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? More here...

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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...

Family Concepts within the Family Therapy Approach

Not every family, or individual within a family, will need counselling however, an understanding of the major theoretical concepts of family will prove valuable in the counsellor's general understanding of the relationship of an individual within a family or families to concepts of bereavement. Family therapy has incorporated theory from various disciplines, including concepts from systems theories, structural approaches, symbolic interaction, and attachment theory and styles, and constructivism. All of these offer insights and tools for assessments and interventions, and can be adapted to counselling for those experiencing loss and grief.

Rule 3 Define the nature of your relationship with the person you want to help

1.What's your relationship to the person (parent, sibling, friend, teacher, significant other, spouse, employer) 5.How formal is your relationship (Are you an authority figure such as a parent, teacher, or employer who is more apt to be perceived as a superior than as an equal, or is the relationship equal in terms of power or status Are you peers in terms of age and life-stage ) Obviously, the nature of your relationship will influence how your efforts are received. If you're the parent of someone who is eating disordered, the ordinary stress, strain, and intensity of that parent-child relationship will color and magnify any reactions to your help. Even if you're 100 right, you might be met with more resistance and denial than a non-relative would. If your relationship with the person is more formal than personal, your efforts may be perceived as coercive or bullying. If you're confidantes, you risk jeopardizing the closeness of the relationship if the person isn't yet ready for...

Family Therapy Theory and Practice

The theory and practice of family therapy has been built on the foundation of the fields of psychology and psychiatry. For this reason, in this section you will find some of the same thinkers and researchers who were pioneers in these fields. Family therapy evolved from marital couple therapy and from attempts to create more supportive family structures for mentally ill patients. Along the way, it integrated the therapeutic concepts and tools of other forms of individual and group psychotherapy. It also created some of its own, custom-made for families. The theories and practices of family therapy tend to focus on three areas Past family patterns The family therapist primarily examines individual behavior in the context of past family patterns, which may be based on conscious or unconscious motives. This category encompasses psycho-dynamic theory and its off-shoots. Theorists include Nathan Ackerman, Murray Bowen, Ivan Boszormenyi-Nagy, and Ross Speck.

Family Therapy with an Eye on the Present

In the 1960s, the here and now approach grew out of Gestalt, psychodrama, and client-centered therapies in which the client did most of the talking. Now referred to as experiential, this family therapy approach stresses present interactions between family members as a means of recognizing and rectifying problems of and between individuals. This approach relies on attachment theory as the basis for positive or negative family interactions. Abstract ideas and unconscious motivations or conflicts are less important. Emotions matter most. Family members' conscious feelings may hide intense, underlying emotions, creating an atmosphere of deadness in a family. The purpose of experiential family therapy is to promote emotional sensitivity and feeling expression by gaining emotional self-awareness and learning better interpersonal skills. Theorists who developed this school of family therapy tended to fall into one of two camps those who relied on the strength of their personalities and used...

Family Therapy

Family therapy can be helpful in changing family members' views of a patient's physical impairment and helplessness. As they cease to see the somatiz-ing patient as permanently or severely ill, parents and siblings may stop reinforcing illness behavior. In addition, important family stressors or dysfunctional family dynamics that are relevant in terms of the etiology of the child's symptoms may be revealed. In some cases of conversion disorder, strategic family therapy centered on symptoms such as pseudoseizures may improve symptom reporting (Griffith et al. 1989). Family therapy is designed not only to help the family support healthy functional behaviors and reduce support for pain behaviors but also to address family conflicts that may be causing stress for the child or interfering with efforts to cope with pain.

Why Family Therapy

The goal of family therapy is to identify and resolve issues and interactions in a family so that it can more adequately meet the needs of its members and function effectively in its surrounding world. There are advantages for a therapist to work with an entire family when one child is seen as having a problem, rather than treating the child as an individual Family therapy allows therapists to see the cause of a problem in a cross-sectional as well as a linear view. This is helpful when dealing with a complicated problem such as an adolescent's anorexia, which may in fact reflect other stresses in the family as well as stresses within the child. Family therapy allows interactions between family members to be seen with an objective mediator present who can point out problematic dynamics between individuals. Family therapy can eliminate secrets and covert alliances within a family by challenging family members to work together to face a problem. Family therapy usually takes less time...

Bowen Family Therapy

Murray Bowen (1913-1990) also advanced a theory of family therapy emphasizing the importance of individuals rectifying relationship patterns from earlier generations, but Bowen characterized this cross-generation inheritance as rooted in anxiety carried from one generation to the next. Anxiety, he said, is common to all human beings, but it can be either high or low based on how well previous generations handled their own anxieties. Bowen family therapy promotes individual differentiation of family members encouraging stronger self-identities among individual members. It encourages de-triangulation so that individuals recognize their projections onto another family member and cease making that person a scapegoat for their own anxieties.

Sociology and Psychiatry Some Paradigmatic Contrasts

By contrast, the assumption that mental disorder originates in the brains or other malfunctioning organs of individuals effectively turns the Mills assertion on its head by implying that the proper study of social problems is the study of personal problems. That is, certain social problems - e.g., school failure, drug and alcohol abuse, premarital pregnancy and marital disruption, unemployment and occupational instability, domestic violence, homelessness, and criminality, to name a few - result from the aberrant dispositions or inadequacies of individuals. One might conclude from this sort of orientation that the treatment - or incarceration -of the deficient and troubled individuals is the way to rid the society of some of its noxious problems. Of course, it is reasonable to suppose that social problems may contribute to personal problems and, once established among large numbers of disadvantaged people, personal problems exacerbate those that are social.

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).

When the Doctor Does Not Take Pain Seriously

You can also ask about a pain specialist or a pain consulting service, such as at a teaching hospital or in a hospital's anesthesiology department (see Appendix 1 for more resources on finding a pain specialist). You might say We have full confidence in you to supervise the cancer treatments, but we'd like to take advantage of the recent developments in cancer pain management. Not every doctor can stay abreast of every development in all cancer-related fields, such as pain and symptom control. We'd like access to state-of-the-art pain management techniques. Express your hope that including a specialist for pain management will eliminate concerns about distracting the oncologist from treating the cancer and will help preserve your relationship with the doctor.

Sociology of Mental Health

Sociology of mental health has been how inequalities in income, power, and prestige affect mental health. The results are clear low socio-economic status increases distress while high status enhances well-being (e.g. Link, Lennon, & Dohrenwend, 1990 Eaton & Mutaner, 1999 Dohrenwend, 2000 Mirowsky & Ross, 2003). Many reasons account for the strong association between socioeconomic status and mental health in addition to alienating conditions of labor including the degree of economic hardship, inability to reach desirable societal goals, and senses of inequity. The impact of poverty extends far beyond economic deprivation to encompass unstable and undesirable employment, physically hazardous environments, marital instability, and unhealthy lifestyles (McLeod & Nonnemaker, 1999). Economic inequality, and resulting social relationships, are a fundamental cause of health disparities, including mental health disparities (Link & Phelan, 1995). A continuing, unresolved, debate exists on how...

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

Psychotherapeutic Interventions

Family Therapy Family therapies attempt to alter interactions among family members for the purpose of improving the functioning of the family unit while also recognizing each family member as a distinct individual member of this unit. Medical family therapy is the biopsychosocial treatment of individuals affected by physical illness it emphasizes the collaboration among the medical team, the family, and the family therapist, with the goals of recognizing the impact of the illness on the family and providing a framework for working with the illness while promoting active involvement of the family in the management of the illness (Sholevar and Sahar 2003). Most families with a physically ill child adjust to the demands of living with the illness while maintaining an intact family structure however, this adjustment can be altered when an individual family member suffers from depression (Jacobs 2000). Family therapy may be an effective adjunct treatment for the physically ill child with...

Human Relationship Capacity

The next category, relatedness to other persons, involves an examination of how the child relates to you. While you are with the child, you should observe how he or she treats you as a person, how your relationship develops, and how differentiated it is. As is true for all these categories, observations belonging to this category begin in the waiting room. As you enter the waiting room and relax for a minute between patients, you want to observe both the interaction between the child and whoever brought him or her and the interaction between the child and others in the room. Is he or she being affectionate or withdrawn and aloof Is he or she making contact with others how much distance does he or she maintain from them Simply by watching for half a minute or so, you get an impression of how the child has negotiated all the available human relationships in the waiting room.

Therapeutic Interventions

Agree to continue to work on family conflict and addiction issues by regularly attending recovery groups and family therapy in aftercare. (25) 25. Help the client develop an aftercare program that includes regular attendance at recovery groups and the family therapy that is necessary to resolve family conflicts and maintain abstinence from addictive behavior.

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

Individual Psychodynamic Therapy

As formulated by Crisp et al. (1991), individual psychodynamic therapy aims at maturational issues associated with puberty and adolescence. In two trials of this modality, substantial improvements in patient groups (including adolescents and adults) were found in both medical nutritional recovery and psychological functioning (Crisp et al. 1991 Hall and Crisp 1987). In 1999, Robin et al. used ego-oriented individual therapy, a manualized form of individual psychodynamic therapy, in a small randomized clinical trial (RCT) comparing individual therapy and family therapy (described in the following section). Ego-oriented individual therapy devised for adolescents posits that individuals with anorexia nervosa

Concluding Comments

Eating disorders and their commonly associated medical problems frequently bring patients to the attention of pediatric psychosomatic medicine services. Brief mental health consultations should focus on clarifying the diagnosis, identifying relevant psychiatric comorbidity, assisting with management in the acute medical or psychiatric setting, and referring patients to specialized centers for follow-up care. For adolescents, family therapy is currently the best-studied treatment, although data support the use of individual approaches, in particular that of CBT for bulimia nervosa. Medications studied to date appear to be of limited utility for the primary symptoms of eating disorders, especially for adolescents. Mental health consultants should be particularly aware of the relative medical fragility of underweight adolescents with eating disorders and be knowledgeable of the behavioral and mental health interventions that are useful during inpatient admissions.

Life Course Perspectives Key Principles

The Intersection of Biography and History. Life course perspectives attend to elements of context that are often ignored or underemphasized by other conceptual frameworks. One of those is historical context. Elder's seminal Children of the Great Depression (1974), generally recognized as the work that first articulated life course perspectives, examined the effects of an historical event on lives in the short- and long-term, including the risk of mental health problems. Historical context takes multiple forms - not only highly visible events such as the Great Depression and wars, but also historical trends (e.g., increasing divorce rates) and changes in public policy (e.g., the deinstitutionalization of mental patients during the 1970s and 1980s). Not all life course studies focus specifically on historical context. Nonetheless, this principle is intended to remind all investigators that their

Assessment of Disability

Other medical and psychiatric problems in addition to the primary psychiatric disorder in question can result in work-related disabilities. Examiners should consider whether individuals have work-related impairments resulting from their psychiatric illness or another concurrent illness, such as substance abuse or depression. In addition, individuals involved in employment litigation or making disability claims are often not working. Secondary damaging effects typically arise when the beneficial personal, social, and financial aspects of work become unavailable. Often, financial and marital difficulties ensue. Examiners should distinguish impairment related to psychiatric illness from the consequences of not working (Gold and Shuman 2009).

Evidence Based Treatment Approaches

Once an episode of CVS has started, over 50 of children will require intravenous rehydration to avoid dehydration and acidosis (Chow and Goldman 2007 Li and Misiewicz 2003). Supportive measures include placing the child in a quiet, less stimulating environment and avoiding bright lighting, along with the use of antiemetics such as on-dansetron and sedatives such as lorazepam (Chow and Goldman 2007 Li and Misiewicz 2003 Li et al. 2008). The off-label use of triptans such as suma-triptan has been suggested as potentially helpful in the management of acute CVS episodes when administered early. Antipsychotic medications such as prochlorperazine have been demonstrated to be efficacious in the management of acute migraine (Siow et al. 2005) and have shown promise in the management of intractable pediatric migraine (Kab-bouche et al. 2001), raising questions about their potential utility in CVS, but clinical experience has apparently been uninspiring (Li et al. 2008). The use of proton pump...

Antisocial Impulsive And Borderlinenarcissistic Trends

The full range of personality disorders may be encouraged under conditions of cultural disintegration and rapid change. One reason for this may involve the loss of family cohesiveness, and the failure of children to receive necessary amounts of nurturance and consistent emotional support. Out of this comes a family structure that is virtually opposite to the traditional Confucian family that stresses structure, rules, cohesion, and marital stability. Although tensions can arise in a Confucian family, its supports and networks are able to buffer most encounters with adversity. To illustrate this point, cross-cultural research related to antisocial personality disorder shows that this form of psychopathology is rare or is nonexistent in cultures that have a Confucian family structure.50 According to some thinkers, the increasing prevalence of personality disorders and related forms of psychopathology is due to the combined effects of family and community breakdown. Temperamentally...

Theoretical Origins of Sociological Stress Research

Stress research has also contributed to many sub-disciplines of sociology through its systematic investigations of the proximal environments through which stratification affects health and well-being. Stressors are defined with reference to the geographic, organizational, and interpersonal contexts in which people live their lives, including the family, work, and neighborhoods (Aneshensel & Sucoff, 1996 Conger, Conger, Elder, Lorenz, Simons, & Whitbeck, 1992 Kohn & Schooler, 1983 Hill, Ross, & Angel, 2005). The resources with which people anticipate, avoid, and respond to stress are also attached to these contexts and are enacted within them. By defining and measuring major status-based experiences (e.g., financial deprivation), role strains and role conflicts (e.g., marital problems), and contextual stressors (e.g., neighborhood violence), stress researchers have taken from, and given back to, other sub-disciplines by developing tools with which to analyze the structure and content...

Copulatory frequencies

Intercourse declined with age, from a median value of twice each week (in men aged 16-24 years) to 0.75 times per week in middle age (45-49 years). Although the majority of sexual activity took place between married partners, and those in long-term relationships, Wellings et al. also found that 'among single people, more than a quarter of men (28.1 per cent) and close to one-fifth of women (17.5 per cent) reported two or more partners in the last year while 13.1 per cent of men and 6.1 per cent of women reported more than two partners, a pattern that contrasts markedly with that of married individuals.' The tendency for males to have a larger number of partners over time is interesting and probably does reflect a biological predisposition for males to be more sexually active. As an aside, I mention here a most interesting hypothesis advanced by Symons (1979) regarding high frequencies of sexual activity with multiple partners among some male homosexuals. Symons suggests that this...

New Base of Competence

By doing all this thinking and preplanning, you've effectively changed the focus of your life from problems to solutions, from negatives to positives. You've made a commitment to therapy and taken the first steps. You're now at a potential transition point in your relationship with family and friends you've confronted yourself and your eating disorder you've admitted the need for help and taken the steps to find it you've shown your strength and guts, and your willingness to grow. You've proven that you can be assertive and self-aware your words and actions show that you can be capable, rational, and assume appropriate control of some aspects of your life. You are building a foundation of competence success breeds success, and confidence comes with competence.

Implications for Treatment

A number of potent and effective pharmacological treatments are available for the mood disorders, as well as empirically-supported psychotherapeutic treatments, notably cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for depression. For depressive disorders a combination of medication and psychotherapy is likely to have the best results, although many people use one or the other. For bipolar disorders psychological treatment is often combined with or secondary to medication management if the client is willing to utilize pharmacotherapy. A variety of empirically supported psychological treatments are available for the bipolar disorders, including psychoeducational interventions to enhance medication compliance, CBT, marital and family therapy (including Miklowitz and colleagues' family focused treatment), as well as interpersonal and social rhythm therapy.

Psychosocial and Emotional Complications

Maternal depressive symptoms are elevated in families in which a child has asthma (Bender and Zhang 2008 Waxmonsky et al. 2006). In a sample of 242 children with asthma, ages 7-17, family observation ratings and self-reports of depressive symptoms indicated that maternal depression was linked to child depressive symptoms by way of negative parenting and to asthma disease activity by way of child depressive symptoms (Lim et al. 2008a). Similar patterns of findings have been identified for paternal depression and marital conflict (Lim et al. 2008b). Thus, family distress and asthma disease activity influence one another in mutual effect. Regardless of where the cycle begins, the reverberating impact of asthma on family disruption distress, and vice versa, constitutes a downward spiral that requires effective intervention to stem increasing asthma morbidity and mortality.

Stress Reduction Programs and Psychosocial Intervention

Researchers are beginning to empirically test family-based interventions. Given that the family provides the main caregiving, problem-solving, stress-buffering (or stress-exacerbating), and developmental relational contexts for the child, the most effective treatments will likely have at least some family-based component. Family interventions based on improving problem solving (Walders et al. 2006), family empowerment for optimal illness management (Canino et al. 2008 Warman et al. 2006), and developmentally sensitive management interventions (Tal et al. 1990) have all shown promise. Incorporating family therapy into asthma group interventions has also had positive results in a randomized waitlist-controlled trial (Ng et al. 2008).

Psychosocial Adjustment

Understanding issues that can arise during various stages of psychological development can enhance therapeutic interventions. For example, with newborn screening and early diagnosis, a child and family need to learn early to cope with the illness related symptoms and complex, time-consuming treatment regimens. Discovering a sense of difference was a central phenomenon described in one study of children with cystic fibrosis during middle childhood years (D'Auria et al. 1997). In adolescents, delayed physical development due to cystic fibrosis may lead to poor body image, low self-esteem, and isolation. They may experience their physical symptoms as being intrusive and having negative impacts on peer activities. In young adulthood, long-term relationships are burdened with fears about prognosis and fear of rejection if the patient becomes ill. and Lester 2002 Quittner et al. 1998). A meta-analysis found evidence that parents of children with cystic fibrosis have decreased marital...

Family and Social Functioning

The effect of pediatric heart disease on mothers appears to vary depending on the level of reported stress and the type of coping used to address these stressors (Davis et al. 1998). A stressful component of parenting a child with a heart defect is the decision-making process associated with the heart surgery, which may cause caregivers and families to experience significant psychological distress, role reorganization, and remodeling of functioning (Lan et al. 2007). Maternal attachment style has been associated with maternal and child psychiatric outcomes. For example, maternal avoidant attachment has been associated with the deterioration of maternal mental health and marital satisfaction, as well as child emotional difficulties and poor self-image at age 7 years (Berant et al. 2008).

Mental Health Treatment Considerations

Despite the burdens of heart disease and its associated treatments, children and adolescents have the capacity for healthy functioning and resiliency. Nevertheless, many youngsters with these illnesses may present with developmental, social, and or emotional vulnerabilities. Due to a lack of literature on psychotherapy and psychopharmacological interventions related to heart disease, child mental health clinicians responding to these vulnerabilities must rely on the general mental health treatment considerations for youngsters with physical illness. Comprehensive reviews of individual psychotherapy, family therapy, and psychopharmacological treatments for youngsters who are physically ill can be found in Chapters 28, 29, and 30, respectively.

Transfusion Of The Wrong Blood 1951 1955 1972

Medical reasons) which they said led to the postpartum hemorrhage and for the transfusion error which they claimed had triggered the events that led to their marital breakdown. On appeal, most of their claims were dismissed, except that she was awarded 20 000 compensation to be paid by the hospital for the negligence of its employee in mixing up the bloods10.

Behavioral Treatments

These treatments focus on behavior and use plans and practices that will modify toxic behavior. Therapy sessions can be individual (one on one) with the counselor, in groups where many patients interact with a trained leader, or in family therapy where family members form the group. In individual therapy, more time can be devoted to the patient's specific needs. Group therapy, however, can be more economical because six to eight patients might share the cost of the therapist. Also, the more experienced members of the group can be mentors and models for newer patients, and the public nature of the process, where admissions of failures are open, and advice can come from many, can be powerful. Family therapy can be effective when the patient is either at home or have family nearby, and they can be recruited to assist in the treatment process.

Bring out the best in the Maybe Person

Surface conflicts and clarify options. Patiently explore, from the Maybe Person's point of view, all of the options and obstacles involved in the decision. Listen for words of hesitation like probably, that could be, and I think so as signals to explore more deeply. If the person is worried about how you will feel should he or she decide something, provide reassurance that you will be fine and it won't adversely affect your relationship.

Review of Empirical Research Using a Functional Perspective

In one study, for example, Wilson and Ross (2003) had undergraduates evaluate their current self and a self from the beginning of the term (i.e., a fixed time ago), which was couched as being either psychologically close or psychologically distant. Individuals in the psychologically close condition recalled their past self as similar to their current self (i.e., self-continuity). Those in the distant condition retrieved their past selves as inferior to their current self (i.e., self-enhancement). This research suggests that people not only use memory to maintain continuity but attempt to view recent selves as positive and continuous with their current self, while downgrading more distant past self memories as needed so as to feel more positive about themselves in the present (i.e., upward comparison). This enhancement adjustment in reflecting on the past occurs in other contexts as well, such as judging marital satisfaction (e.g., Karney & Frye, 2002). Thus, the...

Marriage and Symphonies

Awaiting the verdict of the high court in Dresden, Schumann chose the day before Clara's 21st birthday, September 12, 1840 for their marriage in the village church of Schoenefeld, near Leipzig. They began writing a household and marriage diary together and collaborated on The Springtime of Love (opus 37).

How Do Seizures Affect Reproductive Endocrine Function In

Reproductive endocrine dysfunction is common in men with epilepsy.45-48 Hyposexuality, the most common clinical finding, is often a cause of great concern and, not infrequently, of marital difficulties. Its recognition is thus important, particularly because it is often treatable.

Impact of Pregnancy on the Patient

Postpartum depression, or the postpartum blues, may be related to the diminishing of excitement after delivery, the loss of sleep during labor, anxiety about the ability to care for the child, perineal pain, feeding difficulties, and concern about appearance. Fortunately, postpar-tum depression is usually self-limited and remits within a week. Women at greatest risk for the development of postpartum depression are those with an unwanted pregnancy and those with marital difficulties. Sympathetic reassurance and support can help a woman return to her baseline state.

Deciding What You Expect to Accomplish by Helping

It may mean one thing to you and something entirely different to the object of your attention. Your role will vary depending on your relationship with the person, the severity of the eating disorder, the level and intensity of ongoing therapy, and how much energy you choose to expend. It's impor

The OKeeffe Years 19161946

After his divorce, they married because he wanted marriage. She maintained her name. Several years into their relationship and after their marriage, O'Keeffe became severely depressed. She had already achieved considerable recognition and was financially secure yet her life and marriage unraveled. She recovered and her dependency on Stieglitz lessened she knew the worst side of him as well as his genius for encouragement. She stayed in the marriage until his death but spent significantly less time in New York and found a second home in New Mexico. In 1929 he established his last gallery, An American Place, which remained open until one month before his death in 1946. He showed his own photographs and those of Ansel Adams and Eliot Porter as well as the regulars of the Stieglitz circle.

Toward Ecological Modernity

On the human front, the Amish have no poverty, no crime, and almost no violence. Their rates of mental disturbance and suicide are far lower than those found outside their culture. Some Amish youths experiment with alcohol, but alcoholism is almost nonexistent among adults. Marital conflict is quite low and marriages never end in divorce. The people themselves are never subjected to large dehumanizing institutions, such as factories, big schools, nursing homes, and mental hospitals. The family tends to be a tightly knit unit that cares for everyone, regardless of age or degree of infirmity. They do not have insurance policies since the people are each other's insurance.

Couples and Family Skills

New York Viking Penguin. Another down-to-earth treasure for creating a satisfying marriage. Markman, H., S. Stanley, and S. L. Blumberg. Fighting for Your Marriage Positive Steps for Preventing Divorce and Preserving a Lasting Love. San Francisco Jossey-Bass. From conflict resolution to increasing fun. Practical. Based on solid research. Prevention and Relationship Enhancement Program Resources for a Loving Relationship. P.O. Box 102530, Denver, CO 80250-2530 (1-800-366-0166 www.prepinc.comj. Fighting for Your Marriage and other books. Four excellent, affordable videos help develop communication skills, solve problems, and promote intimacy. Well-researched and respected, PREP is not therapy but is educational and preventive in nature. Includes self-taught programs, workshops, and coached programs.

Prevalence and incidence of disturbances of sexual functioning

Marital disharmony was reported by 57 of the dysfunctional patients compared to 15 of the control group (Sabhesan & Natarajan, 1989). Of the spouses, 62 developed clinically recognisable depression and 28 showed symptoms of anxiety. A random trial among these patients indicated that counselling, education and behavioural therapy were helpful. The females' partners rated their sexual satisfaction as significantly lower after the injury as compared to their evaluation of themselves before the injury (Gosling & Oddy, 1999). Two of the women did not complete the postinjury questionnaire since both reported a complete cessation of their sexual relationship. Another 12 rated their sexual relationship as worse since the injury, three as the same, and only one as improved. Seven women reported that their partner's level of sexual interest had decreased since his injury, seven reported no change, and three reported an increase in interest. Comparison of the female partners' ratings of marital...

Therapeutic Approaches in Child Psychology

Today's mental health practitioners must use all the resources and methods at our disposal to help children cope and thrive. Here you'll find an overview of the theories and therapeutic practices used in individual psychotherapy for children and adolescents. Family therapy involving children with their parents and siblings under the guidance of a family therapist is then covered in its own chapter. We conclude by using general systems and ecological transactional and chaos complexity theories to view the whole child in the context of his or her society. We introduce the concept of juvenile ageism as a way to get the big picture on what's ailing today's families. Finally, with all these tools, we invite you to join us in making the world a better and less perplexing place for our children.

Cybernetic Epistemology

Cybernetics evolved into in what came to be known as 'second-order cybernetics,' which went beyond the useful but mechanistic concepts of negative and positive feedback. Second-order cybernetics moved from the study of observed systems to the study of observing systems. The fundamental role of the observer or inquirer in every inquiry became central, as cybernetics moved into the field of epistemology. Cybernetic episte-mology was later to make a considerable impact in the field of family therapy, and in the sociology of Niklas Luhmann. Cybernetic epistemology holds that every statement is always made by somebody. The speaker knower cannot be left out of

The Internets Impact on Clinical Psychiatry

As Internet technology makes more medical information available to the public, relationships between patients and physicians are changing. Patients often do not tell their physicians about what they learned or did online (Hart et al. 2004). Today, patients go online to research their symptoms and their illnesses, often arriving at the doctor's office with printouts or information they learned online. Pharmaceutical manufacturers have also been using the Internet for direct-to-consumer advertising of prescription medications. When a RealAge quiz became a popular link among users of social networking sites, a journalist found that the quiz was a clearinghouse for several large drug companies allowing them to use almost any combination of answers from the test to find people to market to, including whether someone is taking antidepressants, how sexually active they are and even if their marriage is happy (Clifford 2009). Social networking sites for health, such as PatientsLikeMe (http...

Know I should make more time for myself and my marriage but I feel uncomfortable and guilty about leaving my child with

Parents may feel guilty about leaving their child at all, but it's important to spend time focused on yourself and on your relationship with your spouse. You can teach a babysitter or relative how to take care of your child's special needs. You can also contact teachers at local special education schools or contact psychology departments at local colleges for students majoring in special education. Other contacts include your local autism organizations, chapters of ASA or the ARC (formerly known as the Association for Retarded Citizens).

Interpretation or Meaning of the Stressor

When listening for the precipitant of a crisis, it is important to understand the meaning of even minor stressors in the context of a patient's life. The robbery in Melinda's community had a personalized meaning to her that reawakened old wounds and PTSD symptoms, fueling a major emotional crisis. The following sequence of events, filtered through the lens of Melinda's select past personal experiences, created this current crisis. On learning of a local robbery, Melinda perceived a threat to her home and safety. This precipitant inundated her with traumatic memories of the hurricane and its aftereffects, which destroyed her home and her relationship. She felt anxious, insecure, and emotionally numb, and she was newly avoiding crowded places. The turmoil of her earlier relationship was being reenacted in her current marriage. Her nightmares interrupted her sleep, and she began using alcohol to fall asleep and quell her anxiety. Her alcohol abuse contributed to insomnia and feelings of...

The Divorce and Final Years

Sara had experienced depressions throughout her life. In later years she lost weight. She suffered from insomnia, although during her creative periods she would work on her poems during the night, and she also had trouble getting up in the mornings, typical symptoms of depression. She took Veronal as a sleeping tablet. Her moods varied with the seasons. Her depressions were worse in winter, and she hated the cold weather since it brought on her respiratory illnesses. As she grew older, external events led to an intensification of her depression (such as the marital problems of her friends, the Untermeyers, and the suicide of their son).

Family Psychoeducational Approaches

In summary, psychoeducational programs demonstrate moderate improvement in illness outcome and psychosocial functioning among ill children, siblings, and parents. The beneficial effects occur across illnesses and appear to be greater when illness care requires daily interventions and when illnesses have greater severity. However, situations in which there are significant relationship problems or behavior issues require more individualized and intensive treatment, including family therapy.

Family Psychotherapy

Family therapy has been described for situations in which family relationships are conflictual, the ill child or a sibling is exhibiting poor emotional or behavioral adaptation, or the family is having significant difficulty setting limits that ensure effective illness care or satisfactory developmental outcomes for the ill child or siblings. Methods of family therapy to address poor parenting, poor parental collab Table 29-6. Indications for referral for family therapy Family therapy has been used in the treatment of behavior and relationship concerns in pediatric physical illness and pediatric psychosomatic disorders for the past 30 years (Minuchin et al. 1978 Sargent 1983). There are a variety of family therapy techniques such as structural family therapy (Minuchin 1974 Minuchin et al. 1978), narrative therapy (White 2007 White and Epston 1990), and collaborative therapy (Madsen 2003) that may hold promise with these families. However, although benefits in terms of improved...

CARENurturance and Social Bonding

Another realm of human distress management where such chemistries might find a place is in marriage therapy. A cogent answer has recently been provided for the age-old question What makes some marriages happy, but others miserable The most powerful answer is to be found at an affective level those couples who have the social-emotional skills to make each other feel better tend to thrive whereas those who facilitate negative feelings get themselves into self-sustaining cycles of misery (Gottman et al., 2002). This immediately raises the issue of how social-skills learning might be utilized in conjunction with agents designed to facilitate the affective endpoints they desire. For instance, oxytocin can facilitate the intensity of natural social reward (Panksepp et al., 1999). Might such stimulants for social-neuropeptide systems be able to facilitate psychotherapeutic interventions that aspire to promote social skills to help solidify affectively positive interactions, and thereby...

Object Relations Theory

A more recent theoretical focus of psychodynamic family therapy is object relations theory. An object is someone who is loved. Relations between two people in the present are shaped by residues of strong relationships with past objects (persons) that have been internalized by each person in the form of internal objects. The importance of object relations in family therapy is that it enables psychody-namic family therapists to understand intergenerational relationships and marital choices. It stresses the importance of working with unconscious forces in addressing dysfunctional family patterns.

Behavioral Parent Training

In this model, family therapists function as educators teaching parents new behaviors they can use to socialize and manage their children. They also help improve the self-esteem and well-being of parents. As a first step, problem behaviors of children and parents are identified. Lectures and role playing are used to train parents to use better parenting behaviors. This type of psychosocial parenting program has been shown to be particularly effective in helping families of low socioeconomic status.

More Grist for the Mill

Other theoretical approaches in treating family problems that have added valuable techniques and concepts to the field of family therapy include . Structural family therapy Salvador Minuchin and his colleagues took a systems approach to family dynamics. Family members are given instructions and homework to do between sessions. Treatment focuses on removing symptoms by problem solving. Strategic family therapy Milton Erikson (1901-1980) and later adherents to this school emphasize clarity about what needs to be changed in a family and then they address that single issue. It's also called brief therapy in that it is highly directive and goal-focused. Change doesn't require insights or consideration of family history. Problems are solved by revamping family rules and changing the family culture from a competitive stance to a cooperative one. Solution-focused family therapy Drawn from the ideas and writings of Gregory Bateson (1904-1980) and Michel Foucault (1926-1984), solution-focused...

Physician with Alcohol Use Disorders

Male physicians outnumber female physicians in studies of substance use disorders. Risk factors used in other patient groups apply to physicians as well (see online discussion of causative factors). The pattern of physician abuse differs from that in the general population by the increased use of alcohol, benzodiazepines, and prescription opiates (Hughes et al., 1992). Much of the prescription drug use is self-prescribed. Impairment is generally noted first in the alcohol-abusing physician's family and social life. Marital discord, relationship problems, and heavy drinking at social events can progress to work dysfunction and impairment (Talbott et al., 1987). The physician's thinking initially becomes impaired in spatial and constructive skills, along with negative effects on memory. Verbal skills are maintained, although cognition is affected as drinking continues. An alcoholic physician will frequently turn to benzodiazepines for relief of anxiety or stress symptoms. Further...

Obstructive Sleep Apnea

Some patients described as loud snorers do not snore during sleep studies. In such cases, snoring may be intermittent and related to alcohol use, body position, or allergies. Loud snoring that cannot be verified with objective assessment is sometimes an indication of marital problems.

Iiiiiiiii 2 4 6 8 10 12 14 16 18 Vaginal length

Does the thickness of the human penis have any significance as regards sexual selection during human evolution If human penile morphology evolved to promote pleasurable stimulation of the female partner, there might be at least two avenues of selective advantage. Firstly, if enduring relationships between the sexes with long-term reproductive benefit in terms of offspring survival are facilitated by pleasurable sexual activity, then penile morphology might be adaptive in this context. However, it will be recalled that in the monogamous and polygynous non-human primates, males tend to have the least specialized penile morphologies, despite the occurrence of long-term sexual relationships in such species. There is some evidence that women rate the thickness and length of a partner's penis as significant factors in their sexual satisfaction (Stulhofer 2006). Human mate choice and long-term relationship decisions are immensely complicated, however. Cross-cultural studies indicate that...

Psychosocial and Spiritual History

Because the perpetrator often accompanies the victim to the interview, ask any other person present to leave while you speak to the patient. Begin with the following direct question ''Since domestic violence is so common, I've begun to ask about it routinely. At any time, has your partner hit, kicked, or otherwise hurt or frightened you '' If the patient answers in the affirmative, encourage her to talk about it. Alternatively, you may ask, ''Do you feel safe in your relationship '' Always listen nonjudgmentally to encourage the patient to continue talking about the episode. Showing support is very important. A statement such as ''You are not alone'' or ''Help is available for you'' shows empathy. It is crucial to assess the danger to the patient as quickly as possible before she leaves the medical facility. If the patient is in imminent danger, determine whether she can stay with friends or family. A shelter for battered women may be an alternative. Finally, provide the patient with...

General Arousal States and Mood

In addition to the relationship of biological cycles, brain, and biochemical substrates to mood, more general variations in the autonomic nervous system and the skeletal-muscular system are probably related to mood (cf. Levenson, 1983). Research demonstrating this relationship has been done, but not to any great extent. Two studies of interest in this regard were conducted by Levenson and Gottman (1983, 1985). These investigators asked married couples to discuss a variety of marital situations on videotape while being monitored with physiological sensors (cardiovascular, skin conductance, and somatic activity). Next, these couples separately viewed the videotapes, and continuously adjusted a rating dial representing a scale from very negative to very positive feelings as different segments appeared. From these data, it was possible to predict marital satisfaction, but only on the basis of broad composites of the physiological and affective data taken across situations. Greater general...

Exchange Relationshipspostmarital Depression And Divorce Culture

The motives for divorce in companionate marriages can be quite subtle. Rather than reflecting indifference to or disregard for the partner, they seem more related to unconscious existential assessments made about one's progress with the Dream. With pragmatism no longer able to justify marital continuity, the Dream has achieved as much importance as the marital participants themselves. The modern marriage partner is expected to do his or her part in making the Dream a reality. If both have similar aspirations along these lines, some semblance of harmony will prevail, but if one partner begins to lose sight of the Dream, the other is likely to interpret this as a form of mutiny or rejection. Sometimes this is explained away with the reasoning that they have grown apart, but in reality the split has little to do with growth. With increasing frequency, marital breakdown is the result of the partners' falling out of step in their wider journeys as consumers. The viability of marriage is...

Pratyusha Tummala Narra

The long-term implications for sexual assault, such as risk of anxiety, depression, suicidal ideation, eating disorders, substance abuse, and sexual dysfunction, have been documented by researchers and clinicians working with survivors.1,2,3 The internal life of survivors is often marked with feelings of shame, self-blame, and powerlessness, all of which contribute to challenges in self-care and establishing safe and fulfilling relationships.2 Sexual violence further involves stress that is rooted in social injustice and requires attention on individual, community, and societal levels. Despite these challenges, survivors find ways to cope with the extraordinary demands of the aftermath of sexual violence. told you what happened to me (the rape). You seem like you can handle it. I've always been a strong person, independent. This feels different in here to talk about this stuff. Maybe this is being strong . . . I don't know. Malcolm's statement indicates a movement toward a possibly...

What Can I Do If I Think Im Getting Manic

A manic episode can wreak havoc with a person's life. It can drain finances, ruin marriages and long-term relationships, destroy a person's physical health, produce legal problems, and lead to loss of employment. It can even lead to loss of life. The fall-out can be long-lasting William Coryell and his colleagues at the University of Iowa Medical Center (1993) found that the social and job-related effects of a manic episode are observable for up to five years after the episode has resolved itself.

The Adolescent Interview

It can be challenging to maintain your composure when a teenager discloses high-risk behavior to you. You need to help the teenager appreciate the risk that he or she is incurring at the same time that you support your relationship with your patient. One way to handle this is to invite the teenager to reflect on his or her own behavior

Spirituality Religion as a Healing Pathway for Survivors of Sexual Violence

Valentine, L., & Feinauer, L.L. (1993). Resilience factors associated with female survivors of childhood sexual abuse. The American Journal of Family Therapy, 21, 216-224. 21. Feinauer, L., Middleton, K.C., & Hilton, G.H. (2003). Existential well-being as a factor in the adjustment of adults sexually abused as children. The American Journal of Family Therapy, 31, 201-213.

Communications Systems and Structural Theories

Family setting in order to assess present behaviours and issues. Messages sent among family members are said to have report (content) and command (defining relationships) functions. Jackson (1965) observed that one can discern what the family rules are by listening to the report and command functions and the regularity of these types of family messages. These rules have the primary purpose of maintaining family homeostasis or balance. Homeostasis can be further understood by using concepts from general systems theory which has promoted the idea that a system is more than the aggregate of its parts. In terms of family therapy, this concept has been adapted to propose that a family system should be viewed as more than a collection of people, and that therapists should investigate what is helping to maintain the system. Symptoms are often considered to be mechanisms that maintain a dysfunctional system. Homeostasis (as a self-regulatory mechanism), involving positive and negative...

Interventions Using Psychosocial Data

In the provision of care within a biopsychosocial model, interdisciplinary teams, rather than solo practitioners, have the advantage, and physicians can have more positive impact on their patients' lives when they harness the wisdom of colleagues from other fields through referral or consultation. Depending on physician training, interest, and time, these basic categories of intervention can be supplemented by a wide range of psychosocial interventions, from family therapy to behavior modification.

Social Integration and Family Adaptation to Childhood Disability The Family School Autism Project

Severely compromising the ability of family members to develop and sustain critical social connections, both within and outside the home (Domingue, Cutler, & McTarnaghan, 2000 Gray, 1998 Moes, 1995 Norton & Drew, 1994). Integrative family activities, such as dinners together, weekend outings, and summer vacations, are often severely limited or curtailed (Fox, Vaughn, Wyatte, & Dunlap, 2002 Gray, 1998 Turnbull & Ruef, 1996), while marital discord may result as parents disagree on how to manage the cacophony of difficulties emanating from their child's pervasive developmental disorder (Fisman, Wolf, & Noh, 1989 Marcus, Kunce, & Schopler, 1997 Rodrigue, Morgan, & Geffken, 1990).

Work Leisure And Overeffort Pathologies

There are a variety of factors that contribute to the onset of workaholism. It has been said that this pattern of behavior can represent a compensation for fear of failure, a response to earlier deprivation, or an escape from intimacy. However, one factor that cannot be ignored is that our culture encourages and rewards this addiction.13 The associations between work and the fruits of material success have become so close that work can represent an indirect form of consumption and a symbolic enactment of the American Dream. At the same time, work fever, as it is sometimes called, carries many mental health penalties. It has been related to anxiety, stress, worry, hopelessness, frustration, grief, sleeplessness, and marital breakdown.14

Strategies for assessment and intervention

Counsellors are encouraged to familiarize themselves with additional strategies utilized by family therapists that can be adapted to situations of loss and grief. It is beyond the scope of this book to discuss all of these additional strategies. However, the following suggests some interventions that are especially relevant to grief counselling. Bowen (1974), who proposed that multigenerational issues could impose a grief that extended beyond the immediate nuclear family, encouraged an extended family history assessment of at least two generations. In addition to specific questions to gain insight into past family losses and the emotional integration of the family, the use of the geneogram is a valuable tool for both the counsellor and the family. Bowen believed that the present problem needed to be placed in the context of the multigenerational system. A geneogram helps the counsellor trace the patterns of family issues. Using the geneogram, it is necessary to pay attention to...

The Hierarchy Of Treatment Evidence

Patterns of affect, self regulation, and interpersonal behavior. Diagrams of these patterns are collaboratively developed and modified with the patient during treatment. This study demonstrated that about half of the patients who completed 24 sessions of CAT no longer met full criteria for the BPD diagnosis at the end of treatment. In addition, at six-month follow-up, the patients who no longer met BPD diagnostic criteria were more likely to be employed and involved in long-term relationships. These authors found that more severe BPD features, history of parasuicide, alcohol abuse, and unemployment, were predictors of poorer outcomes, highlighting the influence of pretreatment severity on outcomes in BPD patients. Mean follow-up assessment scores showed continued improvement at 18-month post-treatment, but high attrition rates prohibited statistical analyses of follow-up assessments beyond the 18-month point. Another quasi-experimental study (Rathus & Miller, 2002) compared a group of...

Effects of Stress and Depression on Asthma

A series of multimethod (self-report, clinician report, family observation) studies has demonstrated that the chronic stress of negative family emotional climate, marital conflict, and negative parent-child relationship contributes to child anxiety and depression, which in turn are associated with increased asthma disease activity (Lim et al. 2008 Wood et al. 2006, 2008). These findings are consistent with a longitudinal study in which Klinnert et al. (2008) reported that a negative emotional environment was associated with active asthma and adjustment problems at age 4 in a high-risk population of children whose parents have asthma.

Psychological intervention

Entry in her notes says that this should not be attempted until 6 months stability on medication, providing she is motivated and can then be assessed . However, on consultation with a psychotherapist, it was agreed that such an approach was worth considering and was started relatively early in the course of her illness, initially using dynamic psychotherapy. Nicky accepted this for a number of months but complained that it was persistently dragging things up from the past and this was eventually discontinued after a further admission to hospital. Marital therapy was offered to Nicky and her husband, but not accepted. She was later offered psychological intervention using CBT with voices and participated in some individual work with a trainee under supervision and learned ways to lower voices giving greater control , but she ended this therapy when readmitted to hospital.

Development of the problem

Mary's difficulties appeared to have started about a year before her presentation to the services. She initially painted a rather confused picture, involving her husband and his daughter. She had at some time believed that her husband was going to evict her from the house that they shared, which he had bought. She no longer believed this so strongly, but was convinced that the daughter would throw her out of the house if her father died. This, she reported, was because the daughter was resentful of Mary replacing the daughter's own mother who had passed away. Mary had a number of overheard and third party conversations that seemed to back this up, involving comments made by the daughter and some confusion about whether her name was on the deeds of the house. The husband reported that this had been dealt with by a solicitor in the presence of Mary, and that there was no impropriety or confusion. He appeared to have gone to some lengths to make Mary feel secure within their marriage,...

Background and history

Mary left home at the age of 17 to get married to her first husband. While they were married he had a number of affairs, he physically and emotionally abused her, and was financially irresponsible, again making her feel vulnerable and insecure. He developed a depressive illness towards the end of their marriage, necessitating some time in a psychiatric hospital. She separated from her first husband when she was 48, and met her second five years later. She described this man as rather controlling at times, but extremely caring and loving.

Roles goals and plans

Ships are genuinely unhealthy and destructive, perhaps set about establishing newer, healthier relationships in their lives, as stressed in the interpersonal psychotherapy (IPT) approach (Weissman et al., 2000). This capacity to plan and develop healthy relationships has been dramatically demonstrated to be protective for individuals brought up in care (Quinton & Rutter, 1985) and for adults who had emotional and behavioural problems in childhood (Champion et al., 1995).

Mind content revisited

As we have discussed earlier, goals are hierarchically arranged. So, achieving the goal of being a good father requires the attainment of goals relating to various subsumed qualities. For example, achieving the goal of being around on Sunday afternoons to take the children to the park would, perhaps, facilitate the goal of being a good father. At other times goals are clearly inhibitory, so the goal of going to make a cup of coffee inhibits the short-term achievement of finishing this paragraph in the next 10 minutes. As with self-related goals, our representations of the goals of others can be mutually facilitative or inhibitory. In addition, the representations of goals of self and others may be either facilitatory or inhibitory. So, the woman who decides to leave her loving husband for another woman is pursuing her own goal in a way that inhibits the achievement of her husband's goal of a long and happy marriage, but most likely facilitates the achievement of her lover's goal to be...

Patient Encounter Part 1

A 52-year-old man with type 2 diabetes, hypertension, and dyslipidemia returns to your clinic for follow-up on his chronic disease states. When reviewing his history, he describes problems having satisfactory sexual intercourse. After further questioning, you determine that his dysfunction has progressively gotten worse over the last year. He is quite emotional and states that the problem is distressing and has caused significant marital discord. He wonders about those ads on television suggesting a pill.

Narcissistic Personality Disorder

In a long-term relationship with a narcissistic patient, the current splitting can be interpreted. This can be done by reminding patients that they previously praised the skill and abilities of the physician. Patients can be asked why they are now so critical and angry. When this is effective, it will allow patients to discuss their perception of insults to their self-esteem.

Before the crash

Rimel, Jane, and Bond (1990) summarised the cross-cultural research findings with TBI sufferers and note that someone sustaining a TBI is more likely to be male than female (two to three times more likely), between 15 and 29 years of age, single rather than married, unemployed, of lower socioeconomic status, living in a congested urban area, and more likely than the general population to have a previous history of alcohol and or drug abuse, marital discord, and learning disability (Kraus & Chu, 2005). Inevitably, this demographic picture has important implications for the focus of this discussion on the effects of TBI on emotional and behavioural functioning.

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...

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).

Treatment

Strong evidence supports the use of behavioral and cognitive-behavioral approaches for invasive procedures in pediatrics (Powers 1999). Cognitive-behavioral tools such as systematic desensitization and exposure can help in treating phobias that interfere with medical treatment or treatment adherence. Techniques such as guided imagery, progressive muscle relaxation, and self-hypnosis can help to alleviate anxiety related to symptoms and or medical treatment in both inpatient and outpatient contexts (Spirito and Kazak 2006). Treatments that integrate cognitive-behavioral approaches with family therapy have also been found effective in reducing symptoms of traumatic stress in adolescents with cancer and their families (Kazak et al. 2004b).

Family Factors

According to family systems theory, somatization may serve the function of drawing attention away from other areas of tension, such as marital conflict (Stuart and Noyes 1999). Minuchin et al. (1978) suggested that family enmeshment, overprotective-ness, rigidity, and lack of conflict resolution predisposed family members to the development of somatization. Parental overprotection has been associated with somatization and hypochondriasis (Noyes et al. 2002). Problematic parent interactions have been reported to be predictive of significant somatic complaints by children and adolescents (Borge and Nordhagen 2000 Lackner et al. 2004). R.J. Brown et al. (2005) found that patients with unexplained symptoms score lower on family cohesion and higher on ratings of conflict. Children in families with significant degrees of conflict may develop somatic complaints as a mechanism to avoid emotional expression that may potentially exacerbate familial stress.

Clinical Features

The onset of conversion symptoms is generally acute. Individual symptoms are generally shortlived, remitting within 2 weeks in most hospitalized patients (American Psychiatric Association 2000). Good prognostic factors include sudden onset, presence of an easily identifiable stressor, good premorbid adjustment, and absence of comorbid medical or psychiatric disorders (Crimlisk et al. 1998 Lazare 1981 Speed 1996). Patients with conversion seizures have a poorer prognosis than those with paralysis or blindness. The recurrence of symptoms is not uncommon, occurring in 20 -25 of cases within 1 year (American Psychiatric Association 2000). Comorbid mood, separation, and other anxiety disorders are common. Stressful family events such as recent divorce, current marital conflict, or death of a close family member (Wyllie et al. 1999), as well as overbearing and conflict-prone parenting style (Salmon et al. 2003), are also frequently associated. Estimates of the presence of concomitant...

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).

Marios Future

Flavia and Walter needed all the emotional support Mario's nurses, psychologists, and social workers could give them during their nearly two-year ordeal in the Jimmy Fund Clinic. But they made it through that time. Their marriage survived the enormous stress, and they never removed Mario from the educational track that they had always planned for him. When he turned three, he went to preschool every weekday except Mondays, his exhausting day at the clinic.

Family Based Therapy

Family therapy has been a treatment mainstay for adolescents, but only one model of family treatment has been systematically studied. Maudsley Hospital's family-based treatment (FBT) has been the subject of five RCTs (Eisler et al. 2000 Le Grange et al. 1992 Lock et al. 2005 Robin et al. 1999 Russell et al. 1987). Although these trials are relatively small, they represent the entire evidence-based literature available to date for psychosocial treatments of adolescents with anorexia nervosa (see Table 106). Designed to empower parents to help restore their child's weight outside of the hospital, FBT has consistently demonstrated short- and long-term positive outcomes. Britain's National Institute for Health and Clinical Excellence (2004) considers FBT the treatment of choice for adolescents suffering from anorexia nervosa.

Breach

P., has demonstrated that there was a professional relationship between you and her, she has also established that you had a duty to her because of that relationship. Her next step is to demonstrate what that duty was. Once she has done that, she then has to show that you did not fulfill that duty. She has the burden of proving that you in fact breached the duty you owed her that you did not do all you could for her within the expectations of your relationship, or that you did not have and or use the required skill and judgment. Her goal is to show that you did not meet the standard of care.

Disability

G had a previous history of depression while in law school, for which he received counseling and a brief course of antidepressant medication. He had no other psychiatric or psychological treatment in his life. He has used alcohol regularly, more in recent months in conjunction with marital problems. Two weeks before his admission to the psychiatric unit, his wife left him, claiming that his time away from home and inattentiveness to her be

Helping Yourself

Lawsuits are most often brought by people with whom you have established a professional relationship. You can argue that the duty you owed the patient because of your relationship was not the duty that Ms. P. claimed you had. She will claim that you breached your duty. You have to be able to provide evidence to show that you performed the duty expected of you by the patient and by your profession. You also have to show that your services did not fall below the professional standard of care. This can be done by comparing your services to those in the professional guidelines or recommendations, the NSGC Code of Ethics, and the professional literature. It will be important to demonstrate that your skills and knowledge (1) at least meet a minimum standard by having certification and a valid license if available and (2) are up to date through continuing education credits.

Fridas Early Years

Matilde Calderon y Gonzales, Frida's mother, was of mixed Spanish and indigenous Mexican ancestry and a devout Catholic. Guillermo and Matilde were married shortly after his first wife died during the birth of their second child. Their marriage was quite unhappy, yet they did have four daughters. Frida was the third. Her father was surrounded by women and Frida was his favorite child.

Her Later Years

Throughout their marriage, Frida and Diego traveled a great deal, mostly to the United States. Diego loved the United States while Frida always longed for Mexico. During their marriage they lived in small apartments and in two major houses, Casa Azul and the San Angel, joined homes designed by the famous Mexican designer, Juan O'Gorman. They separated many times and were divorced and remarried. When they remarried in 1940, her later years, Frida lived in Casa Azul and Diego would reside with her frequently while still maintaining his O'Gorman home. Frida became more accepting of Diego's ways and attended to him as if he were her baby, which is best reflected in her painting, 'The Love Embrace of the Universe, the Earth, Me, Diego and Xolotl' (1949). In this piece, Frida cuddles a baby Diego while she is held by the Aztec goddess Xolotl.

Couples Skills

Although most people intend marriage to be a joyous experience, the National Marriage Project reported the percentage of first marriages that were very happy declined from 54 percent in 1976 to 38 percent in 1996. Considerable research2 indicates that two major factors predict marital satisfaction. Satisfied couples tolerate issues that can't be resolved, which occurs in nearly 70 percent of marriages. They seem to understand that it takes at least ten years for high-quality intimacy to develop, which is good because nearly 90 percent of couples who say their marriage is awful will describe it as pretty good or very good five years later. Thus, they tend to hang in during the difficult times and realize that a successful marriage takes effort. I think of one recently married woman who said, I wish someone had told me how hard it would be, and that there are times when you don't want to be with your spouse. Satisfied couples tend to realize that

Couples Conflict

Researchers at the University of Denver and authors of the acclaimed book Fighting for Your Marriage, Markman, Stanley, and Blumberg* described what we call complementary conflict patterns in men and women. In general, men become more aroused by conflict, and find that uncomfortable. So they tend to withdraw from conflict. They prefer that conflict have structure and rules, and be free of emotions.3 They also tend to want to solve the problem, and use sex as a means to be close to their partner. Women tend to approach problem solving somewhat differently. They tend to consider more feelings and relationship aspects of issues. The process of problem solving is often more important than finding an immediate solution. That is, rather than wanting to be given a solution which may seem to suggest that they are not capable of solving the problem they are likely to appreciate a spouse who encourages and supports a richer exploration of the problem. Women tend to want to talk in order to feel...

Postoperative Stage

Posttransplant, patients can experience acute mental status changes (e.g., delirium) and side effects from immunosuppressant medications that can affect physical appearance, emotional functioning, and sleep and eating patterns. Any posttransplant medical complications are understandably stressful. Once patients are medically stable, patients and families commonly experience a honeymoon period, followed by the reality of living with a new chronic illness. Although families are hopeful about an eventual return to a normal life, they often experience anxiety about leaving the safety of the hospital environment, because posttransplant care can appear overwhelming. In a study in which parents of pediatric heart transplant recipients completed questionnaires, nearly 40 of parents indicated moderate to severe posttraumatic stress symptoms relating to communication about the child's illness, balancing of various role demands, emotional strain, and supervision of the child's medical care...

Internet

The issue of when a relationship is established and what duties are then owed to the patient is an area of telemedicine that is also still evolving. Parallels to face-to-face relationships provide guidance for those standards. When a professional enters into a dialogue with a patient, complies with a request for an evaluation and offers advice on which the patient relies, a physician-patient relationship has been established. It does not matter which medium was used. A provider who has an ongoing relationship with a patient and who consults with another provider through the use of electronic techniques, still maintains a professional relationship with the patient. As a specialty consultant, your relationship with the patient will depend on the circumstances. You may be involved as a consultant in the patient's care either by working with the provider or with the patient directly. In a formal consultation setting, a relationship with the patient is established. Failing to provide...

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