How Managed Care Can Help Couples Cope

ABSTRACT

This article traces how managed care became a quick fix to curb out-of-control healthcare costs rather than a real effective approach to managing care. To date, the impact has been not only a negative experience, but impediment to treating couples facing relationship and related problems. The author is optimistic about how managed care will evolve to recognize the importance of couples and family treatment as we enter the future with integrated systems of healthcare. ? The future will also require significant shifts in the thinking and practice patterns of providers and an emphasis on quality and outcomes.     

Women,Mental Health,and Managed Care

Abstract

Managed care has changed the way that mental health care is provided. These insurers manage such factors as length and type of therapy made available, access to therapy, and level of payment for therapy. Women, as the majority of those insured by managed care and as consumers of mental healthcare, are differentially affected by these changes.     

Existential Marital Psychotherapy and the Experience of Managed Care

ABSTRACT

In this article the experience of managed care is over-viewed from the perspective of existential marital therapy. It is concluded that managed care disrupts the experiential nature of participation between couple and therapist, dilutes the authentic nature of the treatment relationship, decreases the importance of subjectivity, disturbs the discovery of meaning and purpose in marital life and deters existential communication.     

The Tao of Communication and the Constancy of Change

SUMMARY

Lao Tsu and Virginia Satir seemed to have spoken a common language when it came to speaking about the art of knowing, being and doing. It is as if they sang from the same sheet of music. This article combines their melodies, intensifying the power of each's message. In a back and forth, fugue-like dialogue between Lao Tsu and Satir, the author explicates her understanding of the sacred work of change and actualization in a six part invention; the Six A'S.     

Narcissistic Vulnerability in Marriage

Many couples who seek therapy with issues around money, work, sex or children are actually dealing at a deeper level with problems of narcissistic entitlement, vulnerability to emotional injury, or defenses that protect against perceived attacks upon a fragile self. This paper considers the concept of narcissism as it relates to marriage and family issues and suggests some important ingredients in treating a narcissistically vulnerable relationship.     

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.     

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.     

Initiating a Couples Group

Couples-group therapy is thought of as a helpful treatment for most couples, and as a primary treatment for married couples who have longstanding problems of a rigid and chronic nature. It is most useful for couples for whom blaming, power plays, and suppression of anger are prominent modes of interaction. Couples-group therapy is helpful to these couples because the group is a microcosm of society, provides a wide variety of coping styles, and offers observable alternatives to dysfunctional behaviors. A group dynamic also decreases the couple's sense of isolation. Issues relevant to starting a couples group--indications, contraindications, policies and balancing a group--are discussed. Clinical vignettes from ongoing open-ended couples groups are presented to illustrate the points made.     

The Practice of Marriage and Family Therapists with Managed Care Clients

This study examined the practice patterns of Nebraska marriage and family therapists (MFTs) working with managed care cases. The participants' two most recently closed managed care cases were examined to determine the types of cases seen, the process of treatment, and treatment outcome. Results indicated that the therapists saw cases for a median number of six sessions. MFTs worked with a variety of presenting problems and diagnoses. Depression was the most common presenting problem, and the most common DSM-IV diagnosis was adjustment disorder. A comparison of pre- and post-treatment GAF scores indicated that clients' level of functioning improved significantly during the course of treatment.     

Discrepant Alcohol Use,Conflict, and Couples Satisfaction in a Community Sample

Abstract

Discrepant alcohol use between partners has been shown to impact couples’ relationship functioning, emphasizing couples therapists’ need for careful assessment and informed treatment. This study recruited 514 participants from online crowdsourcing platforms to participate in an online survey. Participants were predominantly male (62.4%), heterosexual (76.1%), and Caucasian (47.6%). Ages ranged from 18 to 65 years and mean age was 33. Results indicated a negative association between couple satisfaction and both alcohol-related conflict and discrepant alcohol consumption. Being female combined with higher levels of alcohol discrepancies and couple satisfaction predicted increased alcohol-related conflict.     

The Impact of Specific Psychotherapist Beliefs Regarding Managed Care on Prospective Psychotherapy Clients

The purpose of this study was to investigate the separate impact of each of thirteen therapist beliefs that, presented collectively, were previously found to have a significantly negative impact on prospective clients' attitudes toward managed care psychotherapy (Pomerantz, 2000). Participants in this study initially completed a brief questionnaire measuring their willingness to enter psychotherapy and their expectations regarding psychotherapy under managed care. Participants subsequently completed the same brief questionnaire again after being instructed to imagine seeing a hypothetical psychologist and being presented with the psychologist's supposed beliefs regarding managed care (which were actually derived from survey data by Murphy et al., 1998). Results suggest that almost every discrete therapist belief had a significantly negative impact on participants' attitudes toward managed care psychotherapy. Several specific therapist beliefs produced particularly salient negative effects. Implications regarding ethics and informed consent are discussed.     

Family Mobilization: Work with Angry Elderly Couples in Declining Health

When elderly angry couples face difficulties in caring for each other, the ability to monitor each other's health problems is reduced, prompting the mobilization of the family. This article presents three sets of questions that examine for patterns of family mobilization: positive wedging, disentanglement failure, positive in-and-out participation, and defensive paralleling. In our clinical impression, these patterns often accompany the health monitoring problems of angry elderly couples. Brief case studies are used to describe approaches for assisting these couples in terms of both health monitoring and marital interactions involving anger during health decline. A procedure of deliberate paralleling for working with couples who display an especially inflexible interpersonal arrangement is outlined. Implications are drawn for therapists' education.     

Spiritual Beliefs and Barriers Among Managed Care Practitioners

Purpose: Ninety percent of American adults believe in God and 82% pray weekly. A majority wants their physicians to address spirituality during their health care visit. However, clinicians incorporate spiritual discussion in less than 20% of visits. Our objectives were to measure clinician beliefs and identify perceived barriers to integrating spirituality into patient care in a statewide, primary care, managed care group. Methods: Practitioners completed a 30-item survey including demographics and religious involvement (DUREL), spirituality in patient care (SPC), and barriers (BAR). We analyzed data using frequencies, means, standard deviations, and ANOVA. Findings: Clinicians had a range of religious denominations (67% Christian, 14% Jewish, 11% Muslim, Hindu or Buddhist, 8% agnostic), were 57% female and 24% had training in spirituality. Sixty-six percent reported experiencing the divine. Ninety-five percent felt that a patients spiritual outlook was important to handling health difficulties and 68% percent agreed that addressing spirituality was part of the physicians role. Ninety-five percent of our managed care group noted 8lack of time as an important barrier, lack of training was indicated by 69%, and 21% cited fear of response from administration. Conclusions: Managed care practitioners in a time constrained setting were spiritual themselves and believed this to be important to patients. Respondents indicated barriers of time and training to implementing these beliefs. Comparing responses from our group to those in other published surveys on clinician spirituality, we find similar concerns. Clinician education may overcome these barriers and improve ability to more fully meet their patients expressed needs regarding spirituality and beliefs.*This material has previously been presented as an abstract at the Culture and End of Life Conference, Association of Medical Colleges Spirituality, Kansas City, MO, September 12–14, 2002.Project supported by the Foundation for Spirituality in Medicine, Baltimore, MD     

The Use of Metaphors with African-American Couples

SUMMARY

There is a dearth of data in the literature on African-American couples. This omission probably reflects the assumption that interventions that are effective with one race are effective with others. This paper explores the use of metaphor as a tool for working with an underserved and neglected population. Since the African-American culture is extensive in its use of metaphor, this medium provides a fertile channel for therapeutic communication.     

Assessment and Intervention with Black-White Multiracial Couples

SUMMARY

Effective therapy with Black-White multiracial couples begins with therapist work on self attitudes and with sensitive assessment of the ways racism and race may or may not be connected to a couple's problems. We suggest ways to begin to explore self attitudes and suggest basic assessment questions for work with Black-White couples. In addition, we point out important clinical issues that may come up for Black-White couples in the areas of social support/social network, parenting, and grief.     

溢出-交叉视角下工作狂对配偶孤独感的影响

基于溢出-交叉的视角,采用工作狂量表、工作家庭冲突量表、孤独感量表对国内242个双职工家庭进行调查,探索工作狂对配偶孤独感的影响及其中介机制。结果表明,工作狂正向影响工作家庭冲突,继而正向影响配偶的孤独感,但是丈夫工作狂对妻子孤独感的直接影响不显著,而妻子工作狂对丈夫孤独感存在显著的直接影响,即丈夫工作家庭冲突完全中介丈夫工作狂对妻子孤独感的影响,而妻子工作家庭冲突部分中介妻子工作狂对丈夫孤独感的影响。此外,孤独感在双职工夫妻之间存在显著的相互交叉影响。     

Therapeutic Experiences of Lesbian Couples

Abstract

This study explores the therapeutic experience of lesbian couples who had received couples psychotherapy earlier in their relationship. It examines their feelings regarding their own levels of acceptance, disclosure of sexual orientation, and connectedness with the professional providing services using qualitative methodology. The perspectives of both members of the lesbian couple were taken into account and explored. Lesbian couples who had accepted their sexual orientation appeared to have higher levels of satisfaction in their therapeutic experience and reported having an improved sense of self. Couples who had a therapist that portrayed a positive acceptance of homosexuality, low levels of heterosexism, and knowledge of issues relevant to the lesbian community reported an experience that was conducive to growth and development thus leading to an enriched relationship.     

Resources on Same-Sex Couples for Therapists and Clients

SUMMARY

This article provides a brief annotated bibliography of resources for working with same-sex couples. We provide summaries of articles, book chapters, books, and web sites which we have found to be particularly helpful in working with same sex couples. Books covered include those targeted to therapists as well as those targeted to clients (self-help and bibliotherapy books).     

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.     

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.