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By A. Armon. Cumberland College.

In other words discount rumalaya liniment 60 ml with mastercard, according to the systemic perspective, meaning is derived from the relationship between individuals and events, where each defines the other. There must be great tolerance of all the different ways cou- ples find to live together or apart. A more sensible focus would seem to be on the particular problem a couple is having within their type of marriage. The nature of the marriage might not be changed at the end of therapy, but ideally there will be a change in the problems they came in with that were distressing them. SYMPTOMS AS PRESENTING PROBLEMS Haley (1987) posits that it is more expedient to bring in the spouse when an individual presents with a severe symptom because a directive given to a couple is more likely followed than one given only to the individual. Like other systemic therapists, Haley assumes that a symptom can serve some interpersonal function in a couple’s relationship. While some therapists prefer to convince the couple that their real problem is their mar- riage, Haley proposes that the therapist focus on the presenting symp- tom/problem when dealing with the marital problem. That is, the therapist helps the couple improve the presenting symptom while attempting to in- directly improve the marital relationship. When there is an obvious im- provement in the presenting symptom, the couple is more likely to trust the therapist to help them work together on their marriage. A CHILD AS THE PRESENTING PROBLEM Some couples can fight with each other without involving their children, while others center their marital struggle on the child. Rather than dealing with their particular difficulties with each other, they disagree with each other on how to parent. Consequently, their child may cooperate by devel- oping symptoms to distract the parents from their marital conflict, unite them to focus on the child’s problems, and so hold the family together. One of the treatment strategies is to unite the parents as a parental team to deal with the child’s problems, and at the same time improve the marital Strategic and Solution-Focused Couples Therapy 197 relationship. Another way is to detriangulate the child from the marital dyad and advise the child to leave the responsibility of helping the parents’ marriage to the therapist. THE MARRIAGE AS THE PRESENTING PROBLEM Haley maintains that because marital difficulties stem from lack of flexi- bility, one aim of couples therapy is to enlarge the possibilities of the two partners so they have a wider range of behavior.

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Discussion of the family history of these matters led to increased under- standing and an enhanced capacity to differentiate their situation from the one with Christie’s father buy rumalaya liniment 60 ml amex. She decided that she could tolerate performing oral sex on him during intercourse but not his doing it to her. With my help, he was able to understand why and move to a position of feeling they could have a good sexual life without it. When we see couples from varying ethnic and cultural backgrounds, we look for similarities of pattern extending from the culture, to the so- cial groups it contains—the extended family group, the nuclear family, the couple, and the individual. We look to the couple to inform us about the cultural differences that reside in them, and to work with us toward understanding those matters as much as toward understanding their in- dividual and couple dynamics. This is true with couples of any ethnicity so long as we understand that we must let their experience penetrate us, and open ourselves to sharing their in-depth experience in order to let our therapeutic reverie help all couples with culturally saturated projec- tive identifications and interactions. CLINICAL TECHNIQUE We have many functions in mind while working with couples, but rela- tively few specific techniques. Object relations theory is principally a way of working together with couples toward understanding and growth. We do not tell a couple what to do, but work to maintain a psychological space analogous to the environ- mental provision the parent offers the child for safety and space to grow. To this end, we offer regularity of boundaries and conditions, the fee, times of meeting, length of sessions, and other logistical matters that frame a psychological space within which we work. Even though a steady frame of work had been established through setting up regular appointments, and beginning and ending on time, his anxious insecurity was expressed by his frequent urgent phone calls to me, trying to stay past the end of the ses- sions, and, sometimes, even appearing at my office between sessions. Slowly, he internalized the regularity and continuity of the appointments and adapted to the frame I offered. Within the frame, we do not tell pa- tients what to do, where to sit, whether to face each other, or what to say. We ask them to work with us in an environment in which unspeakable things can be voiced and there is growing tolerance for difficult matters. It is up to us to manage the holding environment—analogous to the parents’ environmental provision—and then to work toward the understanding that is the analog of the parents’ in-depth understanding.

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He generic rumalaya liniment 60 ml without a prescription, too, was helpful and understanding, and I certainly could not find any fault with him. But what I was really looking for was a specialist who lived and breathed Parkinson’s disease. The ques- tion kept recurring in my mind: how much time do they really have to keep up with the latest findings on one disease—Parkinson’s? Blaine and I began thinking that we might start a Parkinson’s support group in our area. We needed to talk to others with Parkinson’s and felt that people in our area must have do not disturb! One person we talked to was Mary Dike of Gar- diner, Maine, whom we contacted after reading about her in a newspaper article. A home economics teacher a few years younger than I, Mary was about to leave teaching because of Parkinson’s disease. She told us about her doctor, Robert Feldman, a Parkin- son’s specialist at Boston Medical Center. We found him and his multidisciplinary team to be experts whose aim was to educate the patient about Parkinson’s disease and who knew how to treat the disease. Feldman, Blaine, and I talked together until we agreed on a course of treatment that was satisfactory to all of us. Thus, I have the security of knowing that if I have any imme- diate problems, my family doctor, close by, knows my status. I learned that I needed to take the responsibility of keep- ing myself as healthy as possible and to ask questions in the doc- tor’s office.


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