A Combined- Constructionist Therapeutic Approach To Couples Experiencing Erectile Dysfunction: Part I

Marked changes have occurred in the conceptualization and treatment of Erectile Dysfunction (ED) in the past two decades. Emphasis has shifted to the role of biomedical and organic factors using medical and surgical interventions in the etiology of sexual dysfunction, deemphasizing the quality of the overall couple relationship. However, by using only a medical approach, the couple is left with balancing the positive and negative facets of a considerably different relationship with sex now in their lives and their relationship. This paper is Part I of a two part article on erectile dysfunction. Part I presents information on the bio-medical factors that may be related to ED and the medical model treatment approaches. Part II presents information on the psychological and systemic issues that may be related to erectile dysfunction, encouraging the use of a combined-constructionist framework.     

A Kleinian view of psychoanalytic couples therapy: Part 1

This paper will investigate the central aspects of the psychoanalytic treatment of couples. The concept of analytic contact is introduced and the importance of each party of the couple being witness to the other party's response to analytic contact is discussed. Emphasis will be placed on issues of thinking, projective identification and the concept of container‐contained. Part 1 of the paper will focus mainly on theoretical issues but will then utilize one clinical case to illustrate some of the theoretical points. Using extensive case reports, Part 2 will continue to provide the reader with an in‐depth view of the important process of a couple's therapy within a psychoanalytic framework.     

A Kleinian view of psychoanalytic couples therapy: Part 2

With extensive case material, Part 2 continues to explore the psychoanalytic treatment of couples. Since most couples enter treatment operating in a more primitive paranoid‐schizoid stance, the author contends that it is best to initially focus on each partner's pathological projections and have the other partner witness their struggle to overcome personal issues that contaminate the couple's unified psychology. With continuous working through, the couple can gradually find a more depressive, integrative footing within themselves and as a couple. Again, the value of ‘witnessing’ and working through individual defensive reactions against thinking, pathological projective identifications and the breakdown of the container‐contained function are all examined in the clinical presentations. All these clinical elements are part of the establishment of analytic contact first with each party as individuals and later as a unified couple.     

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.     

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.     

Structural couple therapy in the treatment of inhibited sexual drive

Abstract

This paper presents a study of a structural couple therapy approach to the treatment of inhibited sexual desire (ISD). ISD is first conceptualized as a relational phenomenon that may be most effectively treated in a couple context. Structural couple therapy is advanced and applied to the treatment of a clinical sample of couples presenting with ISD. Results of the study suggest that a structural couple therapy approach to ISD is effective in reducing symptoms of the sexual disorder and in increasing couple satisfaction.     

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.     

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.     

Applying Psychoanalysis to Couple Therapy: The Treatment of a Couple with Sexualized Persecutory Internal Objects Resulting from Trauma

The application of psychoanalytic theory and technique to the treatment of couples has been relatively overlooked despite the long history of concern by psychoanalysts with the role of marriage in individual development and suffering. This paper uses an example of marital and sex therapy to illustrate the application of psychoanalytic object relations theory to couple therapy, and describes the way that in-depth treatment of the couple's persecutory object relations that follow severe trauma can be effectively conducted. The paper concludes with a brief discussion of issues of shame and guilt in psychoanalytic theory and their relevance to this couple.     

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.     

A Conceptual and Empirical Basis for Including Medical Family Therapy Services in Cancer Care Settings

Psychosocial interventions in oncology settings have largely been individually and group-based despite evidence that a family-based approach fills a treatment gap in the cancer care experience. Medical Family Therapists are trained to address the family as the unit of treatment and provide services that consider family dynamics, reorganization of couple and family roles, and broader systemic issues. This article describes the conceptual bases for Medical Family Therapy services provided in cancer care settings, and reviews research on their implementation and effectiveness. Following a review of the literature, recommendations for studying the effectiveness and efficacy of MedFT in cancer care treatment are detailed.     

Couple therapy in a therapeutic community setting†

An account is given of couple therapy offered as part of a comprehensive treatment programme in a unit run as a therapeutic community. The additional therapeutic force provided by couple or family therapy is important in dealing with adult patients who may not be highly motivated for change or who may not initially present their difficulties as springing from marital or family relationships. A combined approach with these kinds of patients may succeed where either group therapy or couple therapy alone is likely to fail.     

Neurocognitive Impairment: Addressing Couple and Family Challenges

Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life‐course development. Discussion addresses key family and couple issues with mild‐to‐severe cognitive impairment and progressive dementias, including: communication, multigenerational legacies, threatened future neurocognitive disability, ambiguous loss, decisional capacity, reaching limits, placement decisions, issues for adult children and spousal caregivers, and the transformation of intimate bonds. Principles and guidelines are offered to help couples and families master complex challenges, deepen bonds, and forge positive pathways ahead.     

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.     

Gender issues in the treatment of welfare couples: A feminist approach to marital therapy of the poor

This article presents a treatment model for work at home with couples in poor families on welfare that incorporates a feminist view targeting sex-role attitudes and behaviors as a central goal. A case study is presented to illustrate these principles. The work is based on both in-depth interviews with 13 Israeli couples on welfare and clinical impressions gained from the treatment of 30 Israeli couples on welfare. Poor couples are analyzed in terms of gender issues and the relationship of these issues to mental health, couple functioning, and couple interaction within the helping profession.Irit Barnea, Hannan Rosenberg, and Moshe Sens contributed to research and treatment with the couples described in this paper.     

Cognitive Behavior Couple Therapy-REBT Model for Traumatic Bereavement

Following the loss of a child, couple counseling focuses on their grief process as well as the impact of the loss on the marital relationship. Individual differences in reacting to and coping with the loss, different patterns of grieving, and differences in attitudes about relationship issues may cause further distress and increase marital conflicts and adaptation to the loss. When bereavement occurs under traumatic circumstances, the conflicts may be further complicated and involve problems in daily functioning related to distorted cognitions and attributions connected with traumatic bereavement. In this paper, cognitive grief therapy using the ABC model of REBT with a couple who lost a child under traumatic circumstances will be described.     

Drug testing in the public and private-sector workplaces: Technical and legal issues

This paper examines the technical and legal issues surrounding the implementation of drug testing programs in the public and private-sector workplaces. In Part I of the paper, technical issues important to an understanding of urinalysis drug testing methods are examined. In Part II, recent federal case law is reviewed in order to identify the different legal parameters associated with drug testing in the public and private sectors. Part III presents guidelines for employers who already have or are about to implement a drug testing program within their organizations.     

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.     

The therapeutic alliance in couples therapy: clinical considerations

This article presents clinical considerations about the therapeutic alliance in couples therapy, stimulated by pertinent new research findings reported in this issue. A loyalty dimension of the couple's relationship is described, as well as its influence on the therapeutic alliance in couples therapy. The therapist's establishment of a "meta-alliance" with the couple around their loyalty conflicts, avoidance of splits and disruptions, and prioritization of marital distress (versus individual symptoms) as the primary focus of treatment all serve to solidify the therapeutic alliance. In addition, identifying the partners' early family-of-origin distress can help predict and respond to strains in the therapeutic alliance that may occur later in therapy. Finally, the therapist helping the couple to balance their relational power differences in therapy and to address their concerns about the impact of the therapist's gender also strengthens their therapeutic alliance. A clinical case and vignettes are included to illustrate these issues.     

Current Issues in the Practice of Integrative Couple and Family Therapy

This paper provides an overview of current issues in integration in couple and family therapy. It summarizes the evolution of integration in couple and family therapy, the various traditions in integration, the strengths of integrative approach, and the possible pitfalls involved. It highlights the extent to which most couple and family therapy is now integrative practice. It concludes with a consideration of an emerging trend toward methods of practice centered on modules of intervention that have been identified as effective with certain presenting phenomena. The example of therapy for high conflict divorce is utilized to illustrate how various components can be brought together to create a maximally effective intervention.