Conceptual and Application Issues: Emotionally Focused Therapy With Gay Male Couples

Therapists working with couples are likely to see gay male couples in their practice yet there is a lack of training to prepare therapists to work with gay couples. Emotionally Focused Therapy (EFT) is an empirically supported approach to couples therapy and offers a clear structure and map for working with gay male couples. This article reviews some of the issues that are specific to EFT work with gay men. Given the range of minority stressors that gay men contend with EFT is particularly appropriate for work with gay male couples because of the focus on the attachment bond. Building a secure relationship is an important source of resilience that can buffer against prejudice and discrimination and provide a secure base for individual and couple exploration.     

Clinical Issues with Gay Male Couples

SUMMARY

Although gay male couples share with all couples three essential tasks of couplehood-creating boundaries in order to form a couple identity, negotiating closeness and distance, and accommodating to their individual differences-gay male couples face special complications in each task. These complications, examined herein, are largely the result of the marginalization gay men experience from living in a homophobic culture, and male gender acculturation that makes male-to-male intimacy difficult. A model of brief couple therapy for gay men is presented that is designed to honor, as well as challenge, the relationship the men have co-constructed and specifically addresses the difficulties men have in maintaining intimate bonds. A case study illustrates the treatment of clinical issues presented by male couples.     

The Journal of Couples Therapy Entelechy Institute CEU Quiz

SUMMARY

The majority of gay male couples are not monogamous. Relationship clinicians can help gay male couples to have a healthy sexually open relationship by working from a family systems perspective. This approach requires the therapist to have an understanding of family systems theory, the Enneagram (a personality topology), gay male sexual culture, as well as being clear of negative countertransference. Assessment of functionality of sexually open gay male relationships is described.     

In Search of Meaning: A Preliminary Typology of Gay Male Spiritual Identity Development

Reconciliation of the conflict between religious identity and sexual orientation has been related to a number of psychological challenges (Lease, Horne, & Noffsinger‐Frazier, 2005; Schuck & Liddle, 2001), and little is known about the convergence of spiritual identity, distinctly defined as separate from religious identity, and sexual orientation identity. This qualitative inquiry investigated the process by which 7 Caucasian gay men from a variety of religious backgrounds constructed spiritual identities outside the realm of institutionalized religion. From the findings, the authors hypothesize a typology of spiritual development influenced by religions of origin. Limitations of the study, implications, and future directions in research are also addressed.     

Integrating Sex and Couples Therapy: A Multifaceted Case History

Traditionally, sexuality has not been a focus in couples therapy training, research, or practice, although it is an important, often complex issue for many couples. This article tells the story of a couple presenting for sex therapy due to their unconsummated marriage, and is told to exemplify how sex therapy and couples therapy can be integrated in order to best meet the needs of couples. As the story unfolds, the multilayered facets of the presenting issue are revealed. The therapy incorporates and weaves together family of origin history, intrapsychic and cognitive issues, relational dynamics, patterns of interaction, and physiological/medical concerns into a postmodern couples therapy with behavioral interventions. This combined approach recognizes the value of each method on its own and their greater usefulness when blended together.     

Using Contextual Therapy to Treat Depression with Couples

Abstract

Though depression is one of the most common presenting problems treated by systemic therapists, there have been relatively few attempts to describe how specific systemic therapy models can be applied to treat couples dealing with depression. In this paper, we discuss how contextual therapy can be used to treat depression in couples therapy. We identify multidirected partiality as an intervention and as a characteristic. We introduce letter writing and internalized other interviewing as contextual interventions that help to facilitate partiality and understanding between clients. A clinical vignette illustrates our discussed concepts.     

A Systems Approach to the Treatment of Chemical Addiction

Therapists are increasingly considering chemical addiction from a family systems perspective. Effects of chemical dependency upon the family are discussed and intervention approaches aimed toward assisting the family as families redefine themselves and change their structure are considered. The integration of chemical dependency treatment and the family therapy is also discussed as it is practiced in an intensive outpatient program at a psychiatric hospital.     

Integrating Sex Therapy Interventions with Couple Therapy

This conceptual/clinical paper presents a couple, integrative, psychobiosocial model of assessment, treatment, and relapse prevention for common sexual dysfunctions. The goal is to encourage couple therapists to integrate sexual permission-giving, scientifically and clinically relevant sexual information and guidelines, and specific sexual suggestions/interventions into their couple work. The artificial barriers between couple and sex therapy is to the detriment of couples who need to address intimacy and sexuality problems.     

Case Report: A Systems Approach to Genetic Counseling for Albinism

A systems approach to family therapy assumes that a person and his/her problems do not operate in a social vacuum but instead are imbedded in a social context. This context includes fairly small social systems such as a nuclear family and larger social systems such as school systems and cultural beliefs. A case of a girl with albinism born to a couple from India will be used to discuss how a systems approach might be useful in a genetic counseling setting.     

Systems Theory and Family Therapy: From a Critique on Systems Theory to a Theory on System Change

Some system therapists reject the systemic view for various reasons, often related to violence, victimisation and power. This critique is based on an outdated narrow and incomplete knowledge of linear systems theory. A better understanding of these linear systems theories and of systems levels of organisation already answers much of the critique, but does not explain change. For the latter, a theory of how systems change is necessary for systems therapy in general and family therapy in particular. Modern dynamic systems and chaos theory are most useful to understand change, chaos, history, unpredictability and flexibility.     

Detoxification at Home: A Brief Solution-Oriented Family Systems Approach

The authors propose an outpatient, solution-oriented, family systems approach to detoxification from alcohol and/or drugs. Research indicates that outpatient detoxification is a viable option, one that will likely be utilized even more frequently as health care costs continue to rise. Nontraditional assumptions about the process of detoxification are suggested that challenge traditional notions about detoxification being only a biomedical, pretreatment event. Criteria are provided for determining the appropriateness of clients for outpatient detoxification and offer information about typical withdrawal symptoms and guidelines for the detoxification environment at home. A case example illustrates the application of this approach in a community mental health program. Suggestions for adapting this approach to various settings are also offered.     

The Application of Family Systems Theory to Organizational Consultation: A Content Analysis

A content analysis was performed on 43 articles published between 1970 and 1998 discerned as relating family systems theory (FST) frameworks and constructs to organizational consultation. Frameworks and constructs were coded and then investigated in relation to four independent variables: type of organization, decade of article publication, gender, and educational training of author. Results indicate that the use of FST frameworks and constructs vary depending upon the characteristics of the organization, time period, and consultant. Results highlight specific FST frameworks and constructs most common in organizational consultation.     

Sandtray Therapy: A Familial Approach to Healing Through Imagination

The application of creative techniques in counseling is often tailored to a unique problem, and limited by individual characteristics of the client. One intervention, sandtray therapy, a derivative of play therapy, has gained strong momentum as a creative technique. With greater flexibility for treating a much larger population, sandtray therapy is more applicable for families than other creative approaches. The purpose of the current article is to give an overview of sand tray therapy, as well as provide information regarding its use for working with families. Specifically, the authors discuss exactly how counselors can successfully incorporate sandtray therapy in the familial population setting, and describe its application through case study.     

A Narrative Approach to Child and Family Therapy in Africa*

Professional family therapy in Africa is heavily influenced by theories and principles of Western family practice. Its practice structure and philosophies are however grounded on African family values and the principles and orientations of traditional African psychology. This paper presents a clinical report that illustrates adaptations we make to incorporate compatible aspects of narrative family practice in African and Western cultures. A summary of African family values and child psychology intended as a background perspective is provided. The paper is significant against the background of the current need for forging multiculturally relevant healing methods that fit well with the globalized nature of the contemporary world. Augustine Nwoye, PhD, is Associate Professor and Chairman, Department of Psychology, Kenyatta University, Nairobi, Kenya (amnwoye@avu.org). Professor. Nwoye has developed an African paradigm for mental health and, in particular, for family and couple therapy. He also has experience in dealing with stress and multiple losses, especially surrounding HIV/AIDS within an African context. *An earlier version of the paper was presented to the members of staff and students of the Faculty of Education, University of Cambridge, England, UK, and the initial version was presented to the members of the Family Therapy Program of the Faculty of Medicine of the University of Calgary, Calgary, Canada. I wish to thank Dr. Colleen McLaughlin (University of Cambridge) and Professor Karl Tomm (University of Calgary) for their invitation, assistance, time, attention, and suggestions.     

The Couple's Mutual Identity and Reflexivity: A Systemic-Constructivist Approach to the Integration of Persons and Systems

This paper presents a systemic-constructivist approach to working therapeutically with couples. Therapeutic change is optimal when both the intrapersonal processes of each individual and their unique interpersonal system are synthesized. This approach targets partners' ways of knowing and experiencing themselves in the context of their relationship. The therapist endeavors to engage the aspect of personal identity which each partner derives through his or her participation in the relationship. Emphasis is placed upon (1) The mutual identity that emerges as a result of the couple's intersubjective, dialectical interplay; (2) each partner's ability to engage as participant–observers within their own relationship; and (3) the ability for the couple to utilize their conjoint reflexive faculty in the service of their own change. Change which arises from this combination of personal motivation and collective agency exhibits a self-generated life of its own predicated upon the couple's own expertise rather than that of an external agent.     

A Systems/Dialectical Model of Supervision: A Symbolic Process

Although there has been a proliferation of models of supervision in the marriage and family therapy literature recently, most tend to focus on methods rather than on the process of supervision. The model presented here is grounded in developmental concepts and focuses on student learning through a dialectical process of cognitive and emotional growth and incorporates three stages: 1) developing relationships; 2) breaking impasses, and 3) orchestrating changes. Students discover that supervision becomes isomorphic with relationship issues that arise in their therapy sessions. Dialectical in nature in that each stage is characterized by the resolution of contradictory emotions, the supervision process helps supervisees experience emotional shifts in their interactions with others, referred to as emotional restructuring.     

Attachment as an Integrating Concept in Couple and Family Therapy: Some Considerations with Special Reference to South Africa

Couples, marital, and family therapy in South Africa and throughout the world have undergone radical changes in theory and practice in the last three to four decades. These developments are seen in the emergence of different approaches which may be regarded as modern or post-modern, intrapsychic or systemic. While these different approaches are often seen as theoretically and clinically incompatible, it is the aim in this paper to suggest that the time has come to seek points of integration of these different approaches, and the construct of attachment is proposed as an ideal integrating concept. Two case illustrations are used to demonstrate attachment as an integrating concept. It is suggested that the concept of attachment may also be applied to family therapists and associations, including and especially in South Africa.     

Expanding the Therapy Paradigm with Queer Couples: A Relational Intersectional Lens

North American and global cultures in general—and the field of Couple and Family Therapy in particular—have made significant strides toward recognizing and validating LGBTQ identities and relationships. However, clinical assessment and conceptualization of queer couples still lack the complexity needed to encompass the issues involved in treatment. Existing literature provides clinicians a basic understanding of queer couples and the dynamics that make them unique from nonqueer couples. However, much of this knowledge has been normed on White middle‐class couples and has rarely included couples with transgender or bisexual members. This article invites clinicians and researchers to apply a feminist model of intersectionality to understand queer couples. Our proposed intersectional lens considers multiple axes of identity and power and their interrelationships (Crenshaw, 1989, 1991). We argue that intersectionality is important for understanding all identities, whether privileged or marginalized (Falicov, 2003). This application of the concept of intersectionality is unique in its relational focus, emphasizing how partners’ complex individual identities overlap with and intersect with one another. Additionally, this lens considers how the therapists’ and clients’ multidimensional identities intersect. Three case studies are presented to illustrate application of the intersectional lens. In each case, exploring the partners’ multiple social locations, their influences on one another, and the therapist's intersections of identity all proved critical to the direction of therapy.