Operant reinforcement with structural family therapy in treating anorexia nervosa

Abstract

This paper integrates clinical data gathered through psychotherapy with dual-career couples and research findings from social psychology and sociology. The paper's main focus is the clinical understanding and therapeutic interventions most appropriate for these couples' marital and individual difficulties. The paper briefly describes characteristics of the dual-career lifestyle and personalities. The analysis provides case examples illustrating external and internal sources of stress generated by a lack of time or the need for an effective system for handling housework and childcare.     

Response to MacIntosh’s Systematic Review of Psychoanalytic Couple Therapy: A Brief Note from the Classical Perspective

ABSTRACT

Working with couples from a classical perspective can be thought of as an oxymoron, unlike working from object relations and relational viewpoints, often seen to be the more natural fits. This article offers a fresh look at those parts of the classical perspective that relate very clearly to working with two partners in a couple. Freud’s theories in Three Essays on the Theory of Sexuality (1905) and On Narcissism (1914a) provide theoretical background for the work. Concepts such as transference (between partners, between the partner[s] and the therapist) and countertransference are shown to be manifested in complex ways with couples. Being mindful of unresolved developmental issues—for example, Oedipal and separation-individuation issues—which may have played a part in partner choice and in the resulting problems, allows the therapist to offer deep interpretations of within- and between-partner conflicts. Interestingly, unresolved Oedipal issues, particularly, may form an important part of the countertransference.     

Happiness in dual-career couples: Changing research,changing values

This article offers a framework for understanding contradictory findings in the field of the dual-career couple by presenting two patterns: (1) the early, conventional one of the 1960s, which viewed married women's participation in the labor force as threatening marriage and the family, and (2) the contemporary view, which emerged during the 1970s and which admits that women can happily combine career with family. The article suggests that there is little evidence to support the view that dual-career couples experience increased rate of marital conflict, marital dissatisfaction, and role blur; rather, the intellectual and psychological benefits in dual-career couples seem to outweigh the disadvantages, particularly for wives.     

Leadership in the Therapist-Centered Group-as-a-Whole Psychotherapy Approach

Psychodynamic group therapy, by definition, offers group members an opportunity to revisit some of the earliest developmental stages. The authors argue that conflicts around separation and individuation are stimulated with each beginning and ending of an intimate group. The leader of that group is similarly challenged around these primary conflicts. The question of group contagion, difficulties around the capacity to be alone, and the problems of projective identification are explored as they have an impact on leaders in a group. Case examples are offered to illustrate leadership problems along these dimensions.     

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.     

Couple Therapy Interventions for Problems with Extramarital Affairs

SUMMARY

A number of couples request therapy because of relational problems resulting from an extramarital affair. In treating such couples, five phases of cognitive and emotional aspects of problematic affairs have been identified: (1) the start, (2) suspicion and negation, (3) explosion and impulsive reactions, (4) making choices and deadlock, (5) working through. Clients may enter therapy at very different points in these phases. Some come in full crisis, others in the deadlock phase, not being able to decide what to do. A different therapeutic intervention is proposed for each phase.     

The Unmanageability of Characterologic Couples in Managed Care

ABSTRACT

This article explores the issues associated with treating characterologic couples in the managed care environment. The article focuses on the definition of the characterologic couple and the specific issues that emerge when the characterologic couple is attempting brief treatment in the managed care environment. Attention is focused on the difficulties in the two-stage approach to character treatment, the potential for hurting the non-characterologic member of the couple, and the problems that emerge when the character is identified, but not worked with.     

Assessing and treating sexual dysfunctions in Orthodox Jewish couples: a summary of 41 consecutive cases

ABSTRACT

Orthodox Jews are a distinct subgroup with specific beliefs and values towards sexuality, reproduction, modesty, and openness to mental health treatment. This paper reviews the treatment of 41 Orthodox Jewish couples who presented for sex therapy. Most couples were referred by a rabbinical leader. The most common presenting problem was an unconsummated relationship; present in 27 couples. In 34 couples the initial presenting complaint was a male sexual problem yet in 20 of 41 couples both partners described having some sexual problem. Almost 50 per cent of both men and women were also diagnosed with a comorbid psychiatric disorder, which was almost always previously undiagnosed. The most common presenting problems were vaginismus, male inhibited arousal, and/or inhibited male orgasm. Two case examples illustrate some adaptations to assessment and treatment that can be helpful in treating sexual problems in Orthodox Jewish couples.     

Group training in communication skills for couples: A preliminary report

Abstract

This article reports on the initial development and evaluation of a group skill-training program for couples. The program, entitled the Communication Skills Workshop (CSW), aims at improving communication and problem-solving skills within the context of relationships. The orientation of the CSW is preventive and educational in that it (a) serves couples prior to the onset of serious relationship discord, and (b) focuses on the learning of general communication skills and problem-solving strategies rather than the amelioration of specific relationship conflicts.     

Therapeutic handling of marital infidelity

Abstract

In working with couples and families, the occasional clinical use of mental imagery techniques can frequently promote therapeutic breakthroughs. When sessions focused on a couple's (family's) current communication problems reach a point where progress seems slow and laborious, a therapist can encourage the couple (parents and perhaps even older children) to try one or more imagery sessions to understand their interactional patterns within the context of their own developmental periods. This article describes how imagery can lead couples to new and more constructive perspectives on the meaning of their interactions.     

What are the Marital Problems of Happy Couples? A Multimethod,Two-Sample Investigation

How couples handle marital conflict may depend on what issues they are facing, as some issues may be more difficult to resolve than others. What is unclear, however, is what issues happy couples face and how these issues may be different for couples depending on their developmental stage. To explore this possibility, the current study used both self-reports and observations drawn from two separate samples of happily married couples—one early in middle adulthood (N = 57 couples; average marital duration = 9 years) and one in older adulthood (N = 64 couples; average marital duration = 42 years). Results indicated that all issues were relatively minor, but early middle-aged couples reported more significant problems than did older couples. As to determining the most salient topic for happy couples, it depended on the spouses’ gender, developmental stage, and how salience was assessed (i.e., highest rated issue vs. most discussed issue). Only moderate links were found between what happy couples said was their most serious concern and what they actually tried to resolve during observations of marital problem-solving, but there were differences in how spouses behaved based on the proportion of their time discussing certain topics. Findings suggest that more attention should be devoted to understanding what marital issues happy couples discuss and why, as doing so may reveal how couples maintain their marital happiness.     

The relationships of career salience,attitudes toward women,and demographic and family characteristics to marital adjustment in dual-career couples

Facilitation of women's increasing involvement and satisfaction in career pursuits necessitates understanding of ways in which multiple roles may be managed and integrated by both women and men. Accordingly, the present study was designed to investigate predictors of levels of marital adjustment in dual-career couples. Both husbands and wives in 42 dual-career couples completed Greenhaus' Career Salience scale, the Attitudes toward Women scale, the Dyadic Adjustment scale, and a demographic information questionnaire. Results indicated, first, that the dual-career couples studied reported relatively high levels of marital adjustment, relatively profeminist attitudes toward women, and moderate levels of career salience; family interests were ranked as more important than were career interests. Second, higher levels of marital adjustment in both husbands and wives were found in couples in which the wife was more highly educated and which had relatively high combined incomes. In addition, greater marital adjustment in husbands was related to higher levels of career salience among wives. Contrary to expectation, husbands' attitudes toward women's roles were unrelated to their levels of marital adjustment. Implications for further research on dual-career couples and for the successful integration of career and family roles are discussed.     

Life Cycle Crises

ABSTRACT

As couples are worked with in therapy, the issues they bring, both individually and as a couple, may reflect important developmental crises. This paper describes some of these issues from the perspective of Erikson'S epigenetic theory. Brief case examples are provided to illustrate the presentation and therapeutic course with these issues. While these issues will present strains that bring the couple into therapy, their understanding can also provide considerable motivation for strength and growth, particularly when worked with in the therapeutic arena.     

Multifaceted Approaches in Spouse Abuse Treatment

SUMMARY

The understanding of spouse abuse has changed considerably in the last 30 years, shifting from a perspective based on individual psychopathology to that of a pervasive social problem. Current treatment solutions for stopping violence are limited to those that address resocializing the batterer. Several states often restrict the use of state funds for batterers' groups and forbid couples treatment as a primary treatment option in spite of the fact that most couples choose to remain in their relationships in the presence of repeated violence. This article argues for broadening options to include a specific type of couples treatment as a part of a coordinated community response to remediate domestic violence. Solution-focused therapy is described as an example of treatment of relationships that makes safety a priority and is not victim-blaming. It is suitable treatment both for couples who wish to stay together and those seeking a safe way to separate.     

Therapy with law enforcement couples: Clinical management of the “high-risk lifestyle”

Abstract

A great deal of attention has been given to the issue of stress in law enforcement and its impact on individual officers. However, the literature has not equally addressed the effects of police work on officers' relationships. This paper reviews three primary ways in which law enforcement can affect relationships (organizational influences, peer/socialization influences, and police role influences). It identifies some common difficulties encountered by these couples, and provides some basic goals and strategies for engaging them in treatment and addressing these issues in couples therapy.     

Working Experientially and Somatically with Couples

SUMMARY

Working experientially and somatically with couples is a powerful method of accessing, exploring, and transforming both intra-psychic issues and interactional patterns. In this article, a number of methods of working experientially will be described, along with their underlying rationale. Basic assumptions about the nature of couple's difficulties and the role of the therapist also will be explored along with an integrated approach to assessment that provides a solid basis for these dramatic interventions.     

Some psychoanalytical experiences with the new fertility techniques

Abstract

The contingencies in life histories of one male and two female patients of their wish to engage in new techniques for fertility and procreation are explored. Remarkable denial strategies defending narcissistic vulnerabilities were found in all cases. Although they are in fact quite stressful and at best moderately succesful the new medical-technical solutions can acquire magic qualities warding off unresolved conflicts around omnipotence and gender differentiation. In the treatment-process transference undergoes distinct shifts in quality, intensity as well as object when oedipal and pre-oedipal conflicts tend to be acted out with the administering physician. As to the fate of the psychic development of children begotten in these new forms of procreation and parenting, e.g. lesbian couples, much is yet unclear; though complex and fluid defenses coloured by denial and magical qualities towards the father introject have been observed.     

Mentalization-Based Interventions in Child Psychiatry and Youth Protection Services I: Objectives,Setting, General Principles and Strategies

ABSTRACT

Many of the children who receive services in child psychiatry or are in the care of Youth Protection Services present with complex, multiple and often severe problems. Classic psychodynamic psychotherapy seems to be of little benefit to them. The majority of these children tend to not use symbolic play as a means of expressing their intrapsychic conflicts or relational difficulties and they do not verbally communicate much with clinicians. They are more likely to display an imaginative poverty that translates into boredom, motor discharge, and an inability to use the material put at their disposal for therapeutic purposes. The systematic and rigorous observations of these children in Quebec revealed that the majority of them present with severe mentalizing difficulties. They often show attitudes and behaviors linked to the prementalizing modes of psychic functioning. This article presents a mentalization-based intervention adapted to these children’s difficulties. The objectives, adaptation of the work setting, and general principles underlying this intervention are discussed. In addition, general intervention strategies are also covered. These interventions are considered as preparatory work whose principal purpose is to enable children to benefit later on from psychodynamic psychotherapy. The authors also recommend specific intervention strategies adapted to children’s predominant mode of psychic functioning. The details of these strategies will be shared in a separate article.     

Fiction,Pleasurable Tragedy,and the HOT Theory of Consciousness

Abstract

The ‘feeling fiction problem’ asks: is it rational to be moved by what happens to fictional characters? The so-called ‘paradox of tragedy’ is embodied in the question: Why or how is it that we take pleasure in artworks which are clearly designed to cause in us such feelings as sadness and fear? My focus in this paper is to examine these problems from the point of view of the so-called ‘higher-order thought theory of consciousness’ (HOT theory) which says that the best explanation for what makes a mental state conscious is that it is accompanied by a thought that one is in that state. I examine the feeling fiction problem in light of the HOT theory and through a critique of Colin Radford's view. For example, I argue that Radford equivocates in his use of the term ‘aware’ in his response to some of the proposed solutions to the feeling fiction problem. Finally, I show how Susan Feagin's approach to the paradox of tragedy can be analysed and supported by the HOT theory.     

The Tasks and Traps of Relationships

SUMMARY

This article approaches relationships from primarily a systemic-psychodynamic framework in that psychoanalytic interpretations and assumptions are integrated into a basic systemic orientation The paper focuses on the prerelationship developmental tasks, relationship developmental tasks, the role of love and intimacy in emotional maturity, and the traps and pitfalls commonly encountered by couples, as illustrated by the activation of protective, defensive mechanisms. The material is illustrated by a case presentation. Implications for counseling are considered throughout.