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221.
222.
Jealousy is a powerful emotional force in couples' relationships. In just seconds it can turn love into rage and tenderness into acts of control, intimidation, and even suicide or murder. Yet it has been surprisingly neglected in the couples therapy field. In this paper we define jealousy broadly as a hub of contradictory feelings, thoughts, beliefs, actions, and reactions, and consider how it can range from a normative predicament to extreme obsessive manifestations. We ground jealousy in couples' basic relational tasks and utilize the construct of the vulnerability cycle to describe processes of derailment. We offer guidelines on how to contain the couple's escalation, disarm their ineffective strategies and power struggles, identify underlying vulnerabilities and yearnings, and distinguish meanings that belong to the present from those that belong to the past, or to other contexts. The goal is to facilitate relational and personal changes that can yield a better fit between the partners' expectations.  相似文献   
223.
The purpose of the current study was to conduct a pilot investigation to determine the effectiveness of Multisystemic Therapy (MST) for improving regimen adherence and metabolic control among adolescents with poorly controlled Type 1 diabetes. Thirty-one adolescents were randomly assigned to either MST or a control condition. MST treatment lasted approximately six months. Data were collected at study entry and at a six-month posttest. Twenty-five adolescents completed the study. Adolescents who received MST had significantly improved adherence to blood glucose testing and metabolic control from study entry to the six-month posttest, whereas controls did not. Adolescents receiving MST also had a decreased number of inpatient admissions at the six-month posttest. Improvements in metabolic control were related to improvements in parent report of adolescent adherence. Results suggest that MST holds promise as an intervention for improving adherence behavior and health outcomes among adolescents in poor metabolic control.  相似文献   
224.
Weight self-stigma is a promising target for innovative interventions seeking to improve outcomes among overweight/obese individuals. Preliminary research suggests acceptance and commitment therapy (ACT) may be an effective approach for reducing weight self-stigma, but a guided self-help version of this intervention may improve broad dissemination. This pilot open trial sought to evaluate the potential acceptability and efficacy of a guided self-help ACT intervention, included coaching and a self-help book, with a sample of 13 overweight/obese individuals high in weight self-stigma. Results indicated a high degree of program engagement (77% completed the intervention) and satisfaction. Participants improved on outcomes over time including weight self-stigma, emotional eating, weight management behaviors, health-related quality of life, and depression. Although not a directly targeted outcome, participants improved on objectively measured weight, with an average of 4.18 pounds lost over 7 weeks, but did not improve on self-reported weight at 3-month follow-up. Processes of change improved over time, including psychological inflexibility, valued action and reasons to lose weight. Coaching effects indicated greater retention and improvements over time with one coach vs. the other, suggesting characteristics of coaching can affect outcomes. Overall, these results provide preliminary support for the acceptability and efficacy of a guided self-help ACT program for weight self-stigma. Implications of these results and how to address clinical challenges with guided self-help are discussed.  相似文献   
225.
Telephone coaching is a treatment mode in Dialectical Behavior Therapy (DBT) that is designed to help clients generalize skills, prevent suicidal behaviors, and repair therapeutic ruptures. To date, phone coaching has received scant empirical investigation. The aims of this study were to (1) describe patterns in frequency of telephone calls and text messaging in DBT and (2) investigate whether demographic factors, baseline severity, suicidal behaviors, and therapeutic alliance are associated with phone and text frequency. Participants were 51 adults (35 treatment completers) with borderline personality disorder (BPD) in a six-month comprehensive DBT treatment program. Phone coaching frequency was documented by therapist weekly session notes. The average number of contacts per month was 2.55 (SD = 4.49). Four of the 35 treatment completers comprised 56% of the contacts. Having a recent history of suicidal behaviors, degree of severity at baseline, or the strength of the therapeutic alliance was not associated with phone coaching use. However, lower income was significantly associated with a higher frequency of phone coaching use. These preliminary results can help clinicians and administrators make informed decisions on how to better provide phone coaching and clarify the degree of effort involved in providing this service to clients with BPD.  相似文献   
226.
Maintenance of fluency after intensive in-patient treatment was studied in eight male stammerers. Reasons for success and failure are discussed in relation to objective and subjective data collected at the final follow-up interview.  相似文献   
227.
    
This article proposes a clinical practice for therapy with couples in which one partner suffered sexual abuse in childhood. Such couples often encounter unique difficulties with physical contact, intimacy, sexuality, communication, and trust, and their relationship dynamic may be marked by reenactments of past traumatic relational patterns. This clinical practice is founded on the assumption that establishing the witnessing lacking during the traumatic event in childhood can break the traumatic reenactments in adulthood, and spur recovery. The suggested practice may facilitate twofold witnessing: the couple's therapist witnesses the reenactments of the trauma in the couple's relationship; and the survivor's partner witnesses the trauma's effect on the survivor's personal life and relationship. Twofold witnessing can help break the cycle of traumatic reenactment and help the survivor integrate the events of her life into a more coherent, continuous narrative. The partner's presence also facilitates acknowledgement of what happened to the survivor, and helps the survivor elaborate on her stories of resistance, survival, and strength. Finally, each of the partners is able to appear more wholly and fully, and together to tell the preferred stories of their life as a couple, replete with the multiple relational patterns they wish to live, which may contradict the characteristics of the original trauma.  相似文献   
228.
    
The main theoretical position on fetishism remains that outlined by Freud, the splitting of the ego and castration anxiety being central to the establishment of the fetish. The dangers and attractions of an oedipal resolution are outlined in the case of 'Stanley', an older adolescent whose nappy wearing, transvestism and obsession with pregnant mothers and their babies brought him to therapy. The paper demonstrates some of the technical difficulties in such work, the slow ego-structuring that is necessary, the patient's swift perception of danger at any failure of attunement by the therapist and subsequent flight to the perverse defence, and the impetus that acceptance of oedipal gain may bring to development. Die wesentliche theoretische Position bezüglich Fetischismus bleibt die von Freud umrissene, dass Ichspaltung und Kastrationsangst bei der Etablierung des Fetischs zentral sind. Es werden die Gefahren und Anziehungspunkte einer ödipalen Lösung im Fall von 'Stanley' dargestellt, einem älteren Jugendlichen, den sein Windeltragen, Transvestismus und Besessenheit mit schwangeren Müttern und ihren Babies zu Therapie brachte. Der Artikel zeigt einige der technischen Schwierigkeiten in solch einer Arbeit, das langsame Ich-strukturieren, das notwendig ist, die schnelle Gefahrenwahrnehmung des Patientens bei jeglicher Missanpassung des Therapeutens und die darauffolgende Flucht in perverse Abwehr, und den Antrieb, den das Akzeptieren des ödipalen Gewinns zur Entwicklung bringen kann, auf. Des conceptions théoriques du fétichisme, la plus connue reste encore celle proposée par Freud, dans laquelle le clivage du moi et l'angoisse de castration sont à l'origine de la mise en place de l'objet fétiche. Les dangers et les charmes d'une résolution ?dipienne sont esquissés à travers le cas de û Stanley ý, garçon en fin d'adolescence qui entreprend une thérapie en raison de certains de ces comportements?:?il aime porter des couches, il se travestit et il est obsédé par les femmes enceintes et leurs bébés. L'auteur souligne quelques-unes des difficultés techniques posées par ce travail, la lenteur avec laquelle il faut laisser se structurer le moi, la perception rapide par le patient d'un danger imminent dès que sa thérapeute n'est plus tout à fait en accordage avec lui, sa fuite alors vers une défense perverse, et la stimulation que l'acceptation des enrichissements ?dipiens peut entraîner pour son développement. La posizione teorica principale sul feticismo resta quella illustrata da Freud, secondo la quale la scissione dell'Io e le ansie di castrazione sono determinanti alla formazione del feticcio. I pericoli e le attrazioni di una risoluzione del complesso edipico sono illustrate nel caso di 'Stanley', un tardo adolescente arrivato in terapia perche' usava i pannolini, si travestiva e aveva un' ossessione per le donne incinte e i loro bambini. L'articolo tratta di alcune delle difficolta' tecniche in questo tipo di lavoro, della lenta e necessaria ricostruzione dell'Io, della rapida percezione del pericolo del paziente quando egli sente una mancanza di sintonia con il terapeuta e la conseguente fuga verso difese perverse, e dell'impeto che l'accettazione dei vantaggi edipici possono portare allo sviluppo.  相似文献   
229.
    
This article outlines key themes that appear in the teaching of poststructuralist ideas and practices for couples counseling within the Postgraduate Diploma in Counseling Program at Unitec Institute of Technology in Auckland, New Zealand, and it explores the congruence of this pedagogical approach with Māori (indigenous) understandings of relationality, collaboration, and partnership. The diploma program's curriculum includes narrative therapy and relational language‐making. Themes explored in this article include: understanding (heterosexual) couple relationships as contextualized entities, deconstructing dominant discourses of coupledom, and the positioning of counselors/teachers as nonexpert. Taking each theme in turn, the authors, one of them Māori and two Pākehā (European), articulate points of alignment with Māori cultural concepts and practices.  相似文献   
230.
    
We describe how we think of identity as relational, distributed, performed, and fluid, and we illustrate the use of this conceptualization within a narrative worldview. Drawing on the work of Michael White, we describe how this relational view of identity leads to therapeutic responses that give value to interconnection across multiple contexts and that focus on becoming rather than on being. We show how a narrative worldview helps focus on the relational, co‐evolving perspective that was the basis of our early attraction to family therapy. We offer detailed examples from our work of practices that help us stay firmly situated in a relational worldview that is counter to the pervasive influence of individualism in our contemporary culture.  相似文献   
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