Couples Therapy Using the Technique of Construct Differentiation

A central problem in couples therapy is the clients' tendency to persist in endless and fruitless alternation between attacking the partner and justifying themselves. The technique of construct differentiation described in this article has proved helpful in coping with this situation. In three clearly structured steps, the therapist explores the personal constructs of each partner in the presence of the other. Instead of concentrating in the usual way on circularity of thoughts, feelings, and behavior, the partners are hindered from interacting and are confronted by the therapist's questions concerning their own inner process, independently of that of the partner. By becoming aware of their own ambivalent constructs and those of the partner, the eagerness to convert the partner to their own point of view can be reduced, and the construct system of each partner can be enriched by the other's constructs. Construct differentiation proves especially useful in the treatment of power struggles and narcissistic collusions.     

Evidence-based psychological treatments for disruptive behaviors in individuals with dementia

In this article, the authors review the literature regarding evidence-based psychological treatments (EBTs) for behavioral disturbances in older adults with dementia, as proposed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology. Fifty-seven randomized clinical trials were reviewed for inclusion on the basis of titles or abstract information. Forty-three were excluded either because they did not meet EBT methodological criteria or because they involved environmental or psychoeducational nursing interventions in which the psychological component could not be separately evaluated. Fourteen studies were considered for inclusion as EBTs; of these, 8 showed significant differences between treatment and control groups. Results of this review indicate that behavioral problem-solving therapies that identify and modify antecedents and consequences of problem behaviors and increase pleasant events and individualized interventions based on progressively lowered stress threshold models that include problem solving and environmental modification meet EBT criteria. Additional randomized clinical trials are needed to evaluate the generalizability and efficacy of these and other promising psychological interventions in a variety of settings with individuals who have a range of cognitive, functional, and physical strengths and limitations.