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...

Developments in family therapy from neutrality to curiosity the use of narrative and a notknowing position

Family therapists have always been interested in the relationship patterns around an event and consider that by focusing on the relationship patterns around an event, rather than the event itself, new ways of thinking are triggered. Family therapy moved from an interest in the different relationship patterns or view points to a focus on the story an individual has about relationships - hence narrative therapy. The family therapist is interested in the multiple stories which can be told about the family and its relationships over time. Narrative therapy is particularly interesting as it links with attachment theory and the way an individual tells their story. In attachment theory, the more securely attached individual is able to tell a story with appropriate emotionality and from a position of self-reflection. In the same way in family therapy, the counsellor's curiosity, in the form of on-going interest and desire to understand, facilitates self-reflection and different thinking to...

Family therapy

Family therapy is a form of psychotherapy that involves all the members of a nuclear or extended family. It may be conducted by a pair of therapists often a man and a woman to treat gender-related issues or serve as role models for family members. Although some types of family therapy are based on behavioral or psy-chodynamic principles, the most widespread form is based on family systems theory, an approach that regards the entire family as the unit of treatment, and emphasizes such factors as relationships and communication patterns rather than traits or symptoms in individual members. The purpose of family therapy is to identify and treat family problems that cause dysfunction. Therapy focuses on improvement in specific areas of functioning for each member, including communication and problem-solving skills. Family therapy is often recommended when Before family therapy begins, family members are required to undergo a comprehensive clinical evaluation (interview) that includes...

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 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,...

Family and social factors

The main survivor from these ideas has been the concept of 'expressed emotion' (EE), whereby patients with schizophrenia who come from families who react strongly to their behaviours are known to be at increased risk of relapse. Family therapy (Pilling et al., 2002) can reduce the risk of relapse, but this result may not necessarily support the concept of EE, as the therapy could be operating in other ways.

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.

Enhancing Therapists Capabilities and Motivation

Comprehensive DBT can be modified for different settings. For example, an inpatient unit may decide to provide a comprehensive treatment, meeting all criteria through the different modes in the treatment. Capabilities can be enhanced on an inpatient unit through psychopharmacology, patient education and through skills training. Motivation on an inpatient unit is often improved by conjoint psychopharmocology and milieu treatment. Discharge planning with an emphasis on skills used for relapse prevention also supports the function of generalization as well as milieu, staff acting as skills coaches for clients on an inpatient or partial hospitalization unit. The environment in an inpatient unit is structured through the structuring of the administrative hierarchy as well as through family therapy and family education or accessing vocational financial support through social work services. Finally, in an inpatient DBT programme, therapists' capabilities and motivation are usually enhanced...

Psychodynamic psychotherapy

While many patients benefit from individual psychotherapy alone, some instances call for such additional therapies as family therapy, couples therapy, or group therapy in combination with individual treatment. A second treatment modality might be recommended when the patient's progress in individual treatment is highly dependent on relationships with significant others or with interpersonal relationships in general. Psychotropic (mood- or behavior-altering) medication may also be prescribed as an adjunct (help) to treatment in order to manage disturbances in anxiety level, mood or thinking. Whether additional treatments are recommended is based on the needs of the individual.

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

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).

Credibility and the Therapeutic Dyad

An Asian American therapist only needs to be bilingual and bicultural to be effective with a particular Asian American client. The consideration of diversity among Asian American clients applies equally to Asian American therapists thus, an acculturated third-generation Chinese American therapist may not necessarily share the cultural history or value system of a recently immigrated Chinese client from Vietnam. Another myth is that non-Asian therapists cannot be effective in working with traditional Asian clients or families. Jung discusses various techniques he uses in his Chinese American Family Therapy (CAFT) Model to gain the trust of Chinese American clients, many of which can be used by non-Asian clinicians.

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...

Debating the possibility of nondirectiveness

The struggle to find a framework for the interview in medical genetics is reflected by a number of authors who have put forward ideas to inform clinical practice. Diekman-Tapon (1999) has suggested an Object Relations Family Therapy as a model and Eunpu (1997) a Systemically-Based Technique. A shared decision-making model has been espoused by other authors (Elwyn et al., 2000) where both the patient and counsellor are involved in investigation and exploration, jointly understanding the story and each other. This means both would have responsibility for management decisions, diagnostic pathways and investigations.

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 probably...

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 and...

Cognitive Behavioral Approaches

DM has been used to effectively treat female orgasmic disorder in a variety of treatment modalities including group, individual, couples therapy, and bibliotherapy. A number of outcome studies and case series report DM is highly successful for treating primary anorgasmia. Heinrich (74) reported a 100 success rate for treating primary anorgasmia using therapist DM training at 2 month follow-up. The study was a controlled comparison of therapist-directed group masturbation training, self-directed masturbation training (bibliotherapy), and wait-list control. Forty-seven percent of the bibliotherapy subjects reported becoming orgasmic during masturbation compared with 21 of wait-list controls. In a randomized trial comparing written vs. videotaped masturbation assignments, the effects of self-directed masturbation training were further investigated (75). Sixty-five percent of women who used a text and 55 of women who used videotapes had experienced orgasm during masturba ion and 50 and 30...

Studies Of Psychological Treatments In Bipolar Disorders

Family or Couples Therapy Four small randomized trials all identified that family therapy may be an important adjunct to pharmacotherapy in BP. Honig et al. (1997) demonstrated that six sessions of a multi-family psychoeducational intervention (n 23) produced a non-significantly greater reduction in expressed emotion in the experimental as compared to the waiting-list control group (n 23). Van Gent, Vogtlander & Vrendendaal (1998) compared 'couples psycho-education' (n 14) with usual treatment (n 12) and found that those couples receiving the active intervention showed greater knowledge of BP and its treatment and improved coping skills at the end of the psychoeducation sessions and at six month follow-up. Glick et al. (1994) studied 50 inpatients of whom 19 had been admitted following a BP relapse. They demonstrated that those randomly allocated to additional family therapy (n 12) showed significant improvements in social and work functioning and family attitudes compared with those...

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...

Etiology Of Personality Disorders

A major development in social and biological sciences in the mid-twentieth century was the development of general system theory whose groundbreaking way of understanding complex systems was applied to communications theory, cybernetics, psychiatry, and was in part the impetus for the family therapy movement (von Bertalanffy, 1968). Von Bertalanffy's theoretical model has largely been incorporated into current psychological thought but remains of use. When we apply the tenets of general system theory to the elements of the biopsychosocial model, we have a powerful way of beginning to understand the interrelatedness of various elements and subsystems of the biopsychosocial model.

Cartwright D S 1957 Annoted Bibliography Of Research And Theory

Dandeneau, M.L. & Johnson, S.M. (1994). Facilitating intimacy Interventions and effects. Journal of Marital and Family Therapy, 20, 17-33. Feixas, G. (1992a). Personal construct approaches to family therapy. In R.A. Neimeyer & G.J. Neimeyer (eds), Advances in Personal Construct Psychology, Vol. 2 (pp. 217-255). Greenwich, CT JAI Press. Johnson, S.M. & Greenberg, L.S. (1985 a). The differential effects of experiential and problem-solving interventions in resolving marital conflict. Journal of Consulting and Clinical Psychology, 53, 175-184. Johnson, S.M. & Greenberg, L.S. (1985b). Emotionally focused marital therapy An outcome study. Journal of Marital and Family Therapy, 11, 313-317. Procter, H.G. (1981). Family construct psychology An approach to understanding and treating families. In S. Walrond-Skinner (ed.), Developments in Family Therapy (pp. 350-366). London Routledge & Kegan Paul.

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

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...

Nonhormonal Pharmacological Treatment of Low Desire Interest

The place of pharmacological management for women's complaints of low desire interest is undecided. This is because of broad normative range of women's appreciation of sexual desire, especially in the long-term relationship and because of the importance of women's subjective arousal in influencing and triggering their desire and the minimal focus until now on the whole entity of subjective arousal. Thus, the appropriate outcome criteria for a desire drug are unclear. Studies with bupropion hydrochloride have suggested benefit over placebo. Of 30 women with active drug, 19 improved during a 12-week double blind placebo-controlled study for nondepressed women having a spectrum of sexual complaints, including low desire interest (91). A more recent study, again of nondepressed women, this time diagnosed with hypoactive sexual desire, were treated in a single blinded manner and 29 responded to the active drug and none had responded to the initial 4-week placebo phase (14). The entity of...

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...

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...

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...

Complex Syndrome Treatment Goals

Parallel Interpersonal Therapies There are three major variants of treatment that focus on the interpersonal domain. The first engages one patient exclusively at a time in a dyadic patient-therapist medium, but centers its attentions primarily on the patient's relationships with others these techniques are known as interpersonal psychotherapy. The second set of techniques assembles an assortment of patients together in a group so that their habitual styles of relating to others can be observed and analyzed as the interactions among the participants unfold these techniques are known as group psychotherapy. The third variant is family therapy where established and ostensibly problematic relationships are evaluated and treated. Developed as a comprehensive modality of interpersonal treatment more than a half-century ago (e.g., see Slavson, 1943), the impact of group psychotherapy in molding and sustaining interpersonal behaviors has been thoroughly explored in recent decades. Clearly,...

General Multicultural Issues

However, the client might not agree to report that he or she has the AIDS virus (HIV) to anyone, minimizing the active role the client should play in making that report. Knowing that the client is heavily involved in church activities and that the client has already revealed to the therapist that he is homosexual, the practitioner might suggest that the client's perception of rejection could be real in the case of the church (for reasons explained above) but imaginary in the case of other members of the extended family and encouraged the client to play an active role in making that report at least in the case of family members he trusts. In this case, the therapist would recommend a reunion (i.e., family therapy) including those individuals the client identified as examples of extended family members who have provided instrumental and emotional supports to the client in the past.

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.

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.

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...

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

Psychological Practice Determining Individual Capacity to Participate in Mediation

Kingdom, social scientific research has helped to confirm the hypothesis that supportive interventions employed in family therapy and individual psychotherapy exert a positive influence over the outcome of the mediation process as well (Robinson, 1988). Victims in England, participating in face-to-face mediation with offenders, reported approximately 14 greater satisfaction as a result of this psychological informed modality than with less direct methods of confrontation and or reintegration (Umbreidt, 2001). Canadian investigators have noted increasing acknowledgment on the part of attorneys that psychological screening is an important pre-mediation function in successful dispute resolution (Girdner, 1990 Lee, Beauregard and Hunsley, 1998 McCoy and Hedeen, 1998).

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.

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 al.,...

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...

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 stressors...

Psychopathologic Assessment Can Usefully Inform Therapy A View from the Study of Personality

That different therapeutic approaches should be pursued with different patients and different problems is practically self-evident to the point of being trite, but given no logical basis from which to design effective therapeutic sequences and composites, even the most self-consciously antidogmatic clinician must implicitly lean toward one orientation or another. Of little consequence is what the actual syndrome or disorder may be a family therapist is likely to select and employ a variant of family therapy, a cognitively-oriented therapist will find that a cognitive approach will probably work best, and so on, including integrative therapists who are beginning to become a school and join this unfortunate trend of asserting the truth that their approach is the most efficacious. In spite of the self-evident admonition against fitting our patients into the proverbial Procrustean beds of our therapeutic approaches, it appears that our approaches continue to resonate more with where...

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.

Maintaining Flexibility

Taking a more integrative approach, Jung (1998) describes his CAFT model as an eclectic, multidimensional, comprehensive family therapy model in which family integration theory, general systems theory, and case management act as foundational theories, combined with crisis intervention and social learning theory (p. 57). Adding to the strategic use of various Western family therapy models and techniques, Jung asserts that family integration, which is the central goal in the CAFT, is based on the Taoist premise that everything in nature is relative and has an opposite, that life is neither all good nor bad, and that we can all learn from both difficulty and success. The overarching goal for CAFT is for the family members to find peace with each other and with the cultural differences between their country of origin and the country of settlement, and to live harmoniously and ethically with each other. Thus in order to find emotional, psychological, and spiritual harmony within the...

Treatment A Anorexia Nervosa

Psychotherapy may be provided individually or in groups. In younger patients with anorexia nervosa, who frequently live with their family of origin, family therapy is also used. Individual psychological therapies include cognitive behavioral psychotherapy, in which faulty cognition regarding eating and weight is examined, and psychodynamic or interpersonal psychotherapy, in which the patient's current interpersonal relationships with others are explored. Cognitive behavioral psychotherapy is described in more detail below.

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).

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

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...

Who attends the consultation

The questions which have been proposed are examples of what family therapists call 'circular interviewing'. The interviewing technique follows a circular or spiralling pattern where the feedback to the counsellor's question shapes the next question and so on. The counsellor is then both conducting the interview and responding to the family. It is perhaps important to point out that the technique applies to the conversation between counsellor and individual as it does to the interaction between counsellor and family.

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).

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.

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.

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.

Family roles and scripts and preselection

Preselection is a particular form of what family therapists call family scripts (Byng-Hall, 1995b) which refer to the beliefs and stories a family constructs about family relations. In genetic counselling, the scripts will be built around the meaning and interpretation the family have given to their family history and how the problem has arisen. The family tree is a useful format for their exploration. Where an abnormality appears de novo, the family has to construct a narrative to understand the event. This narrative may include elements of folklore or superstitions which are used to give meaning to chance happenings or illnesses. Part of the task of a genetic consultation is to facilitate the development by the family of a story which incorporates the genetic information. This might mean that an individual's original script may need to be changed to include accurate information about genetic inheritance patterns and a test result. The family security and flexibility will determine...

Annie Procter

Chris Evans, a psychoanalytic psychotherapist, family therapist, and child psychiatrist, brings together her psychological expertise with long experience of working with clients and counsellors in a genetic counselling unit. The result is a book that resonates far beyond its

About the Editor

Magnavita, PhD, ABPP, FAPA, is a licensed psychologist and marriage and family therapist in active clinical practice. A Diplomate of the American Board of Professional Psychology and Fellow of the American Psychological Association, he is the nominee or recipient of many awards for his work in the practice and theory of psychotherapy and personality disorders, on which he speaks at the national level. He is the founder of Glastonbury Psychological Associates, PC, and the Connecticut Center for Short-Term Dynamic Psychotherapy and is an adjunct professor of clinical psychology at the University of Hartford and lecturer at Smith College of Social Work. He authored Restructuring Personality Disorders A Short-Term Dynamic Approach Relational Therapy for Personality Disorders, and a text Theories of Personality Contemporary Approaches to the Science of Personality and was the volume editor of the Comprehensive Handbook of Psychotherapy Psychodynamic Object Relations Volume 1 and...


Age at marriage has risen substantially, divorce rates are high and stable, and rates of remarriage have fallen, so a larger proportion of adults are unmarried now than in the past. In 1970, unmarried people in the U.S. made up 28 of the adult population. In 2000, 46 of all adults were unmarried. In fact, the shift away from marriage has been so dramatic for blacks that in 2000, only 39 of black men and 31 of black women were married, compared to 59 of white men and 56 of white women (Fields and Casper 2001 Table A1).

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 interviewed...

Closing Comments

Functional Family Therapy. Monterey, CA Brooks Cole. Chamberlain, P. (1994). Family Connections A Treatment Foster Care Model for Adolescents with Delinquency. Eugene, OR Castalia. Dishion, T. & Kavanagh, K. (1989) The Adolescents Transition Programme (manuals and accompanying video vignettes). Eugene, OR Independent Video Services. Henggeler, S. & Borduin, C. (1990). Family Therapy and Beyond A Multisystemic Approach to Treating the Behaviour Problems of Children and Adolescents. Pacific Grove, CA Brooks Cole. Szapocznik, J. & Kurtines, W. (1989). Breakthroughs In Family Therapy With Drug Abusing Problem Youth. New York Springer.

Reflective frames

Adopting a different approach, Sarangi et al. (2004) have focused on the discourse analysis of interviews exploring what actually goes on in the consulting room. In their paper 'Initiating reflective frames in counselling for Huntington's disease', they consider that the counsellor is adopting a non-directive stance by constructing 'reflective frames'. These invite the patients to discuss their feelings and encourage them to span their past, present and hypothetical future. They identify six categories of counsellors' reflective questions non-specific usually used at the beginning awareness of anxiety about the disorder for the patient and their family decisions and how they are arrived at the impact of the result how the patient would disseminate the result and others to include coping and family dynamics. In their analysis of a series of interviews they found that the questions clustered at particular times in a Huntington's disease protocol. In the early stages, the questions...

Case Study

In retrospect, Rebecca had always been more sexually interested than Jim prior to their marriage, and in the early days, sexual frequency seemed not to be a problem. In accord with the psychiatrists' usual pattern of practice to see partners separately as part of an assessment, and in an effort to understand Jim's point of view, he saw Jim alone. The psychiatrist discovered in the process that Jim was in fact just as disinterested in sexual matters as his wife described. He had few thoughts about sexual issues, denied having sexual fantasies or dreams, masturbated rarely, and had never had any sexual experiences with other women (or men). Although Jim understood his wife's distress, he also thought that her sexual interest was excessive. With reluctance, Jim accepted the idea of referral to another psychiatrist who had a special interest in the care of people with sexual problems.

Natural Disasters

Loss of a spouse is regarded as the most stressful experience on the Social Readjustment Rating Scale (SRRS Holmes & Rahe, 1967). Considering the frequency and likelihood of such an event among those who have close long-term relationships, the relevance of research in this eld becomes evident. In fact, the only way to protect yourself from that experience is to die either before or at the same time as the partner.


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...

Family Interventions

Behavioural methods of change and problem solving are both common ingredients of family intervention. Family treatment of schizophrenia can decrease the relapse rate by almost 50 (Mari & Streiner, 1994 Pilling et al., 2002b). Studies show that there is an additional advantage of decreasing the family burden (Cuijpers, 1999). Family therapy has also been successfully applied in non-Western settings (Wang & Phillips, 1994 Xiong et al., 1994 Zhang etal., 1993).

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


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.


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.

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...

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).


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...

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.

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).

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.


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...

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.


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. Some addicts are helped by the combination of individual, group, and family treatment. In family treatment (or family therapy), enabling behaviors can be addressed and changed. Enabling behaviors are the actions of family members who assist the addict in maintaining active...


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...

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).

Genetic Counselling

The role of a genetic counsellor is to mediate between the rapid advances in molecular medicine and an individual's ability to understand and manage the risks of their inheritance. Counsellors therefore, need to be fully in command of the psychological impact of their communications. Written by a psychiatrist who later became a psychotherapist, this book is essential reading for counsellors of all disciplines. It examines the psychological processes involved and uses the framework of attachment theory to explain why people approach and respond to genetic counselling differently. Effective counselling requires a knowledge of the principles from individual and family therapy. In particular an in-depth understanding of empathy enables the counsellor to help the individual contain anxiety and process grief, and so facilitate decision-making or help with the effects of having a test result. The effect of counselling on the counsellor is examined creatively in order to enrich the interview...

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...

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...

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.


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...

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.

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. A...


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).

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.

Concluding comments

This book has worked from the premise of finding a language to describe and understand what genetic counselling is in practice. It has paralleled the genetic interview by putting forward a body of information before moving to exploring the meaning of its impact. It offers macro- and micro-skills and takes the view that a theoretical underpinning is essential to understand the meaning and consequently places genetic counselling within the frame of psychological stress. The theory explains general principles of the behaviour of individuals and families who are seeking counselling. Attachment theory explains the individual differences in approach and reactions and helps the counsellor consider the nature of the professional relationship. The general principles of psychotherapy and family therapy flesh out the interview principles with micro-skills which are specific to the tasks of genetic counselling.

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).

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...


Antidepressant and antipsychotic drugs are the most common treatments for psychotic depression and schizophrenia, but electroshock therapy is still employed in some cases. Antianxiety drugs are quite popular foi treating anxiety disorders, and short- and long-term psychotherapies are also used, Individual psychotherapy, behavioral and cognitive therapies, group therapy, and family therapy have all been found to be effective in treating a variety of patients young and old, nonpsychotic and psychotic, mildly and severely disturbed (Gatz, Popkin, Pino, & VandenBos, 1985). The goals of psychotherapy vary with the presenting symptoms and with other characteristics of the patient. In addition to the relief of symptoms, the goals of psychotherapy may include delaying physical and psychological deterioration enabling the patient to adapt to his or her current situation improving the patient's self-help skills and interpersonal relationships helping the patient become more self-reliant,...

Emotional Problems

Elliott (1999) in a thorough literature review concluded that there is some evidence for the efficacy of behavioural and cognitive-behavioural approaches to school refusal, with effective programmes entailing a high degree of family involvement. For example, Blagg & Yule (1984) found that behavioural family therapy was more effective than a hospital-based multimodal inpatient programme and a home tuition and psychotherapy programme for the treatment of school phobia. Behavioural family therapy included detailed clarification of the child's problem discussion of the principal concerns of the child, parents and teacher development of contingency plans to ensure maintenance of gains once the child returned to school a rapid return to school plan and follow-up appointments with parents and teachers until the child had been attending school without problems for at least 6 weeks. A year after treatment, 93 of children who received family-based behaviour Barrett, Dadds & Rappee (1996) found...


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

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