Family Therapy with Couples and Individuals with Parkinson’s Disease

Family therapists are increasingly called upon to work with individuals and families with medical issues, but often do not have sufficient background on the issue to be most helpful. The purpose of this paper is to help family therapists understand Parkinson’s Disease (PD) and its impact on the individual and his or her family. PD is the second most prevalent neurodegenerative disorder in the United States, following Alzheimer’s disease (Hirtz et al., Neurology 68:326–337, 2007). According to the Parkinson’s Disease Foundation, approximately 60,000 individuals are diagnosed with PD every year, and approximately one million Americans are currently living with PD. In this paper, we provide an overview of PD based on research and the second author’s many years of providing services for individuals with PD, as well as offer specific recommendations for providing family therapy using narrative, solution-focused and emotionally focused therapy based on the first author’s work as a family therapist with individuals, groups, and couples dealing with PD.     

The Impact of Chronic Health Conditions as an Underlying Challenge on Couple’s Wellbeing

Chronic health conditions affect over 100 million Americans (Cano and Leonard in J Clin Psychol 62(11):1409–1418, 2006). Many clinicians are not integrating chronic physical health symptoms into psychotherapy. There is a complexity of issues that arise within the context of chronic health conditions. Making more need for couple and family therapists, whose primary focus is on a systemic family perspective, to understand how chronic health conditions are impacting family systems when they present for therapy (Canavarro and Dattilio in Contemp Fam Ther 33:87–90, 2011; Poleshuck et al. in Prof Psychol 41(4):312–318, 2010). The correlation of chronic health conditions on marriages and relationships has received limited attention in clinical research. This secondary data analysis examines the differences in overall well-being and psychological distress of individuals and couples seeking therapy who report a presence of chronic health conditions. Original research on the relationship between chronic health conditions and well-being, as measured by comparison of means, will be presented. Few studies investigate how chronic health conditions, when not the primary reason for seeking therapy, influence wellbeing and distress upon entering therapy. This study included 2742 participants from a clinical sample of individuals and couple seeking therapy in a family therapy clinic at a university training clinic. Independent t-tests, as well as ANOVA, were run to compare well-being and psychological distress of individuals and couples in the sample. Results showed significant differences in both overall wellbeing and psychological distress for both individuals who reported chronic illness for themselves, or their partners, than those that reported no chronic illness. There were also significant differences between groups on both well-being and psychological distress [F (2, 2706)?=?47.55, p?=?.00, F (2, 2697)?=?54.59, p?=?.00]. This results showed significant differences in well-being when no member of the couple has chronic health conditions, one member, or both members, with both members decreasing wellbeing significantly. This study demonstrates that chronic health conditions impact both the individual diagnosed, their partners, and is especially impactful if both members of a couple are diagnosed with chronic health conditions. Study limitations and clinical implications are also discussed.     

Salience Versus Proportional Reasoning: Rethinking the Mechanism Behind Graphical Display Effects

Two experiments examined predictions from two separate explanations for previously observed display effects for communicating low‐probability risks: foreground:background salience and proportional reasoning. According to foreground:background salience, people's risk perceptions are based on the relative salience of the foreground (number of people harmed) versus the background (number of people at risk), such that calling attention to the background makes the risk seem smaller. Conversely, the proportional reasoning explanation states that what matters is whether the respondent attends to the proportion, which conveys how small the risk is. In Experiment 1, we made the background more salient via color and bolding; in contrast to the foreground:background salience prediction, this manipulation did not influence participants' risk aversion. In Experiment 2, we separately manipulated whether the foreground and the background were displayed graphically or numerically. In keeping with the proportional reasoning hypothesis, there was an interaction whereby participants given formats that displayed the foreground and background in the same modality (graphs or numbers, thereby making the proportion easier to form) saw the probability as smaller and were less risk averse than participants given the information in different modalities. There was also a main effect of displaying the background graphically, providing some support for foreground:background salience. In total, this work suggests that the proportional reasoning account provides a good explanation of many display effects related to communicating low‐probability risks, although there is some role for foreground:background salience as well. Copyright © 2018 John Wiley & Sons, Ltd.     

Learning About Parenting Together: A Programme to Support Parents with Inter-generational Concerns in Pune,India

Rapid developments in the last few decades have brought about dramatic changes in Indian social life, particularly affecting new middle-class families. Inter-generational conflicts, high academic pressures, and modern anxieties lead to stress both in parents and in children. There is a need for parenting programmes that respond to these specific concerns, in order to reduce parenting stress and improve family well-being. This study aimed to develop and evaluate a parenting programme in Pune, India, based on a ‘theory of change’. In this pilot programme, parents were encouraged to learn in a group format about fostering autonomy in children, promoting academic potential in a stress-free manner and remaining in connection with adolescents. Facilitated by a psychologist, parents participated in four sessions involving ‘creativity and play’, ‘self-awareness and bonding’, and ‘communication’. The intervention was based on validated psychotherapeutic approaches and parenting methods to support parents in their learning. Some 16 in-depth interviews were conducted with parents before and eight interviews after the intervention to understand their learning experiences. Additional feedback was gathered from observation notes and debriefings after each session. The results show that the attention for playful quality time helped parents to (re)gain a more creative and flexible attitude towards spending time with their children. Second, parents learned to reflect on their frameworks of meaning (rooted in their own upbringing), listen attentively and communicate more mindful with their children. Furthermore, this study shows that an activity-based approach, connecting parents in co-creating new parenting paradigms, while supporting them with stress-reducing tools, is a useful way of engaging this target group. The study concludes by offering new perspectives for counsellors working with families in countries undergoing rapid change.     

Disputing Irrational Beliefs Among Convicted Terrorists and Extremist Beliefs

This study investigated the most common irrational beliefs among samples of: (1) convicted terrorists and (2) extremists, all of whom were prisoners in the country of Jordan. It also investigated the effectiveness of a program of disputing irrational beliefs (DIBP) with the same populations. The subjects were assigned randomly to two groups: an experimental group (EG) that consisted of 43 prisoners who received an training program, and a control group that consisted of 48 prisoners who received no training. The irrational beliefs scale (IBS) scores were assessed for both groups before and after exposure to the DIBP. To test the hypotheses of the study, means and standard deviations of the IBS measures were submitted to a two-way analysis of covariance. The results revealed that the most common irrational belief loaded on the factors of musts, exaggerations, and perfectionism. Moreover, the results revealed significant differences between the means of the two groups on the total IBS scores at post-test, with the EG scoring lower, which indicated the effectiveness of the training program in reducing the level of IBS. The results yielded significant differences in the effect of the reason for imprisonment in favor of extremists and the interaction between the reason for prison and treatment in favor of the EG and extremists.     

The Relationship Between Automatic Thoughts and Irrational Beliefs Predicting Anxiety and Depression

Cognitive behavioral approaches differ in their views on core cognitions and their hypothesized role in the etiology of depression and anxiety. The present study provides empirical evidence regarding the relationship between irrational beliefs and components of automatic thoughts and their role in the etiology of depression and anxiety. The present study utilized newer and improved questionnaires to assess components of irrational belief. Based on prior research by Safren et al. (Cogn Ther Res 24(3):327–344, 2000), a three-factor structure of the combined automatic thought questionnaires were utilized to measure components of automatic thoughts as they relate to depression and anxiety. Factor analytical methods were utilized to confirm the factor structure of the irrational beliefs and automatic thoughts components. Advanced path modeling was utilized to model the relationship between irrational beliefs and automatic thoughts in predicting anxiety and depression. The study used a sample of N = 542 undergraduate psychology students during stressful exam times. Results indicated that the irrational belief Demandingness represents a primary factor, followed by the secondary irrational beliefs as proposed by Rational Emotive Behavioral Theory. Selfdowning beliefs were fully mediated by depressive automatic thoughts in the case of depressive affect. Low frustration tolerance contributed unique variance to anxious and depressive affect that was not fully mediated by automatic thoughts. Results from the present study add empirical evidence that irrational beliefs indeed represent core and intermediary beliefs that lead to specific automatic thoughts, which is congruent with cognitive behavioral theory as proposed by Rational Emotive Behavioral Therapy.     

The Madonna-Whore Dichotomy: Men Who Perceive Women's Nurturance and Sexuality as Mutually Exclusive Endorse Patriarchy and Show Lower Relationship Satisfaction

The Madonna-Whore Dichotomy (MWD) denotes polarized perceptions of women in general as either “good,” chaste, and pure Madonnas or as “bad,” promiscuous, and seductive whores. Whereas prior theories focused on unresolved sexual complexes or evolved psychological tendencies, feminist theory suggests the MWD stems from a desire to reinforce patriarchy. Surveying 108 heterosexual Israeli men revealed a positive association between MWD endorsement and patriarchy-enhancing ideology as assessed by Social Dominance Orientation (preference for hierarchical social structures), Gender-Specific System Justification (desire to maintain the existing gender system), and sexist attitudes (Benevolent and Hostile Sexism, Sexual Objectification of Women, and Sexual Double Standards). In addition, MWD endorsement negatively predicted men’s romantic relationship satisfaction. These findings support the feminist notion that patriarchal arrangements have negative implications for the well-being of men as well as women. Specifically, the MWD not only links to attitudes that restrict women’s autonomy, but also impairs men’s most intimate relationships with women. Increased awareness of motives underlying the MWD and its psychological costs can help practice professionals (e.g., couple therapists), as well as the general public, to foster more satisfying heterosexual relationships.     

Gender Bias Produces Gender Gaps in STEM Engagement

We explored whether the existence of gender bias causes gender gaps in STEM engagement. In Experiment 1 (n?=?322), U.S. women projected less sense of belonging, positivity toward, and aspirations to participate in STEM than did men when exposed to the reality of STEM gender bias. These gender differences disappeared when participants were told that STEM exhibits gender equality, suggesting that gender bias produces STEM gender gaps. Experiment 2 (n?=?429) explored whether results generalized to a specific STEM department, and whether organizational efforts to mitigate gender bias might shrink gender gaps. U.S. women exposed to a biased chemistry department anticipated more discrimination and projected less sense of belonging, positive attitudes and trust and comfort than did men. These gender differences vanished when participants read about an unbiased department, again suggesting that gender bias promotes STEM gender gaps. Further, moderated mediation analyses suggested that in the presence of gender bias (but not gender equality), women projected less positive attitudes and trust and comfort than did men because they experienced less sense of belonging and anticipated more discrimination. Results were largely unaffected by whether departments completed a diversity training, suggesting that knowledge of diversity initiatives alone cannot close STEM gender gaps.     

From Application to Approach: A Systematic Review of 50 Years of Psychoanalytic Couple Therapy

ABSTRACT

This systematic review of contributions to peer-reviewed journals in the area of couple interventions aims to provide a comprehensive and intensive overview of this evolving field, within psychoanalysis. Using a pan theoretical systematic review methodology, 113 peer-reviewed journal articles were reviewed, dated between 1963 and 2014, addressing the topic of couple therapy and psychoanalysis. This article addresses a number of specific questions including, where authors have published their work, what methodologies they have used, with which couples psychoanalysts have been working, how writers from within different theoretical orientations talk about their work with couples, and how the field has changed over time. It also explores emerging themes of the relationship between couple and individual therapy, sex, and co-therapy. This review of writing over the past 50 years suggests that although Classical contributions have waned over time, couple psychoanalysts from within Object Relations, Self Psychology, Intersubjectivity, and Relational orientations have evolved in their discourse about couple distress, from an application of psychoanalytic concepts to full-bodied, well-articulated, clear, and concise approaches to diagnosis and treatment. The first 50 years of writing in the field of couple psychoanalysis has brought us distinct treatment models, which have opened the door for greater communication and sharing within and between orientations.