Medical Family Therapy for a Woman with End-stage Crohn's Disease and Her Son

Medical family therapy grew out of the experiences of family therapists working with other professionals to provide comprehensive, integrated healthcare for patients (McDaniel, Hepworth, & Doherty, 1992). This is the story of one such patient, her son, and those of us who were the three primary participants on her treatment team. To provide an account that comes closest to the experience itself, we have taken quotes from videotaped sessions and electronic mail communications that occurred throughout the course of therapy. Each provider tells part of the story in his or her own voice. The commentary is provided by Susan McDaniel.     

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.     

Marital Infidelity

SUMMARY

This paper describes die usual course of discovered marital infidelity and its predictable posttraumatic reaction. It contrasts this phenomenon with situations in which the initial reaction to discovery is suppressed, leading to a delayed traumatic reaction. It concludes with suggestions for the treatment of a delayed traumatic reaction, and suggestions designed to sensitize therapists to the possibility of a suppressed reaction to marital infidelity as a possible underlying issue in individual or couples therapy.     

Marriage encounter casualties: A preliminary investigation

Abstract

The purpose of this exploratory study was to investigate the relationship between participation in Marriage Encounter, the largest marriage enrichment program in the world, and subsequent marital or family distress. Analyzing 13 case reports from seven marital therapists, the authors suggest that Marriage Encounter weekends can cause marital or family deterioration for some couples through increased marital conflict, avoidance of constructive problem solving, or marital enmeshment at the expense of children. It appears that the most harmful aspect of the Marriage Encounter experience is its induction of intense couple-centered communication, leading to emotional overload in some couples. The authors offer several recommendations intended to lower the risks associated with participation in Marriage Encounter.     

A Place at the Table: Integrating Diet and Nutrition into Family Therapy Practice

Most schools of family therapy directly or indirectly recognize that personal qualities of the therapist influence therapy process. If personal qualities of therapists are associated with therapy process, it seems plausible that there would be some interaction between their personal relationships and therapy process. The present study examines the relationship between emotion management at home and emotion management at work to job satisfaction and marital satisfaction of marriage and family therapists. Results suggest that men and women experience a different interaction between emotion management, relationship satisfaction, and job satisfaction.     

Wealthy families and their drug abusing adolescents

Abstract

Researchers have hypothesized that providing care to an elderly relative can negatively affect marital relationships of caregivers. However, no research has directly examined this issue. This study explored the impact of elderly depression and impairment, mental caregiving, caregiver/elderly person relationship closeness, spouse burden, and caregiver burden on caregiver marital happiness (and adjustment) in 90 multigenerational families. No significant relationship was found between these variables and caregiver marital adjustment. A causal model involving the six independent variables and caregiver marital happiness was developed and tested. Elderly depression and caregiver burden directly affected level of caregiver marital happiness. The other four independent variables affected caregiver marital happiness indirectly through caregiver burden. Implications for marriage and family therapists are discussed.     

Cognitive restructuring and a collaborative set in couples' work

Abstract

The present study investigated the effects of cognitive restructuring efforts aimed at modifying unrealistic beliefs marital partners might hold. Seventeen couples participated in the study, nine in the treatment group and eight in a waiting-list control group. The treatment program sought to impact proactively upon variables commonly agreed to as contributing to the creation of an optimistic, positive collaborative set as a prelude to behavioral change strategies: positive therapeutic expectations and relationship goals, and an enhanced base level of marital satisfaction. On all outcome measures, the treatment group showed significant gain scores as compared to the control group. Discussion of the results highlights the importance of marital therapists being particularly attuned to specific beliefs partners may hold pertaining to relationship issues.     

Power Differentials in Relationships

Abstract

The issue of sharing power affects many relationships. Many couple theorists and therapists believe that most marital distress is the result of power imbalances between the partners yet the influence of perceived power differentials in relationships is largely ignored in the therapy journals. The focus of this paper is on power differentials in couples. Different types of power are explored and assessment issues are examined. Therapeutic considerations are then presented and illustrated by case material. These issues are explored against a backdrop of gender sensitivity.     

Treating Parents and Children Together

SUMMARY

In this paper I look at two traditions of psychotherapy with children: family therapy {here considered in its common paradigm of systems theory and not in its diversity of approaches) and individual psychodynamically oriented child therapy. The author examines how, in these two modalities of treatment, the real world of the parent-child relationship, which remains mostly a world of women and children, tends to be left out in practice. Many family therapists “exclude” children from their sessions and concentrate on the marital relationship while child therapists “exclude” parents from the core of the therapeutic process. The issues for therapists and the consequences for adults and children in families in this com-partmentalization of services are examined within a feminist framework. The development which is advocated is for therapists to expose themselves fully to the world of the parent-child relationship as a fust step in reexamining their stereotypical views of motherhood and fatherhood which trap women in conflicted and potentially exploitative situations and do not consider that children actively construct their own relationships.     

“Here’s How We’re Seeing It”: An Interview with Susan H. McDaniel, PhD, Jeri Hepworth, PhD and William J. Doherty, PhD

This is an extended interview with medical family therapists Susan H. McDaniel, Ph.D., Jeri Hepworth, Ph.D. and William Doherty, Ph.D. about the first and second editions of their book, Medical Family Therapy, and their views of the current Medical Family Therapy field.     

Surrogate motherhood i: Responses to infertility

Abstract

Surrogate motherhood is one of three recently developed paths to parenthood resulting from modern technological medical research. It is, however, a path filled with legal “potholes” and psychological “rocks.” Mental health specialists, especially marital and family therapists, need to be familiar with this difficult road because they may well be called upon to provide their professional services to people attempting to negotiate it. This paper introduces a number of the potential hazards as well as the points at which therapeutic and related services may be needed.     

Fat Women’s Experiences in Therapy: “You Can’t See Beyond…Unless I Share It with You”

Abstract

This article reports the results of a qualitative exploration of fat women’s experiences with weight-related microaggressions in psychotherapy. We conducted semi-structured interviews with 15 women about their weight-related experiences as therapy clients and asked for their advice to therapists who work with fat women. We used a general inductive approach to code the data into themes and found that common microaggressions included therapists who overly focused on weight, therapists who appeared to be less interested in clients because of their weight, and dissatisfaction with waiting room seating options. Participants advised therapists to allow their clients to initiate conversations about weight. Results suggest the need for increased awareness of: (a) how clients’ weight may impact therapists’ attitudes and choice of interventions and (b) how weight might influence fat clients’ in-session presentations.     

Humor and Marital Satisfaction

Abstract

Fifty married Israeli couples were administered a humor test measuring humor creation and humor appreciation, as well as a questionnaire measuring marital satisfaction. Each spouse completed the measurement for self and for his or her partner. Results obtained showed that marital satisfaction was related to perception of the partner's humor more than the spouse's own humor. There was a significant relation for husbands between their scores on humor appreciation and their marital satisfaction. No relation was found for wives between their humor scores and their marital satisfaction. Multiple stepwise regressions on humor scores showed that complementarity between spouses' perceptions of partners' humor explains most of the variance of marital satisfaction.     

Personal assessment of intimacy in relationships: Validity and measurement invariance across gender

IntroductionIntimacy is central in close relationships and a variety of definitions and instruments exist in scientific literature, making this concept complex to investigate. Furthermore, gender differences were identified in the definition and experience of intimacy.ObjectivesThis study aims to confirm the three-factor structure of the personal assessment of intimacy in relationships (PAIR, Schaefer & Olson, 1981), commonly used in research and marital therapy, developed by Moore et al. (1998) and to examine the measurement equivalence of the scale across gender.MethodA confirmatory factor analysis (CFA) was performed on the responses of 313 women and 251 men in committed relationships in a French population. Measurement equivalence of the scale across gender was then conducted with the best-fitting model.ResultsThe results of CFA and post-hoc analyses revealed that the three-factor model revised with 18 items was the best fit to the data: (1) engagement (10 items), (2) communication (5 items), (3) shared friends (3 items). PAIR-18 displayed a lack of metric and scalar invariance across gender but estimated means of latent variables is not very different between the full invariant model and the unconstraint models.ConclusionNevertheless, consideration of gender differences in the construct of intimacy is very important for theoretical research on intimacy in romantic relationships and for the interventions of marital therapists based on intimacy.     

Tom Thumb in hospital: The fairy tale workshop in a paediatric oncology and haematology ward

Abstract

Definitions of and attitudes towards countertransference have changed throughout the twentieth century. From being seen as a contaminant in the analytical process, countertransference has come to be seen by many therapists as a potentially useful source of information about a client and his or her problems. There are dangers as well as benefits associated with analysis and utilization of countertransference. This article reviews these issues and proposes some guidelines that therapists may find useful when contemplating their countertransference reactions to clients, and when considering how best to utilize these.     

Effectiveness of an Educational and Support Program for Family Members of a Substance Abuser

Abstract

This paper investigates the relationship between marital adjustment and congruency of couple preference regarding wife employment. Implications for marriage and family therapists are emphasized. Husband, wife, and couple scores were obtained on the Marital Status Inventory and Dyadic Adjustment Scale for eight work pattern categories. The first four (Dual-Career, Dual-Work, Pre-Dual-Career, Traditional Single-Career) were current couple work patterns perceived as desirable by both spouses. The last four categories (Incongruent Dual-Career, Incongruent Dual-Work, Incongruent Pre-Dual-Career, Incongruent Traditional Single-Career) were current couple work patterns that one spouse, in conflict with the other spouse, perceived as undesirable. In addition, number and ages of children and number of wife work hours were analyzed for their effects on marital adjustment in these couples. The results of this study indicate that marital adjustment is negatively influenced only when the wife wants to work in her career, is not employed, and her husband does not want her to be employed now or in the future. Possible reasons for these findings and suggestions for further research are included.     

the nature and frequency of medicare/medicaid fraud and neutralization techniques among speech,occupational, and physical therapists

ABSTRACT

The current study examines the nature and frequency of Medicare/Medicaid fraud and the techniques of neutralization utilized by a purposeful sample of speech, occupational, and physical therapists working within the context of hospitals, nursing homes, and with home health agencies, in a southern state. Participant observations, surveys, and in-depth interviews were utilized to obtain data for this study. We identified two main fraudulent practices, cutting sessions short while charging for the entire session and charging individual session rates for group therapy sessions. We also identified three techniques of neutralization utilized by the therapists in our study, including: (1) everyone else does it, (2) denial of responsibility, and (3) denial of injury. The implications of our findings are discussed.     

Strengthening Family Resilience

Abstract

Researchers in the field of marriage and family therapy have largely ignored the effect of gender bias on clinical decision making. The purpose of this study was to explore if patient gender influenced prognostic judgments and if male and female therapists utilized different client characteristics when formulating prognostic judgments. Prognostic judgments were based on clinical profiles of couples seeking marital therapy for inhibited sexual desire. The multidimensional scaling procedure, KYST, was utilized to analyze the data. The findings indicated that the identified patient's gender did not influence prognostic judgments. However, therapist gender did influence the client characteristics used to formulate prognostic judgments.