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2.
BMJ Case Rep ; 12(12)2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31852688

RESUMO

Unindicated hysterectomy is a disturbing problem in India. Women are counselled into the procedure by the fear of cancer, and by reinforcing their notion that unrelated somatic problems are solved by the removal of the uterus. This is a case of a woman from the state of Bihar, India, who was referred to us after an unindicated hysterectomy at the age of 24, performed as a first-line treatment for lower abdominal pain. This highlights the problem of rising hysterectomy in India and the lack of integrated treatment for women with the debilitating condition of chronic pelvic pain. Pelvic pain and vaginal discharge are often not indicative of pelvic inflammatory disease, and need a more considerate and broad-minded approach. Public health initiatives should take more account of women's lack of knowledge of reproductive health and make efforts to disseminate such information by the use of television, radio and newspapers in local languages.


Assuntos
Dor Abdominal/cirurgia , Depressão/psicologia , Histerectomia/efeitos adversos , Procedimentos Desnecessários/efeitos adversos , Adulto , Terapia de Casal , Depressão/etiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Terapia de Reposição Hormonal , Humanos , Histerectomia/psicologia , Hérnia Incisional/tratamento farmacológico , Hérnia Incisional/etiologia , Índia
4.
Diabetes Educ ; 45(6): 629-641, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31617468

RESUMO

PURPOSE: The purpose of the study was to examine feasibility outcomes and obtain initial efficacy data on an intervention testing collaborative implementation intentions (IIs) for physical activity (PA) among participants with type 2 diabetes. METHODS: The study used a pilot randomized design and enrolled people with diabetes (PWD) and their partners (N = 40 couples, 80 individuals). PWD reported psychosocial measures, including self-efficacy for PA, diabetes partner investment in diabetes self-management, and PA-related social support. Accelerometers (objective) and the International Physical Activity Questionnaire (self-report) were used to assess PA. RESULTS: Participants in both experimental conditions reported being satisfied with the intervention and highly committed to their PA plans. Participants were able to follow instructions and completed the intervention in less than 30 minutes. Participants in the collaborative IIs condition reported a greater increase in PA-related social support (partial 2 = .185, P < .05) and self-reported recreational PA (partial 2 = .210, P < .05) at 6 weeks compared to the other 2 conditions. In this pilot study, there were no significant group differences on other psychosocial outcomes or for objective PA; however, time in light PA trended higher for the collaborative IIs condition compared to the other 2 conditions (partial 2 = .237, P = .056). CONCLUSIONS: This study provides initial support for collaborative IIs for PA with PWD and their partners. This brief intervention was feasible and highly acceptable, and it may improve relationship dynamics around PA as well as ultimately increase PA.


Assuntos
Terapia de Casal/métodos , Diabetes Mellitus Tipo 2/terapia , Exercício Físico/psicologia , Autogestão/psicologia , Acelerometria , Adulto , Diabetes Mellitus Tipo 2/psicologia , Estudos de Viabilidade , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Projetos Piloto , Autoeficácia , Autogestão/métodos , Apoio Social , Inquéritos e Questionários
6.
Fam Process ; 58(3): 641-655, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31454436

RESUMO

Integrative Systemic Therapy (IST) is a metatheoretical perspective for the conduct of individual, couple, and family therapy. Following a brief description of IST, this article presents developments in IST and their implication for psychotherapy integration. The nature of problem solving in IST is clarified, and the relationship between IST's essential problem-solving tasks and its core decision-making process is defined. Particular attention is paid to two dimensions of IST that have given it its name: integration and systems theory. The advantages of a therapy that is client system-centered and not model-driven are discussed, and a justification for "good enough" execution of interventions abstracted from specific models is provided. A procedure for balancing pragmatic demands of therapy with a commitment to account, as needed, for broader or deeper systemic issues is presented.


Assuntos
Terapia de Casal , Terapia Familiar , Terapia de Casal/métodos , Características da Família , Terapia Familiar/métodos , Feminino , Humanos , Relações Interpessoais , Masculino , Modelos Psicológicos , Teoria de Sistemas
7.
Fam Process ; 58(3): 595-609, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31381844

RESUMO

The complexity of the African American community in the United States continues to evolve. The growing number of professional African Americans who grew up in the postcivil rights era combined with the persistent reminders of inequity paints a complex backdrop for understanding African American relationships. The majority of our knowledge about African American couples disproportionately comes from nonclinical social science fields such as sociology and demography. Unfortunately, the scholarly literature on how to work with African American couples is relatively scant. This paper seeks to add to this limited literature by providing clinicians and scholars with a proposed set of issues to consider when conceptualizing and treating African American couples. In particular, the complexity and nuance needed to work with African American couples are best done by using an integrative model. Thus, this paper will discuss how the Integrative Systemic Therapy (IST) model is particularly well suited for working with African American couples. This paper will summarize the science on African American marriages with a focus on salient factors such as gender, SES, and trust, which will then be translated into clinical practice by utilizing a case example. The case example will be of a middle-class couple in order to delineate the challenges and the growing heterogeneity of African Americans. The article will conclude with a commentary on the evolving heterogeneity of African Americans, which sheds light on how an integrative perspective is important for disentangling and embracing the growing complexity of African American couples.


Assuntos
Afro-Americanos/psicologia , Terapia de Casal , Afro-Americanos/etnologia , Terapia de Casal/métodos , Cultura , Feminino , Financiamento Pessoal , Humanos , Relações Interpessoais , Masculino , Fatores Sexuais
8.
Fam Process ; 58(3): 610-628, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31334847

RESUMO

This paper provides an overview of current issues in integration in couple and family therapy. It summarizes the evolution of integration in couple and family therapy, the various traditions in integration, the strengths of integrative approach, and the possible pitfalls involved. It highlights the extent to which most couple and family therapy is now integrative practice. It concludes with a consideration of an emerging trend toward methods of practice centered on modules of intervention that have been identified as effective with certain presenting phenomena. The example of therapy for high conflict divorce is utilized to illustrate how various components can be brought together to create a maximally effective intervention.


Assuntos
Terapia de Casal , Terapia Familiar , Terapia de Casal/métodos , Família/psicologia , Características da Família , Terapia Familiar/métodos , Humanos
9.
Fam Process ; 58(3): 569-594, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31334852

RESUMO

This article presents an integrative approach to the special challenges of therapy with couples on the brink of dissolution or divorce-who often describe this therapy as their "last chance." In some, one partner is considering ending the relationship, and in others, both partners are considering ending it. Often, these couples have had prior dissatisfying experiences in couple therapy. Four types of last chance couples are described: high-conflict couples; couples in which partners have differing goals for their lives or different timelines for reaching shared goals; couples in which one or both partners have acted in a manner that violates the values, expectations, emotional comfort, or safety of the other; and couples in which there has been a gradual loss of intimacy. The Therapeutic Palette, a multiperspectival, theoretically eclectic integrative approach, is enlisted as a general framework for selecting and sequencing use of particular theories and their associated practices, based on the three "primary colors" of couple therapy: time frame/focus, level of directiveness, and change entry point. An additional complementary framework, the creative relational movement approach, is proposed to provide an integrative frame encompassing both language-based and action-based practices, suggesting that meaning is held and expressed as much through interaction or "relational motion" as it is through language. Principles of change are described. Due to the couple's level of crisis and desire for immediate evidence of possible improvement, priority is given to action-based interventions in early stages of therapy, by engaging couples in "experiments in possibility." Typical action approaches are described. An extended vignette follows.


Assuntos
Terapia de Casal , Amor , Terapia de Casal/métodos , Divórcio/prevenção & controle , Divórcio/psicologia , Conflito Familiar , Feminino , Objetivos , Humanos , Relações Interpessoais , Masculino , Motivação
10.
Salud Publica Mex ; 61(4): 532-541, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31322846

RESUMO

OBJECTIVE: To describe and discuss the results of non-pharmacological interventions (NPI) adjuvants in the treatment of depressive symptoms among women with breast cancer (BC). MATERIALS AND METHODS: A systematic review on NPI was performed, which was applied to patients with cancer and depressive symptoms in seven databases. The review was limited from January 1, 2006 to December 31, 2017 and to English, Spanish and Portuguese languages. The medical descriptors used were "breast neoplasm" and "depression". RESULTS: There are several NPI that are able stimulate the physical or psychosocial dimensions. In this article we propose a classification based on nine identified therapeutic strategies, among which exercise, psychotherapy and yoga with meditation stand out. CONCLUSIONS: Based on the available evidence, we concluded that psychotherapy and yoga with meditation reduce depressive symptoms in patients with CaMa. More research is needed to determine the magnitude of the reduction of depressive symptoms, according to their severity, presence of comorbidities and diversity of INF.


Assuntos
Neoplasias da Mama/psicologia , Depressão/terapia , Terapia pela Arte , Terapia de Casal , Bases de Dados Factuais , Exercício Físico , Feminino , Humanos , Terapia do Riso , Massagem , Meditação , Psicoterapia , Apoio Social , Ioga
11.
J Marital Fam Ther ; 45(4): 621-634, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31355959

RESUMO

Emotionally Focused Couple Therapy (EFT) is an effective approach to working with distressed couples. It is not only effective in reducing relationship distress, but also in successfully maintaining gains over time. In the current study, we sought to understand the therapy processes that result in the creation of safety during stage one of EFT. Safety is a key ingredient in stage one, setting the stage for deeper interpersonal and intrapsychic work in later stages of treatment. In order to achieve the study aim, we analyzed video recordings of the first six sessions of a single couple case from an EFT randomized controlled trial. Using a theory building case study approach, results reveal that all expected components related to the creation of safety were achieved. Additional findings from our analyses indicate that the therapist was highly active, especially in seizing key moments in the therapy provided by this particular case, which shifted the couple in the direction of safety and deescalated their interactional cycle. Implications of key findings are discussed.


Assuntos
Terapia de Casal/métodos , Conflito Familiar/psicologia , Casamento/psicologia , Apego ao Objeto , Adaptação Psicológica , Adulto , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal
13.
Psychol Assess ; 31(9): 1107-1117, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31219281

RESUMO

The Systemic Therapy Inventory of Change (STIC) is a multisystemic and multidimensional feedback system that provides therapists feedback about systemic domains of client change in individual, couple, and family therapy over time. The goal of the present study is to investigate the sensitivity to change of the scores of the STIC Initial Scales. In total, 583 clients who voluntarily sought individual, couple, or family therapy services and participated in a randomized controlled trial study were included in the study. Their pre- and posttherapy responses to the STIC Initial measures and corresponding validation measures for individual functioning, couple relationship, child adjustment, and family functioning were compared. The results support the sensitivity to change of the scores of the four STIC Initial Scales investigated: Individual Problems and Strengths (IPS), Relationship with Partner (RWP), Family/Household (FH), and Child Problems and Strengths (CPS). Of particular note, the IPS demonstrated even greater change over time than the BDI-II, BAI, and OQ-45. The discriminant validity of measuring change with the CPS was not supported. Thus, the STIC Initial IPS, RWP, and FH can be usefully employed to measure multisystemic changes in both research and clinical work. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Avaliação de Resultados em Cuidados de Saúde/métodos , Psicoterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia de Casal , Terapia Familiar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fatores de Tempo
14.
Fam Process ; 58(3): 550-568, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31095744

RESUMO

Implicitly or explicitly, our ideas about intimacy are the most fundamental notions giving direction to the process of couple therapy. Yet, as a field, we have spent little time conceptualizing intimacy and even less time considering the diversity of priorities and meanings couples bring to our offices. In Part One, Varieties of Intimacy, I describe a kaleidoscope of contexts-socio-historical, cultural, gender, life cycle, and developmental-that inform our ideas and expectations for intimacy in couples' relationships. I highlight different spheres in which intimacy may take place such as the emotional, sexual, intellectual, or familial. I propose a starting point in which the therapist, in a collaborative manner, helps the partners articulate their yearnings and priorities in order to negotiate a shared vision. In Part Two, Conceptualizing Intimacy, I suggest an experiential definition that gives room for each partner's subjective meanings, yet consider diverse relational processes that may need to be addressed for a resilient ebb and flow of intimate experiences. In Part Three, Sexual Intimacy, I outline conditions in which sex is more likely to be experienced as intimate rather than nonintimate. Finally, in Part Four, I describe Therapeutic Principles to guide the therapist in taking couples from reactivity to dialogue to negotiations of intimacy. The integrative framework proposed here discourages monolithic a priori notions of intimacy and highlights instead: nuanced meanings, relational processes to be considered differentially, present and past emotional blocks, and a flexible clinical approach to foster conditions for the creation and resilience of intimate experiences.


Assuntos
Terapia de Casal , Cultura , Relações Interpessoais , Adulto , Terapia de Casal/métodos , Emoções , Empatia , Características da Família , Feminino , Humanos , Masculino , Fatores Sexuais , Confiança
15.
J Sex Marital Ther ; 45(8): 667-672, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31007150

RESUMO

Although Vaginismus, or an involuntary contraction of the vaginal muscles, is one of the reasons sexual intercourse difficulty is relatively common in Iran, few studies have addressed it. This research is a single-case type (AB) design. Initially, a pretest was taken from all participants. The number of sessions was estimated between 4 and 6 sessions, and the duration of each session was 45-60 minutes. Couple therapy sessions were conducted by an individual with a PhD in sexual and reproductive health. An FSFI questionnaire was completed before counseling, just after counseling, and 4 weeks after the last counseling session. During each session, the therapist reviewed the homework assignments of the previous session regarding emotions, thoughts, and experiences, and at the end of each session, the therapist answered the couples' questions. We introduce and follow up on five casesof couples who suffer from Vaginismus. The mean age for females was 29.5, and for males it was 32. The mean length of marriage was more than 5 years. The FSFI score of participants improved from baseline (A) after intervention (B). The study would appear to show that this treatment format may be a cost effective intervention for couples presenting with Genito-pelvic pain/penetration disorder (Vaginismus).


Assuntos
Coito/psicologia , Terapia de Casal/métodos , Vaginismo/terapia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Casamento , Índice de Gravidade de Doença , Comportamento Sexual/psicologia , Vagina/fisiopatologia , Vaginismo/fisiopatologia
16.
Fam Process ; 58(3): 532-549, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30921496

RESUMO

The Principle-Based Integrative Therapy (PBIT) framework harnesses the principles of change underlying each theoretical model within integrative couple therapy treatments. PBIT has commonalities with other integrative approaches, and additional advantages stemming from its four tenets that guide therapists in combining strengths across models and overcoming each of their deficiencies. Tenet 1 advises that each model adds a core principle or mechanism of action that other models do not automatically address. Tenet 2 focuses on how techniques of one model may actualize the principles of other models. Tenet 3 ensures complementarity and a lack of conflict across principles. A case study and common case considerations are presented to illustrate how Tenets 1-3 can work in integrating Cognitive-Behavioral, Multicultural, and Emotionally Focused Therapy models in working with a couple. Finally, Tenet 4 advocates for the use of models and empirically supported principles that also have received empirical support with diverse populations. Prerequisites and training implications for PBIT, and future clinical and research directions to further the utility of PBIT are discussed.


Assuntos
Terapia de Casal , Terapia Cognitivo-Comportamental/métodos , Conflito Psicológico , Terapia de Casal/métodos , Feminino , Humanos , Masculino , Modelos Psicológicos , Papel Profissional , Teoria Psicológica , Religião e Psicologia
17.
J Fam Psychol ; 33(3): 327-337, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30816779

RESUMO

Accurately understanding the thoughts and feelings of romantic partners, termed empathic accuracy, is critical for optimal relationship functioning. Empathic failure is linked to common reasons couples seek therapy (Doss, Simpson, & Christensen, 2004; Jacobson & Christensen, 1996) and is either implicitly or explicitly a target of many couple therapies (e.g., Jacobson & Christensen, 1996). More specifically, couple therapies target partners' abilities to accurately understand one another preceding and during conflict, periods characterized by high levels of stress. The current study tests the hypothesis that acute stress can be harmful for empathic accuracy in romantic couples, and tests two competing path models of the impact of stress on accuracy. Results show that an acute stressor affected accuracy of men and women differently, impairing accuracy in women but not observably affecting men's accuracy. The effect of the stressor on empathic accuracy for women was mediated by curvilinear arousal, and men's accuracy was also associated with curvilinear arousal. This pattern of results suggests that moderate arousal is optimal for empathic accuracy for both men and women, but this effect was twice as large for women relative to men. These findings point toward potential avenues to improve existing couple therapies by incorporating strategies to mitigate the effects of stress, thereby increasing couples' ability to accurately understand one another in therapy. These findings also suggest strategies for couples to be optimally productive when having important relationship conversations by attending to their level of arousal. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia de Casal , Empatia , Parceiros Sexuais/psicologia , Adulto , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Satisfação Pessoal , Testes Psicológicos , Fatores Sexuais , Adulto Jovem
18.
Br J Health Psychol ; 24(2): 396-418, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30852854

RESUMO

OBJECTIVES: Few couple-focused interventions have improved psychological and relationship functioning among men diagnosed with localized prostate cancer and their spouses. This study compared the impact of intimacy-enhancing therapy (IET), a general health and wellness intervention (GHW), and usual care (UC) on the psychological and relationship functioning of localized prostate cancer patients and their partners. Relationship length, relationship satisfaction, and patient masculinity were evaluated as moderators. DESIGN: This study was a randomized clinical trial with three study arms and four assessment time points. METHODS: A total of 237 patients and partners were randomly assigned to receive IET, GHW, or UC. Participants completed measures of psychological functioning and relationship satisfaction at baseline, 5 weeks, 3 months, and 6 months post-baseline. Primary outcomes were psychological adjustment, depression, cancer-specific distress, cancer concerns, and relationship satisfaction. RESULTS: Spouses in IET showed greater increases in relationship satisfaction than spouses in GHW and UC between the baseline and 5-week follow-up. Among patients in longer relationships, significant increases in psychological adjustment were found in both treatments compared to UC. Among spouses in longer relationships, psychological adjustment increased in both IET and UC but declined in GHW. CONCLUSIONS: Intimacy-enhancing therapy did not show an impact on general or cancer-specific distress, but did show an early impact on relationship satisfaction among spouses. IET was superior to UC for patients in longer relationships. It will be important for researchers to understand which couple-focused interventions benefits both patients and spouses and to identify characteristics of patients, partners, and couples who may not benefit from psychological treatments. Statement of contribution What is already known on this subject? Men diagnosed with localized prostate cancer report lower health-related quality of life and both patients and spouses report elevated distress. Relationship communication plays a role in couples' psychological adaptation to prostate cancer. Couple-focused interventions have illustrated an impact on relationship communication. There are no studies comparing different couple-focused interventions. What does this study add? Intimacy-enhancing therapy was not superior to no treatment or a comparison treatment for the broad range of psychological and relationship outcomes. Intimacy-enhancing therapy was superior to no treatment for patients in longer-term relationship. The general health and wellness intervention was not beneficial for men in shorter relationships and for men who did not endorse traditional masculine norms.


Assuntos
Adaptação Psicológica , Terapia de Casal/métodos , Neoplasias da Próstata/psicologia , Cônjuges/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Qualidade de Vida/psicologia , Cônjuges/estatística & dados numéricos
19.
Fam Process ; 58(1): 23-33, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30729514

RESUMO

Social justice tends to be narrowly defined as equality without due recognition of human dignity and respect for those whose daily lives continue to be adversely impacted by race. This article seeks to explore key issues and challenges at the intersection of social justice and race for couple and family therapy. These include: (a) defining social justice; (b) diversity and inclusion; (c) power and privilege; (d) witness; and (e) personal responsibility.


Assuntos
Grupos de Populações Continentais/psicologia , Terapia de Casal/ética , Terapia Familiar/ética , Justiça Social/psicologia , Humanos , Poder Psicológico , Estados Unidos
20.
Personal Disord ; 10(4): 297-308, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30714800

RESUMO

Borderline personality disorder (BPD) is a debilitating mental health condition that is highly associated with distress in close relationships and in romantic and nonromantic (e.g., familial) significant others. Interventions that efficiently improve BPD treatment outcomes are needed. Theory and research suggest that BPD may both promote and be maintained by close relationship distress. Incorporating significant others into BPD treatments may therefore present a novel and unique opportunity to maximize treatment outcomes. This work systematically reviews the empirical support for interventions that incorporate significant others in BPD treatment in addressing three potential treatment targets: (a) BPD pathology, (b) significant other distress, and (c) close relationship distress. Three distinct categories of intervention that involve significant others into BPD treatment are presented, and the interventions that fall within them are reviewed: (a) significant-other-assisted interventions, (b) education- and family-facilitated engagement interventions, and (c) disorder-specific interventions. Twelve articles outlining six treatments that vary in terms of potential treatment target, form of intervention, and level of empirical support are discussed. Interventions that target BPD in the context of close relationships, which are disorder-specific interventions, have amassed the most robust evidence base as an efficacious approach for all three targets at once. We conclude our review with a synthesis of the extant literature and offer future directions in terms of advancing theory to better understand and treat BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtorno da Personalidade Borderline/terapia , Terapia de Casal , Terapia Familiar , Parceiros Sexuais , Cônjuges , Humanos
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