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Jacobson et al 177 note several reasons to expect that MT (also referred to as behavioral marital therapy or BMT) is effective for depression spouses of depressed individuals might have a facilitative effect on treatment outcome 189 depression and marital satisfaction are inversely related 190 disruptions in close relationships often precipitate depression 191 marital distress predicts depressive relapse following recovery 192 the degree to which marital satisfaction improves with therapy is inversely related to relapse 193 a close confiding relationship with a spouse buffers otherwise depressogenic life events 194 .
There are widely differing definitions of the activity of family therapy, but most therapies have the following features in common 77 . First, they typically involve face-to-face work with more than one family member. Second, therapeutic work focuses on altering the interactions among family members. Third, practitioners think of improvement at two levels that of the presenting problem and that of the relationship patterns associated with the problem. There have been at least four randomized controlled trials of family therapy in childhood depression. Two included cases with major depression 7,52 and involved a family intervention only. Two examined the value of parental sessions given in parallel with CBT to children diagnosed with either major depression or dysthymic disorder 51,53 . On present evidence it would be premature, however, to conclude that family therapy is ineffective in childhood depression. With only four trials completed as yet, it could be that significant benefits...
Despite a divorce rate of 50 , 75 of those who divorce remarry, though remarriage rates are lower for African-American and Hispanic women compared with European American women.33 Despite increases in the number of women who choose childlessness, the rate of bearing at least one child is 90 and an additional 4 of the population adopt children.34
Most of the comprehensive family intervention packages evaluated in controlled trials to date comprise psychoeducational and skills training components. Virtually all include formal education, usually in the form of lectures, often supported by printed or audiovisual material, delivered either in the clinic or in the family home. Most utilize either didactic instruction in coping techniques and problem solving, usually accompanied by homework exercises, or the modelling of successful coping strategies used by other families met through relatives' groups. Some include explicit training in communication skills. Packages differ, however, in the site of treatment, whether the intervention is provided in a single or multifamily setting and whether the patient is included in the family sessions. Only a small minority of family interventions have not used this approach but have, rather, borrowed from psychodynamic or other schools of family therapy.
This found that CBT groups were significantly less likely to deteriorate or relapse and that the differences in comparison with standard care were considerable, suggesting that CBT may reduce the risk of relapse by 54 (number needed to treat 6, confidence interval 3-30). It is therefore possible, but by no means established, that, like family therapy, CBT may have an impact on relapse and rehospitalization.
The importance of family therapy is evident in several research lines. Social skills training does not reduce significantly the rates of psychotic relapses. On the contrary, studies carried out on psychotic patients who had been exposed both to social skills training and to family therapy showed significantly lower relapse rates at the 1- and 2-year follow-up compared to patients receiving antipsychotic medication only. The effects of the two interventions were found to be summative, not interactive. This research evidence of the importance of family therapy should lead to a reconsideration of the organization and the allocation of resources in mental health departments. For instance, in Italy, family therapies are often not available and 60-70 of the budget covers residential costs. This is especially true now that decision makers are strengthening rehabilitation programmes in many mental health services.
The following comments will address our work with families. Chronic illness is interpersonal, social and cultural, not merely the story of only one patient's experiences. When a severe illness enters the family, like an unwelcome intruder, there is a disruption of the pre-existing homeostasis of the family system (roles, boundaries, expectations, wishes and hopes). The genetic road and the psychosocial road of the patient's family development both play a role. One cannot neglect the family system. If we neglect this agent, families will work against us with their prejudices, denials, stigma, ambivalence, mistreatments, etc. Family therapy intervention helps
Always consistent with theoretical predictions for example, gains with cognitive-behavioural therapy (CBT) do not follow parallel changes in cognitive dysfunction. Similarly, family therapy or parental components of interventions do not add any benefit, although disturbances in family background of depressed children represent a well-documented risk factor. The available conceptual models of depression, therefore, need to be considered at best as working hypotheses. Further outlining our current knowledge limits, it is worth also keeping in mind that, thus far, we have little understanding of two major defining features of child and adolescent depression namely, that its incidence rises enormously during mid-adolescence and that it affects twice as many girls as boys.
Findings of the study suggested that the majority of patients felt more embarrassed in non-sexual interpersonal relationships than they did in intimate sexual and social relationships. A possible explanation for this may be that, since more than half of the sample interviewed were married, with an average age of 38 years, it was likely that they had been involved in long-term relationships. In these cases the issue of their disfigurement was not something new, and possibly the people who were reporting had already established coping mechanisms. The possibility of a new sexual encounter was probably less likely than a social non-sexual one. It is reasonable to assume, therefore, that they would be more anxious about nonsexual socialising. The authors of the study suggest that psychological counselling could be beneficial if it addressed problems of self-esteem and body image.
Menopause is a transition encompassing a developmental stage in the lifecycle, during which women gradually adapt to biologic, social, psychological, and spiritual changes that accompany recognized physiologic changes. While women throughout the world experience menopause, diagnosis is often difficult because it canbe made only in retrospect. Along withbiologic changes, significant psychological events occur during mid life, including changing relationships with children, marital instability, widowhood, and the illness or loss of parents. Menopause is a time of transition from childbearing and child-rearing to a time of growth, concentration on marital relationships, and sometimes freedom to travel. It is also a transition to old age, increased risk of illness, disability, and grandparenting.
Pain during sexual activity can vary from pain with initiation of intercourse to deep dyspareunia (Table 5.8). Sexual pain syndromes are associated with a history of abuse. Clinicians should screen for this history and provide suggestions for individual and couple therapy to support the woman as she tries to reconcile her past.
Lack of spontaneity, routine, and attention to matters other then sexual relationships can add particular challenges to long-term relationships. The earlier erotic nature of the newness of the relationship becomes replaced by a predictable and less prioritorized sexual exchange. Responsibilities of paying bills, concerns about health, and caringfor children, grandchildren, or agingparents
Problem drinking in mid-life women is associated with marital disruption, children leaving home, and not having employment outside the home. Other risk factors are a failure to adapt to aging, heavy spousal drinking, drinking alone at home, and abuse of prescribed psychoactive drugs.29 Perimenopause is a time of increased psychological and physical vulnerability for some individuals, which may be related to concurrent changes in the reactivity of the hormonal stress system.
Based on a definition of recovery (BDI score 9), 71.4 of the distressed CT treated individuals recovered, compared to 84.6 of the nondistressed CT treated individuals. For BMT, 87.5 of the distressed individuals recovered compared to 54.5 of the nondistressed individuals. For the COMB, 37.0 of the distressed and 69.2 of the nondistressed individuals recovered. BMT was less effective than CT for depression in maritally nondistressed couples, but for maritally distressed couples BMT and CT were equal. Only BMT had a significant positive impact on relationship satisfaction in depressed couples, whereas COMB was the only treatment to enhance marital satisfaction of nondistressed couples. Follow-ups after 6 and 12 months revealed low (0-15 ) and equivalent relapse rates for all three groups 198 . O'Leary and Beach 199 also evaluated married couples complaining of both depression in the wife and marital discord. Random assignment to BMT, CT, or WL revealed both...
The first step in BT is usually a functional analysis by which clinicians determine the functional relationship between behaviors and the environment. They identify antecedents and consequences that surround and presumably control specific depressive behaviors. Detailed descriptions of BT approaches include activity scheduling 165 , self-control techniques 166 , social skills training 167 , behavioral marital therapy 168 , and stress management 165 . Some variations of BT also include problem-solving 42 in this grouping. Lewinsohn et al 165 have developed a treatment manual entitled The Coping with Depression Course, which outlines strategies often used in BT for depressed patients. BT has been used to treat MDD and DD in adults and MDD in adolescents 123 . The Depression Guideline Panel 46 meta-analysis of BT alone revealed a 55.3 response rate (ITT sample) in 10 studies. Jarrett and Rush 70 detailed the individual studies. BT exceeded WL in 7 of 8 trials 40,42,169-173 . Only Usaf...
Brent et al 122 applied individual CBT, systemic behavior family therapy (SBFT), or individual nondirective supportive therapy (NST) in an RCT of 107 adolescent outpatients with MDD. At treatment end, CBT was associated with a lower incidence of MDD (17.1 ) than NST (42.4 ), and a higher remission rate (64.7 ) (absence of MDD and at least three consecutive BDI scores
Birchwood and Spencer suggest that there is robust research evidence endorsing the use of behavioural family therapy (BFT) or cognitive behavioural therapy (CBT) in schizophrenia. These approaches clearly fulfil the criteria for an effective psychotherapy. The evidence supporting the use of social skills training (SST) is equivocal. Also, the data presented indicate that educational approaches, with the exception of compliance therapy, are the least effective interventions. Choosing which evidence-based psychological approach to employ may be influenced by cultural and social factors. The need to change the patterns of interaction between the patient and his or her family or to reduce levels of expressed emotion may increase the likelihood of choosing family therapy. Alternatively, patient preference may mean that individual therapy is more appropriate. Importantly, the lack of an available and fully trained therapist may rule out the use of a particular approach. It is critical that...
Family interventions may also reduce costs. The most recent economic review identified nine economic studies from the USA, the UK, Germany and China 83 . Generally, they were not as comprehensive in their coverage of direct and indirect costs as would now be expected, but they complemented the clinical evidence well. Falloon et al 143 conducted their randomized trial in Los Angeles, comparing a psychoeducational family programme combined with maintenance drug treatment against drug treatment alone. The relapse rate was substantially lower in the family therapy group a result which has been replicated in other studies and there were greater improvements in household tasks, work or study activities and social relations. Caregiver burden was also reduced over both the initial 9 months and the full 2 years of the follow-up period. Three economic studies based their analyses on these trial data 144-146 . A (limited) cost-benefit analysis compared costs with earnings from employment 146 ,...
Obesity is a problem that develops over time and is not easily treated. Unless the patient is experiencing life-threatening complications from severe obesity, the problem should be approached in a nonemergent fashion. Intervention for child obesity begins during the evaluation process. Involving the family in the evaluation gives the message that they are part of the solution. In the course of evaluation, it is important to assess the family's readiness to make the changes necessary to support the child's behavioral treatment program. Obesity is not the child's problem alone. The child lives within the family environment, and the family must be drawn into the process of evaluation and change if the family appears to be dysfunctional, it is appropriate to delay the implementation of behavioral strategies until the family has had more extensive evaluation and entered into family counseling. Referral to a family therapist, particularly one familiar with many of the issues associated with...
Medication, but there are no controlled data available. There are no controlled studies of psychotherapy in the literature. Case reports suggest that cognitive therapy might be helpful. Group therapy may enable relatively healthy patients to improve their social skills. Family therapy may be indicated where the family dynamics are contributing to the patient's difficulties.
Savving Your Marriage
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