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.     

Integrating Sex and Couples Therapy: A Multifaceted Case History

Traditionally, sexuality has not been a focus in couples therapy training, research, or practice, although it is an important, often complex issue for many couples. This article tells the story of a couple presenting for sex therapy due to their unconsummated marriage, and is told to exemplify how sex therapy and couples therapy can be integrated in order to best meet the needs of couples. As the story unfolds, the multilayered facets of the presenting issue are revealed. The therapy incorporates and weaves together family of origin history, intrapsychic and cognitive issues, relational dynamics, patterns of interaction, and physiological/medical concerns into a postmodern couples therapy with behavioral interventions. This combined approach recognizes the value of each method on its own and their greater usefulness when blended together.     

Male Emotional Intimacy: How Therapeutic Men's Groups Can Enhance Couples Therapy

Men's difficulty with emotional intimacy is a problem that therapists regularly encounter in working with heterosexual couples in therapy. The first part of this article describes historical and cultural factors that contribute to this dilemma in men's marriages and same-sex friendships. Therapeutic men's groups can provide a corrective experience for men, helping them to develop emotional intimacy skills while augmenting their work in couples therapy. A model for such groups is presented, including guidelines for referral, screening, and collaboration with other therapists. Our therapeutic approach encourages relationship-based learning through direct emotional expression and supportive feedback. We emphasize the development of friendship skills , core attributes of friendship ( connection, communication, commitment, and cooperation ) that contribute to emotional intimacy in men's relationships. Case examples are included to illustrate how this model works in clinical practice, as well as specific suggestions for further study that could lead to a more evidence-based practice.     

A Caring Framework for Enhancing Couples Therapy

As couples move away from role oriented patterns of relating they enter a transitional phase where marital expectations are less clearly defined. Frequently couples seeking therapy complain of a lack of caring in their relationships. They also express confusion about the appropriateness of their desire for more caring. In this article the authors present a caring framework based on their research with couples in "vital-total" marriages. They also suggest several ways this caring framework can be used in clinical work with couples.     

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.     

Gendered Power in Cultural Contexts: Part II. Middle Class African American Heterosexual Couples with Young Children

When race and gender intersect, understanding gendered power may be complicated. The authors first describe the historical context that serves as important background for understanding gender and power in heterosexual African American relationships. Then they show how family solidarity in the face of social injustices often overrides gender equality as a goal for middle class African American couples with young children. The findings illustrate pragmatic equality within couple relationships and the willful suspension of gender roles for the well-being of the family as a whole. However, gendered power impacts couples in a variety of ways. Sometimes a woman's fear that the man might leave, for example, diminished her power in the relationship. Often a woman accommodated a man's greater power in the family because of her perception that he was often denied power in the larger society. Societal discrimination of women was less visible to couples. Implications for practice are provided.     

Gendered Power in Cultural Contexts: Part I. Immigrant Couples

Immigration is a world-wide phenomenon and practitioners are increasingly called on to work with issues related to it. The authors examine the experience of couples who are immigrants to the United States in regard to gender and power issues. Although the study limited participation to one religious group in order to hold that aspect of culture and gender attitudes constant, the experiences of these couples help to make visible the link between microlevel couple interaction and larger social processes. The results show how the couples manage a delicate balance between the push for gender change and avoiding too much conflict as male power is challenged.     

The Effectiveness of Therapy with Couples Reporting a History of Childhood Sexual Abuse: An Exploratory Study

The purpose of this pilot study was to explore the impact of childhood sexual abuse (CSA) on couples therapy. Participants were couples seeking therapy who were screened for CSA prior to therapy. Groups were compared using self-report and therapist-rated measures of individual and relational distress. Results indicate that although therapists report significant differences between CSA couples and couples not reporting abuse at the onset of therapy, those differences do not translate into significant differences in the perceived effectiveness of therapy as measured by change scores on therapist rated levels of distress, questions regarding the effectiveness of therapy, dropout, and length of treatment.     

A Systems Approach to Sex Therapy with Gay Male Couples

SUMMARY

Sex therapy with gay male couples is difficult for many family and relationship therapists. Family therapists lack knowledge of the nature of sex therapy, gay male culture and sexuality, the dynamics of gay male couples, and the sexual issues gay male couples are likely to bring to sex therapy. Countertransference also makes sex therapy with gay male couples difficult for some family and relationship therapists. This paper addresses those issues and then explains a systems approach to sex therapy with gay male couples.     

Marriage Counseling: A Christian Approach to Counseling Couples

An approach to marriage counseling aimed at Christian couples is described. The theoretical bases of the approach are cognitive behavioral therapy and structural and strategic marital therapies. Techniques are drawn from various schools of marriage therapy. Shared Christian values between counselor and clients are used to promote increased marital commitment, marital satisfaction, and personal spiritual growth. Marital satisfaction might be increased through helping the couple increase their intimacy, enhance their communication, improve their conflict management, and forgive each other for past and present hurts.     

The Phenomenological Approach to Art Therapy

The present paper discusses the phenomenological approach to art-therapy and suggests an operational terminology for its main theoretical concepts. First we present the general assumptions that underline art therapy. Definitions, leading approaches, and the therapeutic effect of artwork are considered. Next we indicate the need for relevant and particular theories of art therapy. Phenomenological theory is examined as a case in point because of its popularity among art therapists. Despite its philosophical appeal, however, we find phenomenological theory lacking the operational terminology that is essential to form a coherent and distinct school of therapy. In the present paper, we extract from phenomenological theory operational principles, which can be followed and applied by art therapists. In this analysis, we take into consideration Betensky's pioneer attempt to create the bridge between phenomenological theory as applied in verbal psychotherapy and art therapy. We end by discussing the urgent need to operationalize other verbal psychotherapeutic theories so they are relevant for art-therapy practice and may help create greater similarities among art therapists of the same school of psychotherapy.     

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.     

A (Post)Foundational Approach to the Philosophy of Science: Part II

Summary  This is a sequel to my paper, “Searching for a (Post)Foundational Approach to Philosophy of Science”, which appeared in an earlier issue of this Journal [Ginev 2001, Journal for General Philosophy of science 32, 27–37]. In the present paper I continue to scrutinize the possibility of a strong hermeneutics of scientific research. My aim is to defend the position of cognitive existentialism that combines the advocacy of science’s cognitive specificity and the rejection of any form of essentialism. A special attention will be paid to the notion of the thematizing project of scientific research.     

实验设计:一种非模式的方法

实验设计通常被当作一种种设计模式．这种方法可称之为实验设计的模式方法。但本文认为,这种常用的方法事实上存在着不少缺点。于此．本文尝试提出了一种新的实验设计方法——实验设计的变量方法。实验设计的变量方法的基本思想是．从实验研究的问题出发,根据实验中变量的性质或特点确定实验设计的具体内容。本文最后讨论了实验设计变量方法的优越性。     

A Cognitive-Behavioral Approach to Family Therapy

Although cognitive behavioral spectrum approaches with individual children are plentiful and demonstrate effectiveness, cognitive behaviorally oriented clinicians are frequently left to their own devices when it comes to treating families. Cognitive behavioral family therapy is a relatively recent development and there are precious few reports of its clinical use. This article presents a conceptual foundation and clinical rubrics for the practice of cognitive behavioral family therapy. Basic theoretical background information is presented and places the therapeutic processes and procedures in a proper context. Session structure in cognitive behavioral therapy is illustrated and the way it propels therapeutic momentum and adds focus to each session is explained. Rudimentary processes of self-monitoring, self-instruction, rational analysis, and behavioral enactment are described and augmented with case material. Finally, the conclusion offers directions for further theory building, research, and clinical practice.     

Couples Therapy for Drug Abusing Women in an Inpatient Setting: A Pilot Study

This article describes a pilot study to examine the usefulness of adding a couples therapy component to inpatient drug and alcohol treatment for women. The treatment model was modified from a 12-week integrative systems model that has been empirically supported in outpatient treatment settings. A team of student-therapists received intensive training and supervision in the modified version. This article discusses the ability of chemical dependency counselors to implement this model, includes pre and post treatment comparisons, and qualitative findings regarding the efficacy of the project. The treatment model promises to be usable, safe, and practical in inpatient settings, and merits a more thoroughgoing clinical trial.     

Healthy Nests Transition to Parenthood Program: A Mixed-Methods Study

Intimate partner relationship distress is associated with a wide range of negative adult and child outcomes. The transition to parenthood is often a time in the life of a couple where relationship distress increases and satisfaction and intimacy decrease and thus is an ideal time for targeted intervention. The Healthy Nests (HN) intervention is a three-meeting, strength-focused couples intervention for first-time parents designed to decrease maladaptive relationship conflict and increase couple well-being. The authors conducted a mixed-methods exploratory study investigating participants' overall experiences with the HN intervention and measured outcomes associated with relationship satisfaction, help seeking, father involvement, substance use, and depression. A total of 130 parents (65 dyads) participated in a randomized intervention and educational materials–only alternative intervention. Twenty dyads were interviewed as a part of the qualitative portion of the study. While the authors did not find significant quantitative effects on key outcomes, the qualitative findings suggested that participants had a positive experience with the HN intervention and indicated it was useful to have designated time and space to communicate as a couple. Qualitative findings also suggest that the focus on “aspects of strength” and “areas of change” in their relationship was useful. Implications for practice, research, and training are discussed.     

A Cognitive-behavioral Approach to Reconstructing Intergenerational Family Schemas

This article suggests the use of cognitive-behavioral techniques, namely cognitive restructuring combined with family-of-origin sessions, for reconstructing intergenerational family schemas. A case example portrays the use of the techniques as an effective intervention for addressing ingrained schemas, such as in the case of spousal abuse.Portions of this article were drawn from a lecture provided to the University of London’s Institute of Psychiatry at the Maudsley Hospital, UK in August of 2005. The author wishes to acknowledge Mr. Eric Frey and Ms. Katherine Adams for their assistance with the literature search.