The Unseen Spouse: Pitfalls and Possibilities for the Individual Therapist

Individual therapists often hear a great deal about our patients' spouses or partners, and naturally develop ideas and beliefs about that unseen other and about the causes of any relationship difficulties the patient reports. Not uncommonly, therapists can lose touch with the fact that their impressions of an unseen spouse are constructions that have emerged from the transference/countertransference field, based on only partial or limited information—not veridical truths. They can then talk with the patient about his or her partner or relationship issues in ways that can ultimately do both patient and spouse a significant disservice and perhaps distract from the patient's own issues and analytic goals. This paper discusses several factors that seem to contribute to the development of this problematic dynamic, including various qualities of the transference/countertransference field, and offers suggestions for avoiding or reducing it. Clinical material is used to illustrate key points.     

Prospective patterns of resilience and maladjustment during widowhood

Using prospective longitudinal data on an older sample beginning prior to the death of a spouse, G. A. Bonanno et al. (2002) distinguished 5 unique trajectories of bereavement outcome: common grief, chronic grief, chronic depression, depression followed by improvement, and resilience. These trajectories having been identified, the aims of the current study were to examine differences in how respondents in each group reacted to and processed the loss. Specific hypotheses were tested regarding differences in coping, meaning making, context, and representations of the lost relationship. Results suggest that chronic grief stems from the upheaval surrounding the loss of a healthy spouse, whereas chronic depression results from more enduring emotional difficulties that are exacerbated by the loss. Both the resilient and the depressed-improved groups showed remarkably healthy profiles and relatively little evidence of either struggling with or denying/avoiding the loss.     

Self-reported problems: a comparison between PTSD-diagnosed veterans,their spouses,and clinicians

This study investigated self-reported problems in a sample of help-seeking Vietnam veterans, comparing the veteran's own view with clinician and spouse perspectives, with the aim of examining convergence in reports across different informants. Veterans with PTSD (N = 459) were asked to list and rate their five most serious problems. Spouses and treating clinicians completed the same questionnaire in relation to the veteran. Rates of endorsement for each problem area, and levels of agreement between raters, were calculated. Veterans, spouses, and clinicians were all likely to rate anger as a high priority, with veterans also likely to nominate anxiety and depression. Spouses were likely to nominate more observable behavioural problems such as interpersonal difficulties and avoidance, while clinicians were likely to nominate indications of psychopathology, such as anxiety, depression, and intrusive thoughts. Agreement across raters was generally high, although interpretation of agreement levels was complex.     

Managerial Support for Dual-Career Relocation Dilemmas

This study examined managerial decision making in the context of a dual-career relocation dilemma. Specifically, 143 managers and professionals responded to a memo contained in an in-basket simulation exercise that involved a dual-career employee relocation and corresponding request for spouse employment assistance. Competing theoretical predictions were tested with regard to managerial support for this dual-career work-family situation as a function of the gender of the employee. Findings indicated that managers offered more extensive assistance to the spouse of a female employee than to the spouse of a male employee. A content analysis of decision-makers' responses indicated a wide range of specific responses, with offering multiple forms of assistance being most common (27%), followed by delegating the issue to human resources (22%). The results are discussed in terms of implications for future research on managerial support for work-family and employee mobility. Practical suggestions are outlined.     

Long-term effects of losing a spouse or child in a motor vehicle crash

In this article we examine the long-term effects of the sudden, unexpected loss of a spouse or child. In the spouse study, interviews were conducted with 39 individuals who had lost a spouse in a motor vehicle crash 4 to 7 years ago and with 39 matched controls. In the parent study, interviews were conducted with 41 parents who had lost a child in a crash and with 41 matched controls. Control respondents were matched to bereaved respondents case-by-case on the basis of sex, age, income, education, and number and ages of children. Significant differences between bereaved spouses and controls were revealed on several indicators of general functioning, including depression and other psychiatric symptoms, social functioning, psychological well-being, reactivity to good events, and future worries and concerns. For the most part, these differences persisted when variables such as present family income and present marital status were statistically controlled. Comparisons between bereaved and control parents also revealed significant differences on some measures of general functioning (especially depression), but these were not as pervasive as the differences obtained in the spouse study. Responses to questions about current thoughts and feelings suggest that the deceased continued to occupy the thoughts and conversations of bereaved spouses and parents. Moreover, a large percentage of respondents (from 30% to 85%, depending on the question), continued to ruminate about the accident or what might have been done to prevent it, and they appeared to be unable to accept, resolve, or find any meaning in the loss. Taken together, the data provide little support for traditional notions of recovery from the sudden, unexpected loss of a spouse or child.     

The unforgivable humiliation: A Dilemma in couples' treatment

Therapists sometimes encounter cases of intense marital discord in which the disaffected spouse seems unable to specify the reason for his or her discontent except in the vaguest, most general terms. Such cases may be extraordinarily difficult to treat, as the disaffected partner may seem impervious to any attempt at negotiation, to the point of dissolution of the marriage. The reason for the disaffected spouse's intransigence may seem unclear to the other spouse, to the therapist, and even to herself/himself. We hypothesize an explanation for this phenomenon in terms of the disaffected partner's experience of having suffered humiliation at the hands of the other spouse and offer a plan for treatment, citing case materials.     

Starting over: a tentative theory exploring the effects of past relationships on postbereavement remarried couples

Using grounded theory methodology 24 participants were asked to discuss how the death of a previous spouse, either theirs or their partner's, was currently affecting their second marriage. Participants were interviewed individually and as a couple. The central category was memories of the deceased spouse. Six additional categories emerged from the data: past spouse on pedestal, current/past comparison, insecurity of current spouse, curiosity about past spouse/relationship, partner's response to curiosity, and impact on the current relationship. Existing literature, auditors, and participant feedback were all used to validate the results. Expanding on a tentative theory (Brimhall, Wampler, & Kimball, 2008), provisional hypotheses were developed, thus helping clinicians who work with complex issues involving remarried couples.     

Do subjective measures of attention and memory predict actual performance? Metacognition in older couples

Older individuals who recognize their cognitive difficulties are more likely to adjust their everyday life to their actual cognitive functioning, particularly when they are able to estimate their abilities accurately. We assessed self- and spouse-ratings of memory and attention difficulties in everyday life of healthy, older individuals and compared them with the respective test performance. Eighty-four older individuals (women's age, M = 67.4 years, SD = 5.2; men's age, M = 68.5 years, SD = 4.9) completed both the self and the spouse versions of the Attention Deficit Questionnaire and the Everyday Memory Questionnaire and completed two neuropsychological tests. Using the residual score approach, subjective metacognitive measures of memory and attention were created and compared with actual test performance. Significant associations between subjective and objective scores were found only for men and only for episodic memory measures. Men who underreported memory difficulties performed more poorly; men who overreported memory difficulties performed better. Men's recognition performance was best predicted by subjective measures (R2 = .25), followed by delayed recall (R2 = .14) and forgetting rate (R2 = .13). The results indicate gender-specific differences in metacognitive accuracy and predictive validity of subjective ratings.     

Stress‐buffering or stress‐exacerbation? Social support and social undermining as moderators of the relationship between perceived stress and depressive symptoms among married people

This prospective panel study examined social support and social undermining from the spouse as moderators of the relationship between perceived stress and depressive symptoms. Participants were 181 married people who completed questionnaires at two points in time. The interval between time 1 (T1) and time 2 (T2) was approximately 6 weeks. Multiple regression analysis showed that T1 perceived stress and T1 spouse undermining, but not T1 spouse support, predicted increases in depressive symptoms from T1 to T2. T1 spouse undermining, but not T1 spouse support, moderated the association between T1 perceived stress and T2 depressive symptoms. These findings supported a stress-exacerbation hypothesis for the effect of spouse undermining on the stress process. Discussion focuses on possible mechanisms for the stress-exacerbation effect.     

Spouse marital adjustment and patient dietary adherence in chronic hemodialysis: A Comparison of Afro-Americans and Caucasians

Abstract

This study investigated racial differences in the relationship between spouse marital adjustment and dietary adherence of chronic hemodialysis patients. Sixty-eight adult patients and their spouse were subjects. Fifty-two percent of the patients were Caucasians while 48% were Afro-Americans. Spouses completed the Locke-Marital-Questionnaire (LMQ) and provided demographic data pertaining to their patient spouses. The patients' predialysis potassium levels (indices of food intake compliance) for the previous three months were matched with the respective questionnaires. Afro-American spouses, especially males, evidenced significantly lower marital satisfaction than Caucasian spouses. Afro-American female patients seemed to be most compliant as far as food intake wasconcemed. Although the spouse LMQ score was negatively correlated with interdialysis weight gain. Afro-Americans who generally scored lower on the LMQ did not differ from Caucasians in so far as their adherence to the dietary regimen was concerned. Implications for improving quality of life of hemodialysis couples in general, and Afro-Americans in particular are discussed.     

Favouritism,fairness and joint profit in long-term relationships

This study was designed to test a number of hypotheses about the use of FAV and other strategies as measured by the intergroup ‘matrices’ in four long-term relationships-with spouse, child, friend and workmate. Forty subjects filled in matrices giving three measures of self-favouritism (FAV), and one each of fairness (F) and maximum joint profit (MJP), in relation to the allocation of money and time. It was found that FAV was not used for spouse, and was used less for child than for the non-family relationships (p < 0.01, p < 0.05). There was also an influence of altruism (A) against FAV, when time was distributed between spouse (p < 0.01) or child (p < 0.001) and the self. F was used most for spouse, followed by child, friend and workmate (p < 0.001), and was used more by females in distributing money (p < 0.01). MJP was not used at all for money, but was used to some extent for time.     

Investigation of a developmental model of risk for depression and suicidality following spousal bereavement

Data from a community-based multi-wave investigation were used to examine a developmental model of risk for depression and suicidality following the death of a spouse. Measures of perceived parental affection and control during childhood were administered to 218 widowed adults 11 months after the death of the spouse. Self-esteem, spousal dependency, depression, and suicidality were assessed 9 months later. Dependency on the deceased spouse mediated a significant association between retrospectively reported parental control during childhood and post-loss depressive symptoms. Depressive symptoms mediated significant associations of dependency on the deceased spouse and low self-esteem with suicidal ideation and behavior.     

The time course of grief reactions to spousal loss: evidence from a national probability sample

Most studies of widowhood have focused on reactions during the first few years postloss. The authors investigated whether widowhood had more enduring effects using a nationally representative U.S. sample. Participants were 768 individuals who had lost their spouse (from a few months to 64 years) prior to data collection. Results indicated that the widowed continued to talk, think, and feel emotions about their lost spouse decades later. Twenty years postloss, the widowed thought about their spouse once every week or 2 and had a conversation about their spouse once a month on average. About 12.6 years postloss, the widowed reported feeling upset between sometimes and rarely when they thought about their spouse. These findings add to an understanding of the time course of grief.     

Commitment to one’s spouse as a predictor of marital quality among older couples

The present study examined the relationships between several independent variables (ego development, commitment to the spouse, length of marriage, church attendance, and sex of subject) and three marital quality variables (marriage problems, expression of love, and dyadic adjustment) in a community sample of 72 married couples age 50 and up. Commitment to the spouse was the strongest and most consistent predictor of marital quality; commitment was negatively related to marriage problems and positively related to expression of love and dyadic adjustment. The other independent variables were generally unrelated to marital quality.     

Brief Reviews

Abstract

Family lawyers are well aware that there can be physical danger to an attorney in representing the abused spouse in violent families where spouse or child abuse exists. We have all documented through hard experience the circumstance of the abused spouse seeking immediate assistance from our office in removing the violent spouse from the home, obtaining restraining orders, and immediately instituting proceedings, often after 1 o'clock on a Friday afternoon, only to be followed in a fairly brief span of time by     

Capitalising on Positive Work Events by Sharing them at Home

The authors integrate existing theory on work–family integration and interpersonal capitalisation on positive work events by examining the effects of sharing positive work events with one's spouse on employee life satisfaction. A field study was conducted with 131 employees of a large Midwestern university, who completed surveys online. Participants provided accounts of their most important positive event during the prior week and indicated whether they had shared this event with their spouse. They also retrospectively rated their positive affect and life satisfaction over the course of the study. Results based on hierarchical regression analysis indicated that having shared that event with one's spouse was positively associated with positive affect and life satisfaction after controlling for personality and event characteristics. These results were corroborated in a subsample of 99 employees whose spouses provided independent reports of whether the event was shared with them. This research reveals that sharing positive events with others has unique and significant contributions to positive affect and life satisfaction. More importantly, these findings show that the interpersonal act of sharing is effective when conducted cross‐domain: the act of sharing positive work events with family members increases positive affect and life satisfaction.     

Interventions for Suicidal Children and Their Parents

ABSTRACT: Five features of the family organization of suicidal children include family inhibition of change, lack of defined generational boundaries, severity of spouse conflict, projection of inappropriate parental feelings onto the child, and a symbiotic parent-child interaction. The treatment of suicidal children must encompass a holistic family technique. The acute phases of treatment include protecting the child from harm, promoting family recognition of the seriousness of the child's suicidal behavior, promoting appropriate parental role responsibilities, and effecting an immediate significant family change. During the long-term process of treatment, attention must be focused on the child's unique psychopathology, the conflicts that preclude appropriate parental response to the child's needs, and the characterological difficulties of each parent.