By J. Sivert. Harding University. 2018.

Infidelity is said to affect a large number of couples and presents particular challenges order fertomid 50 mg online. In Chapter 19 generic fertomid 50 mg with amex, Lusterman explores issues related to working with couples who have been touched by infidelity and proposes an effective model for intervention order fertomid 50mg without a prescription. Psychotherapists are often uncomfortable with exploring spiritual issues in therapy cheap 50mg fertomid with visa. Yet, spiritual and religious differ- ences, like other forms of cultural difference, contribute to some couples’ dissatisfaction with their relationship. Serlin (Chapter 20) considers how to interweave spiritual concerns in the course of psychotherapy. While couples comprised of two same-sex partners share many of the same issues as het- erosexual partners, Alonzo (Chapter 21) describes some unique issues for gay or lesbian couples. Kaslow (Chapter 22) examines the impact of socio- economic factors on couples’ functioning and describes some approaches to working with money issues in therapy. Not all couples presenting for psychotherapy are there to improve the couple’s bond. Some couples initiate therapy to provide a smoother transi- tion to divorce, while other couples initiate therapy in the hopes of sav- ing their relationship but ultimately decide instead to focus on marital 4 S ETTING THE STAGE FOR WORKING WITH COUPLES dissolution. Finally, while many of the chapters interweave empirical information with clinical information, in Chapter 24, we consider what the research has to tell us about the nature of couples functioning and the effectiveness of our interventions. Stabb reviews both the literature on well-functioning and dysfunctional couples and research that elucidates what is useful in couples therapy interventions. Chapter 25 summarizes the multiplicity of threads that have been developed in the many outstanding contributions to this volume. Nonetheless, since couples and families provide the major building blocks of our society, the work that we do in shoring up the foundations has impact beyond those we touch di- rectly. As we know from systems theories, the concentric circles of involve- ment of the individuals who comprise our families and couples, within the larger context of our communities and cultures, makes our impact ricochet from its point of impact to the entire pond. As such, couples therapists have the possibility of being change agents at a much wider scale than they may have believed. Number, timing and duration of mar- riages and divorces: 1996 (Current population reports). SECTION I LIFE CYCLE STAGES CHAPTER 2 Premarital Counseling from the PAIRS Perspective Lori H. Adams HE PREMARITAL COUPLE treads a challenging path between falling in love and solidifying a commitment. Premarital couples seek profes- Tsional help to prevent or to understand and resolve relationship diffi- culties that may have arisen even before marriage. The status and circumstances of premarital couples seeking help vary from the young- and-inexperienced to the previously married (with or without children) to long-term cohabiters who have not committed to marriage. Statistics tell us that the likelihood they will find happiness and longevity in marriage is despairingly low whereas 90% of couples married during the years 1945 to 1949 made it to their 10-year anniversary. Forty years later, barely 70% of those married during the years 1985 to 1989 celebrated a decade of wedded bliss—and the statistics continue to decrease (Fleming, 2003). Premarital couples seek assurance that they can create a lifelong inti- mate partnership. Each partner needs accurate concepts, conducive atti- tudes, technical knowledge and skills, and practiced competencies to sustain a loving relationship. As in ballroom dancing, the couple relation- ship gains best through co-learning, by acquiring and practicing these in- timate relationship skills together. The couple needs to acquire high levels of skill to continue dancing lovingly in the face of changing family life with its unrelenting and often discouraging economic, domestic, and parental responsibilities. The counselor, who wishes to effectively offer such knowledge and skills to couples, needs to undertake relevant profes- sional training. The creator and developer of PAIRS (co-author Lori Gordon), on the demise of her own 17-year marriage, set out to find missing answers. PAIRS is drawn from many emerging humanizing in- terpersonal therapies of the second half of the twentieth century (Satir, Casriel, Bach, Sager, Brandon, Framo, Bowen, Wynne, Perls, Guerney, Brandon, Zilbergeld, etc. Gordon has refined the keys to intimacy and shaped and polished the training exer- cises needed to create deep personal transformative learning by relation- ship partners. PAIRS has been experienced by tens of thousands of couples, many who were on the brink of divorce (DeMaria, 1998); and by tens of thou- sands of individuals, wanting to develop skills to prevent a repeat of the devastation of relationship breakup.

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First purchase 50mg fertomid mastercard, all patients were served by the National Although self-perception of health is heavily influenced Health Service purchase fertomid 50mg line, which appeared to have requisite features by an individual’s disease burden and its current activity fertomid 50 mg line, for satisfactory geriatric care discount 50 mg fertomid free shipping. All enrollees had a desig- norms and expectations concerning health in the group nated primary care community physician, who received against which one measures health and dependence also an annual sum to provide care at no cost to the patient. Those over age 65 generally give more When relatives were questioned about their older fam- positive evaluations of their healthiness in the face of ily members, one-third responded that medical care was increasing burden of disease and disability. Brody also demonstrated minimizing of prob- lems11; of 20 potentially Serious symptoms (e. In either case, late recognition unsteady on feet), only a slight majority were reported at and delayed intervention are the usual outcome. Previ- all, and most of the reports were to a family member ous neglect of symptoms by health care professionals is rather than a health professional. Explanations were "no also likely to teach older patients that frailty and loss of big deal; nobody cares; nothing can be done about it" or independence are normal and to be expected with aging; "don’t want to bother people. Besdine cally ill individuals who were surveyed in one study failed toms to aging and reacted to those symptoms by (1) to report at least one disease. As with many "old saws" about Among patients seen in the emergency room for chest older persons, the stereotypical image of hypochondria- pain due to cardiac ischemia, elderly patients were more cal older patients could not be documented. Among elderly among nonhypochondriacal patients, complaints in older (70–80 years old) and very elderly patients (>80 years adults are more often "validated" by the identification of old) whose chest pain represented acute myocardial disease than in younger persons. Rehabilita- many symptoms classically associated with common tion to independence from these losses is difficult; per- diseases were often considered by community-dwelling manent dependence in spite of "successful" treatment elderly to be normal for old people. The message to clinicians is clear: aggressive symptoms, such as blackouts or paralysis of a limb, were case-finding and surveillance of at-risk older persons is understandably not considered to be normal. However, necessary to prevent perpetuation of the discouraging although nonspecific symptoms of psychiatric distur- and expensive pattern of late discovery of disease re- bances were also frequently considered not normal, they sulting from insufficient symptom reporting by older were not considered to represent disease. It may be that In addition to provider-related reasons, failure by older underreporting is a cohort phenomenon, likely to abate persons to recognize symptoms as abnormal may help as contemporary generations of Americans age, aware of explain why depression is frequently underreported and the benefits of medical intervention and having height- undertreated. For the present, clinicians assumes more importance, because it has been shown should expect symptom underreporting by their older that, compared with younger suicide cases, older suicides patients. Recent data suggest that African-American health-promoting behavior, they were also least likely to and Hispanic women use complementary and alternative take action in response to symptoms of serious illness. Clinical Approach to the Older Patient 151 health care demands that physicians and other providers That night, she develops atrial fibrillation; evaluation understand diversity and its relationship to care. Over the next Goldstein and Griswold27 point out that the challenge 5 days, although hemodynamically stable, she is in and to acquire competence and sensitivity in dealing with out of atrial fibrillation; she is found hemiplegic and patients of diverse cultures is especially important for aphasic on the 6th postoperative day. Evaluation reveals health professionals in gateway cities, in urban commu- mural thrombus and left ventricular clot. The broad doubly incontinent, confused, aphasic, and requiring total categories commonly used to define ethnic minorities— nursing care. African-Americans, American and Alaskan Natives, Her prefracture problem list of (1) degenerative Asian-Americans, and Hispanics—do not capture the osteoarthritis of the knee causing slow gait, (2) atrophic wide array of cultural differences that can affect defini- vaginitis causing urinary urgency, (3) osteoporosis, (4) tion of illness and selection of treatment. It is important cataracts, (5) periodontal disease, (6) type II diabetes to view elders with multicultural sensitivity and to under- mellitus, and (6) coronary insufficiency had never been stand that there may be great heterogeneity within cul- assembled or considered by her physician, who thought tural or ethnic groups. Another unique Her gait had not been evaluated, either for primary challenge is presented by the care of persons who have treatment of the underlying arthritis nor for support with come to the United States in late life, often to join sons a walking aid. Her cataracts had not been considered, nor and daughters who previously emigrated. Late detection of treat- able problems whose neglect and interaction have led to Multiple Pathology functional decline is common in older patients and can Multiple pathology, or concurrence of diseases, is com- be one of the few discouraging features of geriatric care. An early Scottish study of Preventive dental and medical care could have avoided community-dwelling persons over age 65 reported 3. Multiple pathology poses multiple risks to older A second risk is that unidentified multiple pathologies patients and their physicians. The more frail and delicately compensated 82-year-old man with coronary heart disease and im- the patient, the more quickly unattended disease pro- paired systolic function presents to an urgi-center for duces major functional losses; these can be permanent in shortness of breath; treatment is begun with furose- spite of subsequent detection and treatment. Diabetes mellitus (type II, dwelling widow who walks slowly and limps because of diet-controlled), prostatism, and early Parkinsonian left knee pain, who chews incompletely because of gum gait are not considered. Dehydration is precipitated by pain, who sees poorly, and who has urinary urgency and furosemide and exacerbated by poor oral intake result- "a touch of diabetes.

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