Fostering Strength and Resiliency in Same-Sex Couples

Abstract

Same-sex couples are presented widiin tiieir cultural contexts to examine how those contexts might influence me strength and resilience of their relationships. We are particularly interested in the ability of the couple relationship to fulfill family functions that serve the social, psychological, and physical needs of each of the partners and society (Patterson, 2002a). Three family functions: family formation and membership, nurturance and socialization, and protection of vulnerable members, are particularly germane to same-sex couples. We examine several topic areas related to these three functions in order to assist clinicians in identifying factors that may prohibit same-sex couples from becoming and remaining strong and resilient.     

The Drama of Couples Therapy

In the author's view, the intensity of couples/family treatment arises from a suppressed acknowledgment of reciprocity, of interconnectedness among family members, beyond the often familiar dynamics of blaming and deprivation. Eliciting a recognition of profound interdependence raises anxiety, and stands in opposition to culturally prescribed concepts of autonomy and independence. To this end, a dramaturgical model of couples/family is proposed and discussed, involving the therapist's participation as director, witness or audience, and protagonist.     

A Caring Framework for Enhancing Couples Therapy

As couples move away from role oriented patterns of relating they enter a transitional phase where marital expectations are less clearly defined. Frequently couples seeking therapy complain of a lack of caring in their relationships. They also express confusion about the appropriateness of their desire for more caring. In this article the authors present a caring framework based on their research with couples in "vital-total" marriages. They also suggest several ways this caring framework can be used in clinical work with couples.     

Family Mobilization: Work with Angry Elderly Couples in Declining Health

When elderly angry couples face difficulties in caring for each other, the ability to monitor each other's health problems is reduced, prompting the mobilization of the family. This article presents three sets of questions that examine for patterns of family mobilization: positive wedging, disentanglement failure, positive in-and-out participation, and defensive paralleling. In our clinical impression, these patterns often accompany the health monitoring problems of angry elderly couples. Brief case studies are used to describe approaches for assisting these couples in terms of both health monitoring and marital interactions involving anger during health decline. A procedure of deliberate paralleling for working with couples who display an especially inflexible interpersonal arrangement is outlined. Implications are drawn for therapists' education.     

Couples Therapy for Drug Abusing Women in an Inpatient Setting: A Pilot Study

This article describes a pilot study to examine the usefulness of adding a couples therapy component to inpatient drug and alcohol treatment for women. The treatment model was modified from a 12-week integrative systems model that has been empirically supported in outpatient treatment settings. A team of student-therapists received intensive training and supervision in the modified version. This article discusses the ability of chemical dependency counselors to implement this model, includes pre and post treatment comparisons, and qualitative findings regarding the efficacy of the project. The treatment model promises to be usable, safe, and practical in inpatient settings, and merits a more thoroughgoing clinical trial.     

Grief Therapy: An Experiential Workshop

The authors conducted a workshop at a family therapy conference in South Africa in 1997 to explore the use of healing rituals in grief work. There were two levels involved: First, an experiential workshop, and, second, a metalevel in exploring the use of rituals as a rite of passage to facilitate transitions. A draft of the authors' paper was sent to all participants for their comments, which are included in the text.     

Discrepant Alcohol Use,Conflict, and Couples Satisfaction in a Community Sample

Abstract

Discrepant alcohol use between partners has been shown to impact couples’ relationship functioning, emphasizing couples therapists’ need for careful assessment and informed treatment. This study recruited 514 participants from online crowdsourcing platforms to participate in an online survey. Participants were predominantly male (62.4%), heterosexual (76.1%), and Caucasian (47.6%). Ages ranged from 18 to 65 years and mean age was 33. Results indicated a negative association between couple satisfaction and both alcohol-related conflict and discrepant alcohol consumption. Being female combined with higher levels of alcohol discrepancies and couple satisfaction predicted increased alcohol-related conflict.     

An Ounce of Prevention: A Model for Working with Couples At-Risk for Battering

Literature on preventing spousal battering before it starts is virtually non-existent. This article describes a prevention of abuse program that targets couples at-risk for battering. At-risk couples and the process of engaging them in couples counseling are described. The prevention model is based on a Bowenian approach that focuses on partner differentiation and reducing emotionality and promoting rational thinking. It is assumed that increasing differentiation decreases the risk of spousal battering. The various techniques used to facilitate differentiation are presented as well as a case example illustrating a successful prevention of abuse experience.     

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.     

Therapeutic Experiences of Lesbian Couples

Abstract

This study explores the therapeutic experience of lesbian couples who had received couples psychotherapy earlier in their relationship. It examines their feelings regarding their own levels of acceptance, disclosure of sexual orientation, and connectedness with the professional providing services using qualitative methodology. The perspectives of both members of the lesbian couple were taken into account and explored. Lesbian couples who had accepted their sexual orientation appeared to have higher levels of satisfaction in their therapeutic experience and reported having an improved sense of self. Couples who had a therapist that portrayed a positive acceptance of homosexuality, low levels of heterosexism, and knowledge of issues relevant to the lesbian community reported an experience that was conducive to growth and development thus leading to an enriched relationship.     

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.     

The Efficacy of Behavioral Couples Therapy and Emotionally Focused Therapy for Couple Distress

Twenty treatment outcome studies, 13 of which evaluated behavioral couples therapy (BCT) and seven of which evaluated emotionally focused therapy (EFT) were reviewed, leading to the following conclusions. BCT leads to short and long-term gains for moderate to severe couple distress. In the long term BCT probably leads to no better outcomes than its constituent components—behavioral exchange training and communication and problem solving skills training. Addition of a cognitive therapy component to BCT or the use of a variety of treatment formats does not improve the efficacy of BCT. Integrative couples therapy and insight-oriented marital therapy may be more effective than BCT, but studies supporting this conclusion require replication. EFT leads to short and long-term gains for mild to moderate couple distress. Addition of a cognitive therapy component to EFT does not enhance its efficacy. EFT may be more effective than problem solving therapy and less effective than integrated systemic therapy, but the two studies supporting this conclusion require replication.Michael Byrne, PhD, is a Clinical Psychologist, Midland Health Board, Ireland; Alan Carr, PhD, is Director of the Clinical Psychology Training Programme, Department of Psychology, Arts Building, University College Dublin, Belfield, Dublin 4, Ireland (alan.carr@ucd.ie). Marie Clark, PhD, is Lecturer, Department of Psychology, University of Surrey, United Kingdom.     

The Use of Metaphors with African-American Couples

SUMMARY

There is a dearth of data in the literature on African-American couples. This omission probably reflects the assumption that interventions that are effective with one race are effective with others. This paper explores the use of metaphor as a tool for working with an underserved and neglected population. Since the African-American culture is extensive in its use of metaphor, this medium provides a fertile channel for therapeutic communication.     

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.     

Indigenous Healing Practices and Asian Immigrant Women

ABSTRACT

The current article highlights the importance of indigenous psychology for Asian immigrant women. A brief overview is provided about Asian American immigration and the importance of understanding women’s experiences with the contextual lens of gender, ethnicity, and race. Key values relevant to help-seeking and service utilization are also presented. Complementary alternative approaches to Western-based mental health treatment are discussed as ways in which feminist and multicultural treatment approaches can be integrated. Given the inherent diversity of Asians and Asian Americans, which includes over 60 ethnic subgroups, the article is not meant to provide an exhaustive list of available native practices nor to reflect the experiences of Asians as a homogenous group. Instead, the goal of this article is to provide readers with an understanding of how culturally based healing practices and concepts are needed to complement and contribute to our extant understanding of help-seeking. We conclude by highlighting the ways in which Western-based healthcare would benefit by integrating indigenous practices with gender and ethnic/racial cultural perspectives.     

Resources on Same-Sex Couples for Therapists and Clients

SUMMARY

This article provides a brief annotated bibliography of resources for working with same-sex couples. We provide summaries of articles, book chapters, books, and web sites which we have found to be particularly helpful in working with same sex couples. Books covered include those targeted to therapists as well as those targeted to clients (self-help and bibliotherapy books).     

Warriors,authors and baseball coaches: the meaning of metaphor in theories of family therapy

This article examines the metaphors family therapists use in their theories to reveal aspects of the theories which are not explicitly stated, using Whitaker's symbolic experiential therapy, Minuchin's structural therapy and White's narrative therapy as examples. Such examination, drawing on social constructivist understandings of metaphor and meaning making, reveals that Minuchin's metaphors of family as organism and therapist as artist and warrior emphasize the family as relatively holistic and the therapist as relatively interventionist. In contrast, Whitaker's metaphor of family as ecological system or team and therapist as coach emphasizes the interdependence and context sensitivity of the family and relative powerlessness of the therapist to impose change. Finally, White, reflecting his explicitly post‐structural commitment, uses the metaphor of therapy as a journey undertaken with a map and as therapy as an act of re‐narrating a story.