Articles
How to Get the Most
from your Couples Therapy
This Article is borrowed from the Couples Institute www.CouplesInstitute.com
By Peter Pearson, Ph.D
Oct 1, 2004, 14:30
Couples are often uncertain what to expect from the process of couples
therapy. They are not sure of how what to expect of the therapist or even if the
therapist has any expectations of them.
I have found most couples approach therapy with the notion that each person
will describe their distress and somehow the therapist will assist them to
create a happier, more functional, relationship. They expect to learn some new
or better skills. However, most people hope their partner will do most of the
learning in problem areas.
After 30 years of clinical experience and specializing in working with (by
now) thousands of couples, I have arrived at some guidelines that can make our
work more effective. First, I do have some expectations of you. I am not
neutral. I have evolved principles and concepts that I believe give us the
greatest chance for success.
I believe My primary role is to help you improve your responses to each other
without violating your core values or deeply held principles. So that you may
know some of my key guiding principles, I have created this document to provide
clarity and focus to our work.
Your job is to create your own individual objectives for being in therapy.
Like a good coach, my job is to help you reach them. I have many, many tools to
help you become a more effective partner - they work best when you are clear
about how you aspire to be.
Goals and Objectives of Couples Therapy
The major aim of therapy is increasing your knowledge about yourself, your
partner and the patterns of interaction between you. Therapy becomes effective
as you apply new knowledge to break ineffective patterns and develop better
ones.
The key tasks of couples therapy are increasing your clarity about:
• The kind of life you want to build together
• The kind of partner you aspire to be in order to build the kind of life and
relationship you want to create
• Your individual blocks to becoming the kind of partner you aspire to be
• The skills and knowledge necessary to do the above tasks.
Tradeoffs and Tough Choices
To create sustained improvement in your relationship you need:
• A vision of the life you want to build together
• To have a life separate from your partner because you are not joined at the
hip.
• The appropriate attitudes and skills to work as a team
• The motivation to persist
• Time to review progress.
To create the relationship you really desire, there will be some difficult
tradeoffs and tough choices for each person.
The first tradeoff will be time – it simply takes time to create a
relationship that flourishes- time to be together –time to play- coordinate-
nurture- relax – hang out- plan – family time etc. This time will encroach on
some other valuable areas – your personal or professional time.
The second compromise is comfort – emotional comfort- going out on a limb to
try novel ways of thinking or doing things – listening and being curious instead
of butting in, speaking up instead of becoming resentfully compliant or
withdrawing. At the beginning, there will be emotional risk taking action, but
you will never explore different worlds if you always keep sight of the
shoreline. In addition, few people are emotionally comfortable being confronted
with how they don’t live their values or being confronted with the consequences
of their actions.
The third comfort that will be challenged is energy comfort – it simply takes
effort to sustain improvement over time- staying conscious of making a
difference over time- remembering to be more respectful, more giving, more
appreciative etc. – it takes effort to remember and act.
The fourth effort is even more difficult. That is, improving your reaction to
problems. For example, if you are hypersensitive to criticism, it will take
effort to become less sensitive instead of hoping your partner will stop
ignoring or criticizing.
In all these areas, there is generally a conflict between short-term
gratification and the long-term goal of creating a satisfying relationship. The
blunt reality is that, in an interdependent relationship, effort is required on
the part of each person to make a sustained improvement. It is like pairs figure
skating – one person cannot do most of the work and still create an exceptional
team.
How to Maximize the Value from your Couples Therapy Sessions
A common yet unproductive pattern in couple’s therapy is making the focus be
whatever problem happens to be on someone’s mind at the moment. This is a
reactive (and mostly ineffective) approach to working things through.
The second unproductive pattern is showing up and saying, “I don’t know what
to talk about, do you?” While this blank slate approach may open some
interesting doors, it is a very hit or miss process.
The third major unproductive pattern is discussing whatever fight you are now
in or whatever fight you had since the last meeting. Discussing these
fights/arguments without a larger context of what you wish to learn from the
experience is often an exercise in spinning your wheels.
Over time, repeating these patterns will lead to the plaintive question, “Are
we getting anywhere?”
A more powerful approach to your couple’s therapy sessions is for each person
to do the following before each session:
1. Reflect on your objectives for being in therapy.
2. Think about your next step that supports or relates to your larger
objectives for the kind of relationship you wish to create, or the partner you
aspire to become.
This reflection takes some effort. Yet few people would call an important
meeting and then say, “Well, I don’t have anything to bring up, does anyone else
have anything on their agenda?” Your preparation will pay high dividends.
Brief Concepts for Couples Therapy and Relationships
The following ideas can help identify areas of focus in our work and/or
stimulate discussion between you and your partner between meetings. If you
periodically review this list, you will discover that your reflections and
associations will change over time. So please revisit this list often, it will
help you keep focus during our work.
Attitude is Key
When it comes to improving your relationship, your attitude toward change is
more important that what action to take.
Identifying what to do and how to do it is often easy to identify. The bigger
challenge is why you don’t do it.
How to think differently about a problem is often more effective than just
trying to figure out what action to take.
Your partner is quite limited in his/her ability to respond to you.
You are quite limited in your ability to respond to your partner.
Accepting that is a huge step into maturity.
The definite possibility exists that you have some flawed assumptions about
your partner’s motives. And that he/she has some flawed assumptions about yours.
The problem is, most of the time we don’t want to believe those assumptions are
flawed.
Focus on Changing Yourself Rather than Your Partner
Couples therapy works best if you have more goals for yourself than for your
partner. I am at my best when I help you reach objectives you set for yourself.
Problems occur when reality departs sharply from our expectations, hopes,
desires and concerns. It’s human nature to try and change one’s partner instead
of adjusting our expectations. This aspect of human nature is what keeps
therapists in business.
The hardest part of couples therapy is accepting you will need to improve
your response to a problem (how you think about it, feel about it, or what to do
about it). Very few people want to focus on improving their response. It’s more
common to build a strong case for why the other should do the improving.
You can’t change your partner. Your partner can’t change you. You can
influence each other, but that doesn’t mean you can change each other. Becoming
a more effective partner is the most efficient way to change a relationship.
It's easy to be considerate and loving to your partner when the vistas are
magnificent, the sun is shining and breezes are gentle. But when it gets bone
chilling cold, you’re hungry and tired, and your partner is whining and
sniveling about how you got them into this mess, that's when you get tested.
Your leadership and your character get tested. You can join the finger pointing
or become how you aspire to become.
Nothing is impossible for the person who doesn’t have to do it.
Fear lets you know you’re not prepared. If you view fear in that mode, it
becomes a signal to prepare the best you can.
You can learn a lot about yourself by understanding what annoys you and how
you handle it.
The more you believe your partner should be different, the less initiative
you will take to change the patterns between you.
Zen Aspects of Couples Therapy (Some Contradictions)
All major goals have built in contradictions, for example, speak up or keep
the peace.
All significant growth comes from disagreements, dissatisfaction with the
current status, or a striving to make things better. Paradoxically, accepting
that conflict produces growth and learning to manage inevitable disagreements is
the key to more harmonious relationships.
It’s not what you say. It’s what they hear.
Solutions, no matter how perfect, set the stage for new problems.
Tough Questions
Asking good questions--of yourself and your partner--helps you uncover causes
beneath causes.
In a strong disagreement, do you really believe your partner is entitled to
their opinion?
Under duress, do you have the courage and tenacity to seek your partner’s
reality and the courage to express your reality when the stakes are high?
Why is it important to let your partner know what you think, feel and are
concerned about? (Because they really can’t appreciate what they don’t
understand.)
What is the price your partner will have to pay to improve their response to
you? How much do you care about the price they will have to pay? (Everything has
a price and we always pay it.)
Can you legitimately expect your partner to treat you better than you treat
him/her?
If you want your partner to change, do you think about what you can do to
make it easier?
When a problem shows up, it’s natural to think “What should I do about it?”
A much more productive question is. “How do I aspire to be in this
situation?”
The Importance of Communication
The three most important qualities for effective communication are respect,
openness and persistence.
Good communication is much more difficult than most people want to believe.
Effective negotiation is even harder.
A couple’s vision emerges from a process of reflection and inquiry. It
requires both people to speak from the heart about what really matters to each.
We are all responsible for how we express ourselves, no matter how others
treat us.
Communication is the number one presenting problem in couples counseling.
Effective communication means you need to pay attention to:
• Managing unruly emotions, such as anger that is too intense
• How you are communicating – whining, blaming, vague, etc.
• What you want from your partner during the discussion
• What the problem symbolizes to you
• The outcome you want from the discussion
• Your partner’s major concerns
• How you can help your partner become more responsive to you
• The beliefs and attitudes you have about the problem.
No wonder good communication is so hard.
Some Final Thoughts…
You can’t create a flourishing relationship by only fixing what’s wrong. But
it’s a start.
Grace under pressure does not spring full-grown even with the best of
intentions - practice, practice and more practice. Practice the right things and
you will get there.
Love is destroyed when self-interest dominates.
If you don’t know what you feel in important areas of your relationship, it
is like playing high stakes poker when you see only half your cards. You will
make a lot of dumb plays.
The possibility exists that we choose partners we need but don’t necessarily
want.
To get to the bottom of a problem often means you first accept how complex it
is.
Trust is the foundational building block of a flourishing relationship.
You create trust by doing what you say you will do.
It’s impossible to be in a highly inter-dependent relationship without ever
being judgmental or being judged.
If you strive to always feel emotionally safe in your relationship and get
it, you will pay the price of becoming dull.
If both of you never rock the boat, you will end up with a dull relationship
Knowledge is not power. Only knowledge that is applied is power.
Most of the ineffective things we do in relationships fall into just a few
categories:
• Blame or attempt to dominate
• Disengage/withdraw
• Resentful compliance
• Whine
• Denial or confusion.
These are the normal emotional reactions to feeling a threat or high stress.
Improving your relationship means better management of these reactions.
Can you legitimately expect your partner to treat you better than you treat
yourself.
Everything you do works for some part of you, even if other parts of you
don’t like it.
Three motivations will govern any sustained effort you make. You will seek
to:
1. Avoid pain or discomfort
2. Create more benefits
3. Be a better person.
It’s also true for your partner.
If you are asking your partner to change something, sometimes it’s a good
idea to ask if the change is consistent with how they aspire to be in that
situation.
Businesses and marriages fail for the same three reasons. A failure to:
• Learn from the past
• Adapt to changing conditions
• Predict probable future problems and take action.
Effective change requires insight plus action. Insight without action is
passivity.
Action without insight is impulsive. Insight plus action leads to clarity and
power.
If you want to create a win-win solution, you cannot hold a position that has
caused your partner to lose in the past.
“To be a champ you have to believe in yourself when nobody else will.”
Sugar Ray Robinson –Middleweight boxing champion, considered by many to be
the best fighter in history, pound-for-pound.
P.S. please review this document periodically as there is simply too much to
absorb in one reading of it. We all will benefit your efforts.
© Copyright MMIII The Couples Institute
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Dealing with Desire
Discrepancy
Question: We've been happily married for ten years, but lately we are having
a disagreement. My husband wants to have sex much more often than I do. How do
we figure out a way so that both of us can be happy?
Answer: This is a problem with very few clues. It's like trying to
reconstruct an entire civilization from a few shards of pottery. Or like asking
a travel agent, "We don't agree on where we want to go for an important
vacation. What should we do and what should we pack?"
Undaunted, I will respond to the clues you offer.
The first clue, your marriage is a good one. Ironically, good marriages are
sometimes bad for good sex. The very qualities that can make for a good
marriage--predictability, safety, and routine--can make for sex that is
predictable, safe and routine. Marriages that are oriented around compassion,
caring and politeness often end up with a sexual relationship that is
predictable, safe and routine. Over time, even Inspector Clouseau could predict
the sexual outcome.
The second clue: ten years married. Time enough to figure out there is rust
on Prince Charming's armor. Maybe he doesn't wield his sword (or lance) the way
you hoped. Maybe his shield is too protective. Maybe you spend too much time
trying to polish his armor and he spends too little time treating you like his
fair maiden.
You didn't mention your ages, but maybe there is a change of life process you
are going through or increased stress/responsibilities that dampen the fires of
eroticism. You could also ask him if he got better sex would he be satisfied
with a little less.
* * * * *
There's rarely time in a newspaper column to solve such a complex problem. So
I'd like to add a few action steps that can help bring you closer together and
strengthen your bond, even if the problem of sexual discrepancy is not solved
immediately:
Set aside time to talk about your partner's desires. Take turns talking and
listening without being defensive. I know it's is a tall order to stay
non-defensive, but it will be a key component of working this out. Ask lots of
questions and keep recapping what you hear. Couples tackle lots of difficult
questions, and this one is close to the top of the list for most people.
When you talk, the discussion is going to require taking a series of
emotional risks. You will be describing what is sexually important to you and
why it is important. This takes patience and reassuring your partner that you
appreciate their vulnerability.
It is important you approach this subject without expecting one discussion
will solve it. If one talk does solve things, terrific, but don't put that
pressure on yourself. Please define success as the willingness to experiment
with discussions instead of having to rapidly come up with solutions. Creating a
better sexual relationship is trial and error with a lot of patience and
tolerance for practicing and experimenting.
Most of all, if you approach the problem with a kind and open heart realizing
you want the best for each other, it goes a long way to strengthening the
connection between the two of you.
Peter Pearson
© Copyright MMIIII: CouplesInstitute.com
All rights reserved.
http://www.couplesinstitute.com
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"Love that Lasts"
FAQ
By Dr. Ellyn Bader, Ph.D. and Peter Pearson, Ph.D.
Mar 15, 2004, 12:43
This month we thought we’d do something a little bit different. We thought
we’d share some of the most commonly asked questions by couples we see for
therapy. In this way we can cover a wide range of topics and give you a peek
into other couples’ concerns.
Q. What is the most common complaint you hear from other couples?
A. “We can’t communicate.”
Q. Why is communication so difficult? We talk all day long, it should be
easy. What’s the big deal?
A. Effective communication with your partner is a series of unnatural
responses. It is rare for two people to want the same thing at the same time.
That means that to communicate effectively you have to be a good advocate for
yourself and still be responsive to your partner. It also means handling
disappointment without exploding. Very few people will ask for more information
when their partner complains, “You never listen to me.” Asking for more
information when you hear a criticism is quite effective but very unnatural.
Q. So what’s the solution?
A. That’s as difficult as answering the question, “How do you cure poverty?”
But here is a suggestion: when you feel like an argument is starting, ask your
partner two or three questions before starting to defend yourself.
Q. When we learn to communicate better, will things improve?
A. Sometimes. Other times you might feel worse. When you are asking good
questions, you might hear some disturbing responses. You might even hear things
you didn’t want to hear in the first place. And it’s no fun to listen without
interrupting or defending yourself. Like exercise, it often hurts at the
beginning.
Q. It’s often said that marriage is full of compromises. Are there any limits
to compromises?
A. Yes. You can compromise on day in and day out decisions like what movie to
see, where to go for dinner or who will do what chores. However, do not
compromise on your core values. This may mean some tension-filled discussions
with your partner until you arrive at solutions that incorporate both people’s
values. Compromising on your core values is a sure road to depression.
Q. Many couples think their partner has most of the power. How do you see
power in relationships?
A. Power is the ability to get something done or have the influence to get
what you want. This is why in many marriages both people can feel helpless –
they can’t influence the other in directions they want. Because they don’t
believe they have much influence, they think the other one has most of the
power.
Here’s an example. Pat feels like Terry makes all the major decisions.
Because Pat feels like a victim in the marriage, Pat ends up withholding sex,
affection, and appreciation, and refuses to cooperate with Terry’s decisions.
Terry wants sex and appreciation for all the contributions that are made. Who
has the power?
Q. How do I know if I am over compromising or being co-dependant?
A. If you frequently feel depressed and as if you are losing much of your
identity, you are probably over-accommodating. If you do things that maintain or
increase your self esteem and are aligned with your higher values and integrity,
you are probably on the right path.
Q. I have done everything possible to fix a problem and my partner still
won’t change, now what?
A. I don’t think anyone literally does everything possible, but people often
do all they are interested in doing. You may need to spell it out. Write a
letter. Writing is good because you can say everything that needs to be said
without being interrupted. Nobody puts a letter down in the middle to challenge
what is being said. They read it all the way through first.
In your letter discuss the situation and your reaction to it (what you think,
feel and do when the situation shows up). Discuss what you want and why it’s
important to you. Include what the consequences are if you get or don’t get the
problem solved. Include in the letter why you think it may be difficult for your
partner to be responsive. If appropriate, say what you can do to make it easier
for your partner to be more responsive. Think about the situation from a team
perspective instead of just “getting your own needs met.”
Q. Do other couples struggle as much as we do?
A. Every couple has their own struggles. But the amount of struggle is not
the issue. It is whether you learn from your struggles. You can use them to
pinpoint new skills that will help you move forward. Struggling does not make
you or your relationship bad.
Q. What do effective couples do?
A. #1. These partners don’t get caught up in each others’ negative feelings.
#2. They can apologize or say they are sorry when things go off track.
#3. Each partner takes initiative: initiative to give positive strokes,
initiative to complete family and household responsibilities, and initiative to
repair hurt or angry feelings.
Our question to you…..Can you use some of this information to make your
relationship better this month? We hope so. If you’d like to see a more thorough
discussion of couples therapy, you might be interested in the video, “Couples
Therapy: An Introduction,” with Ellyn Bader. Call us toll free at 1-877-327-5915
for more information on this encouraging, informative videotape.
Until next month,
Ellyn Bader, Ph.D. and Peter Pearson, Ph.D.
Click here to subscribe to "Love That Lasts."
© Copyright MMIII The Couples Institute
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The
7-Step Approach to Influence A Partner to Change
By Ellyn Bader, Ph.D and Peter Pearson, Ph.D
Jun 15, 2004, 10:27
Everyone has something they’d like to change in their partner. As a
therapist, you know that the biggest improvements in a couples’ relationship
come when both people change and grow. Couples’ relationships present an
interesting paradox. Growth is spurred by partners pushing up against each other
and challenging one another to change. This pushing and challenging can result
in positive developmental changes and the softening of defenses. However, too
often partners request change in a way that is controlling, demanded and
entitled. These requests lead to power struggles and very painful interactions.
But sometimes one partner has a legitimate desire to see a change in their
partner. And this format can help them. We invite you to share it with your
couples.
* * * * *
Here is a 7-step process to create change in your partner. The key to the
success of this process is that it makes your partner want to change — instead
of feeling coerced. Why? Because your gain will not feel like their loss.
Here’s what you do.
1. MAKE A LIST of the top three behaviors your partner does that annoy you.
For example, leaves messes around house; pouts; doesn’t do their share of
household tasks, etc. Then, select the one problem that has the best chance of
your partner responding to your discomfort. You will increase your chances for
success dramatically by focusing on one problem at a time. Let’s go for a big
one here and say the problem is that your partner is not pulling their weight
around the house.
2. DESCRIBE THE PROBLEM in clear detail. This includes what they do and your
reaction to the problem. For example: “Honey, there is a problem I need to
discuss with you. When you come home from work and start reading the mail,
change your clothes, turn on the news, return a phone call without looking
around and noticing the kids are cranky, squalling for dinner, and I’m up to my
neck in getting dinner ready, I see you as a blind and insensitive clod. This
problem has persisted for over a year now with little relief in sight.”
3. DESCRIBE YOUR REACTION to the problem. “When you act so oblivious, I think
you care much more about responding to your own needs first and foremost, and
you pitch in only when it is convenient for you. I feel angry, alone, and
resentful. When I feel that way I end up being chilly to you and withdrawing any
spontaneous signs of affection. I don’t like how I react but that is what I have
been doing.”
Here is the “formula” for describing the problem.
A) You have specified the behavior of “not pulling his weight” by giving
specific examples.
B) You have given your reaction to it by stating: “when you do (their
behavior) I think_____ (you’re inconsiderate...) and feel _____ (angry, alone,
resentful), and then I do _____ (withhold affection). It is important to let
your partner know what your complete response is to the behavior that is a
problem. Especially let them know what you do when you think and feel the way
you do. This really informs your partner of the consequence to them when they do
the undesired behavior. Include in your reaction the meaning of the problem for
you. For example, not pulling their weight represents not being loved,
respected, or valued.
4. BE EMPATHETIC. Tell your partner why you think that would be hard for them
to change the undesired behavior. This lets them know you see the problem from
both perspectives and that you have an appreciation for what you’re asking them
to change. For example, “Honey, I think pitching in when you get home would be
difficult because you feel depleted and want some time to yourself in order to
regenerate. I think pitching in at the level I want is a lot to ask of you.
5. DESCRIBE HOW YOU WILL HELP. Because you’re not “just” going to make a
request and then hope for the best, (this hasn’t been successful in the past,
neither has been nagging or pleading) the next step is to describe what you will
do to help your partner make the change you want. For example, “Honey, your
pitching in is so important to me when you get home that I will do
¬_____________ (fill in here what you think will be a high motivator for your
partner to make the requested change).
6. ASK IF THEY ARE WILLING to make the change you’re requesting. They may
agree to all or part or none of your request. They might say “no” to you but
would be more willing to consider the change if you offered a different
motivator or inducement to change. Then you can decide if it is worth your
efforts.
7. FIND OUT WHY. Regardless of whether they are willing to change or not, ask
why. Knowing why they are willing to change will help you understand what
motivates them. You’ll be able to encourage them better along the way. If they
don’t want to change, finding out why will help you determine how to move
forward. In that case you still have 2 more options. One, you can ask if this is
a temporary or more permanent condition. If it seems there will be no change for
now, let them know the consequences — how you think, feel and act — and then
drop it for now. The second option is to go to the second problem on your list
and repeat the sequence described above.
* * * * *
When you give couples this information, “The 7-Step Approach to Influence
Your Partner to Change,” they have both the tools and the motivation to move
forward. If you help them work through the steps for the first time in a
session, they’ll be better prepared to continue their progress at home. You’ll
also find that couples who work on it at home come to their next appointment
with new, relevant issues to discuss with you. You can print a copy that’s
suitable for your clients from the newsletter section of the couples’ side of
our website. You might even encourage couples to visit it themselves, and sign
up for our free monthly couples’ newsletter while they’re there.
Until next month,
Ellyn Bader and Peter Pearson
Subscribe to the "Practice Development Dispatch."
© Copyright MMIII The Couples Institute
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Caregiving for Elderly Parents
In this new age, families are taking care of elderly parents inside the home
more than ever. This generation of caretakers has been given the name “sandwich
generation” because they are still raising children of their own when they find
themselves in the midst of taking care of an elderly parent in their home.
These families juggle many roles and responsibilities, including working full
time, raising their own immediate families and adjusting their lives to make
room for an elderly parent. Many times these caregivers have little or no
experience taking care of the elderly. They have to learn how to administer
medications, arrange nutritional needs, and deal with behaviors associated with
disease or disability including dementia or Alzheimer’s disease. There are many
adjustments a family must make and all members of a family must adapt to their
new responsibilities. Change is not left just to the caregiver but the whole
family system. Children and friends might be asked to help run errands and do
household chores because the primary caregiver is busy arranging meals and
making doctor appointments.
One of the most intense issues surrounding caregiving of a parent is the
parent-child relationship. Parent-child relationships are difficult to begin
with, but add having to care for your parent in a way that makes you act as
their parent, and this is a nightmare waiting to happen, if you let it.
The first thing you must remember is that you are NOT parenting your parent.
Yes, you may be doing some of the things that a parent would do for a child like
tying shoelaces, changing diapers and administering medications but this in no
way means you are now the parent. Your parents are still your parents and you
are still their child and will always be their child. You may have new
responsibilities and be dealing with a rebellious behavior, but that does not
change your roles.
One of the biggest mistakes a caregiver can make is to begin thinking of
their elderly parent as a child. Sometimes an elderly parent will revert to
acting in childish way, act rebellious or stubborn, refuse to eat the right
foods or take their medicine but this does not make them a child. If you begin
to think that they are, then you will only cause frustration for yourself down
the road. If you can continue to act as an adult and treat your parent as an
adult you will make this transition in both your lives much easier.
One important and useful way of making this transition work is to encourage
your parents’ independence in any way possible. In the end it will be better for
you and for them. Encourage them to clean up after themselves, make their own
lunch and take walks to the store to shop. Activity is good for their body, mind
and spirit. When your parents every need is being taken care of by someone else
and they feel as if they have completely lost control over their lives, they can
become disheartened and become helpless. This isn’t healthy for the mind or
body. Be sure to find new ways of fostering you parents’ independence.
Providing care for elderly parents is a stressful, emotional and
physically/mentally exhausting responsibility. Balancing concerns for their own
immediate family, working outside the home and caregiving for an elderly parent
can cause stress related symptoms to the caregiver. If you know a caregiver with
some or most of these symptoms you may want to reach out for support or
professional services from a an experienced family therapist:
· Lack of sleep
· Anxiety
· Depression
· Poor immune systems
· Irregular eating habits
· Not maintaining their own health
Many communities offer support groups for caregivers and family therapy is a
viable and proven resource. Family therapists can enhance relationships between
parent and child, reduce caregiver stress and increase the health of the
caregiver.
For more information please reach out the following resources.
Web Resources
Administration on Aging
(800) 677-1116
www.aoa.dhhs.gov
Family Caregiver Alliance
(415) 434-3388
www.caregiver.org
Well Spouse Foundation
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How to Care for Aging Parent’s by Virginia Morris
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Spirituality in
Marriage & Family Therapy
The great malady of the twentieth century, implicated in all of our troubles
and affecting us individually and socially, is “loss of soul.” When soul is
neglected, it doesn’t just go away; it appears symptomatically in obsessions,
addictions, violence, and loss of meaning. - Thomas Moore
Recently, in various mental health professions there has been an increase in
interest regarding the integration of spirituality, religion and clinical
practice. On the shelves in bookstores you can find an increase of literature
available that has shifted focus towards this new controversial topic –
spirituality and therapy. So what are the benefits and/or necessity of
reintegrating mind/body with spirit/soul?
Historically, there was not a clear distinction between the psychological and
spiritual. The mental health profession began with less of a distinction between
the spirits and mental illness and often patients that exhibited schizophrenia
were considered possessed by spirits.
More recently, we have left the issues related to spirituality in the hands
of religion, and the intellectual in the hands of the physicians and teachers.
In an effort to change this dualistic view, many mental health professionals are
urging clinicians to conceptualize persons as bio-psycho-social-spiritual
beings. What this view offers to a therapist is the option to expand their view
and see their clients as individuals with many different layers.
When a therapist ignores their clients’ spiritual beliefs they are ignoring
an important assessment tool. If spirituality can be useful as a tool in therapy
clients will then be able to openly express issues in areas that otherwise would
be overlooked. Thomas Moore believes that psychology is incomplete if it doesn’t
include spirituality and art in a fully integrative way.
So are all these mental health professionals headed in the wrong direction?
Not according to a survey by Stewart & Gale (1994) where the majority of clients
(66%) prefer a therapist with spiritual values; and an even greater percentage
(81%) desire a therapist who would enable them to integrate their values and
beliefs in therapy.
So what is soul/spirituality? How do we find it? Where is it hiding? Is there
a need for it in therapy? Soul/Spirituality has been described in different ways
and differently over time. However, all of these different definitions seem to
have a common theme. All of these theories describe spirituality and soul as a
way of experiencing everyday life and placing meaning to events and things in
our lives that we might ordinarily overlook. Spirituality is a way of living and
a way of seeing life.
In addition to the individual soul, what about the soul of a family? What
does it mean when we say a family has a life of its own? Are we implying a
communal soul? A communal soul gives a family unity and direction and offers
love, support, and a sense of identity. Families are presented to the public as
a place where traditions are upheld and the soul is created and nurtured. We
expect that the family will provide us with love and direction. We also expect
this love to be healing and whole.
The traditional image of the family only serves to protect us from the
reality that family can sometimes be a comforting and, at the same time,
devastating place. Families are always so concerned with how to succeed and
overcome family problems. However, if we can learn to honor the family as it
presents itself, with all of it’s paths that seem to have a direction of their
own, only then can we begin to understand what it means to find the soul of the
family.
So is it vital to incorporate soul/spirituality in family therapy? I don’t
think a therapist can work with a client/family without it. A shift in our view
of the family is in order. To recover the soul/spirituality of an individual or
family, I believe we need to stop trying to fix it or become free of the
problems associated with it, but instead look deeply at our daily experiences
and live and feel every moment. When we try to avoid our experiences or troubles
they reappear in our lives as symptoms of illness, emptiness, aggression etc.
Through family therapy and the integration of soul/spirituality, the essence of
soul can be recaptured. The tradition of family can be upheld and we can again
expect the family to provide us with love and direction that can be healing and
whole.
References and Resources
Abbott, D., Berry, M.m & Meredith, W. (1990). Religious belief and practice:
A potential asset in helping families. Family Relations, 39, 443-448.
Anderson, H. (1994). The recovery of the soul. In B. Childs & D. Waanders
(Eds.), The treasure in earthen vessels: Explorations in theological
anthropology (pp. 208-223). Louisville, KY: Westminster Press/John Knox Press.
Anderson, H. (1999). Feet planted firmly in midair: A spirituality for family
living. In F. Walsh (Ed.), Spiritual Resources in Family Therapy (pp. 157-177).
New York: The Guilford Press.
Anderson, D., & Worthen, D. (1997). Exploring a fourth dimension:
Spirituality as a resource for the couple therapist. Journal of Marital and
Family Therapy, 23, 3-12.
Antonovsky, A. (1987). Unraveling the mystery of health. San Fransisco: Jossy-Bass.
Aponte, H. (1999). The stresses of poverty and the comfort of Spirituality.
In F. Walsh (Ed.), Spiritual Resources in Family Therapy (pp. 61-75). New York:
The Guilford Press.
Bergin, A. (1991). Values and religious issues in psychotherapy and mental
health. American Psychologist, 46, 394-403.
Doherty, W. (1999). Morality and spirituality in therapy. In F. Walsh (Ed.),
Spiritual Resources in Family Therapy (pp. 179-192). New York: The Guilford
Press.
Dombeck, M. & Karl, J. (1987). Spiritual Issues in mental health. Journal of
Religion and Health, 26(3), 183-197.
Ellison, C. & Levin, J. (1998). The religion-health connection: Evidence,
theory, and future directions. Health Education and Behavior, 25, 700-720.
Gallup, G. (1994). Religion in America: 1994, Supplement. Princeton, NJ: The
Gallup Organization, Inc.
Klass, D. (1995). Spiritual aspects of the resolution of grief. In H. Wass &
R.A. Neimeyer (Eds.), Dying: Facing the facts (pp. 243-268). Washington, DC:
Taylor & Francis.
Marrone, R. (1997). Death, mourning and caring. Pacific Grove, CA:
Brooks/Cole/Wadsworth.
Marrone, R. (1999). Dying, Mourning, and Spirituality: A Psychological
Perspective. Death Studies, 23, 495-519.
Montalvo, B., & Gutierrez, M. (1990). Nine assumptions for work with ethnic
minority families. In G.W. Saba, B.M. Karrer, & K.V. Hardy (Eds.), Minorities
and family therapy (pp. 35-52). New York: Haworth Press.
Moore, T. (1992). Care of the Soul: A Guide for Cultivating Depth and
Sacredness in Everyday Life. New York: HarperPerennial.
Patterson, R. (1994, June). Learning from suffering. Family Therapy News, pp.
11-12.
Roberts, J. (1999). Heart and soul: Spirituality, religion, and rituals in
family therapy training. In F. Walsh (Ed.), Spiritual Resources in Family
Therapy (pp. 61-75). New York: The Guilford Press.
Schell, B. (1992). Elements of couple psychotherapy and awakening. In B. J.
Brothers (Ed.), Spirituality and Couples (pp. 65-76). New York: Hawthorne Press.
Stewart, S. & Gale, J. (1994). On Hallowed ground: marital therapy with
couples on the religious right. Journal of Systemic Therapies, 13, 16-25.
Turbott, J. (1996). Religion, spirituality, and psychiatry; conceptual,
cultural, and personal challenges. Australian and New Zealand Journal of
Psychiatry, 30, 720-727.
Walsh, F. (1999). Religion & spirituality: Wellsprings for healing and
resilience. In F. Walsh (Ed.), Spiritual Resources in Family Therapy (pp. 3-27).
New York: The Guilford Press.
Walsh, F. (1999). Opening family therapy to spirituality. In F. Walsh (Ed.),
Spiritual Resources in Family Therapy (pp. 28-58). New York: The Guilford Press.
Walsh, F., & McGoldrick, M. (1991). Living beyond loss: Death in the family.
New York: Norton.
Wright, L., Watson, W., & Bell, J. (1996). Beliefs: The heart of healing in
families and illness. New York: Basic Books.
Wright, L. (1999). Spirituality, Suffering, and beliefs. In F. Walsh (Ed.),
Spiritual Resources in Family Therapy (pp. 61-75). New York: The Guilford Press.
Top
Acupuncture and Family Therapy: A Holistic Approach
Even though acupuncture has been a practiced Chinese medical treatment for
over 4,500 years, in most western cultures it is considered a “new alternative”
medicine. Acupuncture is the oldest form of curing still practiced in the world
today.
In Chinese medicine, and therefore in acupuncture, health is determined by a
person’s ability to maintain balanced and harmonious internal environment.
Disease occurs when the internal environment is disturbed and the normal
processes that act to restore balance and harmony are unable to cope (Mills &
Finando, 1989, p. 8). Harmony and balance depend on the smooth and uninterrupted
flow of Qi (pronounced ch’i). The Chinese ideogram for “energy” is called Qi.
Acupuncture is based on the theory that Qi runs through the body as an energy
force. The Qi consists of all vital activities including the spiritual,
emotional, mental, and physical part of life that is within all living beings.
Acupunctures premise is that nature is a part of all living beings rather than
something outside them.
Qi is comprised of two parts, Yin and Yang. Yin and Yang are opposite forces,
that when balanced, work together. Any upset in the balance will result in
natural calamities, in nature, and disease in humans. It is the right balance of
Yin and Yang that is responsible for the harmonious functioning of the universe,
including mankind (Nightingale, 1987, p. 19).
An individuals’ health is a reflection of the flow of Qi and the universal
forces of the Yin and Yang. If the flow of Qi is unbalanced or interrupted, then
the Yin and Yang will also be unbalanced. When these forces become unbalanced
illness can surface (Singer, 1999).
The flow if Qi moves in the body along pathways called “meridians". Meridians
are pathways along which energy is transmitted around the body by oscillation
and vibration (Nightingale, 1987, p. 50). The meridians are paired, one on
either side and run vertically up and down the surface of the body. The meridian
system in the body could be thought of like our nervous system: It is a means of
communication. Unlike our nervous system, though, the meridians are not a
physical structure, but an energy structure (Sundarii, 1999).
Qi flows up and down these meridians and when these pathways become
obstructed or stuck (unbalanced), Yin and Yang also become unbalanced and this
is said to cause illness. Acupuncture is the practice of bringing balance back
to the QI and the Yin and Yang.
The specific acupuncture points are where the meridians come to the surface
of the skin. This makes it easy to access these points through needling that
will restore circulation to the flow of Qi bringing back balance between Yin and
Yang. Through the insertion of needles at specific acupuncture points on the
Meridian, we are coaxing the energy to flow properly. When energy is flowing,
the bodies own healing mechanisms are able to “kick in,” and the process of
healing begins (Sundarii, 1999).
Possible reasons cited for obstructing the flow of Qi include internal or
emotional disturbances, external factors, imbalances in diet or lifestyle, and
too much work and stress. Stimulation by acupuncture is said to remove these
blockages by diffusing lactic acid and carbon monoxide that accumulates in
muscle tissue. These accumulations are believed to cause stagnation of blood and
stiffness throughout the body (iVillage, 2000).
Acupuncture relies on the body’s own natural healing energy. Individuals are
treated differently using acupuncture, as no two people are alike. As
acupuncture treatment begins the body will access its own healing energy and the
body will rebalance itself. Symptoms will begin to fade as the body begins to
heal itself.
Millions of Americans have turned to acupuncture and other alternative
medicines for relief or prevention of pain and for a variety of health
conditions. The National Institute of Health (NIH) gave their approval of
acupuncture and in 1997, the NIH Consensus Panel examined all available research
on acupuncture treatment. The NIH panel's consensus statement found that
acupuncture (National Institute of Health, 1997):
Is an effective treatment for a variety of health conditions including nausea
from chemotherapy, surgery and pregnancy, and pain after surgery; May also be an
effective adjunct therapy for a number of other conditions, including stroke
rehabilitation, relieving addictions, headaches, menstrual cramps, a variety of
muscle pains, carpal tunnel syndrome, tennis elbow, low back pain,
osteoarthritis, and asthma;
Adverse side effects are known to occur less often than with many drugs or
other medical procedures used for the same conditions; Should be integrated into
standard medical practice and be covered by Medicare, Medicaid and private
insurance companies.
Moreover, the World Health Organization (WHO), the medical branch of the
United Nations issued a provisional list of 41 diseases treatable by
acupuncture. Some of those included in the list are respiratory ailments, pain
and chronic pain conditions, PMS and other gynecological disorders, and
gastrointestinal disorders (World Health Organization, 1979).
Today the practice of acupuncture has increased in the United States and
there are over 50 schools of acupuncture nationwide, 21 of which are accredited
by the U.S. Department of Education and over 40 states have laws or regulations
governing the practice of acupuncture (http://www.thehealthpages.com/articles/aracupn.html).
What is Acupuncture?
Acupuncture is comprised of a grouping of procedures that involve stimulating
specific points on the skin using a variety of styles. Some of the acupuncture
techniques practiced today have incorporated the traditions from China, Japan,
Korea, and other countries (National Institute of Health, 1997).
For conditions that cannot be helped with Western medicine, acupuncture can
be a viable source of treatment. Acupuncture deals with the physical body, the
mental being and the spiritual being, whereas Western medicine only deals with
the physical body. Therefore, it can help people on levels that go untouched by
Western medicine (Sundarii, 1999). Not everyone is helped by acupuncture
treatment however some people do experience relief after only one or two
sessions. For others, relief could take up to ten to twelve sessions.
Acupuncture is a procedure that involves the penetration of specific
locations on the skin using thin, solid, metallic needles in order to influence
physiological functioning of the body. These specific points on the skin are
called acupuncture points. As many as nine different types of needles can be
used in acupuncture, however only six are most commonly used today. The needles
may vary in length, width of shaft, and shape of head. For health reasons, most
needles are disposable and are only used once then discarded in accordance with
medical biohazard regulations and guidelines (Singer, 1999).
Acupuncturists use a few types of methods when inserting needles. Techniques
are carefully chosen based on the ailment and no two individuals are treated
alike. Points can be needled anywhere in the range of 15 degrees to 90 degrees
relative to the skin surface, depending on the treatment called for (Singer,
1999). The following techniques are sometimes used following insertion of
needles: Raising and Thrusting, Twirling or Rotation, Combination of
Raising/Thrusting and Rotation, Plucking, Scraping (vibrations sent through the
needle), and Trembling (another vibration technique) (Singer, 1999).
These techniques are not painful, however there is a sensation felt by the
patient. This sensation, which is not pain, is called deqi (pronounced dah-chee)
and is desired by the acupuncturist (Singer, 1999).
How Does Acupuncture Work?
Scientists have no real answer to how acupuncture works, however there are
many theories. What they do know is that acupuncture treatment can influences
function rather than structure (Nightingale, 1987). What this means is that
structural problems such as a broken bone, severed nerve, or irreversibly
damaged internal organ cannot be helped by acupuncture. Functional problems,
such as muscle spasms, joints pain or swelling, allergic reactions, and
digestive disturbances, can be influenced by acupuncture (Rind, 1999). Pain,
whether acute or chronic, often responds dramatically to acupuncture
(Nightingale, 1987, p. 23).
A short answer to how acupuncture works is that acupuncture works by
correcting disharmony within the body (Nightingale, 1987). The traditional
Chinese describe this disharmony as either a deficiency or a blockage in the
meridians. The meridians or pathways of energy that run through the body and
over its surface flow through the body to irrigate and nourish the tissues. Any
blockage or obstruction to this flow will cause a back up in the system and
cause other parts to have deficiencies. These blockages and deficiencies of the
flow of energy through the body will eventually lead to disease (Chinese Pain
Center, 1999). Acupuncture or needling will unblock these dams of energy and
bring back a regular flow of energy through the meridians. Acupuncture
treatments can therefore help the body's internal organs to correct imbalances
in their digestion, absorption, and energy production activities, and in the
circulation of their energy through the meridians (Chinese Pain Center, 1999).
This method of healing encourages the body to promote a natural self-healing
process.
The western medical view of how acupuncture works is that the stimulation of
needling the acupuncture points produces a controlled, sterile, and harmless
stimulus to the nervous system. The body's defenses are triggered into
responding with a desirable response, such as a release of chemicals in the
muscles, spinal cord, and brain (Chinese Pain Center, 1999). These responses can
increase endorphin production, improve circulation, improve immune response, or
decrease inflammation changing the experience of pain or stimulating the body to
use its own internal regulating system (Rind, 1999).
The Different Types of Acupuncture
There are different styles and schools of thought in acupuncture, ranging
from traditional Chinese acupuncture to modern Western approaches. Within each
of these different approaches there are many variations. No two practitioners
will perform the same treatment techniques for the same problem. There are also
different theoretical orientations (e.g., Chinese, Japanese, Korean) that a
practitioner may use to approach treatment. There are many acupuncture
techniques that may be used as treatment as well as many variations of these
techniques. The following are brief descriptions of some of the most popular
acupuncture techniques:
Traditional Chinese Acupuncture
Traditional Chinese acupuncture practitioners believe that Qi flows through
the body through the meridians. Therefore, treatment from this view involves
using needling to stimulate the acupuncture points that will promote the body’s
natural healing process. The purpose of the needling is to release any blockage
of energy that may be causing pain or disease in the body. Traditional Chinese
acupuncture healers focus on the unity of the body and mind, meaning that if a
person is having pain or illness they are also in emotional turmoil, and vise
versa (Rind, 1999).
Rvodoralru
Yoshio Nakatani, a Japanese physician, developed Rvodoralru an estimated 40
years ago (Rind, 1999). Ryodoraku is different from traditional Chinese
acupuncture in that it doesn’t attempt to increase the flow of Qi but instead
attempts to balance the meridians.
Ryodoraku is a system of measuring skin resistance at the many different
acupuncture points. This information is then used to balance the 12 main
meridians. This method of acupuncture is based on the theory that good health
comes from the balancing of the meridians (Rind, 1999).
Korvo Sooii Chim
Dr. Tae-Woo Yoo developed Korvo Sooii Chim (Korean hand acupuncture) in 1971
(Rind, 1999). This method of acupuncture used only points on the surface of the
hands. The beliefs behind this method are that every acupuncture point on the
body has a corresponding acupuncture point on the surface of the hand (Rind,
1999). Therefore, if an acupuncturist wanted to perform a treatment that would
bring relief to a certain part of the leg, they would insert a needle in the
corresponding part of the hand.
Modern Western Acupuncture
Modern Western acupuncture is similar to traditional Chinese acupuncture,
however the difference lies in the underlying premise of each theory. Modern
Western acupuncture is based on the premise that the insertion of an acupuncture
needle will induce a controlled stimulation and have a measurable response. This
stimulation will produce a reflex response from the body that may increase
production of endorphins or create increased blood flow to a particular area of
the body that will enable the body to initiate self-healing.
A traditional Chinese acupuncturist may insert a needle into the same point
the Western acupuncturist inserted a needle but instead the premise would be
that inserting a needle in that acupuncture point will stimulate the meridian
and increase the flow of Qi which will bring balance and health (Rind, 1999).
Auricular Acupuncture
Auricular acupuncture is a commonly used treatment in the United States. This
method of acupuncture involves placing needles into acupuncture points in the
ear. This theory is based on the premise that the ear has a rich nerve and blood
supply and therefore has connections all over the body. Much like the Korean
method of Korvo Sooii Chim (Hand acupuncture), it is assumed that the ear has
acupuncture points that correspond to the many different parts and organs of the
body and therefore when these points are stimulated they will bring relief to
the corresponding area of the body (Singer, 1999).
Acupuncture and Moxibustion
The method of acupuncture and moxibustion is the burning of the herb moxa
(Chinese mugwort) over certain acupuncture points of the body to treat disease
(Nightingale, 1987). This is method warms, tones, and stimulates the acupuncture
points. Doing moxa regularly on specific acupuncture points is said to promote
strength and longevity (Cohen, 1999). Acupuncture and moxibustion are considered
complimentary forms of treatment, and are commonly used together. Moxibustion is
used for ailments such as bronchial asthma, bronchitis, certain types of
paralysis, and arthritic disorders (Singer, 1999).
Electro-Acupuncture
This method of acupuncture is used primarily in analgesia (pain relief). This
form of acupuncture sends very small electrical impulses through the acupuncture
needles. The amount of power used is only a few microamperes, but the frequency
of the current can vary from 5 to 2,000 Hz (Singer, 1999). For surgical
procedures the higher frequency is used. In China, this is a common form of
surgical analgesia (Singer, 1999).
Cupping Acupuncture
Cupping is a method of stimulating acupuncture points by applying suction
through a metal, wood or glass jar, in which a partial vacuum has been created
(Singer, 1999). The cupping technique produces blood congestion at the
acupuncture points creating stimulation. It involves taking small glass cups,
burning a small amount of cotton wool impregnated with alcohol for a few seconds
inside the cup, and then placing the cup over the area to be treated
(Nightingale, 1987, p. 90). Cupping is used for low backache, sprains, soft
tissue injuries, and helping relieve fluid from the lungs in chronic bronchitis
(Singer, 1999).
How safe is Acupuncture?
Acupuncture is a very safe treatment when practiced by a trained, qualified
acupuncturist using sterile, disposable needles and proper skin cleansing
methods (Rind, 1999). One of the advantages of acupuncture is that the incidence
of adverse effects is substantially lower than that of many drugs or other
accepted medical procedures used for the same conditions (National Institute of
Health, 1997).
However, it is important to consider the risks involved with any invasive
procedure. Because needles are inserted into the skin during treatment, it is
important to make sure the practitioner is using the most sterile techniques as
to avoid infection or the transmission of diseases such as hepatitis or AIDS,
even though the transmission of HIV through acupuncture is unlikely
(Trachtenberg, 1989).
One way to reduce risk is to ask the practitioner if they use individually
sealed, disposable needles (iVillage, 2000). Some acupuncturists use silver or
gold needles, which must be sterilized after each use (Rind, 1999).
The individually sealed sterile, disposable needles are approximately the
diameter of a human hair. The needle is solid, nothing is injected into the
body, and the depth of the insertion is very shallow (Sundarii, 1999). When
compared to the benefits of acupuncture, the risks and adverse side effects seem
quite low.
Training and Healthcare Providers
Acupuncturists are licensed independently in most states. However, some
states require you to be a Medical Doctor to practice acupuncture. Approximately
30 percent of the 10,000 practicing acupuncturists in the United States are
physicians, according to the World Health Organization (World Health
Organization, 1979). Thirty-four states license or otherwise regulate the
practice of acupuncture by non-physicians, and have established training
standards for certification to practice acupuncture (iVillage, 2000).
Consistency among the States in regulating the qualifications of acupuncture
practitioners will increase the confidence of the public and the health care
community.
Some of the leading associations for acupuncture are the National
Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), the
National Commission for the Certification of Acupuncturists (NCCA), and the
Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM).
Are there people who should not have acupuncture?
Even with acupunctures success rates there are some medical conditions that
require extreme caution. For example bleeding disorders, taking prescribed
blood-thinning medication, and pregnancy (Rind, 1999). Pregnant women should use
extreme caution when being treated with acupuncture because acupuncture may
stimulate production of hormones in pregnant women that help initiate labor and
can be harmful to the fetus in early pregnancy (http://www.thehealthpages.com/articles/ar-acupn.html).
Caution should also be used in cases of extreme susceptibility to infection or
if the area to be treated is infected (Rind, 1999). Extremely weak and very old
people and those who are unduly nervous as well as those who are particularly
frightened of needles are better treated by some other method, such as laser
(Nightingale, 1987, p. 25).
There are some conditions that do not respond as well to acupuncture. They
include cancer, severe infections, heart disease, muscular dystrophy, venereal
disease, motor neurone disease, and any cases where surgery is clearly
indicated, such as appendicitis (Nightingale, 1987, p. 25).
How to Select an Acupuncturist?
When you are selecting an acupuncturist there are two important factors to
consider, the doctor's training and your goals. There are two things that you
want your acupuncture practitioner to have these are reputable training and a
keen sense of the philosophical underpinning of Chinese medicine (Cohen, 1999).
The best way to determine if a practitioner meets those standards is to ask a
lot of questions about his or her training, length of practice, scope of
practice, specializations, attitudes about wellness and disharmony and
understanding of Chinese medicine philosophy (Cohen, 1999).
The acupuncturist you choose should be licensed (in states with licensing
requirements) or certified. If you live in a state that does not require
licensing, then you will want to make sure your acupuncturist is certified from
the NCCA. There are about 10,000 licensed, registered, or certified
acupuncturists in the U.S. and an additional 3,000 medical doctors (MDs) or
doctors of osteopathy (DO’s) who practice the technique (PDR, 1999).
The next thing to investigate is your goal of acupuncture treatment. Are you
looking for a primary care physician or a short-term treatment? Are you more
comfortable with a physician who practices acupuncture or with a non-physician
practitioner? A physician will have a medical degree with training in
acupuncture whereas a non-physician may have more faith in the body’s natural
healing process and the use of alternative medicines. More training is required
of non-physician acupuncturists because of the importance of knowing what
conditions can and cannot be safely treated with acupuncture, which locations on
the body can be safely treated, and the importance of using safe, sterile
technique (Rind, 1999). If a primary care physician is what you are looking for
then you will want to select a practitioner that is knowledgeable about all
aspects of Chinese medicine and Western medical procedures (Cohen, 1999). The
following summarized what to look for in a primary care Chinese medicine
practitioner (Cohen, 1999):
Someone who does not make promises to cure disorders and diseases for which
there is no cure.
Someone who understands that there may be many different modalities that work
for an individual and does not insist that his or her way is the only right or
good way to go
Someone who has a bedside manner that pleases you
Someone who is able to explain what she or he is doing from both a Chinese
and a Western viewpoint-or is at least willing to find out about the alter
native perspective when necessary
A practitioner who is not unconditionally opposed to any drug therapy in
conjunction with acupuncture or herbal treatment, and who understands the
interactions of drugs and herbs
Someone who will work with medical doctors and other practitioners
In cases of serious illnesses, you want to select a practitioner who
understands Western medical terminology and concepts of the immune system,
viruses and cancer, as well as Chinese concepts, if you are going for treatment
of these problems.
If you have HIV, chronic hepatitis, or CFIDS (chronic fatigue immune
deficiency syndrome), be sure that the practitioner's attitude is that you can
live with this chronic, manageable viral infection and that acupuncture and
herbs may help you be more successful in that process.
Another factor to consider is whether or not your insurance will cover
acupuncture treatment. Sometimes properly worded requests for acupuncture will
be covered. Talk to your regular physician to see if he or she can prescribe
acupuncture treatment (http://www.thehealthpages.com/articles/ar-acupn.html).
What can I expect at a first visit?
When you go to a Chinese medicine practitioner, the evaluation and diagnosis
will be based on a system of observation and questioning. This system of
evaluation and diagnosis follows the philosophy of the Tao. Diagnosis is a
process of perceiving signs and symptoms and relating them to one another to
reveal how they form patterns of harmony or disharmony; each symptom or sign has
meaning only in relationship to other signs and symptoms and to the whole of
your mind/body/ spirit (Cohen, 1999).
The first visit to an acupuncturist will include a questionnaire regarding
health history, an interview, and a physical assessment. The acupuncturist will
also observe how you walk, stand, sit and talk. Your face will be examined to
note your complexion, and any odors will be noted that might lead to diagnosis.
The tongue is especially important. Touching is also a very important part of
the examination to see if there are any sensitive points on the body
(Nightingale, 1987). For the most part the first visit will consist of the Four
Examinations.
The Four Examinations are a traditional Chinese method of assessing an
individuals needs. The Four Examinations include: inquiring, looking,
listening/smelling, and touching. This process of examination reveals which of
the Eight Fundamental Patterns of disharmony are at work and what type of
disharmony of the Essential Substances, Organ Systems and channels you may have
(Cohen, 1999).
After the Four Examinations the practitioner will decide on a course of
treatment created uniquely for the individual based on their evaluation. The
practitioner will rub alcohol on the acupuncture points and insert the needles
about one inch into the points. Generally, the practitioner will use 10 to 12
needles and upon insertion may twist them to stimulate the points. The needle
insertion reportedly does not hurt, however some say that they experience a
tingling or tugging sensation. Some people find they are very relaxed and may
even fall asleep. The needles are left in anywhere from 15 to 60 minutes. Some
practitioners use an electrical pulse to stimulate the acupuncture points. Other
practitioners may use heat and massage in addition.
Relevance to Marriage & Family Therapy
One of the great contributions of Chinese medicine is the ability to link
physical and mental diseases, whereby it is often found that a physical disease
has a mental cause, and a mental disease a physical cause (Mann, 1971, p. 90).
In either case they may be treated with acupuncture. Therefore psychotherapy and
acupuncture may work hand in hand to cure both physical and mental illness.
Social constructionism is a new outlook to intervention procedures that are
currently influencing the field of marriage and family therapy today. Much like
the social constructionist view of treatment Chinese alternative medicine also
looks for the resources and strengths of the client. Chinese alternative
medicine treatments are holistic approaches to illness that focus on using a
person’s inner healing resources to maintain health and fight illness. Research
suggests that patients are attracted to Chinese alternative medicine because
therapies are more in line with their philo-orientation toward health. A sense
of self-control is helpful in healing and staying well. Chinese alternative
medicine tends to allow a sense of control that aids healing, where illness and
pain situations lower that sense (Astin, Shapiro, & Shapiro, 1999).
Chinese alternative medicine and social construction therapy have in common
the belief that when diagnostic labels are used when referring to a client they
may be creating a reality for them that gives the client a description of their
identity in a social context that can be hurtful. The moment people become binge
eaters, anorectics, obsessive-compulsive, depressed or what have you, much of
their behavior gets swept into a category and is no longer available for
alternate appraisals (Efran, Lukens, & Lukens, 1990, p. 90).
This process reduces uncertainty by telling the therapist what the therapist
ought to do and suggesting how the client ought to change in order to get well (Gergen,
Hoffman, & Anderson, 1996). These labels take the control away from the client
and put it into the hands of physicians and therapists. The holistic approaches
to treatment give back to the client a sense of control over their health.
Traditional Chinese medicine has been an effective treatment for a variety of
ailments for over 5,000 years. The Western medical society has only recently
considered acupuncture a valid form of treatment alongside other alternative
forms of treatment, as well as Western medicine.
Many research studies have shown excellent response to acupuncture treatment
for many different health conditions. However, if the Western medical society
and health care providers are going to take alternative medicine seriously,
research studies will need to have better controls over design, sample size, and
other areas. Even with the current available research, more and more insurance
companies are discovering the cost effectiveness of acupuncture and the benefits
that acupuncture offers with only minor side effects.
Alternative medicine offers an option for individuals to take control over
their health and give a sense of empowered. As opposed to the Western medical
view of illness that uses labels and diagnostics, traditional medicine believes
in the natural healing process of the individual. Marriage and family therapy
follows the same theoretical view as traditional medicine. In conjunction with
therapeutic treatment, acupuncture can offer a holistic, client guided,
self-healing treatment option.
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