should be interpreted with caution owing to potential dependencies in the wives' posttherapy adjustment scores. Neither SES nor pretherapy adjustment predicted therapist defensive behavior in therapy, and SES did not predict marital therapy outcome variance. Results suggest that therapist defensive behavior may reflect a style or characteristic of some marital therapists.     

Family Measurement Techniques

Abstract

This study examined the extent to which a brief, structured couples therapy program based on Imago Relationship Therapy was associated with improvements on the COMPASS scales of individual psychological functioning as well as on a measure of relationship satisfaction, the Marital Satisfaction Inventory. An examination of pre- to post-treatment differences revealed statistically significant differences on three of the four COMPASS scales and all three MSI scales. The rate of improvement in individual distress per couples therapy session was approximately equal to the improvement, found in previous studies, yielded by individual therapy. The results support previous findings that couples therapy may be an effective modality for the treatment of intrapersonal difficulties, and suggest that both relationship and individual distress indices should be utilized in the evaluation of the efficacy of marital therapies.     

The effects of marital adjustment and spouse involvement on the behavioral treatment of agoraphobia: A meta-analytic review

Abstract

In a meta-analysis of 12 recently published therapy outcome studies, the effects of marital distress and spouse-involved therapy on the outcome of exposure-based treatments for agoraphobiawere evaluated. Analyses indicated that the better the pre-treatment marital functioning of the patient, the greater the reduction in agoraphobic symptomatology up to one year following treatment. The effectiveness of spouse-involved exposure treatment, at least as currently practiced, was not found to be significantly different from the effectiveness of the more commonly used spouse-noninvolved exposure treatments. Specific research suggestions which may assist in providing a better understanding of the relations among agoraphobia, marital functioning, treatment modality, and treatment outcome are offered. In addition, we present guidelines for the conduct and reporting of future agoraphobia treatment research.     

Couples treatment for major depression: critique of the literature and suggestions for some different directions

Current couples approaches to the treatment of depression show considerable promise for some couples, but have substantial room for improvement – in terms of efficacy as well as applicability and acceptability to a broader population. Although conjoint approaches have been shown to be efficacious in reducing couple distress and are possibly efficacious in ameliorating depression that co-occurs with couple distress, methodological problems hamper generalization from the published findings. Therefore, it is not clear that most depressed persons are likely to benefit from currently available conjoint formats. Most basically, there may often be obstacles that prevent or delay partner involvement, highlighting the need for treatments that can enhance relationship functioning without relying on a conjoint format. Existing treatment delivery systems may also fail to reach a considerable segment of the population. Developing a more flexible set of options for implementing couple-focused treatment, as well as rethinking dominant assumptions about depression, may be integral to extending the viability of couples therapy for depression.     

Cognitive marital therapy

This article reviews recent applications of cognitive therapy to the treatment of marital distress. Three categories of cognitive phenomena that can decrease marital satisfaction and elicit dysfunctional interactions between spouses are described. First, automatic thoughts that comprise an individual's stream-of-consciousness thinking about marital events can be biased by systematic cognitive distortions. Inaccurate attributions about the causes of marital problems are a major form of such automatic thoughts. Second, individuals' behaviors toward their partners are influenced by their expectancies about the probabilities of the partner's subsequent responses, and these expectancies also are susceptible to systematic distortion. Third, an individual's unrealistic or irrational beliefs about the nature of intimate relationships can produce distress and dysfunctional behavioral responses toward the partner. Methods for assessing and modifying these dysfunctional cognitions, particularly in conjoint treatment, are described. Similarities and differences between cognitive therapy and rational-emotive therapy in the treatment of marital problems are noted.     

Contemporary Psychotherapy: Moving Beyond a Therapeutic Dialogue

Psychotherapy was developed as a means of using words to heal emotional pain. Although a therapeutic dialogue can be helpful to many clients, some people need a more action-based intervention. Psychotherapy may be enhanced by adapting several therapeutic procedures that have been found effective in physical therapy. Where physical therapy can help clients learn to manage chronic physical pain, psychotherapy can help clients learn to manage chronic emotional pain. Both physical therapy and psychotherapy can help to facilitate awareness, flexibility, strength and endurance in order to maximize the clients functional ability.     

Behavioral marriage therapy in the 1980's: The challenge of integration

Abstract

Only two years ago, my colleagues and I participated in a published debate over the sufficiency of a predominantly behaviorally oriented approach to marital therapy (Gurman and Kniskern, 1978c; Gurman and Knudson, 1978; Gurman et al., 1978; Jacobson and Weiss, 1978). This debate has stimulated a good deal of discussion (e.g., Colapinto, 1979; Taggart, 1979), presumably because it focused attention on a number of issues which are fundamental to how clinicians conceive of marital conflict and treatment, which had not received enough of a public airing for some time. In that debate, my colleagues and I argued that a single-minded application of behavioral principles to marriage therapy was insufficient for effective clinical practice. While behavioral marital therapy (BMT) was the focus of that particular interchange, in several other places I have taken the position that psychodynamically oriented and systems-oriented methods, when applied monolithically to marital problems, are also subject to serious criticism on both theoretical (Gurman, 1978; 1979; Gurman and Klein, 1980) and empirical (Gurman and Kniskern, 1978a; 1978b; 1980a; Kniskern and Gurman, 1980a; 1980b) grounds.     

Family Therapy and Alternative Medicine: Acupuncture as a Case in Point

Collaboration between family therapists and alternative medicine practitioners is recently cultivated ground that may prove to be fertile territory for the application of family therapy skills. Acupuncture and family therapy are two healing practices that differ in cultural tradition, language, and technique, yet they appear to share some underlying assumptions suggestive of a natural alliance in helping people with a variety of biopsychosociospiritual problems. This paper describes the process of interdisciplinary collaboration between an acupuncturist and family therapist via a clinical vignette, identifying different types of referral situations, and suggesting factors of effective collaboration that can synergistically enhance a patient and family's treatment.     

Couple therapy in a therapeutic community setting†

An account is given of couple therapy offered as part of a comprehensive treatment programme in a unit run as a therapeutic community. The additional therapeutic force provided by couple or family therapy is important in dealing with adult patients who may not be highly motivated for change or who may not initially present their difficulties as springing from marital or family relationships. A combined approach with these kinds of patients may succeed where either group therapy or couple therapy alone is likely to fail.     

The Effect of Problem-Solving Based Family Therapy on Emotional Intimacy and Marital Quality of Cultural Couples in Tabriz

Abstract

This study aimed to investigate the effect of problem-solving based family therapy on the emotional intimacy and marital quality of cultural couples in Tabriz. The research method was quasi-experimental by designing the pretest and post-test with the experimental group. The statistical population of this research consisted of all cultural couples with marital problems referring to counseling centers of Tabriz Education in 2019. The research sample based on The Cochran formula consisted of 32 couples that were selected by purposeful sampling and were randomly assigned into two experimental and control groups. The experimental group was exposed to 10 sessions of problem-solving based family therapy and the control group received no interventions. The research tool was the Marital Quality Index and the Intimacy Questionnaire, which was completed by both groups at the beginning and end of the intervention. The collected data were analyzed using SPSS software and inferential statistics of covariance analysis were also investigated. The results of covariance analysis showed that problem-solving based family therapy had a significant impact on the emotional intimacy and marital quality of cultural couples. Therefore, problem-solving based family therapy can be used as a treatment in couples with marital problems.     

Contrasting Approaches in Marital Counseling

My Aim in this paper is to look at the therapist-marital couple relationship as a social system, and from this perspective to outline some aspects of the difference between treating a husband or wife as an individual patient and treating them together as a marital couple.
I will try to differentiate individual treatment and treatment of the marital pair on two dimensions: their respective use as sources of data about the marital relationship, for both therapy and research, and their potentialities for changing the marital interaction.     

Does family therapy produce change? an overview of outcome studies

Summary Families were randomly assigned to one of two forms of conjoint marital therapy: an insight-oriented treatment (n=10) or a problem-solving intervention (n=10.). The results on self-report measures of family functioning indicate that the problem-solving intervention produced more favorable changes after three months. However on long-term follow-up after a year, this more positive effect did not apparently persist, since the insight treatment group reported better results. Experienced therapists did better than inexperienced therapists in the insight treatment condition, but level of experience did not make a difference in the problem-solving intervention. A group of eight families who dropped out of the insight treatment group provided data on correlates of premature termination. Several of the practical obstacles to implementing an experimental design in a clinic setting are illustrated by the research.As we develop more sophisticated methodology, we hope that is the near future family therapy researchers will be better able to state which type of approach is more effective for whom and under what circumstances. A review of current studies of family therapy outcome research indicates that family therapy seems to be as effective as individual psychological treatment.     

Telephone-Administered Cognitive Behavior Therapy for Obsessive-Compulsive Disorder

Exposure with response prevention and cognitive behavior therapy are widely recognized as effective treatments for obsessive-compulsive disorder. Unfortunately, many people with obsessive-compulsive disorder - particularly those living in rural areas - do not have access to therapists providing these treatments. Accordingly, we investigated the efficacy of telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Two open trials are reported, for a total of 33 people with obsessive-compulsive disorder (without major depression). The first trial consisted of 12 weeks on a waiting list followed by 12 weeks of treatment (delayed treatment). The second trial consisted of 12 weeks of immediate treatment. Obsessive-compulsive symptoms did not change during the waiting period. Symptoms declined from pre- to post-treatment, with gains maintained at 12-week follow-up. For the pooled sample our pre-to-post-treatment effect size was as large or larger than those obtained in other studies of reduced contact treatment, and similar to those of face-to-face exposure with response prevention. Our proportion of treatment dropouts tended to be lower than those of other reduced contact interventions. The results suggest that telephone-administered cognitive behavior therapy is effective and well-tolerated, at least for people with obsessive-compulsive disorder without major depression. It remains to be seen whether this treatment is safe and effective when comorbid major depression is present.