Sleep Symptoms as a Partial Mediator Between Combat Stressors and Other Mental Health Symptoms in Iraq War Veterans

Sleep symptoms are a prominent feature of mental health disorders like PTSD and depression. However, it is unknown whether sleep symptoms mediate the relationship between combat stress and these disorders. We examined the mediating role of sleep symptoms on the relationship between combat stress and PTSD; and the relationship between combat stress and depression using data from 576 Army veterans of the Iraq War surveyed in 2004. Correlational analyses revealed that when insomnia was included in the model, the correlation between combat stressors and other depression symptoms decreased by 65%; and when nightmares were included in the model, the correlation between combat stressors and other PTSD symptoms decreased by 69%. We replicated these analyses using individual items assessing PTSD and depression and found that the insomnia and nightmare items had the largest and second largest mediation effect between combat stressors and PTSD and depression symptoms. Our result support the theory that sleep symptoms contribute to the development and/or maintenance of other mental health symptoms and that early treatment of sleep symptoms may mitigate the other mental health consequences of combat stress.     

Divorce in the kibbutz: Past and present

In the kibbutz today, there are no ideological or economic barriers to prevent a couple from deciding to divorce. Both husband and wife are assured continued economic security and equal opportunities for co-parenting, thus reducing fears of disruption in the daily contact with the children. In spite of these favorable circumstances, marital breakups in the kibbutz are less frequent than in the larger cities in Israel. In recent years, however, at a time when a stronger and more intensive family life has gained legitimacy within the kibbutz structure, there is a marked tendency toward a rise in the rate of divorce. In this article we analyze the possible causes of the variations in the frequency of divorce within the kibbutz framework.The authors express appreciation to Esther Mivtzari, a psychologist on the staff of the Kibbutz Child and Family Clinic and a member of the religious kibbutz Ein-Tzurim, for assistance in gathering data on divorce in the religious kibbitzum.     

A biopsychosocial model for treating infertility

With approximately one out of six married couples experiencing infertility, having a basic knowledge of infertility is important to marriage and family therapists. This paper presents important themes that infertile couples often struggle with and stresses the importance of having a biological, psychological, and social understanding of infertility. In addition, the paper suggests possible interventions that family therapists can use in helping infertile couples.     

A benevolent conceptualization of marital power: The case of depression

Treatment of the depressed client with low self-esteem, external locus of control, and an absent spouse often is frustrating due to the limitations of modifying the social context. An approach to the problem using a systemic view which is based on examining the notion of power and examining the problems in their context is presented. Interventions which sidestep the temptation of emphasizing self-esteem of the client and, instead, utilize client strengths and interactional dynamics within the marriage are presented.     

The client: Therapist's partner or therapist's opponent? thoughts on the question of power and cooperation in therapy

The difference in process and outcome of two therapies conducted by the author with families having a psychotic adolescent is considered. Attention is paid to the fact that in one case the client was regarded theoretically as an opponent and in the other as a partner. It is concluded that the contention thatthe therapist must decide whether to be influential or cooperative arises from a logical confusion by failing to recognize that therapy cannot be anything other than cooperation.Originally published as part of a special issue on the power metaphor guestedited by Klaus G. Deissler inZeitschrift fur systemische Therapie (1986),4, 253–257. Translated by S. Awodey.