Save Your Marriage

Save The Marriage

Lee Baucom, Ph. D. shows couples with marriage troubles a new way to save their marriage that is far more effective than any marriage counselor in this marriage course. In 4 easy-to-read modules, Dr. Baucom shows the step by step way to save a marriage that is in danger of ending any day. These show the top 5 mistakes that most people make in marriage, the REAL secrets to a happy marriage, why marriage counseling can actually HURT your marriage more, and how to move beyond your emotions into action. This module can actually have you saving your marriage in less than an hour, sometimes even 10 minutes. This book also comes with 4 bonus gifts free: Coping With a Midlife Marriage Crisis, Recovering from an Affair, 5 Rules for Fighting Fair, and an eBook written by a couple who was on the edge of divorce and the methods they used to get a happy marriage back. Marriage can be hard, but divorce is harder, on you and your children. Why risk it? Read more...

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Marital Disruption and Union Dissolution

A substantial proportion of all marriages end in divorce or separation due to marital discord. The divorce rate, which reflects the number of divorces in a year relative to the number of married people, rose continuously for more than a century in the U.S. and many similar industrialized countries, then leveled off at a fairly high level in about 1980 (Goldstein 1999). In the U.S., the best estimates suggest that around one-half of all marriages will end in separation or divorce rather than in the death of one of the partners (Martin and Bumpass 1989). Recent data for the U.S. show that after five years, 20 of all first marriages have disrupted through separation or divorce. By 10 years after the wedding, 32 of white women's first marriages, 34 of Hispanic women's first marriages, and 47 of black women's first marriages have dissolved. Asian women show the lowest levels of marital disruption after 10 years only 20 have divorced or separated. The marriages most likely to end include...

Marital disharmony

Family doctors often have to provide marital counselling for one or both partners. The problems may be resolved quite simply or be so complex that marital breakdown is inevitable despite optimal opportunities for counselling. Opportunities for prevention, including anticipatory guidance about marital problems, do exist and the wise practitioner will offer appropriate advice and counselling. Examples include an accident to a child attributable to neglect by a parent, or similar situation in which that parent may be the focus of blame leading to resentment and tension. The practitioner could intervene from the outset to alleviate possible feelings of guilt and anger in that marriage. Some common causes of marital disharmony are

The effect of illness

Serious illness often precipitates crises in individual members of the family, crises which have not previously surfaced in the apparently balanced family system. It is recognised, for example, that bereavement over the unexpected loss of a child may lead to marital breakdown, separation or divorce. In the long term, other family members may be affected more than the patient. This may apply particularly to children and manifest as school underachievement and behaviour disturbances. During the crisis the obvious priority of the doctor is to the patient but the less obvious needs of the family should not be ignored.

Epidemiology Of Sexual Dysfunction

A population study of US females aged 18-65 (25) found that -33 of US females reported low libido, trouble with orgasm, or difficulty with lubrication for at least 1 month in the previous year. Other surveys have reported similar findings. Hawton (38) studied sexual activity in a community sample in Oxford, United Kingdom and found that 17 reported never experiencing an orgasm and only 29 reported experiencing orgasm at least 50 of the time. Marital satisfaction was the major predictor of sexual activity and satisfaction. Dunn (39,40) also reported several population studies in the United Kingdom. Approximately 40 of the women reported a sexual problem, the most common being difficulty reaching orgasm. A recent population survey in Sweden (41) of sexual behavior in women aged 18-74 found that the most common problems were low desire followed by orgasm and arousal difficulties. They also reported considerable co-morbidity between sexual disorders. Some (42) questioned the methodology...

Individual life experience

Adverse experiences in childhood, such as losing one's mother or father, or being sexually abused, would be expected to increase the risk of psychiatric disorder in adult life, and most research studies tend to confirm this long-term association. There is also evidence for a short-term effect whereby psychosocial stress in adult life can precipitate psychiatric illness in predisposed people. This effect applies both for individual life events of a common kind, such as family bereavement or divorce, and for extraordinary disasters (see Chapter 6 on PTSD). Chronic social stresses, such as marital difficulties or bad housing, can also contribute. In contrast, supportive social networks, and close confiding relationships with others, provide some protection against psychiatric disorder following adverse life events.

Working Together A Multidisciplinary Team Approach

The concept is a simple one with a long history sometimes, two heads are better than one. Treatment may require a multidisciplinary team in cases of severe dysfunction, and may be recalcitrant to success even under this ideal circumstance. There are many models for working together. Team approaches and composition will vary according to clinician specialty training, interest, and geographic resources. Although some expert physicians work alone, other PCPs, urologists, and gynecologists have set up in house multidisciplinary teams where nurses, physician associates, and master's level MHPs provide the sex counseling. This approach has obvious advantages and disadvantages. In cases of more severe PSOs, the patient(s) will be referred out for psychopharmacology, cognitive-behavioral therapy, and marital therapy in various permutations, provided by doctoral level MHPs (55-57). However, typically a clinician refers within their own academic institution, or within their own professional...

Case Study Jon and Linda

Jon and Linda were referred to the author by Jon's current psychopharmacolo-gist. Jon is a 62 years old financier who has been married to Linda (53 years old) for over 20 years. She began HRT 4 years ago, which successfully stopped her hot flashes. This is his second marriage and her first marriage. They had three teenage children together. Their marriage was marked by periods of disharmony secondary to multiple etiologies. Jon and Linda had a symbiotic relationship where she dominated much of their daily life. She tended to be explicitly critical of him, which he resented but managed passive-aggressively. This, of course, merely exacerbated their marital tension. Linda was particularly sensitive to rejection, and was considerably upset when Jon withdrew from her in response to her criticism. This infuriated her and she provoked confrontations. He eventually responded, becoming loud and aggressive, which initially dissipated his tension. He then felt guilty as she expressed hurt and...

Conjoint IPT for Depressed Patients with Marital Disputes IPTCM

It is well established that marital conflict, separation and divorce can precipitate or complicate depressive episodes (Rounsaville et al., 1979). Some clinicians have feared that individual psychotherapy for depressed patients in marital disputes can lead to premature rupture of marriages (Gurman & Kniskern, 1978). To test and address these concerns, Klerman and Weissman developed an IPT manual for conjoint therapy of depressed patients with marital disputes (Klerman & Weissman, 1993). Both spouses participate in all sessions and treatment focuses on the current marital dispute. Eighteen patients with major depression linked to the onset or exacerbation of marital disputes were randomly assigned to 16 weeks of either individual IPT or IPT-CM. Patients in both treatments showed similar improvement in depressive symptoms but patients receiving IPT-CM reported significantly better marital adjustment, marital affection and sexual relations than did individual IPT patients (Foley et...

Psychological Treatments

Behavioral therapy (CBT) focuses on the restructuring of myths or distorted thinking about sex. Couple therapy may be necessary focusing on interpersonal issues including trust, respect, as well as ways to relate to each other, which foster sexual attraction. Psychodynamic therapy is often recommended to address issues in the woman's past developmental period. Particular attention to family of origin and relationships to parental figures is often needed. A further component is that of systemic therapy sexual differentiation, that is, the ability to balance desire for contact with the partner vs. desire for uniqueness as an individual. Schnarch (79) suggests that this is extremely important for healthy sexual desire.

Structure of the Family

In the U.S. and many industrialized societies, the structure of the family looks quite different than it did a half a century ago. In fact, fewer people live in families as traditionally defined and more live in nonfamily households. The rise in nonfamily living can be traced to earlier nest-leaving by young adults (Goldscheider, Thornton, and Young-DeMarco 1993), to delayed marriage and to nonmarriage, to continued high rates of marital disruption with lower rates of remarriage (Cherlin 1992), and to increases in independent living at older ages (Michael, Fuchs, and Scott 1980). In 1998, 15 of all people lived in nonfamily households, 10 alone (U. S. Bureau of the Census 1999 Table 16), compared to 6 in nonfamily households in 1950 (U.S Bureau of the Census 1955).

Clinical classification of depression

A 44-year-old married man came to the attention of a junior hospital psychiatrist after taking an overdose in the context of marital breakdown. He described depressed mood, anhedonia, and continuing suicidal ideation. Although he made a fairly rapid improvement sufficient to return to work, his symptoms only partially resolved. The psychiatrist tried a number of antidepressants and some cognitive therapy to little avail, and, determined to explore all treatment options, he was thinking of suggesting ECT or referral for dynamic psychotherapy.

Power and Empowerment

Marriage timing is also a key issue in recent fertility in Japan delayed marriage age has substantially influenced falling fertility rates in that country. Here again, changes in women's position have been central to these demographic changes. Tsuya (2000) has examined marriage behavior of young Japanese women and has argued that women view marriage more negatively than do men, and unmarried women residing with their parents are particularly likely to see the negative consequences (both psychological and material) of marriage. The subordination of and constraints placed on women within marriage makes these issues particularly salient. As Tsuya has phrased it, ''the institution of marriage is not serving the needs and desires of adult Japanese, especially

Communication Training

Relationship distress between partners can give rise to a dramatic increase in the risk of clinical depression. About half of the women who are in treatment for depression report marital difficulties. In some cases individual therapy for the depressed patient is inadequate and needs to be supplemented with treatment efforts focused on the relationship issues. Three controlled studies examined the effect of couple's therapy (communication training) on depression (Beach & O'Leary, 1992 Emanuels-Zuurveen & Emmelkamp 1996 Jacobson et al., 1991). There was no overall difference in mood improvement between patients in the individual cognitive behavioural therapy versus those in couple's therapy but relationship improvement was significantly higher among patients in couple's therapy. These findings suggest that depressed patients with marital difficulties are better served by couple's therapy than by individual cognitive behavioural therapy. Moreover, the additional benefit in terms of...

Prioritization of Treatment Strategies

Behavioural couple therapy (BCT) is as effective as individual CBT not only with alcohol abuse but also with depression and anxiety disorders (Emmelkamp & Vedel, 2002). Because of Mick's early retirement and the consequences this was going to have on their relationship, and taking into account their overall low marital satisfaction, we decided to offer Dianne and her husband BCT, focusing on the drinking problem as well as their relationship. If still needed, the spouse-aided therapy for alcohol abuse could be supplemented by spouse-aided therapy for depression or anxiety. Because Dianne had already started using Acamprostate, we agreed that she would continue using the anti-craving agent during the course of our treatment.

Structuring The Treatment In

Are told that keeping them alive is the highest priority in the treatment. The second target is to decrease therapy-interfering behaviours (behaviours on the part of the therapist, such as missing appointments, beginning the session late, taking calls during session, or on the part of the client, such as non-compliance, coming late, missing appointments) that reduce the motivation of the other party to continue in the therapy. Addressing problems in the relationship head on and immediately, reduces therapist and client burnout and dropout. The third Stage 1 target addresses other quality of life issues, such as substance abuse, eating-disordered behaviours, marital difficulties, vocational issues or high-risk sexual behaviour. While reducing the targeted behaviours, clients work to enhance their capabilities, and therefore maintain a reduction in the targeted behaviours by learning new behaviours in skills training.

Rqgeliq Saenz and M Cristina Morales

The unique experience of these and other minority groups has major implications for the United States population. Race and ethnicity are important dimensions in understanding the demography of the United States, for racial and ethnic groups vary tremendously with respect to population composition, population processes, as well as their life chances and access to opportunity structures. Referring to the social world of African Americans, Weeks (2002 411) notes that ''being of black-African origin in the United States is associated with higher probabilities of death, lower levels of education, lower levels of occupational status, lower incomes, and higher levels of marital disruption than for the non-Hispanic white population. The inequality of groups in American society along racial and ethnic lines has important implications for the future of the United States because of the major demographic transformations already underway in this country. Of the 75.8 million inhabitants that the...

Theoretical Issues

The proximate determinants paradigm provides a second organizing framework. It rests on the observation that the sequential biological process is influenced through only a few mechanisms, specifically, variables that influence sexual activity, the likelihood of conception, and the likelihood that conceptions result in live births (see Davis and Blake 1956). Bongaarts and Potter's (1978) operationalization of the proximate determinants demonstrates that most fertility variability between populations and over time can be accounted for by the following four determinants (1) marriage and marital disruption (as indicators of the segments of the life cycle when women are sexually active), (2) postpartum infecundability (the period after a birth without ovulation its length is determined primarily by the duration and intensity of breastfeeding), (3) use and effectiveness of contraception, and (4) induced abortion. Three other determinants are

Causes and symptoms

Attitudes concerning age and psychological factors, commonly associated with ED in the past, have changed in the last two decades. Although the prevalence of ED increases with advancing age, ED is no longer regarded as an inevitable consequence of aging. Whereas most cases of ED were once considered primarily psychological and or psychiatric in origin, it is now well-recognized that organic, non-psychological causes of ED play a much more significant role in the development of ED. Most researchers agree that pure psychological (emotional) mechanisms are causative in 15 to 20 of cases with organic causes responsible for at least 80 of ED cases. In a number of cases, the situation is mixed, with significant secondary psychological and social components such as guilt, depression, anxiety, tension or marital discord being present in addition to one or more underlying organic components.

Psychosocial Factors Related To Womens Orgasm

Relationship factors such as marital satisfaction, marital adjustment, happiness, and stability have been related to orgasm consistency, quality, and satisfaction in women for review see Ref. (65) . These findings are correlational in nature. Clearly, a satisfying marital relationship is not necessary for orgasm, particularly given rates of orgasm consistency in women are higher during masturbation than with a partner (60). A satisfying marital relationship most likely promotes orgasmic function via increased communication regarding sexually pleasurable activity, decreased anxiety, and enhancement of the subjective and emotional qualities of orgasm (65).

Longterm Effects Of Cancer Diagnosis And Treatment On Survivors Family Members

The literature on the effect of cancer diagnosis and treatment on family members is sparse.74 Of studies in this area, most have focused on the impact of cancer soon after diagnosis, during recurrence, or at the terminal phase of the disease.75-77 One study shows that partners of men with prostate cancer, generally from small convenience samples, report more distress than their sick partners, but also believe that their partners are more distressed. The only reviewed study of long-term prostate cancer survivors found that couples' health-related QOL was associated with marital satisfaction.61 Distress was inversely related to levels of family support. The men's focus of concern, on their sexual functioning (i.e., impotence), was not shared to an equal degree by their non-sick partners.78,79 The most relevant study included

Psychological treatments see Chapter 22

Marital therapy may be indicated, because conflicts in a marriage often become more obvious when the partners are brought into constant contact by retirement or restricted mobility. Special techniques for this age group include reality orientation (RO) and reminiscence therapy.

The Significance Of Childrens Mental Health Problems

Long-overdue concern for the mental health of children and adolescents is gradually coming to the forefront of the political agenda. For example, in the United States the new millennium witnessed White House meetings on mental health in young people and on the use of psychotropic medications with children. A Surgeon General's Conference on Children's Mental Health resulted in an extensive report and recommendations (U.S. Public Health Service, 2001a), closely followed by a similar report on youth violence (U.S. Public Health Service, 2001b). Increasingly, researchers in the fields of clinical child psychology, child psychiatry, and developmental psy-chopathology are becoming attentive to the social policy implications of their work and in effecting improvements in the identification of and services for youth with mental health needs (Cicchetti & Toth, 2000 Weisz, 2000c). Greater recognition is also being given to factors that contribute to children's successful mental functioning,...

Postmenopausal Dyspareunia

Brenda (age 55) and Alexander (age 57) had been married for 30 years when they were referred to a sex and couple therapy clinic for dyspareunia by her gynecologist. A comprehensive pain assessment revealed that Brenda experienced a rubbing, cutting, and sometimes burning pain upon penetration and a deeper dull, pulling pain during intercourse. She reported that the pain started 4 years ago, at a time when she began to experience hot flashes and irregular periods, with an increase in intensity of the superficial pain over the last

Environmental adversity and sexual maturation

Suggested that environmental adversity is associated with a decreased quality of parental care that directly leads to early menarche and earlier onset of sexual activity in human females. There is strong evidence that insecure attachment is more prevalent in populations living under conditions of risk and uncertainty (i.e., poverty and inequality Belsky, 1997a McLoyd, 1990 Repetti, et al., 2002 and see above). The age of menarche is influenced by the quality of family function (Ellis et al., 1999), number of major life events (Coall and Chisholm, 2003 Surbey, 1990) family conflict (Graber et al., 1995 Moffitt et al., 1992), marital conflict (Kim and Smith, 1998a,b Wierson et al., 1993), and negative family relationships (Ellis and Garber, 2000 Kim et al., 1997). Despite some exceptions (Campbell and Udry, 1995 Graber et al., 1995), the majority of studies show that childhood psychosocial stress predicts earlier menarche. There is strong evidence for familial influences on sexual...

Behaviour Therapy Rationale

As with other models of therapy for depression, behaviour therapy has also been employed as a couples therapy. When compared with individual CBT (Jacobson et al., 1991) found no difference in capacity to reduce depressive symptoms and reported that only those receiving behavioural marital therapy (BMT) demonstrated a significant improvement in marital adjustment. Similarly, Beach & O'Leary (1992) found BMT and CT to be equally effective in reducing depression and superior to waiting list controls but only BMT improved the marital relationship. Both studies found that depressive symptoms were mediated by marital adjustment, suggesting a specific mechanism of change whereby depression reduces with increase marital satisfaction. Behavioural marital therapy progresses through three stages, employing social learning, behavioural change and cognitive techniques. The initial phase concentrates on the patterns of reinforcement that exist within the couple and aims to eliminate the...

Teaching An Introductory Course In Personality Assessment

Students should be taught that each type of data collected in an assessment has its strengths and its weaknesses. For example, observational and history data are especially helpful in assessment, but these sources can also be quite misleading. Anyone who has done marital therapy or custody evaluations has experienced a situation in which each spouse's story sounds quite plausible, but the husband and the wife tell opposite stories. Such are the limitations of history and observational data. People typically act differently in different situations, and they interpret their behaviors and intentions, and the behaviors and intentions of others, from their own biased vantage points. It soon becomes obvious that additional methods of understanding people are necessary in order to avoid the types of errors described above. Adding test data to the history and observational data should increase the accuracy of the assessment and can allow access to other key variables involved in knowing...

Validity Research On Computerized Narrative Reports

The validity of computerized reports has been extensively studied in both personality testing and psychiatric screening (computer-based diagnostic interviewing). Research aimed at exploring the accuracy of narrative reports has been conducted for several computerized personality tests, such as the Rorschach Inkblot Test (e.g., Harris, Niedner, Feldman, Fink, & Johnson, 1981 Prince & Guastello, 1990), the 16PF (e.g., Guastello & Rieke, 1990 O'Dell, 1972), the Marital Satisfaction Questionnaire (Hoover & Snyder, 1991) and the Millon Clinical Multiaxial Inventory (MCMI Moreland & Onstad, 1987 Rogers, Salekin, & Sewell, 1999). Moreland (1987) surveyed results from the most widely studied computer-based personality assessment instrument, the MMPI. Evaluation of diagnostic interview screening by computer (e.g., the DIS) has also been reported (First, 1994).

Cognitive Therapy for Different Populations and in Different Settings

Individual cognitive therapy is the most common format, although couples, family, groups and organisational consultancy formats have also been developed. In individual therapy it is common to involve spouses, friends, parents or others, either as informants or as people who can help the client change (see Baucom et al., 1998). Cognitive couple therapy has been shown to be acceptable and effective in depression in one spouse, chronic interpersonal problems, and marital problems (Baucom et al., 1998 Dattilio & Padesky, 1990 Epstein & Baucom, 1989). Cognitive therapy in group format has been shown to be acceptable and effective for depression (Robinson, Berman & Neimeyer, 1990) and social phobia (Heimberg etal., 1993).

Lifelong Delayed Ejaculation

By vibratory stimulation (93) of the penis an ejaculation can be induced. The percentage of success to cure lifelong delayed ejaculation, however, is unknown. Electrical stimulation (94) of the internal ejaculatory organs by a transrectal electrical probe (electro-ejaculation) is mainly used to obtain semen in paraplegic men. This intervention is extremely painful in men with normal sensation and is not an option to treat lifelong delayed ejaculation. Masturbation exercises have been extensively used in the treatment of delayed ejaculation. Kaplan (85) describes a method in which a period of undemanding sensate focus exercises is followed by a period in which a man masturbates, initially alone and subsequently in circumstances in which he becomes gradually closer to his female partner. Once the patient has had an orgasm in the presence of his partner, he masturbates in a number of steps in which the penis is closer to the vagina during masturbation. Finally, he enters the vagina and...

Partner Relational Problem

Relational problems (Paniagua, 1998). For example, a Hispanic female may experience negative communication with her husband regarding their expectations regarding the role the wife should play at home if she does not share the values of machismo and marianismo. Similarly, an acculturated individual (e.g., someone who shares most values, lifestyle situations, and beliefs in the American culture) may experience marital conflicts with a less acculturated partner who recently emigrated to the United States from a country with very distinct values, beliefs, and lifestyle situations. Another example of the application of V-Code 61.1 in a cultural context is the impact of intertribal marriages on the discipline of their children. For example, in the Hopi tribe the wife is primarily responsible for the management of children, whereas in the Cherokee tribe both husband and wife share the discipline of children. Thus, a Cherokee woman who marries a Hopi man would express marital discord with...

Homosexual Relationships

The conception of aging homosexuals as lonely, depressed, and sexually frustrated is an overgeneralization. Living in a predominantly heterosexual society creates problems for older homosexuals, but there are also compensations. Among the problems are discrimination against homosexuals by society as a whole, disrespect from family members, inability to have their marriages sanctioned by law, and, in some cases, lack of visitation rights with their children by former marriages. One advantage of homosexuality, particularly in older adulthood and especially for lesbians, is the availability of partners (Raphael & Robinson, 1980). One often hears about wedded bliss or matrimonial harmony, but these are obviously not descriptive of many conjugal relationships. It may be that marriages are made in heaven, though it is doubtful unless one is a bride of Christ or married to the church. Duration is certainly not a sure-fire indicator of marital happiness. Most people who get married...

Interpersonal Psychotherapy Rationale

Various prognostic factors have been examined in relation to IPT. Marital adjustment in the NIMH study was reported to show significant improvement with treatment but no specific interaction with treatment type and was mediated by change in depression (Kung & Elkin, 2000). Poorer pre-treatment adjustment was revealed as an indicator of poor prognosis at the end of treatment and poorer end-of-treatment marital functioning was a negative indicator for follow up. Imber et al. (1990), reporting on the same sample, revealed the importance of tailoring therapy to patients' strengths as IPT produced better outcome in those patients with lowest social dysfunction at the start of treatment. Repeated studies have examined the impact of co-morbid anxiety symptoms and while GAD symptoms have been found to slow response to treatment they have not been associated with poorer outcome (Brown et al., 1996). Panic agoraphobic symptoms however have been associated with higher early termination rates...

The Politics And Misunderstandings In Personalityassessment

Another issue is the place of assessment in the clinical psychology curriculum. For many years graduate curricula contained many courses in assessment. The number of courses has gradually been reduced, in part because the curricula have become crowded with important courses mandated by the APA, such as professional ethics, biological bases of behavior, cognitive and affective aspects of behavior, social aspects of behavior, history and systems, psychological measurement, research methodology, techniques of data analysis, individual differences, human development, and psychopathology, as well as courses in psychotherapy and in cultural and individual diversity (Committee on Accreditation, Education Directorate, & American Psychological Association, 1996). Courses have also been added because they have become important for clinical training (e.g., child therapy, marital therapy, health psychology, neu-ropsychology, hypnosis). Therefore, there is sometimes little room for assessment...

Methods Are Hypothetical Constructs

Technical, nonpsychological, or different than substantive variables. But method is a summary concept for a multitude of ways in which we obtain psychological information. The result of a method has psychological significance as does the method itself. Returning to the neighbor example, self-report, other-report, and observation were introduced as methods because the different procedures collected the method's provided data. Yet the data are psychological data and the status of these data is the same for each method. They are indicators of assumed causes (altruistic personality, need for approval, marital satisfaction, sympathy). Methods are sets of causes and different sets (methods) contain different elements (causes). Causes as components of a method do not differ from causes that appear in psychological theories. Both the causes of substantive models and the causal components of methods are hypothetical constructs. Therefore, methods (self-report) can be imbedded in psychological...

Addiction

Disease model adherents believe that the compulsion to use is genetically and physiologically based and that, while the disease can be arrested, the disease is progressive and, if unchecked, fatal. Researchers have found the sons of alcoholics to be twice as prone to alcoholism as other people. Among pairs of identical twins, if one is alcoholic, there is a 60 chance that the other will be also. In spite of an apparent inherited tendency toward alcoholism, the fact that the majority of people with alcoholic parents do not become alcoholics themselves demonstrates the influence of psychosocial factors, including personality factors and a variety of environmental stressors, such as occupational or marital problems.

Multidetermination

Ual differences in altruistic personality and by individual differences in need for approval. Individual differences obtained with Method 2 might be caused by individual differences in altruistic personality and by my sympathy for the neighbors. Liking versus disliking may create a perceptual bias, leading me to overestimate or underestimate the help. Individual differences obtained with Method 3 might be caused by individual differences in altruistic personality and by individual differences in marital satisfaction. In a happy relationship, a neighbor's spouse might overestimate her husband's help, whereas in an unhappy relationship, she might underestimate that help. Several important conclusions can be drawn from this analysis First, a method usually measures more than one cause or factor. Second, the results obtained with different methods will converge to the extent that they share causes or factors. In our example, the common factor was altruistic personality In addition to this...

Discussion

However, samples of breast cancer survivors have demonstrated less profound cancer impact.22 As noted, breast cancer survivors may have a quality of life as good as or better than age-matched control women.23 Similar rates of sexual dysfunction are seen between breast cancer survivors and postmenopausal women who have not had cancer.24 Marital breakdown was no more common among women after

Marriage

Beginning in the mid-1960s, however, states in the U.S. substantially liberalized and simplified their divorce laws. One of the key features of these changes was a shift from divorce based on fault or mutual consent to unilateral divorce, which required the willingness of only one spouse to end the marriage. Most states also adopted some form of ''no-fault'' divorce, which eliminated the need for one spouse to demonstrate a violation of the marriage contract by the other. The shift to unilateral or no-fault divorce laws was accompanied by a surge in divorce rates in the U.S. At least some of the increase in divorce rates appears to have resulted directly from the shift in the legal environment in which couples marry and decide to remain married or in which they divorce (Friedberg 1998). The link between divorce rates and laws that permit unilateral divorce has led several states to develop alternative, more binding, marriage contracts, such as covenant marriage. The institution of...

Measures

Two basic measures of marriage and divorce are based on events occurring in a calendar year as captured by vital statistics. The marriage rate is measured as the number of marriages in a year per 1,000 population. The divorce rate is measured as the number of divorces in a year per 1,000 population. These rates present snapshots of marital events, which can be compared across years to see if the events of marriage and divorce are taking place at a faster or slower rate than in the past and compared across countries to answer the same questions. These crude rates are sensitive to differences in the characteristics of the populations being compared, which limits their utility. MARITAL HISTORY LIFE TABLES. Marriage and divorce can be studied using life table techniques (Preston, Heuveline, and Guillot 2001). If research questions are addressed to surviving members of a cohort, first marriage can be treated as a single-decrement process, with marriage the only mode of leaving the...

Problem Analysis

When conducting a macroanalysis, the therapist charts the various problem domains while seeking possible connections between the problems. For instance, a patient may be depressed and also experience marital distress. It is of importance to ascertain whether the depression is associated with the marital problems, or whether these are two independent problem areas. If there is a connection between the depression and the marital problems, the therapist should examine the nature of the relation. If the marital distress is fundamental to the depression it may be appropriate to direct early treatment efforts to improving the relationship. With some patients the relation is reversed the depression causes the marital distress. In this latter case it is not useful to first address the distress. For an illustration of a macroanalysis we refer the reader to Figure 4.3.

Gender and Fertility

The connections between gender and fertility at the community societal level are clearly strong but complicated. Mason (1993 30ff) has hypothesized seven major links between women's position and fertility. These include the ways that women's economic and social independence might delay age at marriage and how women's access to knowledge and technology can influence women's innovative behavior,'' including fertility regulation. A series of potential links revolves around the way that women's position in society can influence motivations to limit fertility within marriage. Women will be less interested in limiting the number of children when their roles, status, and respect derive particularly from their position as mothers and when they are dependent on males (husbands and sons).

Case study

In talking with them of the history of their premarital sexual relationship, it became apparent that she particularly appreciated the fact that she did not have to fend-off his sexual advances as she had to do with other men, and more often than not, she would take the initiative sexually. The difference in sexual interest became more apparent immediately after their marriage. To her great distress, no sexual activity occurred on their honeymoon and since then, had been only a few times each year.

Marital Adjustment

According to the Maudsley Marital Satisfaction Questionnaire (MMQ) (Arrindell, Emmelkamp & Bast, 1983). Mick was clearly more negative about their relationship than Dianne as is evident from the fact that Mick had a score of 42 while Dianne had a score of 20 on marital dissatisfaction. The Level of Expressed Emotion (LEE) (Cole & Kazarian, 1988) showed that Mick experienced little emotional support from his wife. Dianne was more positive, finding Mick supportive in some areas. To establish if there was any form of violence or fear of violence, verbal or physical abuse, we used the Conflict Tactics Scale (CTS) (Straus, 1979) and interviewed both partners. In the past year Dianne had hit her

Macroanalysis

Concerning Dianne, there were four major related and intertwining issues her drinking, her depressive mood, her anxious symptoms and marital problems. In addition, Dianne met criteria for both the avoidant personality disorder and the obsessive-compulsive personality disorder.

Evaluation

During the course of the treatment Mick's marital dissatisfaction decreased from 41 to 22 (MMQ). Dianne's score did not change significantly. At post-treatment both partners were near the cut-off point differentiating martially distressed from non-martially distressed couples. The LEE showed Mick to experience more emotional support from his wife compared to the situation before treatment. Dianne seemed to find Mick somewhat less supportive then before treatment.

Ill Partner

Tanya and Phillip (not their real names) were each 27 years old and married for the first time for 3 years. They did not have children, did not smoke or use street drugs, and neither had had major health problems in the past. They described themselves as Christian and although they did not have intercourse before marriage, they could not keep their hands off each other during that time and enthusiastically engaged in a variety ofsexual activities. Their sexual experiences in the early years of their marriage were uncomplicated and highly pleasurable to both. In the second year of their marriage Tanya developed an episode of mania. When they were initially referred (because of lack of sexual desire on Phillip's part), she had been taking maintenance medication for the previous 12 months. When Phillip was seen alone (they were initially seen together), he professed his continuing love for Tanya but at the same time said that she was not the same person whom he married. He hoped that...

Diagnosis

Low sexual desire is usually seen as a symptom of andropause ADAM PADAM. To explain the desire change, a great deal of emphasis has been given to laboratory values, especially alterations in T. However, the typical history has received much less attention. Only one study of aging men seems to have examined various manifestations of sexual desire. Schiavi et al. reported on 77 volunteer couples who responded to an announcement concerning a examination of factors contributing to health, well-being, and marital satisfaction in older men. Three groups of men were compared 45 -54, 55 -64, and 65 -74. The following were conclusions related to the issue of sexual desire (i) sexual interest, responsiveness, and activity was noted even among the oldest men (ii) increasing age was associated with ED, but not with HSDD or PE (premature ejaculation) (iii) the following frequencies consistently decreased with age desire for sex, sexual thoughts, maximum time uncomfortable without sex, coitus, and...

Empirical Findings

In addition, the marital context for women still affects labor force participation, although wives' participation rates have risen relative to the 1950s (Gurak and Kritz 1996). Brinton, Lee, and Parish (1995), examining East Asian cases, found that where labor demand increases, married women joined the labor force, even where working wives had not been culturally accepted. Marital instability and divorce also lead to more continuous female employment (South 2001).

Multiproblem Milieu

Problems in the family climate and parenting behaviour interact with more objective and demographic family risks. These are, for example, poverty, lower socio-economic class, early and single motherhood, parental divorce, alcoholism, and criminal record. Taken individually none of these factors explains much variance (Hawkins et al., 1998 Lipsey and Derzon, 1998). However, their accumulation and interaction with other risks constitutes a multi-problem milieu of high risk for delinquency (Rutter, Giller and Hagell, 1998). Such accumulations are found outside the family as well. For example, deprived, disintegrated and violent neighbourhoods represent a delinquency risk (Catalano et al., 1998 Gorman-Smith and Tolan, 1998). Such a milieu contains social models for delinquency, violence, truancy, drug use, and so forth. However, the influence of the wider social context must be seen in interaction with family and individual factors. Wikstrom and Loeber (2000), for example, found that a...

Cohabitation

An estimated 50 of all couples living together in heterosexual relationships today are nonmarried cohabitants. Most of these relationships are fairly short-term arrangements that end in either marriage or separation, whereas others may last for years (Macklin, 1988). In some instances, the cohabiting couple decides to forego a traditional marriage ceremony and become common-law partners by declaring themselves to be married. They combine their assets, file joint tax returns, and can only dissolve their common-law marriage by divorce or death. In states that recognize common-law marriages, the spouses can collect insurance, social security benefits, and community property after a stipulated time has expired. However, fraudulent claims resulting from common-law marriages have led many states to outlaw them (Marriage, 1993).

Matrimonial Disputes

For divorce, as we have fully recognised, is not a single circumscribed event, but a multistage process of radically changing family relationships. This process begins in the failing marriage, sometimes many years prior to the marital breakdown, may include one or more separations within the marriage, and extend over years following the decisive separation and the legal divorce. Rodgers and Pryor (1998) estimate that 19 of children born to married couples will experience parental divorce by the age of 10 and 28 by age 16. Haskey (1993,1994) states that in the early 1990s in England and Wales 160 000 families with children under 16 went through the experience of parental divorce. Of these children one in three was under 5, and a further 7000 were between 5 and 10 years. Dunn, Deater-Deckard, Pickering, O'Connor, Golding and Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) Team (1998) have looked at a community sample to examine the implications for children. The risk factors...

Divorce

Nothing lasts forever love dies, a spouse dies, and many marriages end in divorce. Marital discord occurs for a number of reasons, 11 of which are listed in Figure 6-5. Not all of these reasons necessarily lead to divorce, but they are now more likely to do so than in previous times. In the last century, marriages ended in death as often as in divorce, but divorce has become the principal cause of marital breakups in this century. Legal grounds for divorce in previous times adultery, alcoholism, brutality, desertion, and nonsupport are still acceptable reasons, but incompatibility is a more common reason, and no-fault divorces are also becoming fashionable. Unlike former times, when the marital roles of husband and wife were relatively fixed and men and As shown in Figure 6-6, divorce rates for both men and women are at a peak in the early forties. The average number of years of marriage before divorcing has been declining and is now slightly over 6 years. Approximately 40 of first...

Families and Friends

In addition to being smaller, the families of today are different in other ways from what they used to be. Social changes have been accompanied by higher educational levels, higher divorce rates, a greater number of single-parent families, more mothers employed outside the home, earlier and more extensive retirement of older family members, and more leisure time and entertainment. Such developments have affected the attitudes, values, behaviors, and expectations of all family members, and particularly the younger ones. This chapter considers many of these structural and dynamic changes in the population and how they have affected the activities and ambitions of individual members of families.

Child Rearing

Because a child competes for their attention and often dominates their lives, the parents' personal happiness and satisfaction with their marriage frequently suffers (Wallace & Gotlib, 1990). Mothers in particular complain that they are tied down by children and that children limit their ability to work outside the home and achieve financial stability (Jacoby, 1982 Roper Organization, 1985). In a study by Thompson and Walker (1990), one-third of the mothers who were interviewed reported that they derived no meaning or enjoyment from motherhood, and another one-third had mixed feelings about it. These negative responses should, however, not be interpreted as meaning that parenthood is without rewards. A child brings love, joy, and meaningful-ness to most mothers and fathers, and the process of bringing up a child can have a positive effect on the development of both the child and the parents. For example, Lowenthal, Thurnher, and Chiriboga (1975) found that the parents they...

Postnatal depression

A 29-year-old professional woman lived comfortably with her husband and two small children. Her third pregnancy was unplanned, but the couple seemed to accept it well. Midway through the pregnancy, the husband was made redundant, and they began to experience some marital difficulties. During the third trimester, the patient became increasingly tearful and tired. She had a prolonged and painful labour, but the baby was well, and breast-feeding was established satisfactorily.

African Americans

Poverty are higher, and incomes are lower than average. Affecting socioeconomic status is the fact that the percentage of blacks who graduate from high school is significantly lower than that for whites. Quality of life, as indicated by a greater rate of substandard housing, a larger percentage of single-parent families, a lower marriage rate, and a higher divorce rate, is poorer for blacks than for whites. Ladner (1971) attributes some of these problems to the long period of slavery and segregation to which blacks were subjected in the United States. Because black slaves were not permitted to marry, a family system that deemphasized legal marriage, tolerated premarital intercourse, and accepted illegitimate children developed. The contemporary African-American community, with its emphasis on the extended family, strong kinship bonds, and intrafamilial cooperation, also originated in the historical experiences of African-Americans in Africa and, subsequently, in America.

Hispanic Americans

Hispanics, consisting primarily of a mixture of white, black, and Native American racial origins, are the second largest (and predicted to soon become the largest) ethnic minority in the United States. Of Hispanic-Americans, approximately 64 are Mexican, 11 are Puerto Rican, 5 are Cuban, and 13 are of Central or South American origin. Hispanic-Americans have the highest birthrate and the lowest divorce rate of all ethnic groups, but their per capita income is substantially lower than average (see Figure 8-3). In general, the incomes of Cuban-Americans are higher than those of Mexican-Americans, and the incomes of Mexican-Americans are higher than those of Puerto Rican-Americans (Torres-Gil, 1996). The percentage of Hispanics who have graduated from high school is also substantially lower, the unemployment rate is higher, and a greater percentage live below the poverty line than non-Hispanic-Americans ((U.S. Bureau of the Census, 1995).

Causes of stress

Social scientists have observed that the increased isolation of married couples from extended families and friendship networks increases strains on the marriage. The rising divorce rate in the United States has been attributed in part to the loss of social supports that once helped to keep married couples together. The experience of divorce then adds to the stress level on the former spouses and the children, if any. A long-term study at the University of Pittsburgh has found that divorce is associated with a higher rate of premature death in men.

Experimental Studies

Another method of research sometimes used to assess a variety of aspects of children's functioning is experimental studies (usually laboratory) in which some aspect of the situation is experimentally manipulated. For example, in studies of young children's regulation, investigators sometimes have manipulated the degree to which the mother is in the room or available to the child when the child is experiencing a potentially stressful situation (Diener & Mangelsdorf, 1999 Grolnick, Kurowski, McMenamy, Rivkin, & Bridges, 1998). In marital conflict research, studies have examined children's responses to conflict in a laboratory setting by having children view a video that portrays marital conflict or by having actors in a lab engage in varying forms of conflict in the child's presence (Cummings, Iannotti, & Zahn-Waxler, 1985 Davies, Harold, Goeke-Morey, & Cummings, 2002). The obvious advantage of such methods is the degree of control over the potential influences on the child....

Future Directions

Given the physiological, cognitive, affective, and interpersonal complexity of dyspareunia, it is likely that no one cure for dyspareunia or for other chronic pain conditions will be found. Thus, we propose a multimodal treatment approach for all types of urogenital pain discussed in this chapter, tailored to each patient, and including careful assessment of the different aspects of the pain experience. Clinicians should also educate their patients as to the multidimensional nature of chronic pain so that the treatment of so-called psychological or relationship factors is not experienced as invalidating. Although pain reduction is an important goal, sexual functioning should also be worked on simultaneously through individual or couple therapy, as it has been shown that pain reduction does not necessarily restore sexual functioning (97).

Social Functioning

Overall, findings suggest that survivors of testicular cancer have good social functioning. While it is difficult to reach definitive conclusions (for the reasons previously discussed), when assessed, survivors generally report equal or more satisfaction with relationships after cancer treatment, compared to before treatment. For example, early efforts to describe marital satisfaction among survivors indicate that men are more likely to report improvement as opposed to deterioration in their relationship satisfaction.19 Gritz and colleagues36 also examined marital relationships among testicular cancer survivors by interviewing both the survivors and their wives. Results indicated that the majority of relationships were strengthened after the cancer experience. Fac tors identified as important for a couple's adjustment to cancer (good communication, spousal support, and marital satisfaction) all acted positively to facilitate relationship functioning. Other studies examining...

Closing Thoughts

Sons who are more or less likely to benefit from treatments, and the identification of variables that affect the outcome of treatments. Clinical research also involves the description of behavior problems and their associated features and variables associated with their onset, duration, intensity, or time-course (e.g., research on the characteristics and causes of eating disorders, conduct disorders, marital problems). Multimethod assessment (i.e., the measurement of clinical phenomena with various methods) is considered essential for good clinical research.

Validity

High convergent validity is not always the goal of research. Take, for example, a questionnaire measuring different facets of marital satisfaction. Spouses rate their own satisfaction and also their perception of the satisfaction of their spouse. If the aim of the test construction process was to develop a questionnaire that detects deficiencies in intraspouse perception and communication processes, the items with the lowest convergences might be the most interesting. In other words, method influences are not inevitably unwanted random disturbances (e.g., measurement error) but they can indicate valid and valuable information. A deeper understanding of method influences can enlarge our knowledge of the construct under consideration, and this knowledge, in turn, can help explain method effects, correct for method effects, and plan and conduct studies in which method effects are minimized or depending on the aim of the study considered maximized. Beyond the traditional search for...

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