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By E. Sanuyem. Nebraska Wesleyan University.

Since illness is considered to be the domain of medicine buy generic viagra extra dosage 150 mg on line, therapists often are untrained and uninterested in dealing with these issues order viagra extra dosage 120 mg visa, despite their prevalence in the general population. Yet the emotional and relational dynamics that are of interest to therapists play a critical role in determining how in- dividuals and couples cope with illness, and the presence of illness in the family often has a profound impact on the individual and relational func- tioning. Therapist reluctance to address medical illness in couples can also be compounded by countertransference issues. Confronting serious illness in patients can arouse therapists’ own fears of mortality and feelings of impotence in the face of overwhelming pain, loss, and disability. Illness in one fam- ily member can have not only emotional but physical repercussions for other family members, especially spouses. Recent studies have supported the con- tention that chronic stress—especially the stress of caring for a chronically ill spouse—weakens the immune system and makes one more susceptible to becoming physically ill. Physicians and other health professionals are increasingly recognizing the need that couples and families have for assistance in dealing with the psychosocial impact of illness, from infertility and epilepsy to cancer and heart disease. It behooves us in the mental health professions to equip our- selves to deal with these needs. This chapter discusses how illness affects couples, reviews the basics of medical family therapy, and presents a tech- nique for addressing emotional roadblocks in the marital or couple relation- ship that can emerge as couples deal with the particular challenges that illness presents. A REVIEW OF THE LITERATURE ON PSYCHOTHERAPY WITH COUPLES FACING ILLNESS A significant body of research examines the impact of couple relationships on health, and the impact that chronic illness or disability has on the couple (Campbell, 2003; Kiecolt-Glaser & Newton, 2001; Osterman et al. Very few studies, however, focus on couple inter- ventions that might inform psychotherapeutic treatment. We review two cases here and then turn to the clinical literature on couple interventions with medically ill patients that provides guidance for therapists working with this population. Early research focused on couple interventions to improve disease man- agement, medical compliance, quality of life, and mortality for patients with chronic illness. In another controlled study (Taylor, Bandura, Ewart, Miller, & De- Busk, 1985), wives of heart attack patients were asked either to observe their spouse take a treadmill stress test or to take the test with their spouse, three weeks after the heart attack. Wives who walked the treadmill and directly experienced what their husbands were capable of were significantly more confident and less anxious about their husbands’ health and capability than the wives who only observed the test. They were also less overprotective of their husbands, which may relate to the finding that their husbands showed improved cardiac functioning at 11 and 26 weeks after the heart attack. Managing Emotional Reactivity in Couples Facing Illness 255 Although there is a significant body of clinical literature that addresses psychotherapy with families facing illness (see McDaniel, Hepworth, & Doherty, 1992), literature that focuses on helping couples in particular is still relatively scarce—usually found either in textbooks on couples therapy with illness treated as a special issue (e. A wide variety of specific approaches have been offered on the subject of couples and illness, including behavioral (Schmaling & Sher, 2000), existen- tial (Lantz, 1996), and interpersonal (Lyons, Sullivan, Ritvo, & Coyne, 1995). Many of these approaches delineate key issues that couples must con- front when illness strikes and offer strategies, drawn from their particular theoretical framework, to help couples negotiate these issues.

They act as cues which further reinforce both the subjective state of thirst in its dominance over consciousness proven viagra extra dosage 200 mg, and its production of water seeking behavior order 120mg viagra extra dosage visa. The "push" of the DEWEY’S VIEW OF SITUATIONS, PROBLEMS, MEANS AND ENDS105 drive, habit or trait is reinforced by the "pull" of the cue or aim-in-view which could either be present in the environment or produced in fantasy. The final ends are twofold: one is the correction of a physiological imbalance manifested by thirst and perhaps other sensations like a dry mouth, fatigue, dizziness and overheating; the other is the pleasurable sensations accompanying and following quenching of thirst. We have now seen partially how "ends," at least envisioned fulfillments, can operate as means. Dewey reevaluates, as noted in the last chapter, certain things which have usually been seen as ends in themselves, placing them in context. It turns out that the whole notion of anything "in itself" is suspect when the very nature of any entity has to do with its relations. Also both an end and a means, knowledge is, for the pragmatist, opinion which has been tried out and found effective in handling situations. There is debate, of course, about what constitutes proper "handling" of a situation and whether there is something sufficiently objective about a situation that "proper handling" of it can be justified to everyone’s satisfaction. In the absence of any common basis for understanding the nature of situations, any assertions about the "truth" of knowledge which results in proper handling of them look purely idiosyncratic. Nevertheless, on this view, while knowledge remains an end, and while the attainment and use of it have their own intrinsic delights, the criterion by which it is ultimately validated is its usefulness as a tool, i. Scientific knowledge, which quantifies objects, assorts their characters in definable categories and reduces them to formulae for manipulation, brackets objects for certain uses. These qualities are evanescent and fragile, aesthetic, moral or spiritual qualities which elude compre- hension within the categories of instrumental knowledge. We had to drop the immediacy, the intangible aesthetic and other final qualities of things so that science could render our understanding of them useful in material manipulation. In their immediacy we "can do nothing" with the terminal qualities "save have, suffer and enjoy them. Sensuous immersion in and experience of the immediate qualities of things is something most of us would refer to as a kind of knowledge, but this is not the knowledge of science. Science knows things in order to deal with them, whereas qualitative understanding is final. The quality of my experience of this "home" is related to qualities and values of many other past and present things. Although experience provides the raw material for both "knowledge" and qualitative familiarity, only that replicable part of experience which can be placed under concepts and stored for future instrumental use keeps the name of knowledge for the pragmatist. The aesthetic and emotive dimensions of experience cannot be retained in the same sense and drawn upon for instrumental use.

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