The Family Environment in Chronic Pain Patients: Comparison to Controls and Relationship to Patient Functioning

Operant and cognitive-behavioral models of chronic pain have called attention to the importance of examining the marital and family environments of chronic pain patients. In this study, 50 chronic pain patients and their spouses and 33 control participants and their spouses completed measures of the family environment, marital satisfaction, and patient physical and psychological functioning. Patients' overt pain behaviors were coded from videotapes of patient–spouse interactions. Compared to controls, pain patients and their spouses rated their family environments as lower in cohesion and higher in control, and there was a trend for spouses to report more marital dissatisfaction. Chronic pain patient depression was associated negatively with patient-rated family cohesion and expressiveness and spouse-rated family organization and positively with patient-rated family conflict. Overt patient pain behaviors and spouse-rated patient disability were related negatively to spouse-rated family cohesion. Spouse marital satisfaction was associated negatively with patient depression and with spouse ratings of patient disability and pain behaviors.     

Functional impairment, marital quality, and patient psychological distress as predictors of psychological distress among cancer patients' spouses.

This study investigated contextual determinants of psychological distress among 197 spouses of cancer patients. It was hypothesized that higher levels of patient functional impairment would lead to greater patient distress. Patient distress, in turn, would lead to lower spouse marital satisfaction and ultimately to higher spouse distress. Spouses completed measures of distress and marital quality at three time points. Cancer patients rated their functional impairment and psychological distress at the same time points. Results indicated that at all time points, greater patient impairment was associated with higher levels of patient distress, which, in turn, was related to lower marital satisfaction. However, marital quality was related to spouse distress at only 1 time point, but spouse distress was directly associated with patient distress at each time point. Implications for cancer patients and spouses are discussed.     

Spousal understanding and marital satisfaction in pain patients and their spouses

The current study tested the hypotheses that knee osteoarthritis (OA) patients and spouses who report more spousal understanding of patient's pain would report greater marital satisfaction. A total of 124 couples completed interviews at three time points across 18 months. Results from dyadic analyses showed that patients who felt more understood by their spouse report, and have spouses who report, higher marital satisfaction concurrently. In addition, patients who felt more understood by their spouse reported higher marital satisfaction over time. Spouses' reports of understanding also had a significant influence on the patients' and their own marital satisfaction concurrently. Results highlight the importance of spouses understanding knee OA patients' pain for both dyad members' marital satisfaction.     

Life With a Partner with ADHD: The Moderating Role of Intimacy

Adult attention deficit and hyperactivity disorder (ADHD) manifests itself through a variety of symptoms, some of which affect not only occupational and recreational activities but also intimate relationships. Previous findings have focused on the effects of adult ADHD on intimacy and relationships from the ADHD diagnosed person’s point of view. However, spouses of people with ADHD are a neglected population with regard to the effects that ADHD has on their romantic relationships. Our aim was to assess the effects of being married to a spouse with ADHD on marital relationships, and the moderating role of intimacy. We compared healthy spouses of people with ADHD to healthy spouses of healthy adults (M?=?38.23, SD?=?4.78) in their degree of self-reported intimacy and marital satisfaction. Our findings indicate that spouses of individuals with ADHD report significantly lower intimacy and lower marital satisfaction compared to spouses of individuals without ADHD. Moreover, our findings indicate that spousal reports about their degree of intimacy mediate the relationships between their spouses’ ADHD and their marital satisfaction. Results are discussed in relation to the broad implications that adult ADHD has for romantic intimacy. Our research addresses healthy partners married to a spouse with ADHD, suggesting that living with a partner with ADHD behaviors is challenging. ADHD symptoms negatively affect various qualities in the person experiencing them, but of equal importance is the damage occurring to his or her spouse. Implications for future research and recommendations for clinical work are suggested.     

Marital Satisfaction: A Validation Approach

It was hypothesized that the desire for equity in relationships and the desire for validation from significant others are common human concerns which affect marital relationship satisfaction. Sixty married couples completed a series of questionnaires which assessed equity in 23 areas of the marital relationship, global equity in the marital relationship, relationship satisfaction, perceptions of relationship stability, understanding from spouse, validation from spouse, assistance from spouse in intellectual and emotional growth, frequency of stimulating conversations between the marital pair, frequency of affectionate touching from spouse, and sexual satisfaction in the marital relationship. Subjects who felt validated by their spouses reported more relationship satisfaction, greater relationship stability, more assistance from their spouses in intellectual and emotional growth, and greater sexual satisfaction than did subjects who did not feel validated by their spouses. Overall, equitably treated subjects reported more relationship satisfaction, greater relationship stability, more assistance from spouse in emotional growth, greater sexual satisfaction, and a greater frequency of affectionate touching from their spouses than did inequitably treated subjects. However, these differences between equitably treated and inequitably treated subjects applied primarily to non-validated subjects.     

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.     

Attribution processes in distressed and nondistressed couples: 4. Self-partner attribution differences

The importance of the self-other distinction for understanding the relation between attributions and marital satisfaction is examined in two studies. In Study 1, causal attributions for naturally occurring behavior by the self and spouse were investigated. Study 2 examined both causal and responsibility attributions for hypothetical behaviors. In both studies, the attributions of spouses seeking therapy were investigated in relation to those of happily married persons in the community. The results showed that self-other attribution differences varied as a function of marital distress. Nondistressed spouses showed a positive attribution bias by making more benign attributions for partner behavior as opposed to self-behavior, whereas distressed spouses showed a negative attribution bias by making less benign attributions for partner behavior than for self-behavior. These findings suggest that self-attributions may, in part, determine the impact of attributions for spouse behavior on marital satisfaction. The clinical relevance of the results and their implications for research on actor-observer attribution differences are outlined.     

Socioemotional selectivity and psychological health in amyotrophic lateral sclerosis patients and caregivers: a longitudinal,dyadic analysis

Abstract

Objective: Socioemotional selectivity theory predicts that as the end of life approaches, goals and resources that provide immediate, hedonic reward become more important than those that provide delayed rewards. This study tested whether these goal domains differentially affected psychological health in the context of marital dyads in which one partner had been diagnosed with amyotrophic lateral sclerosis (ALS), a life-limiting disease.

Design: ALS patients (N?=?102) being treated in three multidisciplinary clinics and their spouses (N?=?100) reported their loneliness, financial worry and psychological health every 3 months for up to 18 months.

Main Outcome Measure: Psychological health composite.

Results: In multilevel dyadic models, patients and spouses had similar levels of financial worry and loneliness. Both patients and spouses had worse psychological health with higher loneliness, but only spouses had worse psychological health with higher financial worry. Significant interactions with age and disease severity indicated that older spouses were more affected by loneliness than were younger spouses, and patients with less severe disease were more affected by financial worry than patients with more severe disease.

Conclusion: The results provide good support for socioemotional selectivity theory’s implications for psychological health in a strong test of the theory.     

Couple Therapy for Depression Within a Naturalistic Setting in Finland: Factors Related to Change of the Patient and the Spouse

The study examined factors related to change in treatments for depression in couple therapy (CT; N = 29) and treatment-as-usual (TAU; N = 22). Treatments were adapted in accordance with the patient’s need. The patients’ depressive symptoms, general mental health and marital satisfaction were assessed at baseline and at 6 months post-baseline. The Hamilton Depression Rating Scale, the Beck Depression Inventory (BDI), the Symptom Check List-90, and the Dyadic Adjustment Scale (DAS) were used for the patients. The BDI and the DAS were used for the spouses. The couples in CT group assessed their subjective distress (SD) at every session by using the Outcome Rating Scale. The results showed that the spouses’ gender, the spouses’ depressive symptoms at baseline, and the number of therapy sessions were related to differing changes in the CT and TAU groups at the 6-month post-baseline assessment. The spouses in the CT group demonstrated a higher treatment response than those in the TAU group. In the CT group, the spouse’s benefit from the treatment was related to SD at the outset on the part of either the patient or the spouse or both. The change in the patient’s SD predicted the patient’s change in depressive symptoms, general mental health, and was associated with the patient’s change in marital satisfaction. The study emphasizes the importance of the spouse’s involvement in the treatment of depression, the provision of feedback on SD, and discussion of individual well-being and relational issues, in addition to the focus on depression.     

Pronouns in marital interaction

Recent studies in social psychology have found that the frequency of certain words in people's speech and writing is related to psychological aspects of their personal health. We investigated whether counts of "self" and "other" pronouns used by 59 couples engaged in a problem-solving discussion were related to indices of marital health. One spouse in each couple had a diagnosis of obsessive-compulsive disorder or panic disorder with agoraphobia; 50% of the patients and 40% of their spouses reported marital dissatisfaction. Regardless of patients' diagnostic status, spouses who used more second-person pronouns were more negative during interactions, whereas those who used more first-person plural pronouns produced more positive problem solutions, even when negative behavior was statistically controlled. Moreover, use of first-person singular pronouns was positively associated with marital satisfaction. These findings suggest that pronouns used by spouses during conflict-resolution discussions provide insight into the quality of their interactions and marriages.     

Negative representations of the self/spouse and marital distress

The link between marital distress and negative representations of both the self and the spouse was examined with data from an initial sample of 538 married couples studied over the first four years of marriage (Study 1) and 98 of these couples studied in their tenth year of marriage (Study 2). Findings from Study 1 indicated that, for both husbands and wives, representations of the self and representations of the spouse accounted for unique variability in distress. Across spouses, representations of the spouse accounted for more of the variability in distress than did representations of the self. Cross–spouse effects were especially pronounced for husbands such that their distress was linked to wives’ representations. Findings from Study 2 with self/spouse measures anchored to the marital context replicated this pattern. Findings support the view that marital distress is uniquely influenced by models of both the self and the spouse, that representations of the self and the spouse are dynamic relationship schemas, that models of the self and the spouse can be meaningfully assessed within the marital context, and that negative representations of the spouse—particularly those of wives—are especially diagnostic of marital distress.     

Spousal conflict resolution strategies and marital relations in late adulthood

In this study, we examined differences in the spousal conflict resolution strategies of husbands and wives in late adulthood among a sample of 76 married Israeli couples (N = 152). Using dyadic analysis (the actor–partner interdependence model), we examined the impacts of the strategies adopted by each spouse as well as their partner on evaluations of marital life as reflected in their assessments of positive and negative dimensions of marital life. The findings revealed that integration was the most prevalent strategy used by both spouses, whereas dominance and avoidance were the least prevalent strategies. Moreover, integration contributed most significantly to explaining assessments of marital life.     

The Partners for Life Program: A Couples Approach to Cardiac Risk Reduction

Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses. What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness. Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise, nutrition, and medication adherence. Ninety‐three patients and their spouses/partners consented to participate (26% of those eligible) and were randomized into either the individual or couples condition. However, only 80 couples, distributed across conditions, contributed data to the analyses, due to missing data and missing data points. For exercise, there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time. In addition, there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment, while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment. In terms of medication adherence, patients in the couples treatment exhibited virtually no change in medication adherence over time, while patients in the individuals treatment showed a 9% relative decrease across time. There were no condition or time effects for nutritional outcomes. Finally, there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction, while non satisfied patients in the couples treatment showed improvement over time.     

Differentiation of Self and Marital Adjustment of Clinical and Nonclinical Spouses

ABSTRACT

Bowen theory posits that spouses in problematic marriages are lower on differentiation of self and marital adjustment than spouses in nonproblematic marriages. This paper reports the findings from an empirical study which provide support for this aspect of Bowen theory. Differentiation of self and marital adjustment were also found to be moderately, positively related to each other. Implications for clinical practice and research are discussed.     

The Application of Facilitated Imagery to Marital Counseling

SUMMARY

The purpose of this study was to assess whether facilitated imagery is a successful technique for improving both marital satisfaction and individual psychological functioning. Twenty marital couples were randomly assigned to two experimental groups: Both received three sessions of structured marital enrichment and one also received three facilitated imagery sessions. Posttests were given at one month and four months following treatment. Subjects exposed to facilitated imagery showed significantly greater improvement on some scales of marital satisfaction and individual psychological functioning, and these improvements persisted at the four-month posttest. In posttest interviews, subjects reported the primary benefit was insight into themselves and their spouses.

A series of 2x(3) repeated measure analyses of variance were used to detect changes for husbands and wives. Subjects exposed to facilitated imagery reported significantly greater improvement than enrichment-only subjects on some scales of marital satisfaction and individual psychological functioning. In addition, improvements persisted at the four-month posttest for the enrichment-plus-imagery subjects, but declined for the enrichment-only subjects. In interviews, the majority of imagery subjects reported that the process had been helpful to them both personally and relationally. Subjectively they reported gaining insight into themselves or their spouse as the primary benefit obtained from the imagery work.     

Social Support in Marriage

The current study examines the role of perceived adequacy of social support provided by spouses for both marital and individual functioning. Married individuals from a college sample (N = 177) recorded the adequacy of specific supportive behaviors provided by the spouse on a daily basis for 7 days. Perceived support adequacy was correlated in the expected direction with marital quality, depressive symptomatology, and perceived stress. Furthermore, hierarchical multiple regressions indicated that perceived support adequacy accounts for significant unique variance in marital quality, depressive symptomatology, and perceived stress, even after controlling for social desirability. Discussion focuses on limitations of the study and implications of the findings for clinical work with couples.     

Marital Interactions of Male versus Female Alcoholics

This study assessed the interactions of 131 alcoholic and nonalcoholic couples as they engaged in discussions of personally relevant problems. For 50 couples, the husband was alcoholic; for 15 couples, the wife was alcoholic; for 16 couples, both spouses were alcoholics; and for 50 couples, neither spouse was alcoholic. Observations were conducted during sessions when alcohol was consumed and in nondrinking sessions. Female alcoholic couples (with nonalcoholic spouses) demonstrated high negativity in the “no-drink” session, which was normalized in the drink session, suggesting an adaptive function to alcohol use. Concordant couples (both members were alcoholic) also demonstrated high negativity in the no-drink session, but exhibited increased negativity in the drink session, suggesting that concordance has a maladaptive impact on marital interaction. All alcoholic groups demonstrated greater negativity and lower positivity and congeniality in their marital interactions compared to nonalcoholic couples. Couples with male alcoholics were the least divergent from normal control couples. Unique female patterns in alcoholism are discussed in terms of adaptive and reinforcing patterns and spousal influences.     

Spouses of Cancer Patients: A Review of the Literature

This article discusses the impact on the spouse when his or her partner is being treated for cancer. The disease is defined, treatment effects are outlined, and issues affecting the psychological and marital adjustment of spouses are described. Implications are offered for counselors who work with spouses of cancer patients.