Understanding Thai Families: A Cultural Context for Therapists Using a Structural Approach

This article describes six cultural influences that affect Thai families: religious beliefs, rural and urban considerations, family relationships, societal values, masculine and feminine roles, and sexuality. A case study of a Thai family struggling with these issues and interventions from a structural therapy perspective is presented.     

A Case Study of Cognitive-Behavioral Conjoint Therapy for Combat-Related PTSD in a Same-Sex Military Couple

Military deployments to Iraq and Afghanistan are associated with increased risk for posttraumatic stress disorder (PTSD), depression, and relationship impairment. Unfortunately, the perceived stigma associated with seeking deployment-related behavioral health care in military settings has been a significant barrier to care. Historically, active-duty military service members involved in same-sex intimate relationships have experienced further stressors and barriers to care related to additional stigma and lack of social support. Prior federal regulations excluded sexual minorities from openly serving in the military, thereby limiting the available behavioral health services for same-sex couples. Since this ban was lifted after the repeal of the U.S. policy known as "Don’t Ask, Don’t Tell" in 2010, gay and lesbian service members have increased opportunities to obtain behavioral health care. One therapy that is newly available to sexual minority military couples is Cognitive-Behavioral Conjoint Therapy (CBCT), which effectively addresses co-occurring PTSD and relationship dysfunction. This case study illustrates the use of CBCT for the treatment of deployment-related PTSD in a same-sex active-duty military couple. After completing all 15 CBCT sessions, the couple reported clinically meaningful changes in the service member’s PTSD symptoms, which was maintained at the 2-month follow-up. The results of this case study indicate that CBCT for PTSD can have positive treatment outcomes with military same-sex couples. Further clinical implications are discussed.     

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.     

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.     

The Drama of Couples Therapy

In the author's view, the intensity of couples/family treatment arises from a suppressed acknowledgment of reciprocity, of interconnectedness among family members, beyond the often familiar dynamics of blaming and deprivation. Eliciting a recognition of profound interdependence raises anxiety, and stands in opposition to culturally prescribed concepts of autonomy and independence. To this end, a dramaturgical model of couples/family is proposed and discussed, involving the therapist's participation as director, witness or audience, and protagonist.     

Conceptual and Application Issues: Emotionally Focused Therapy With Gay Male Couples

Therapists working with couples are likely to see gay male couples in their practice yet there is a lack of training to prepare therapists to work with gay couples. Emotionally Focused Therapy (EFT) is an empirically supported approach to couples therapy and offers a clear structure and map for working with gay male couples. This article reviews some of the issues that are specific to EFT work with gay men. Given the range of minority stressors that gay men contend with EFT is particularly appropriate for work with gay male couples because of the focus on the attachment bond. Building a secure relationship is an important source of resilience that can buffer against prejudice and discrimination and provide a secure base for individual and couple exploration.     

Using Contextual Therapy to Treat Depression with Couples

Abstract

Though depression is one of the most common presenting problems treated by systemic therapists, there have been relatively few attempts to describe how specific systemic therapy models can be applied to treat couples dealing with depression. In this paper, we discuss how contextual therapy can be used to treat depression in couples therapy. We identify multidirected partiality as an intervention and as a characteristic. We introduce letter writing and internalized other interviewing as contextual interventions that help to facilitate partiality and understanding between clients. A clinical vignette illustrates our discussed concepts.     

Longitudinal Test of Forgiveness and Perceived Forgiveness as Mediators between Religiosity and Marital Satisfaction in Long-Term Marital Relationships

Abstract

Substantial research has found relations between religiosity and martial satisfaction. More longitudinal studies are needed to understand the inner-workings of this relationship. Over a four-year period, dyadic data from 331 married couples was used to test the longitudinal mediating effects of spousal forgiveness and partners’ perceptions of spousal forgiveness between religiosity and marital satisfaction. Husbands’ religiosity was associated with increases in wives’ marital satisfaction but the measures of forgiveness were not significant mediators in this relationship. Wives’ religiosity was predictive of lower levels of wives’ perceptions of spousal forgiveness, which led to decreases in both wives’ and husbands’ marital satisfaction.     

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.     

Overprotective Parenting: Helping Parents Provide Children the Right Amount of Risk and Responsibility

Overprotective parenting in low-risk environments may have negative consequences for the psychosocial development of children and youth. Though not well studied, a number of different bodies of literature can be used to speculate on the reasons for overprotective parenting and the impact it has on children. In this article, the social and familial dynamics leading to overprotection are discussed. It is shown that overprotection among middle-class families may result from poorly informed parents regarding the psychosocial developmental needs of their children for risk and responsibility and a lack of familiarity with population-wide data which shows that many of today's youth are safer that at any previous time in history. Focusing on the “risk-taker's advantage,” this article uses a case example to illustrate a three-part model of intervention to help challenge overprotective parenting while opening up safe opportunities for youth to experience manageable amounts of risk and responsibility.     

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.     

The Efficacy of Behavioral Couples Therapy and Emotionally Focused Therapy for Couple Distress

Twenty treatment outcome studies, 13 of which evaluated behavioral couples therapy (BCT) and seven of which evaluated emotionally focused therapy (EFT) were reviewed, leading to the following conclusions. BCT leads to short and long-term gains for moderate to severe couple distress. In the long term BCT probably leads to no better outcomes than its constituent components—behavioral exchange training and communication and problem solving skills training. Addition of a cognitive therapy component to BCT or the use of a variety of treatment formats does not improve the efficacy of BCT. Integrative couples therapy and insight-oriented marital therapy may be more effective than BCT, but studies supporting this conclusion require replication. EFT leads to short and long-term gains for mild to moderate couple distress. Addition of a cognitive therapy component to EFT does not enhance its efficacy. EFT may be more effective than problem solving therapy and less effective than integrated systemic therapy, but the two studies supporting this conclusion require replication.Michael Byrne, PhD, is a Clinical Psychologist, Midland Health Board, Ireland; Alan Carr, PhD, is Director of the Clinical Psychology Training Programme, Department of Psychology, Arts Building, University College Dublin, Belfield, Dublin 4, Ireland (alan.carr@ucd.ie). Marie Clark, PhD, is Lecturer, Department of Psychology, University of Surrey, United Kingdom.     

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.     

The Couple's Mutual Identity and Reflexivity: A Systemic-Constructivist Approach to the Integration of Persons and Systems

This paper presents a systemic-constructivist approach to working therapeutically with couples. Therapeutic change is optimal when both the intrapersonal processes of each individual and their unique interpersonal system are synthesized. This approach targets partners' ways of knowing and experiencing themselves in the context of their relationship. The therapist endeavors to engage the aspect of personal identity which each partner derives through his or her participation in the relationship. Emphasis is placed upon (1) The mutual identity that emerges as a result of the couple's intersubjective, dialectical interplay; (2) each partner's ability to engage as participant–observers within their own relationship; and (3) the ability for the couple to utilize their conjoint reflexive faculty in the service of their own change. Change which arises from this combination of personal motivation and collective agency exhibits a self-generated life of its own predicated upon the couple's own expertise rather than that of an external agent.     

Predictors of Partner Engagement in PTSD Treatment

A telephone survey was conducted to identify predictors of treatment engagement in 83 cohabitating female partners of 83 Vietnam theater veterans with combat-related post-traumatic stress disorder (PTSD). The survey assessed veterans for their trauma history and PTSD symptoms. Partners were assessed for caregiver burden, patient–partner involvement, PTSD treatment engagement, self-efficacy relating to PTSD, beliefs about benefits of PTSD treatment, and PTSD treatment barriers. Significant predictors of partner PTSD treatment engagement were the couple’s income, patient–partner involvement, and partner caregiver burden. These findings have implications for family interventions that may increase partner PTSD treatment engagement and improve PTSD treatment outcome.     

The Application of Family Systems Theory to Organizational Consultation: A Content Analysis

A content analysis was performed on 43 articles published between 1970 and 1998 discerned as relating family systems theory (FST) frameworks and constructs to organizational consultation. Frameworks and constructs were coded and then investigated in relation to four independent variables: type of organization, decade of article publication, gender, and educational training of author. Results indicate that the use of FST frameworks and constructs vary depending upon the characteristics of the organization, time period, and consultant. Results highlight specific FST frameworks and constructs most common in organizational consultation.     

The Role of Theory and Research in the Practice of Cognitive-Behavioral Couple Therapy: If You Build It,They Will Come

Cognitive-behavioral couple therapy (CBCT), while empirically validated and highly efficacious, does not always have positive results for couples. One factor that may limit the efficacy of this intervention is the way in which therapists are trained to provide this type of therapy. More specifically, there is a need for therapists to gain a solid foundation in CBCT theory in order to maximize treatment results. This paper presents an argument for why an understanding of theory is necessary for therapists in treating couples. Then, this paper presents our training model and how we integrate theory into our training of both graduate student therapists and more experienced clinicians. We take the stance that “if you build it, they will come.”     

A Pilot Study of the Effects of Cognitive-Behavioral Conjoint Therapy for Posttraumatic Stress Disorder on Parenting

Parental posttraumatic stress disorder (PTSD) is associated with parenting difficulties. Cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD) improves PTSD symptoms, relationship adjustment, and partners’ mental health functioning. However, the impact of CBCT for PTSD on parenting competency is unknown. In this pilot study, the effects of CBCT for PTSD on parenting competency were investigated in 14 individuals (6 patients with PTSD and 8 partners) who had children under age 18. Results suggested that most participants perceived themselves as competent in their parenting prior to treatment, and some enhancements in competency occurred following CBCT for PTSD. Moreover, changes in parenting competency were associated with improvements in patient-rated PTSD. Adjunctive interventions targeting parenting and goals for future research are discussed.