A Combined-Constructionist Therapeutic Approach to Couples Experiencing Erectile Dysfunction: Part II

This paper is Part II of an exploration of the treatment and conceptualization of Erectile Dysfunction (ED). In the past two decades, there has been a shift in the treatment of Erectile Dysfunction to more medically based approaches. Part I of the paper presented the role of biomedical and organic factors involved in ED. However, although important for the couple therapist to understand, by focusing only on the bio-medical aspects of ED, the couple may face new issues in their considerably different relationship with sex now a part of their lives. The current paper, while respectful of the medical model approach, emphasizes the overall quality of the couple relationship, presenting information on the psychological and systemic therapies and issues that may be related to Erectile Dysfunction, encouraging a combined-constructionist approach.     

Management Strategies of Sexual Dysfunctions

The purpose of this essay is to discuss on the possible impact on a couple's sexual relationships when the male partner's erectile problems contribute to a sexual dysfunction on the part of the female. The complex reciprocal nature of sexual interactions emphasizes the importance of the relationship for sexual function and dysfunction. The treatment of sexual dysfunction then takes into account the contribution of factors from the couple and the system. An integrated behavioural-systems approach is applied to address both sexual and non-sexual aspects of the interaction in the marital unit. This approach outlines a range of methods that may be used during the treatment of sexual dysfunctions in order to bring about relevant changes in sexual functioning and general relationships.     

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.     

Cognitive-Behavioral Erectile Dysfunction Treatment for Gay Men

The purpose of the present paper is to assist cognitive-behavioral therapists who are treating erectile dysfunction among gay men. Little information is available to cognitive-behavioral therapists about the psychological and social effects of erectile dysfunction in this population, or how to incorporate the concerns of gay men with erectile dysfunction into a case conceptualization and treatment plan. The present paper provides an overview of the extant research on erectile dysfunction and of its treatment among gay men. The application of clinical research on erectile dysfunction to treatment for gay men will be illustrated using two case examples.     

Standardized assessment of relationship functioning in OEF/OIF Veterans with and without PTSD

Posttraumatic Stress Disorder (PTSD) is associated with difficulties in intimate relationships, with most prior research examining associations with continuous, single-dimension, and often-unstandardized measures of general relationship quality or aggression. Standardized, well-normed assessments that include multiple couple problem areas could provide more precise information about the presence and specific nature of clinically significant concerns in patient care settings. This investigation aimed to replicate findings regarding increased difficulties in relationship functioning among Operations Enduring and Iraqi Freedom Veterans with PTSD and their romantic partners, specifically using a standardized assessment that permits identification of cases of clinically significant general couple distress and difficulties across multiple problem areas. We compared 32 male Veterans with PTSD and 33 without PTSD, and their romantic partners on reports of several problem areas using the revised Marital Satisfaction Inventory (MSI-R). All participants underwent structured diagnostic interviewing. PTSD couples reported clinically significant levels of relationship distress several times more frequently than comparison couples, both for general distress and across all specific problem areas (e.g., aggressive behavior, quality of leisure time together, sexual functioning, conflicts about finances and child rearing). The most notable problem areas for PTSD couples were affective and problem-solving communication. These results replicate associations of PTSD with general couple discord and multiple specific areas of couple difficulties and extend them by documenting the clinical severity of these problems. Mental health providers may consider incorporating standardized couple assessments into their evaluations of Veterans’ functioning. Couple therapies may consider using such measures to prioritize targets for treatment.     

Remaking the real man: Erectile dysfunction palliatives and the social re-construction of the male Heterosexual life cycle

The popularity of impotence or erectile dysfunction (ED) drugs and the powerful imagery of their promotional campaigns may be a significant contributor to the social reconstruction of male sexuality and aging in general, and popular understandings of the male heterosexual in particular. This is note-worthy given that the heterosexual male is a demographic that has, historically, been quite resistant to the whims of the psycho-medical establishment. Given men’s psychological and physiological makeup, the emerging social expectations of male sexuality may be wholly unrealistic, with its matter-overmind rhetoric. Examining the language and imagery of several ED drug campaigns, and considering some popular therapeutic, and academic discourse on the subject, the paper considers some of the expectations facing men in our society today that have recently been generated by the sexual pharmacology industry. The analysis suggests how these new expectations potentially liberate and constrain men in various ways, solidifies a male ethos that focuses almost exclusively on the physical component, and thereby displaces men from the context of the romantic relationship.     

Commitment First,Communication Later: Dealing with Barriers to Effective Couples Therapy

Teaching communication techniques to couples is a common way for therapists to begin treatment. In many cases, couples then use these newly acquired skills to express negative or even hostile information to each other, sometimes doing more harm than good to the relationship. Based upon years of clinical experience with hundreds of couples in treatment, this article presents the idea that having the couple see themselves as an entity first, not as two individuals, may be necessary before clear communication can be maximally therapeutic. The article outlines the Couple Power model of treatment, suggesting that four basic tasks—commitment, cooperation, communication and community—need to be accomplished in that order, postponing the teaching of communication skills until later in therapy. Theory behind the tasks and suggestions for effective techniques to achieve the “Four C’s” of Couple Power are presented and discussed.     

“Whenever Jack sees a condom,he falls asleep”: experiences of condom use and erectile disorder among HIV positive men in a Zimbabwean rural setting

In this qualitative inquiry, we set out to explore the experience of condom use and erectile disorder (ED) among men living with HIV in a rural district of Zimbabwe. Data on condom use related erectile disorder with antiretroviral (ART) medication were collected from a purposive sample of 18 men living with HIV and AIDS (age range 23–54 years). These data were supplemented with those from a convenience sample of 23 women living with HIV who self-identified as partners of men living with HIV and AIDS (age range 26–37 years). The data were thematically analyzed. Results suggest that men attributed their experiencing of erectile problems to two main explanations: use of condoms and ART medication. These men reported inconsistent use of condoms and/or adherance to ART therapy due to a belief that these cause their ED. The women informants reported similar observations, including the shared gendered perspective that the men perceived a loss of sense of manhood from ED. Beliefs that influence health promotion with men living with HIV and AIDS are important to public health interventions with them.     

Couple-based interventions for medical problems

The current paper discusses general principles, therapeutic strategies, common factors, and domains commonly addressed in the treatment of couples who have a partner with a medical condition. Couple-based interventions for medical problems are contrasted with couple therapy and relationship education in that the emphasis is on assisting the patient in addressing the medical disorder, along with being attentive to the patient's partner and their relationship. Guidelines are provided showing how knowledge and understanding of medical disorders and couple functioning are integrated in order to conduct such interventions. Five common domains addressed during intervention are elaborated upon: (a) psychoeducation about the disorder, (b) sharing thoughts and feeling regarding the disorder, (c) making decisions focal to the medical disorder, (d) implementing relationship changes that are nonmedical but that result from the disorder, and (e) addressing relationship functioning unrelated to the disorder. The importance of empirically demonstrating the utility of each domain in future investigations is noted.     

The self in the couple relationship: part 1

This paper discusses the importance of the ‘good-enough’ development of the core self in the couple relationship. It argues that difficulties in the development of the self lie behind a significant number of troubled couple relationships. Part 1 focuses on individual psychotherapy and how changes to the core self are often attended by shifts in the marital relationship. It traces how this occurs through clinical material and analyses what kinds of changes to the self are needed for the couple relationship to function well. Psychodynamic theory is used to understand the core changes over time and how these are related to significant second-order change in the couple relationship. The construct of the ‘transitional space’ is used to theorize the couple relationship. Implications for the practice of individual psychotherapy are discussed. In Part 2, the significance of change in the experience of the self of one or both partners for a successful outcome of couples therapy is discussed, along with the place of work with individual partner(s) in the course of conjoint couples therapy.     

Women Living with Men who Use Viagra

ABSTRACT

Since the launch of Viagra, there have been few studies on the perspective of the female partner. Through a multiple case study approach drawing from phenomenology and the constant comparative method of analysis, this qualitative exploratory study examines the stories of four women living with a spouse who is currently taking Viagra. Findings highlight the need for a more holistic approach to treating erectile dysfunction that supports both partners within the couple relationship. It is also suggested that greater attention should be given to the relationship and to the sexual needs of women.     

A Solution-Based Approach to Couple Therapy

Abstract

Couples often present for counseling as a last resort. As relationships in crisis may not last it is important that treatment be time-effective. Solution-based therapies have been described as brief and time-effective and applied effectively to working with couples. This article presents a case example demonstrating the application of a solution-based approach to therapy with a married African-American couple entering therapy to resolve their relationship difficulties that lead to the initiation of divorce proceedings. The processes of reducing blame and conflict, creating hope and solution building utilizing solution-based interventions are discussed, as well as the treatment outcomes.     

The self in the couple relationship: part 2

Part 1 of this paper examined some of the ways in which individual therapy, by assisting in the development of a more cohesive sense of self in the individual, inevitably has an impact on the individual's relationships, especially their relationship with a partner. This paper approaches the topic of the significance of ‘the self’ in the couple relationship from an alternative direction. It focuses on the significance of ‘the self’ for couples therapy, and argues that couples therapy may sometimes need to include therapeutic work with one partner to facilitate change in the relationship. In both parts of the paper, a conceptualization of the couple relationship as ‘a transitional space’ is central.     

A Systemic Approach to Fetal Loss Following Genetic Testing

Advances in genetic technology challenge couples to make complex life and death decisions about their fetus that have far-reaching practical and emotional consequences. When genetic defects lead to fetal loss, whether by miscarriage, elective interruption, or still birth, it can be a devastating experience with ripple effects on couple and family development. This paper presents a systemic approach to coping and adaptation to fetal loss in the wake of genetic testing. Clinical vignettes illustrate common experiences and present interventions designed to help the individual grieving partners as well as the marriage. thereby strengthening the family fabric at a vulnerable transitional stage.     

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.     

Phase-based Emotionally Focused Couple Therapy for Adults With Complex Posttraumatic Stress Disorder

Complex posttraumatic stress disorder (complex PTSD) presents unique challenges to treatment beyond that of posttraumatic stress disorder (PTSD). The expert consensus best practice for treatment of complex PTSD is a phase-based or sequenced approach that has typically been offered in individual or group therapy modalities. Emotionally focused couple therapy (EFCT) shows promise as a couple-based treatment for PTSD, but the standard protocol may inadequately incorporate best practice guidelines of phase-based treatment for complex PTSD. Integration of phase-based treatment of complex PTSD within an EFCT format is proposed, giving direction to EFCT providers on incorporating best practice guidelines into their work with survivors.     

The Holden Psychological Screening Inventory and sexual efficacy in urological patients with erectile dysfunction

This paper examined the relationship between psychological adjustment and sexual ability in a sample of 33 men with erectile dysfunction and their spouses. Indices of sexual efficacy converged and were negatively associated with self-reported depression. Data are interpreted as confirming the association between erectile dysfunction and psychological disturbance and as providing evidence of validity for the Holden Psychological Screening Inventory Depression Scale and the Sexual Self-efficacy Scale.     

“I don’t want to be an artificial man”: Narrative reconstruction of sexuality among prostate cancer survivors

After interviewing prostate cancer support group members, I use narrative analysis to examine survivors’ post-illness stories of changes in sexual activity and identity. The main events in the narratives were the choice of a treatment option and the post-treatment changes in survivors’ sex lives, whether described as the end of the sex life or the beginning of a modified one. Survivors characterized their wives as uninterested in sex and seldom described support group peers as helpful sources of sex-related information. The value of health took precedence over the desire for sex among men who experienced erectile dysfunction. My observations suggest implications related to (a) masculine identity, (b) sex among the elderly, (c) the social construction of sexuality, (d) defining and redefining sexuality, (e) physician-patient interaction, (f) sex talk among social support group members, and (g) the apparent clash between the values of sex and health.     

Premarital Predictors of Remarital Quality: Implications for Clinicians

This paper presents a review of the research literature from 1980 to present on the premarital predictors of remarital satisfaction and stability (quality). The predictive factors are organized with an ecosystemic theoretical model using three general predictor categories: background and context factors (e.g., stepchildren), individual traits and behaviors (e.g., attachment to an ex-spouse), and couple interactional processes (e.g., couple consensus). Major factors related to lower remarriage quality include the roles of stepchildren, stepfamily complexity, emotional attachment to an ex-spouse, serial marriage, and economic strain. Predictors related to higher remarital quality include couple consensus on important topics, social support from family and friends, and financial stability. Implications for couple therapy before remarriage are discussed.     

The language of pain intensity and complexity: new methods of scoring the McGill Pain Questionnaire

In Part I the McGill Pain Questionnaire was administered to 25 cancer patients, scored and analyzed in the traditional manner. Results indicated that patients with cancer pain appear to be similar in terms of intensity of the pain and the kind of pain which they experience with respect to sensory, affective, and evaluative qualities. Part II presents a new method of administering, scoring, and analyzing responses to the questionnaire, which allows for a more comprehensive interpretation of pain. In Part III the data from Part I are reanalyzed using the new scoring system. As hypothesized, the intensity of cancer pain is higher along the affective dimension than along the sensory. With regard to complexity of the experience of cancer pain, neither the sensory nor the affective dimension is more salient. The new system of scoring and analysis may enable future investigators to specify a unique pain intensity-complexity relationship for each clinical pain syndrome.