This document summarizes a research article about the role of relationships and families in healing from trauma. The article discusses how most trauma treatment focuses on the individual, but trauma is also a relational event that affects close relationships. It argues that systemic protocols addressing interpersonal difficulties in addition to intrapersonal issues are critical for healing. To illustrate, a graphic case study is presented of a family experiencing trauma due to a kidnapping, and how individual versus systemic treatment approaches would differ in addressing their needs.
Running head RESEARCH PROPOSAL ON COUPLES COUNSELING RESEA.docxtoltonkendal
Running head: RESEARCH PROPOSAL ON COUPLES COUNSELING
RESEARCH PROPOSAL ON COUPLES COUNSELING 5
Research Proposal on Couples Counseling
Social Work Practice Research I (SOCW - 6301 - 3)
Introduction
This research proposal is about undertaking research to find the best therapy method for couples between individual, group, and couples therapy. The proposal will detail the findings of past researchers and will occasionally focus on the therapy methods in the context of a couple that is experiencing conflict mainly based on the rejection of their same-sex marriage by their respective families. It will also detail the methodologies used by other researchers in investigating the therapy methods. The study will reveal the most recommended therapy method and the variations of the method.
Research Problem and Question
Many couples quarrel because their respective families reject their union or relationship or marriage. Most of the affected couples are those whose respective families are deeply divided on the basis of religion, race/ethnicity and socio-economic status. However, some families just oppose relationships because they threaten their traditions, which are mostly rooted on religion. Some families oppose gay or lesbian relationships or marriages. Even when a family member reveals that he or she may attracted to a member of the opposite sex, the other family members may rise up against that family member. It may make teenagers and young adults hide about their sexual orientation. The stigmatization may be too unbearable for the affected individuals, who may choose to go into seclusion and engage in suicidal actions. There are couples like Kathleen and Lisa who courageously seek the help of therapists. Upon setting a stage for positive development, couples can ease the tension in the mind. They can open up to people and feel ready to solve problems together. The question that comes in mind in light of these facts is: What it the true impact of sexual orientation-based rejection by family members on a relationship? How can a social worker help couples overcome sexual orientation-based rejection by family members on a relationship? The research question of the study is: which between individual, group, and couples therapy is the best therapy method for couples?
Literature Review on Individual, Group, and Couples Therapy
The therapeutic alliance concept is mainly associated with individual psychotherapy, particularly in literature. Yet, the concept is increasingly used together within the marital and family therapy domains. According to Pinsof and Catherall (1986), “a systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework”. The authors examined family, couple and individual therapy and used some methodologies and deve ...
Coping Strategies Among Caregivers Of Patients With Schizophrenia: A Descript...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Running head: SCHIZOPHRENIA 1
Working with Families
1. Effects of a psych educational intervention program on the attitudes and health perceptions of relatives of patients with schizophrenia
The article highlights the importance of both family and relatives to support the victim who has schizophrenia. Moreover, the article goes further and highlights the purpose of the study. The article assesses the effectiveness of a family psych educational program in the different outlook and health insights of the relatives of the patient with suffering from schizophrenia. Various programs aid in supporting both the family and relatives to gain more information about the schizophrenia and how they can best offer support to them.
The psych educational program was efficient in adjusting to the caregivers’ outlooks. Nonetheless, the program did not influence the perceptions of healthcare. Moreover, the family and relative psych educational management program transforms the deleterious approaches of both family and relatives to schizophrenia. On the other hand, not all the agenda of this type may advance health difficulties; otherwise, their consequences might only appear in a long-term condition or situation.
The psycho-educational plan gave an enhancement in the outlooks of families to schizophrenia. Besides, this signifies that they have known how to think, feel, and act, in a positive method in regards to the disorder.
Seeing the unfortunate result of the majority of people who have schizophrenia, the process has made it possible for individuals to discover the influence of psych educational programs, which may aid indirectly or directly to advancing the quality and the course of life of these people and their families. Besides, it is vital to evaluate the efficiency of the agendas in diverse cultures and nations.
2. The Mediating Effect of Family Cohesion in Reducing Patient Symptoms and Family Distress in a Culturally Informed Family Therapy for Schizophrenia: A Parallel-Process Latent-Growth Model
The paper examines whether a CIT-S (Culturally Informed Family Therapy for Schizophrenia outdid the usual family psych education (PSY-ED) by not only in reducing patient schizophrenia signs but also in diminishing a person’s DASS. Since CIT-S nurtured family consistency in therapy; moreover, it is anticipated that an increase in family solidity would facilitate the cure effects.
The procedure permitted individual’s to be fixed in latent-change or latent-growth models to check the treatment impacts and guarantee the model fit was sufficient prior to joining them to parallel-procedure models and investigating the secondary outcomes. The latent-change model is assessing the medication influence on family solidity from standard to average, as shown in a Time Treatment Interaction (TTI). The CIT-S team displayed a natural growth of approximately on.
Running head RESEARCH PROPOSAL ON COUPLES COUNSELING RESEA.docxtoltonkendal
Running head: RESEARCH PROPOSAL ON COUPLES COUNSELING
RESEARCH PROPOSAL ON COUPLES COUNSELING 5
Research Proposal on Couples Counseling
Social Work Practice Research I (SOCW - 6301 - 3)
Introduction
This research proposal is about undertaking research to find the best therapy method for couples between individual, group, and couples therapy. The proposal will detail the findings of past researchers and will occasionally focus on the therapy methods in the context of a couple that is experiencing conflict mainly based on the rejection of their same-sex marriage by their respective families. It will also detail the methodologies used by other researchers in investigating the therapy methods. The study will reveal the most recommended therapy method and the variations of the method.
Research Problem and Question
Many couples quarrel because their respective families reject their union or relationship or marriage. Most of the affected couples are those whose respective families are deeply divided on the basis of religion, race/ethnicity and socio-economic status. However, some families just oppose relationships because they threaten their traditions, which are mostly rooted on religion. Some families oppose gay or lesbian relationships or marriages. Even when a family member reveals that he or she may attracted to a member of the opposite sex, the other family members may rise up against that family member. It may make teenagers and young adults hide about their sexual orientation. The stigmatization may be too unbearable for the affected individuals, who may choose to go into seclusion and engage in suicidal actions. There are couples like Kathleen and Lisa who courageously seek the help of therapists. Upon setting a stage for positive development, couples can ease the tension in the mind. They can open up to people and feel ready to solve problems together. The question that comes in mind in light of these facts is: What it the true impact of sexual orientation-based rejection by family members on a relationship? How can a social worker help couples overcome sexual orientation-based rejection by family members on a relationship? The research question of the study is: which between individual, group, and couples therapy is the best therapy method for couples?
Literature Review on Individual, Group, and Couples Therapy
The therapeutic alliance concept is mainly associated with individual psychotherapy, particularly in literature. Yet, the concept is increasingly used together within the marital and family therapy domains. According to Pinsof and Catherall (1986), “a systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework”. The authors examined family, couple and individual therapy and used some methodologies and deve ...
Coping Strategies Among Caregivers Of Patients With Schizophrenia: A Descript...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Running head: SCHIZOPHRENIA 1
Working with Families
1. Effects of a psych educational intervention program on the attitudes and health perceptions of relatives of patients with schizophrenia
The article highlights the importance of both family and relatives to support the victim who has schizophrenia. Moreover, the article goes further and highlights the purpose of the study. The article assesses the effectiveness of a family psych educational program in the different outlook and health insights of the relatives of the patient with suffering from schizophrenia. Various programs aid in supporting both the family and relatives to gain more information about the schizophrenia and how they can best offer support to them.
The psych educational program was efficient in adjusting to the caregivers’ outlooks. Nonetheless, the program did not influence the perceptions of healthcare. Moreover, the family and relative psych educational management program transforms the deleterious approaches of both family and relatives to schizophrenia. On the other hand, not all the agenda of this type may advance health difficulties; otherwise, their consequences might only appear in a long-term condition or situation.
The psycho-educational plan gave an enhancement in the outlooks of families to schizophrenia. Besides, this signifies that they have known how to think, feel, and act, in a positive method in regards to the disorder.
Seeing the unfortunate result of the majority of people who have schizophrenia, the process has made it possible for individuals to discover the influence of psych educational programs, which may aid indirectly or directly to advancing the quality and the course of life of these people and their families. Besides, it is vital to evaluate the efficiency of the agendas in diverse cultures and nations.
2. The Mediating Effect of Family Cohesion in Reducing Patient Symptoms and Family Distress in a Culturally Informed Family Therapy for Schizophrenia: A Parallel-Process Latent-Growth Model
The paper examines whether a CIT-S (Culturally Informed Family Therapy for Schizophrenia outdid the usual family psych education (PSY-ED) by not only in reducing patient schizophrenia signs but also in diminishing a person’s DASS. Since CIT-S nurtured family consistency in therapy; moreover, it is anticipated that an increase in family solidity would facilitate the cure effects.
The procedure permitted individual’s to be fixed in latent-change or latent-growth models to check the treatment impacts and guarantee the model fit was sufficient prior to joining them to parallel-procedure models and investigating the secondary outcomes. The latent-change model is assessing the medication influence on family solidity from standard to average, as shown in a Time Treatment Interaction (TTI). The CIT-S team displayed a natural growth of approximately on.
Literature ReviewA search was conducted using electronic database.docxssuser47f0be
Literature Review:
A search was conducted using electronic databases in the fields of nursing, medicine, education, psychology, and sociology. Using ProQuest Direct and EBSCO search engines, the following databases were accessed: CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE in PubMed, Ovid, and PsycINFO. The search terms were grouped in the following key concepts: (a) occupational stress in nursing, (b) stress perception in nursing, (c) occupational stressors in nursing, (d) nursing generational diversity, and (e) coping in nursing. In a commentary on patient safety in nursing practice from the Agency for Healthcare Research and Quality, Hughes and Clancy7 reported that complexity and bullying represent 2 clear examples of nurse stressors. Li and Lambert8 concluded that nurses who are more satisfied with their job are more likely to remain in the workforce and to be committed to delivering high-quality patient care. Hall9 found that healthcare professions have some unique characteristics leading to occupational stress including physical responsibility for people, potential catastrophic effects on the patient and the employee, frequent exposure to pain and suffering, and exposure to infectious diseases and potential hazardous substances. Hamaideh et al10 identified that death and dying were the strongest stressors perceived by Jordanian nurses. In this study, workload and guidance were found to be the most supportive behaviors provided to nurses facing stress followed by emotional support.10
Carver and Candela11 concluded that considering the global nursing shortage, managers should increase their knowledge of the generational diversity. It is suggested that understanding how to relate to multiple generations can lead to improved nursing work environments.11 Repar and Patton12 found that the combined effects of compassion fatigue, chronic grief, and emotional and physical exhaustion led to significant burnout and prolonged job dissatisfaction in the nursing profession. In this study, using guided sessions, a massage therapist gave 10-minute chair massages, and a visual, language, or musical artist engaged participants in imaginative and creative activities such as poetry reading, free writing, guided imagery, and listening to live music.12 The results suggest that the activities reduce some of the unpleasant, stressful, and tension-producing emotions that nurses typically experience at work, leaving them more peaceful and energized.12 Based on the findings of this review of the literature, it is recognized that stress is a major component of nursing and can be detrimental to nurse retention. In addition, most studies identified some differences that exist between the present generational nursing cohorts in terms of values and beliefs. No studies were identified reporting how work-related stress affects different generations of nurses, how the generations perceive stress, and what coping styles are used.
Study Des ...
Family Therapy CourseUsing the brief case description below, pre.docxssuser454af01
Family Therapy Course
Using the brief case description below, prepare a script you could use to call the mock client’s pediatrician for a 10-minute conversation. To prepare, consider the following: What facts do you need to communicate to the doctor? What will the doctor likely want to know from you? What will you want to be sure to tell the doctor about your diagnosis of him having ADHD and treatment plan for family? You diagnose that he should be placed on medication and pediatricians nurse prescribe the diagnosis level
Case description: Your client is an 8-year-old male whose parents are concerned might have ADHD. He is the middle child of three boys. You have met the parents and the child in your initial sessions. At this point, you have had only three sessions with the family. Your client says he has lots of friends, he hates school because it’s boring, and his parents yell at him too much!
Write a mock transcript of an imaginary phone call between you and the client’s physician. In your mock discussion, include information you would provide to the doctor about your assessment, treatment plan, and orientation to treating ADHD; include the doctor’s questions or responses to the information you provide. Also, include questions you would ask the doctor, and the doctor’s responses.
Transcript Length: 5 pages
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it ...
Please I need a response to this case study.1 pagezero plagi.docxcherry686017
Please I need a response to this case study.
1 page
zero plagiarism
three references
The Case:
The sleepy woman with anxiety
This week’s discussion presents a case study involving a 44-year old woman with a chief complaint of anxiety beginning at age 15 years old. She has a long history of mental illness and continued therapies. The purpose of this discussion is to analyze her case history to determine medication and treatment effectiveness.
Client Questions
Question 1. Are you having feelings of harming yourself or harming someone else?
Rationale: This is a possibly uncomfortable yet important set of questions to ask each client. Primary care providers may be in a unique position to prevent suicide due to their frequent interactions with suicidal patients. Reviews suggest that among patients who committed suicide, 80 percent had contact with primary care clinicians within one year of their death, whereas only 25 to 30 percent of decedents had contact with psychiatric clinicians within the year of their death (Stene-Lars & Reneflot, 2017).
Question 2. What was happening in your life as a teenager when the anxiety started and you began to self-medicate?
Rationale: Per our report, this patient began suffering signs and symptoms of anxiety at 15-years old. Asking these types of questions we may gain insight into an underlying cause or triggering event. Anxiety disorders are the most common psychiatric disorders with onset in childhood, with prevalence estimates ranging from 10 to 30 percent. Nearly 37 percent of behaviorally inhibited preschool-age children had social anxiety disorder at age 15, compared with 15 percent of non- behaviorally inhibited children
.
Children with anxiety disorders are more likely to have persistent anxiety disorders into adulthood. (Rapee, 2014).
Question 3. What was happening in your life a year ago when these symptoms returned and became debilitating? Let’s discuss what the triggering events may have been.
Rationale: Self-discovery of triggering events may help the client to come to terms with the determinants of her anxiety and depression. Studies have shown that specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety (McLaughlin & Hatzenbuehler, 2009).
Support System
The support system as reported by our client is her husband. She states he is supportive and has little to no contact with the family of origin. She has a few friends and a few outside interests. As PMHNP, discussing relationships with the client is one avenue to gain insight into anxiety patterns and coping mechanisms as seen by outside support. With the client’s permissio.
Child Adolesc Psychiatric Clin N Am16 (2007) 111–132The JinElias52
Child Adolesc Psychiatric Clin N Am
16 (2007) 111–132
The Case Formulation in Child
and Adolescent Psychiatry
Nancy C. Winters, MD
a,*, Graeme Hanson, MD
b
,
Veneta Stoyanova, MD
a
a
Division of Child and Adolescent Psychiatry, Oregon Health and Science University,
3181 SW Sam Jackson Park Road, Mail Code:DC-7P, Portland, OR 97239-3098, USA
b
Department of Psychiatry, University of California San Francisco,
513 Parnassus Avenue, San Francisco, CA 94143-0410, USA
Put simply, case formulation is a process by which a set of hypotheses is
generated about the etiology and factors that perpetuate a patient’s present-
ing problems and translates the diagnosis into specific, individualized
treatment interventions. It is central to the practice of child and adolescent
psychiatry. Even if not articulated explicitly, the case formulation guides all
clinical activity. For example, how one understands a child’s biologic
vulnerabilities and how they interact with personality or family factors
and the importance assigned to each clearly influence choices made in the
assessment process and the treatment plan. Despite the widely acknowl-
edged importance of case formulation, it is often taught cursorily in
residency programs, and residents often perceive it as too challenging to
actually perform [1]. Consequently, case formulation is often relegated to
secondary status behind the DSM-IV-TR differential diagnosis. Such
attitudes are manifested in the American Board of Psychiatry and Neurol-
ogy Child and Adolescent Psychiatry certification examinations. When
asked to formulate the case just presented, candidates generally return a per-
functory statement and transition quickly to discussion of DSM-IV-TR
diagnoses.
How can case formulation be taught systematically and effectively to
child psychiatry residents? This article reviews the various definitions of
case formulation, differences between diagnosis and case formulation,
how case formulation for a child patient differs from an adult patient,
and case formulation in the context of residency training, including
challenges for residents transitioning from adult psychiatry. It presents
* Corresponding author.
E-mail address: [email protected] (N.C. Winters).
1056-4993/07/$ - see front matter � 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.chc.2006.07.010 childpsych.theclinics.com
mailto:[email protected]
112 WINTERS et al
a suggested structure for constructing a biopsychosocial formulation that
can be applied in a training setting. Several specialized types of psychother-
apy formulation are reviewed in more detail. The article concludes with
a case example of a child psychiatry resident’s case formulation before
and after discussion in supervision.
Definitions of case formulation
If one searches the literature on case formulation in child psychiatry, one
finds a surprisingly small number of articles relative to its importance. The
indices of several textbooks in child psychiatry (and a ...
Model of TreatmentEducation and its EvaluationProblem.docxhelzerpatrina
Model of Treatment/Education and its Evaluation
Problem(s)
Will Power +
Common Factors +
Any Specific Factor (any treatment model EBP or other) +
Feedback Informed Treatment + Deliberate Practice =
Effective Outcome
SPECIAL ARTICLE
How important are the common factors in
psychotherapy? An update
BRUCE E. WAMPOLD
Department of Counseling Psychology, University of Wisconsin, Madison, WI, USA; Modum Bad Psychiatric Center, Vikersund, Norway
The common factors have a long history in the field of psychotherapy theory, research and practice. To understand the evidence supporting
them as important therapeutic elements, the contextual model of psychotherapy is outlined. Then the evidence, primarily from meta-
analyses, is presented for particular common factors, including alliance, empathy, expectations, cultural adaptation, and therapist differ-
ences. Then the evidence for four factors related to specificity, including treatment differences, specific ingredients, adherence, and compe-
tence, is presented. The evidence supports the conclusion that the common factors are important for producing the benefits of psychotherapy.
Key words: Common factors, contextual model, psychotherapy, alliance, empathy, expectations, cultural adaptation, therapist differences,
specific ingredients
(World Psychiatry 2015;14:270–277)
The so-called common factors have a long history in psy-
chiatry, originating with a seminal article by S. Rosenzweig
in 1936 (1) and popularized by J. Frank in the various
editions of his book Persuasion and Healing (2-4). During
this period, the common factors have been both embraced
and dismissed, creating some tension (5-9). The purpose of
this paper is not to review or discuss the debate, but to pro-
vide an update, summarizing the evidence related to these
factors.
To understand the evidence for the common factors, it is
important to keep in mind that these factors are more than a
set of therapeutic elements that are common to all or most
psychotherapies. They collectively shape a theoretical mod-
el about the mechanisms of change in psychotherapy.
A particular common factor model, called the contextual
model, has been recently proposed (8,10). Although there
are other common factor models (e.g., 4,11), based on differ-
ent theoretical propositions, the predictions made about the
importance of various common factors are similar and the
choice of the model does not affect conclusions about the
impact of these factors. The contextual model is presented
below, followed by a review of the evidence for the common
factors imbedded in the model.
THE CONTEXTUAL MODEL
The contextual model posits that there are three path-
ways through which psychotherapy produces benefits. That
is, psychotherapy does not have a unitary influence on
patients, but rather works through various mechanisms.
The mechanisms underlying the three pathways entail
evolved characteristics of humans as the ultimate social spe-
cies; as such.
Model of TreatmentEducation and its EvaluationProblem.docxroushhsiu
Model of Treatment/Education and its Evaluation
Problem(s)
Will Power +
Common Factors +
Any Specific Factor (any treatment model EBP or other) +
Feedback Informed Treatment + Deliberate Practice =
Effective Outcome
SPECIAL ARTICLE
How important are the common factors in
psychotherapy? An update
BRUCE E. WAMPOLD
Department of Counseling Psychology, University of Wisconsin, Madison, WI, USA; Modum Bad Psychiatric Center, Vikersund, Norway
The common factors have a long history in the field of psychotherapy theory, research and practice. To understand the evidence supporting
them as important therapeutic elements, the contextual model of psychotherapy is outlined. Then the evidence, primarily from meta-
analyses, is presented for particular common factors, including alliance, empathy, expectations, cultural adaptation, and therapist differ-
ences. Then the evidence for four factors related to specificity, including treatment differences, specific ingredients, adherence, and compe-
tence, is presented. The evidence supports the conclusion that the common factors are important for producing the benefits of psychotherapy.
Key words: Common factors, contextual model, psychotherapy, alliance, empathy, expectations, cultural adaptation, therapist differences,
specific ingredients
(World Psychiatry 2015;14:270–277)
The so-called common factors have a long history in psy-
chiatry, originating with a seminal article by S. Rosenzweig
in 1936 (1) and popularized by J. Frank in the various
editions of his book Persuasion and Healing (2-4). During
this period, the common factors have been both embraced
and dismissed, creating some tension (5-9). The purpose of
this paper is not to review or discuss the debate, but to pro-
vide an update, summarizing the evidence related to these
factors.
To understand the evidence for the common factors, it is
important to keep in mind that these factors are more than a
set of therapeutic elements that are common to all or most
psychotherapies. They collectively shape a theoretical mod-
el about the mechanisms of change in psychotherapy.
A particular common factor model, called the contextual
model, has been recently proposed (8,10). Although there
are other common factor models (e.g., 4,11), based on differ-
ent theoretical propositions, the predictions made about the
importance of various common factors are similar and the
choice of the model does not affect conclusions about the
impact of these factors. The contextual model is presented
below, followed by a review of the evidence for the common
factors imbedded in the model.
THE CONTEXTUAL MODEL
The contextual model posits that there are three path-
ways through which psychotherapy produces benefits. That
is, psychotherapy does not have a unitary influence on
patients, but rather works through various mechanisms.
The mechanisms underlying the three pathways entail
evolved characteristics of humans as the ultimate social spe-
cies; as such.
Running head Multi-actor modelling system 1Multi-actor mod.docxglendar3
Running head: Multi-actor modelling system 1
Multi-actor modelling system3
Multi-actor modelling system
Yogesh Dagwale
University of the Cumberland’s
Ligtenberg, A., Wachowicz, M., Bregt, A. K., Beulens, A., & Kettenis, D. L. (2004). A design and application of a multi-agent system for simulation of multi-actor spatial planning. Journal of environmental management, 72(1-2), 43-55.
They talk about the potential and restrictions of the MAS to manufacture models that empower spatial organizers to incorporate the 'actor factor' in their examination. Their structure system contemplates actors who assume a functioning job in the spatial planning. They included actors who can watch and see a spatial domain. Using these perceptions and discernment they produce an inclination for a preferred spatial situation. Actors at that point present and discuss their inclinations amid their exchanges with different actors.
The inclinations of the actor fill in as inputs for an official choice making. Finally, ultimate conclusions are actualized in the spatial framework. They found that MAS can produce space utilization designs in light of a portrayal of a multi-actor planning process. It additionally can clear up the impacts of actors under the administration of various planning styles on the space utilization and prove how the relations between actors change amid a planning process and under different orders of coming up with decisions. Unlike the work by Parker, Manson, Janssen, Hoffman & Deadman,2003, cited below, this paper did not include the various challenges associated with the use of MAS.
Parker, D. C., Manson, S. M., Janssen, M. A., Hoffmann, M. J., & Deadman, P. (2003). Multi-agent systems for the simulation of land-use and land-cover change: a review. Annals of the association of American Geographers, 93(2), 314-337.
In this paper, they studied different models. These models, however, were not thorough enough and therefore they took into account the multi-actor system, dynamic spatial Simulation, which has two components, that is, a cellular model that speaks to biogeophysical and biological parts of a demonstrated framework and an actor-based model to speak to human conclusion making. Because of its nature and ability to model complex situations, they highlighted some of the areas that MAS can be applied where other models cannot be able to deliver. Such areas are modeling of emergent phenomena whereby MAS can model landscape plans, due to its flexibility, MAS can represent complex land use/ cover systems, and they can be used to model dynamic paths. They also outlined the various challenges to Multi-actor systems. Such challenges include an understanding of complexity, individual decision making, empirical parameterization and model validation, and communication.
Faber, N. R., & Jorna, R. J. (2011, June). The use of multi-actor systems for studying social sustainability: Theoretical backgrounds and pseudo-specifications. In Com.
Running head: MY MOTHER MY HERO 1
MY MOTHER MY HERO 4
My Mother My hero
Institution Affiliation
Students’ Name
Date of Submission
My Mother My hero
Once I think of a hero, there are specific qualities that surround my imagination, being courageous, hardworking, truthful, strong, resilient, and generous have been the qualities I taught about. I also think a hero is someone protective, caring, and so concerned to change the life of the others and make them happy in their life. My Mother has all these qualities and recognizes her as my hero. Otherwise, she grew up on the support of two great parents who had a good life where she grew up and become a teacher in her life. Almost every individual has had some achievements in their life, and there must be a factor behind those achievements, especially someone who had a significant impact on their life. My mother appears to be my hero, who had a substantial impact on my life.
She is currently 54 years old. She was a teacher by profession, and she did her best as a teacher, where she influenced the lives of many students positively; up to now, some still call her and pass their appreciation to her. She was blessed and gave birth to seven kids; the first three are daughters, then a boy and a girl, and then the last two are boys. All of them have been significantly raised, everyone has something to do for a living, my big brother is a doctor, and three of my sisters are teachers, (like Mother like daughters). Our last born is an engineer interior designer and all of us are married with happy family. All these were not for granted but because of the love of God and the efforts, commitment, and great concern of our beloved parents, especially our Mother.
Even though she did not make a complete journey in her teaching profession, but up to where she stopped, she did a lot. They have been in a relationship with my father for thirty-six years of marriage, and when they had their third kid, my dad suggested that she stop teaching and remain at home to take care of the children. Throughout my entire life, my Mother had been supportive of me, a center of inspiration, and she has always been telling me to have self-confidence and believe in myself that I can make it. In case I face a problem, and I have to make a concrete decision towards it, my Mother always had behind me because I seek for her consultation before I move on to the next step.
It feels so great knowing that there is someone who will support you despite the intensity of the problem you face. It relieves much of the stress that comes along with making decisions. My Mother is beautiful inside and out, but most importantly, she has the biggest heart. She's a hard-working person and can play both parent roles. Everyon.
Running head PROGRAM EVALUATION PLAN1PROGRAM EVALUATION PLAN.docxglendar3
Running head: PROGRAM EVALUATION PLAN 1
PROGRAM EVALUATION PLAN 10
Program Evaluation Plan
Name:
Tanisha Hannah
Institution:
Strayer University
Professor:
Dr. Jacob
Course:
Edu 571
Date:
March 2, 2020
Program Evaluation Plan (Part 3)
Goals of Evaluation
Evaluation refers to the act of checking various things thoroughly in order to characterize their worth or value, with reference to a certain context. In the field of education, the amount of success in a person’s aims can only be determined through evaluation. Therefore, there is a very close relationship between various aims and evaluation. The main goals of evaluation in schools are as discussed below. The first goal of evaluation in the field of education is to create an educational program ("Evaluation in Teaching and Learning Process | Education", 2020). Through evaluation, evaluators and the school management can build a given program of learning among the students. This is after gathering and checking various factors in order to find what program will fit and make a positive impact in the school. This involves consulting all the stakeholders of the program and developing strategies that will ensure the development of a good program.
The second goal of evaluation is assessing the effectiveness of the program. Evaluation ensures that the developed program is up to standards and serves the purpose that it was intended to. It helps the evaluators to check if the teaching strategies and techniques are being applied properly. The third goal of evaluation is to ensure improvement of the program. Through evaluation, evaluators can gauge the impact of the program on the school and learners. They can also identify various things that can make the program more effective. It acts as an in-built monitor in the program in order to review the progress of the program from time to time. It also gives feedback regarding the design and the implementation of a given program. Through such assessments, the school management can know where to work on, and what they need in order to enhance effective programs in teaching and learning.
For instance, in our case, evaluators can comfortably tell whether or not the program is helping girls become more superior in math. If not they can suggest better or other strategies that will make positive impact.
Cultural Issues Affecting the Program
Culture can influence how different people view things. An individual’s culture and upbringing can affect their way of processing information. Among the cultural issues that might be faced in the evaluation plan include cultural stereotypes. Some students believe that they cannot perform as expected in school or in a particular subject due to lack of preparation from their home environment. This makes them believe they do not have enough potential to do well in a given subject when they get to school. For instance, some students may not have calculat.
Running head Project 21Project 22Projec.docxglendar3
Running head: Project 2 1
Project 2 2
Project 2: Historical Context and Introduction
Your Name
Southern New Hampshire University
Research Plan
Research Question: [Revised research question from Topic Exploration Worksheet.]
Introduction
[Three- to five-sentence discussion of background information about your historical event to capture the interest of your audience.] [Two- to three-sentence thesis statement based on your research question that addresses your historical event and explains how your event has been influenced by historical context.] [Two- to three-sentence explanation of how you will use the primary and secondary sources you listed in the Research Plan in your hypothetical research paper.]
Historical Context: [Three- to five-sentence explanation of your event’s historical context, citing sources one and two.]
Impact of Historical Context: [Three- to five-sentence discussion of how historical context impacted your event, citing sources one and two.]
Resources
HIS 100 Project 2: Historical Context and Introduction Guidelines and Rubric
Overview
“If you want to understand today, you have to search yesterday.”
—Pearl Buck
Your second project in this course is to complete a historical context and introduction project. The work you did on the Topic Exploration Worksheet in Theme 1
will directly support your work on this project as well as your third longer term project—the multimedia presentation—due in Theme 4.
One of the prime benefits of studying history is that it allows us to learn about who we are and where we came from. The people and events of the past can
often shed light on the conditions and social norms of the present. Having historical awareness can inform various aspects of your life as well as future
aspirations. Learning from past failures and successes can shape ideals and values for years to come.
This is your second longer-term project designed to help you understand the fundamental processes and value of studying history. In the first project, you
completed the Topic Exploration Worksheet on one of the topics or themes from the library guide. You investigated the types of research you might need to do
to learn more about the topic and developed research questions. In Project 2, you will use your completed Topic Exploration Worksheet to explore the
historical context and develop an introduction. You will choose one of your research questions and do some secondary source research, speculate on primary
source needs, and use the information to write the introduction and thesis statement for a possible research paper. (You will not write the entire paper—
only the introduction.) In the third project, you will create a multimedia presentation that explores both major developments in historical inquiry and the value
of examining history.
This research plan and introduction assignment will assess the following course outcome, which you focused on throughou.
Running head: MILESTONE ONE 2
2
Milestone One Final Project
John Doe
Southern New Hampshire University
I. Executive Summary
In this section, you should accurately highlight the essential elements of the intelligence report for quick reference by the agency receiving the report. You should include the name of referring agent (your name), the name of the agency that you are imagining you work for, the current date, dates of the activities being covered in the intelligence report, and a brief summary (two to three sentences) on the adversary, scope, and nature of the potential threat. Although this is the opening section of the report, you may wish to complete it last in order to accurately capture the analysis of the body of your report. (This section is the summary so be sure this section is brief. Additional relevant details should be written in their respective sections of the report.)
II. Adversary, Motivation, and Jurisdiction
Summary
Accurately summarize the intelligence collected from the SARs to date, focusing on the “who, what, when, where, why, and how” of the threat situation. Information should be annotated with dates and times from relevant SARs, and information from each date should be provided in a separate paragraph, from inception to most recent. Your summary should focus on connecting the dots, with as much detail as needed to present all the relevant intelligence. It should highlight information that would be of particular relevance for the law enforcement agency doing follow-up in understanding the potential threat. (If it makes it easier, you can format your first section as follows:
A. Who
B. What
C. When
D. Where
E. Why
F. How
Adversary
Determine who the adversary is for this potential threat. It may be an individual or a group. You should identify the names of suspects (if known) and also the type of adversary. For example, is the adversary an international terrorist group, a domestic terrorist group, an organized crime, a local or international gang, drug traffickers, an extremist or militia group, a hacker, or a white-collar criminal? Support your answer using relevant information from the SARs.
Range
Analyze the range of the adversary’s operations. Are their activities focused within one city or state or across multiple states? Support your answer with relevant information from the SARs.
Motivation
Analyze what is known about the adversary’s motivation and how that might affect their choice of target (individual or location). Might it affect whether they choose one target or many, the type of target they select, or the location of the attack? Support your answer with relevant information from the SARs.
Jurisdiction
Based on your analyses in Parts A–C above, determine which agency has jurisdiction in following up on the potential threat. For example, should local or state law enforcement follow up? Should federa.
Running Head PROJECT 31DISCUSSION5Project 3.docxglendar3
Running Head: PROJECT 3 1
DISCUSSION 5
Project 3
Problem statement:
The specific problem to be addressed is how McDonald's is going to deal with a decrease in demand in the wake of COVID-19 pandemic. The general problem to be addressed is how fast-food chains and food outlets are changing their operations during the pandemic of Corona Virus in the world, especially in the United States (Daniel, 2016).
You must always list your general problem statement first. Provide context for that statement. Then present your specific problem statement and provide context for that statement. Per the assignment instructions you should list your research questions following your problem statements.
The method selected for research:
To conduct research on the above-stated problem stated, the right methodThe research method that will be adopted in conducting the proposed research will be the mixed method approach a combination approach withwhich includes both quantitative and qualitative methodologies. A quantitative approach will help understand the insights into what is triggering a certain behavior in participants. While on the other hand, quantitative study is important to figure out the proportion of customers who is are not availing their previous interest in fast food and epically McDonald's (Apuke, 2017). But dueDue to the lockdown and social distancing, going in the market and conducting research is out of option. The suitable technique is to develop a flexible approach where both primary and secondary sources are sued. For secondary resources, the reports by McDonald's' Company and other institutions regarding the change in the food industry will be a suitable option. For primary data collection, developing an online survey is the safest option. For the qualitative study, online interviews can be scheduled. Both structured and unstructured interviews can be planned. Similarly, panel discussion over video calls is also a safe option. Through a mixed approach data for both quantitative and qualitative questions can be gathered (Yoshikawa & Kalil, 2008). Comment by Terrance Woods: What does this mean? Poor word choice. Consider rephrasing Comment by Terrance Woods: Word choice
Per the assignment instructions you were required to “include the justification as to why other methods would not be appropriate”. You failed to do that here.
Research question
Qualitative Research Question:
1. How the fast-food business of McDonald's in the United States is getting affected by the pandemic of COVID-19? Comment by Terrance Woods: I provided you with feedback in your Project 2 submission regarding this research question. My exact feedback was - This questions is not well-articulated. Reword for clarity. You failed to address the feedback received and merely presented the same question in this submission.
Quantitative research question:
2. How many Americans have stopped buying McDonald's because of coronavirus threat in the United States? Comment by.
Running head: PROBLEM STATEMENT 1
PROBLEM STATEMENT 3
Problem statement
Name:
Institution:
Date:
There is a critical need for a good instructional design because it is a multipurpose learning tools that not only serves instructional designers but also learners of all ages. According to Clark (2016), e-learning courses need to be integrated with instructional methods which align with high-quality research.” The implication is that the process of designing instructional designs should involve careful planning, preparing and researching in order to achieve high quality learning outcomes. In this regard, those responsible for designing must identify their strategic purpose as it predetermines the goals, objectives, expected outcomes, and resource allocation of the entire instruction model.
The main approach involves studying the critical elements in the design phases of an instructional model which enhances the learning experience of learners based on evidence-based literature. This is because humans apply appropriate cognitive processes to learn and thus instruction must adopt similar cognitive processing (Clark, 2016).The main purpose is therefore to emphasize the importance of good instructional design in enhancing the quality of education among instructors and learners. The objective involves highlighting the goals of an instructional program, the instructional objectives, relevant instructional materials and design assessment which rationalize the need for a good instructional design with the goal of engaging both learners and instructors. After all, learning is a process that requires the active participation of the learners (Reigeluth, 1987). This research study seeks to identify answers to two questions: a) What are the critical elements that build up a strong foundation for a good instructional design and b) what value do these elements offer to the learners and instructor who are the main consumers of learning instructional designs.
References
Clark, R.C. (2016). E-learning and the science of instruction: proven guideline for consumers and designers of multimedia. Walden University Library.
Regeiluth, C.M. (1987). Instructional Theories in Action: Lessons Illustrating Selected Theories and Models. Walden University Library.
Running head: PROBLEM STATEMENT 1
PROBLEM STATEMENT 6
Need working title
Problem statement
Tangela Jones
Walden University
11/10/18
Need section heading
There is a critical need for a good instructional design because it is a multipurpose learning tools that not only serves instructional designers but also learners of.
Running head MUSIC AND GENDER WOMEN PORTRAYAL IN RAP 1.docxglendar3
Running head: MUSIC AND GENDER: WOMEN PORTRAYAL IN RAP 1
MUSIC AND GENDER: WOMEN PORTRAYAL IN RAP 15
Music and Gender: Women Portrayal in Rap Music
Student’s Name:
Course:
Music and Gender: Women Portrayal in Rap Music
The introduction of rap music in the 1980s was welcomed with a lot positivity. However, this genre of music has on many occasions been considered as being controversial. Rap music has been accused of advancing messages and themes that deal with sexism, violence, gender stereotyping and materialism. Previous studies on rap music have indicated the content found in rap music promotes negative behavior. Moreover, research has shown that rap music videos generally differ in their portrayals of men and women in music videos. Males are often cast in positive light compared to females who are depicted in positions that portray them as a submissive gender to males.
The scope of this research narrows down on rap music produced from the years 2016 to 2018.The songs selected for this research are songs with lyrics that have misogynistic themes on women. Rap songs are observed in normalizing, objectifying, glorifying, victimizing and even exploiting women. Moreover, the rap songs are observed in defaming women through using innuendos and stereotypical language which portray misogynistic and sexist perspectives. The main area of focus for this paper is on the kind of nouns that are used in rap music to refer to the concept of woman and ways in which these nouns depict women. It is critical for this project to investigate the lyrics and its representations, as rap music has in the past years been under criticism for increasingly presenting a negative and controversial image of women in the society. A theological perspective on these issues is undertaken at understanding and criticizing the misogynistic and sexist culture of rap music generally.
Men in rap music have a higher probability of perpetuating violence on women. A review done on the common rap images found out that women were more likely to be dressed in images which portrayed them in provocative ways, especially in videos that had sexual content. Research has suggested that the perpetuation of gender in the media is a theme which has been occurring for eons of time[footnoteRef:1]. Specifically, music and gender and the portrayal of women in rap music has not been extensively studied previously. It is essential to consider the differences of gender in rap music and the portrayal of women in this genre of music. [1: Ronald Weitzer and Charis E Kubrin, “Articles Misogyny in Rap Music A Content Analysis of Prevalence and Meanings,” accessed October 23, 2018, https://doi.org/10.1177/1097184X08327696.]
Although scholars have attempted examining the interactions between rap music and religion, there has been a gap in regard to how artists frame religious messages within their lyrics. However, this lack of sufficient research does not reflect on the continued .
Running head Museum Focus1Museum Focus.docxglendar3
Running head: Museum Focus
1
Museum Focus
4
Museum Focus
Linda Dotson
Walden University
Interdisciplinary Experience: Sustaining Quality of Life in the City
Professor Paige Parker
September 15, 2018
Question 1
Brief introduction of Ohio City
Ohio is a great city named after the Ohio River in the 18th century. The area was disputed by the France and Great Britain. After the dispute, it established its own territories. This territory included the land where west of Pennsylvania in United States and the northwest of the Ohio River. The area covered more than 260,000 square miles (Turner, & Bogue 2010).
The History of Ohio City that has led to construction of Museums.
The area remained as a hunting ground by the Iroquois after the dispute. Later, some American groups began to migrate to the area. Later there was a seven years war between the Europeans, British and France. They all wanted to colonize the area. Unfortunately, the British worn and after the win, they ordered French settlers to leave the area. It is evident that the war brought about the breakdown of ethnicities.
How museum focus has been of great importance to the citizens of the city
The area is known for its landscape, mountains, rivers and minerals. This makes Ohio City to be a great city suitable for great museums. It is evident that, Ohio City creates the best environment for a museum with the theme of History and Natural History to be built. For instance, Miami River is known to be a great river. Many people admire visiting the area just to see the river. This creates the best conditions to build a museum. People within the city can also visit the museum and get to enjoy the benefits of the museums.
How people from outside the city benefit from the construction of the museums.
People outside Ohio City can also visit the museums. These museums will offer the history of the river to its visitors. They will also address an increasing array of issues in the dynamic environment (Edson, 2017).
Question 2
Permanent Exhibition.
Modern museum are designed to have a permanent exhibit, in this case the museum must have enough collections and classification of a field of knowledge for research and for display purposes. This will enlighten the visits about the history of Ohio City. The history stored in this museum will also be of great use to students as they will learn a lot in these museums,
References
Edson, G. (2017). Museum management. In Encyclopedia of Library and Information Sciences(pp. 3185-3198). CRC Press.
Turner, F. J., & Bogue, A. G. (2010). The frontier in American history. Courier Corporation.
If you can do it send confirmation at [email protected]
If you can do it send confirmation at [email protected]
Assessment Details and Submission Guidelines
Trimester
T2 2018
Unit Code
MN603
Unit Title
Wireless Networks and Security
Assessment
Individual
Type
Assessment
Design and implementation of secure enterprise wireless network
Tit.
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Literature ReviewA search was conducted using electronic database.docxssuser47f0be
Literature Review:
A search was conducted using electronic databases in the fields of nursing, medicine, education, psychology, and sociology. Using ProQuest Direct and EBSCO search engines, the following databases were accessed: CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE in PubMed, Ovid, and PsycINFO. The search terms were grouped in the following key concepts: (a) occupational stress in nursing, (b) stress perception in nursing, (c) occupational stressors in nursing, (d) nursing generational diversity, and (e) coping in nursing. In a commentary on patient safety in nursing practice from the Agency for Healthcare Research and Quality, Hughes and Clancy7 reported that complexity and bullying represent 2 clear examples of nurse stressors. Li and Lambert8 concluded that nurses who are more satisfied with their job are more likely to remain in the workforce and to be committed to delivering high-quality patient care. Hall9 found that healthcare professions have some unique characteristics leading to occupational stress including physical responsibility for people, potential catastrophic effects on the patient and the employee, frequent exposure to pain and suffering, and exposure to infectious diseases and potential hazardous substances. Hamaideh et al10 identified that death and dying were the strongest stressors perceived by Jordanian nurses. In this study, workload and guidance were found to be the most supportive behaviors provided to nurses facing stress followed by emotional support.10
Carver and Candela11 concluded that considering the global nursing shortage, managers should increase their knowledge of the generational diversity. It is suggested that understanding how to relate to multiple generations can lead to improved nursing work environments.11 Repar and Patton12 found that the combined effects of compassion fatigue, chronic grief, and emotional and physical exhaustion led to significant burnout and prolonged job dissatisfaction in the nursing profession. In this study, using guided sessions, a massage therapist gave 10-minute chair massages, and a visual, language, or musical artist engaged participants in imaginative and creative activities such as poetry reading, free writing, guided imagery, and listening to live music.12 The results suggest that the activities reduce some of the unpleasant, stressful, and tension-producing emotions that nurses typically experience at work, leaving them more peaceful and energized.12 Based on the findings of this review of the literature, it is recognized that stress is a major component of nursing and can be detrimental to nurse retention. In addition, most studies identified some differences that exist between the present generational nursing cohorts in terms of values and beliefs. No studies were identified reporting how work-related stress affects different generations of nurses, how the generations perceive stress, and what coping styles are used.
Study Des ...
Family Therapy CourseUsing the brief case description below, pre.docxssuser454af01
Family Therapy Course
Using the brief case description below, prepare a script you could use to call the mock client’s pediatrician for a 10-minute conversation. To prepare, consider the following: What facts do you need to communicate to the doctor? What will the doctor likely want to know from you? What will you want to be sure to tell the doctor about your diagnosis of him having ADHD and treatment plan for family? You diagnose that he should be placed on medication and pediatricians nurse prescribe the diagnosis level
Case description: Your client is an 8-year-old male whose parents are concerned might have ADHD. He is the middle child of three boys. You have met the parents and the child in your initial sessions. At this point, you have had only three sessions with the family. Your client says he has lots of friends, he hates school because it’s boring, and his parents yell at him too much!
Write a mock transcript of an imaginary phone call between you and the client’s physician. In your mock discussion, include information you would provide to the doctor about your assessment, treatment plan, and orientation to treating ADHD; include the doctor’s questions or responses to the information you provide. Also, include questions you would ask the doctor, and the doctor’s responses.
Transcript Length: 5 pages
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it ...
Please I need a response to this case study.1 pagezero plagi.docxcherry686017
Please I need a response to this case study.
1 page
zero plagiarism
three references
The Case:
The sleepy woman with anxiety
This week’s discussion presents a case study involving a 44-year old woman with a chief complaint of anxiety beginning at age 15 years old. She has a long history of mental illness and continued therapies. The purpose of this discussion is to analyze her case history to determine medication and treatment effectiveness.
Client Questions
Question 1. Are you having feelings of harming yourself or harming someone else?
Rationale: This is a possibly uncomfortable yet important set of questions to ask each client. Primary care providers may be in a unique position to prevent suicide due to their frequent interactions with suicidal patients. Reviews suggest that among patients who committed suicide, 80 percent had contact with primary care clinicians within one year of their death, whereas only 25 to 30 percent of decedents had contact with psychiatric clinicians within the year of their death (Stene-Lars & Reneflot, 2017).
Question 2. What was happening in your life as a teenager when the anxiety started and you began to self-medicate?
Rationale: Per our report, this patient began suffering signs and symptoms of anxiety at 15-years old. Asking these types of questions we may gain insight into an underlying cause or triggering event. Anxiety disorders are the most common psychiatric disorders with onset in childhood, with prevalence estimates ranging from 10 to 30 percent. Nearly 37 percent of behaviorally inhibited preschool-age children had social anxiety disorder at age 15, compared with 15 percent of non- behaviorally inhibited children
.
Children with anxiety disorders are more likely to have persistent anxiety disorders into adulthood. (Rapee, 2014).
Question 3. What was happening in your life a year ago when these symptoms returned and became debilitating? Let’s discuss what the triggering events may have been.
Rationale: Self-discovery of triggering events may help the client to come to terms with the determinants of her anxiety and depression. Studies have shown that specific types of stressors were found to differentially predict increases in specific facets of anxiety sensitivity; health-related stressors predicted increases in disease-related concerns and fear of mental incapacitation, whereas stressors related to family discord predicted increases in fear of feeling unsteady, fear of mental incapacitation, and fear of having publicly observable symptoms of anxiety (McLaughlin & Hatzenbuehler, 2009).
Support System
The support system as reported by our client is her husband. She states he is supportive and has little to no contact with the family of origin. She has a few friends and a few outside interests. As PMHNP, discussing relationships with the client is one avenue to gain insight into anxiety patterns and coping mechanisms as seen by outside support. With the client’s permissio.
Child Adolesc Psychiatric Clin N Am16 (2007) 111–132The JinElias52
Child Adolesc Psychiatric Clin N Am
16 (2007) 111–132
The Case Formulation in Child
and Adolescent Psychiatry
Nancy C. Winters, MD
a,*, Graeme Hanson, MD
b
,
Veneta Stoyanova, MD
a
a
Division of Child and Adolescent Psychiatry, Oregon Health and Science University,
3181 SW Sam Jackson Park Road, Mail Code:DC-7P, Portland, OR 97239-3098, USA
b
Department of Psychiatry, University of California San Francisco,
513 Parnassus Avenue, San Francisco, CA 94143-0410, USA
Put simply, case formulation is a process by which a set of hypotheses is
generated about the etiology and factors that perpetuate a patient’s present-
ing problems and translates the diagnosis into specific, individualized
treatment interventions. It is central to the practice of child and adolescent
psychiatry. Even if not articulated explicitly, the case formulation guides all
clinical activity. For example, how one understands a child’s biologic
vulnerabilities and how they interact with personality or family factors
and the importance assigned to each clearly influence choices made in the
assessment process and the treatment plan. Despite the widely acknowl-
edged importance of case formulation, it is often taught cursorily in
residency programs, and residents often perceive it as too challenging to
actually perform [1]. Consequently, case formulation is often relegated to
secondary status behind the DSM-IV-TR differential diagnosis. Such
attitudes are manifested in the American Board of Psychiatry and Neurol-
ogy Child and Adolescent Psychiatry certification examinations. When
asked to formulate the case just presented, candidates generally return a per-
functory statement and transition quickly to discussion of DSM-IV-TR
diagnoses.
How can case formulation be taught systematically and effectively to
child psychiatry residents? This article reviews the various definitions of
case formulation, differences between diagnosis and case formulation,
how case formulation for a child patient differs from an adult patient,
and case formulation in the context of residency training, including
challenges for residents transitioning from adult psychiatry. It presents
* Corresponding author.
E-mail address: [email protected] (N.C. Winters).
1056-4993/07/$ - see front matter � 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.chc.2006.07.010 childpsych.theclinics.com
mailto:[email protected]
112 WINTERS et al
a suggested structure for constructing a biopsychosocial formulation that
can be applied in a training setting. Several specialized types of psychother-
apy formulation are reviewed in more detail. The article concludes with
a case example of a child psychiatry resident’s case formulation before
and after discussion in supervision.
Definitions of case formulation
If one searches the literature on case formulation in child psychiatry, one
finds a surprisingly small number of articles relative to its importance. The
indices of several textbooks in child psychiatry (and a ...
Model of TreatmentEducation and its EvaluationProblem.docxhelzerpatrina
Model of Treatment/Education and its Evaluation
Problem(s)
Will Power +
Common Factors +
Any Specific Factor (any treatment model EBP or other) +
Feedback Informed Treatment + Deliberate Practice =
Effective Outcome
SPECIAL ARTICLE
How important are the common factors in
psychotherapy? An update
BRUCE E. WAMPOLD
Department of Counseling Psychology, University of Wisconsin, Madison, WI, USA; Modum Bad Psychiatric Center, Vikersund, Norway
The common factors have a long history in the field of psychotherapy theory, research and practice. To understand the evidence supporting
them as important therapeutic elements, the contextual model of psychotherapy is outlined. Then the evidence, primarily from meta-
analyses, is presented for particular common factors, including alliance, empathy, expectations, cultural adaptation, and therapist differ-
ences. Then the evidence for four factors related to specificity, including treatment differences, specific ingredients, adherence, and compe-
tence, is presented. The evidence supports the conclusion that the common factors are important for producing the benefits of psychotherapy.
Key words: Common factors, contextual model, psychotherapy, alliance, empathy, expectations, cultural adaptation, therapist differences,
specific ingredients
(World Psychiatry 2015;14:270–277)
The so-called common factors have a long history in psy-
chiatry, originating with a seminal article by S. Rosenzweig
in 1936 (1) and popularized by J. Frank in the various
editions of his book Persuasion and Healing (2-4). During
this period, the common factors have been both embraced
and dismissed, creating some tension (5-9). The purpose of
this paper is not to review or discuss the debate, but to pro-
vide an update, summarizing the evidence related to these
factors.
To understand the evidence for the common factors, it is
important to keep in mind that these factors are more than a
set of therapeutic elements that are common to all or most
psychotherapies. They collectively shape a theoretical mod-
el about the mechanisms of change in psychotherapy.
A particular common factor model, called the contextual
model, has been recently proposed (8,10). Although there
are other common factor models (e.g., 4,11), based on differ-
ent theoretical propositions, the predictions made about the
importance of various common factors are similar and the
choice of the model does not affect conclusions about the
impact of these factors. The contextual model is presented
below, followed by a review of the evidence for the common
factors imbedded in the model.
THE CONTEXTUAL MODEL
The contextual model posits that there are three path-
ways through which psychotherapy produces benefits. That
is, psychotherapy does not have a unitary influence on
patients, but rather works through various mechanisms.
The mechanisms underlying the three pathways entail
evolved characteristics of humans as the ultimate social spe-
cies; as such.
Model of TreatmentEducation and its EvaluationProblem.docxroushhsiu
Model of Treatment/Education and its Evaluation
Problem(s)
Will Power +
Common Factors +
Any Specific Factor (any treatment model EBP or other) +
Feedback Informed Treatment + Deliberate Practice =
Effective Outcome
SPECIAL ARTICLE
How important are the common factors in
psychotherapy? An update
BRUCE E. WAMPOLD
Department of Counseling Psychology, University of Wisconsin, Madison, WI, USA; Modum Bad Psychiatric Center, Vikersund, Norway
The common factors have a long history in the field of psychotherapy theory, research and practice. To understand the evidence supporting
them as important therapeutic elements, the contextual model of psychotherapy is outlined. Then the evidence, primarily from meta-
analyses, is presented for particular common factors, including alliance, empathy, expectations, cultural adaptation, and therapist differ-
ences. Then the evidence for four factors related to specificity, including treatment differences, specific ingredients, adherence, and compe-
tence, is presented. The evidence supports the conclusion that the common factors are important for producing the benefits of psychotherapy.
Key words: Common factors, contextual model, psychotherapy, alliance, empathy, expectations, cultural adaptation, therapist differences,
specific ingredients
(World Psychiatry 2015;14:270–277)
The so-called common factors have a long history in psy-
chiatry, originating with a seminal article by S. Rosenzweig
in 1936 (1) and popularized by J. Frank in the various
editions of his book Persuasion and Healing (2-4). During
this period, the common factors have been both embraced
and dismissed, creating some tension (5-9). The purpose of
this paper is not to review or discuss the debate, but to pro-
vide an update, summarizing the evidence related to these
factors.
To understand the evidence for the common factors, it is
important to keep in mind that these factors are more than a
set of therapeutic elements that are common to all or most
psychotherapies. They collectively shape a theoretical mod-
el about the mechanisms of change in psychotherapy.
A particular common factor model, called the contextual
model, has been recently proposed (8,10). Although there
are other common factor models (e.g., 4,11), based on differ-
ent theoretical propositions, the predictions made about the
importance of various common factors are similar and the
choice of the model does not affect conclusions about the
impact of these factors. The contextual model is presented
below, followed by a review of the evidence for the common
factors imbedded in the model.
THE CONTEXTUAL MODEL
The contextual model posits that there are three path-
ways through which psychotherapy produces benefits. That
is, psychotherapy does not have a unitary influence on
patients, but rather works through various mechanisms.
The mechanisms underlying the three pathways entail
evolved characteristics of humans as the ultimate social spe-
cies; as such.
Running head Multi-actor modelling system 1Multi-actor mod.docxglendar3
Running head: Multi-actor modelling system 1
Multi-actor modelling system3
Multi-actor modelling system
Yogesh Dagwale
University of the Cumberland’s
Ligtenberg, A., Wachowicz, M., Bregt, A. K., Beulens, A., & Kettenis, D. L. (2004). A design and application of a multi-agent system for simulation of multi-actor spatial planning. Journal of environmental management, 72(1-2), 43-55.
They talk about the potential and restrictions of the MAS to manufacture models that empower spatial organizers to incorporate the 'actor factor' in their examination. Their structure system contemplates actors who assume a functioning job in the spatial planning. They included actors who can watch and see a spatial domain. Using these perceptions and discernment they produce an inclination for a preferred spatial situation. Actors at that point present and discuss their inclinations amid their exchanges with different actors.
The inclinations of the actor fill in as inputs for an official choice making. Finally, ultimate conclusions are actualized in the spatial framework. They found that MAS can produce space utilization designs in light of a portrayal of a multi-actor planning process. It additionally can clear up the impacts of actors under the administration of various planning styles on the space utilization and prove how the relations between actors change amid a planning process and under different orders of coming up with decisions. Unlike the work by Parker, Manson, Janssen, Hoffman & Deadman,2003, cited below, this paper did not include the various challenges associated with the use of MAS.
Parker, D. C., Manson, S. M., Janssen, M. A., Hoffmann, M. J., & Deadman, P. (2003). Multi-agent systems for the simulation of land-use and land-cover change: a review. Annals of the association of American Geographers, 93(2), 314-337.
In this paper, they studied different models. These models, however, were not thorough enough and therefore they took into account the multi-actor system, dynamic spatial Simulation, which has two components, that is, a cellular model that speaks to biogeophysical and biological parts of a demonstrated framework and an actor-based model to speak to human conclusion making. Because of its nature and ability to model complex situations, they highlighted some of the areas that MAS can be applied where other models cannot be able to deliver. Such areas are modeling of emergent phenomena whereby MAS can model landscape plans, due to its flexibility, MAS can represent complex land use/ cover systems, and they can be used to model dynamic paths. They also outlined the various challenges to Multi-actor systems. Such challenges include an understanding of complexity, individual decision making, empirical parameterization and model validation, and communication.
Faber, N. R., & Jorna, R. J. (2011, June). The use of multi-actor systems for studying social sustainability: Theoretical backgrounds and pseudo-specifications. In Com.
Running head: MY MOTHER MY HERO 1
MY MOTHER MY HERO 4
My Mother My hero
Institution Affiliation
Students’ Name
Date of Submission
My Mother My hero
Once I think of a hero, there are specific qualities that surround my imagination, being courageous, hardworking, truthful, strong, resilient, and generous have been the qualities I taught about. I also think a hero is someone protective, caring, and so concerned to change the life of the others and make them happy in their life. My Mother has all these qualities and recognizes her as my hero. Otherwise, she grew up on the support of two great parents who had a good life where she grew up and become a teacher in her life. Almost every individual has had some achievements in their life, and there must be a factor behind those achievements, especially someone who had a significant impact on their life. My mother appears to be my hero, who had a substantial impact on my life.
She is currently 54 years old. She was a teacher by profession, and she did her best as a teacher, where she influenced the lives of many students positively; up to now, some still call her and pass their appreciation to her. She was blessed and gave birth to seven kids; the first three are daughters, then a boy and a girl, and then the last two are boys. All of them have been significantly raised, everyone has something to do for a living, my big brother is a doctor, and three of my sisters are teachers, (like Mother like daughters). Our last born is an engineer interior designer and all of us are married with happy family. All these were not for granted but because of the love of God and the efforts, commitment, and great concern of our beloved parents, especially our Mother.
Even though she did not make a complete journey in her teaching profession, but up to where she stopped, she did a lot. They have been in a relationship with my father for thirty-six years of marriage, and when they had their third kid, my dad suggested that she stop teaching and remain at home to take care of the children. Throughout my entire life, my Mother had been supportive of me, a center of inspiration, and she has always been telling me to have self-confidence and believe in myself that I can make it. In case I face a problem, and I have to make a concrete decision towards it, my Mother always had behind me because I seek for her consultation before I move on to the next step.
It feels so great knowing that there is someone who will support you despite the intensity of the problem you face. It relieves much of the stress that comes along with making decisions. My Mother is beautiful inside and out, but most importantly, she has the biggest heart. She's a hard-working person and can play both parent roles. Everyon.
Running head PROGRAM EVALUATION PLAN1PROGRAM EVALUATION PLAN.docxglendar3
Running head: PROGRAM EVALUATION PLAN 1
PROGRAM EVALUATION PLAN 10
Program Evaluation Plan
Name:
Tanisha Hannah
Institution:
Strayer University
Professor:
Dr. Jacob
Course:
Edu 571
Date:
March 2, 2020
Program Evaluation Plan (Part 3)
Goals of Evaluation
Evaluation refers to the act of checking various things thoroughly in order to characterize their worth or value, with reference to a certain context. In the field of education, the amount of success in a person’s aims can only be determined through evaluation. Therefore, there is a very close relationship between various aims and evaluation. The main goals of evaluation in schools are as discussed below. The first goal of evaluation in the field of education is to create an educational program ("Evaluation in Teaching and Learning Process | Education", 2020). Through evaluation, evaluators and the school management can build a given program of learning among the students. This is after gathering and checking various factors in order to find what program will fit and make a positive impact in the school. This involves consulting all the stakeholders of the program and developing strategies that will ensure the development of a good program.
The second goal of evaluation is assessing the effectiveness of the program. Evaluation ensures that the developed program is up to standards and serves the purpose that it was intended to. It helps the evaluators to check if the teaching strategies and techniques are being applied properly. The third goal of evaluation is to ensure improvement of the program. Through evaluation, evaluators can gauge the impact of the program on the school and learners. They can also identify various things that can make the program more effective. It acts as an in-built monitor in the program in order to review the progress of the program from time to time. It also gives feedback regarding the design and the implementation of a given program. Through such assessments, the school management can know where to work on, and what they need in order to enhance effective programs in teaching and learning.
For instance, in our case, evaluators can comfortably tell whether or not the program is helping girls become more superior in math. If not they can suggest better or other strategies that will make positive impact.
Cultural Issues Affecting the Program
Culture can influence how different people view things. An individual’s culture and upbringing can affect their way of processing information. Among the cultural issues that might be faced in the evaluation plan include cultural stereotypes. Some students believe that they cannot perform as expected in school or in a particular subject due to lack of preparation from their home environment. This makes them believe they do not have enough potential to do well in a given subject when they get to school. For instance, some students may not have calculat.
Running head Project 21Project 22Projec.docxglendar3
Running head: Project 2 1
Project 2 2
Project 2: Historical Context and Introduction
Your Name
Southern New Hampshire University
Research Plan
Research Question: [Revised research question from Topic Exploration Worksheet.]
Introduction
[Three- to five-sentence discussion of background information about your historical event to capture the interest of your audience.] [Two- to three-sentence thesis statement based on your research question that addresses your historical event and explains how your event has been influenced by historical context.] [Two- to three-sentence explanation of how you will use the primary and secondary sources you listed in the Research Plan in your hypothetical research paper.]
Historical Context: [Three- to five-sentence explanation of your event’s historical context, citing sources one and two.]
Impact of Historical Context: [Three- to five-sentence discussion of how historical context impacted your event, citing sources one and two.]
Resources
HIS 100 Project 2: Historical Context and Introduction Guidelines and Rubric
Overview
“If you want to understand today, you have to search yesterday.”
—Pearl Buck
Your second project in this course is to complete a historical context and introduction project. The work you did on the Topic Exploration Worksheet in Theme 1
will directly support your work on this project as well as your third longer term project—the multimedia presentation—due in Theme 4.
One of the prime benefits of studying history is that it allows us to learn about who we are and where we came from. The people and events of the past can
often shed light on the conditions and social norms of the present. Having historical awareness can inform various aspects of your life as well as future
aspirations. Learning from past failures and successes can shape ideals and values for years to come.
This is your second longer-term project designed to help you understand the fundamental processes and value of studying history. In the first project, you
completed the Topic Exploration Worksheet on one of the topics or themes from the library guide. You investigated the types of research you might need to do
to learn more about the topic and developed research questions. In Project 2, you will use your completed Topic Exploration Worksheet to explore the
historical context and develop an introduction. You will choose one of your research questions and do some secondary source research, speculate on primary
source needs, and use the information to write the introduction and thesis statement for a possible research paper. (You will not write the entire paper—
only the introduction.) In the third project, you will create a multimedia presentation that explores both major developments in historical inquiry and the value
of examining history.
This research plan and introduction assignment will assess the following course outcome, which you focused on throughou.
Running head: MILESTONE ONE 2
2
Milestone One Final Project
John Doe
Southern New Hampshire University
I. Executive Summary
In this section, you should accurately highlight the essential elements of the intelligence report for quick reference by the agency receiving the report. You should include the name of referring agent (your name), the name of the agency that you are imagining you work for, the current date, dates of the activities being covered in the intelligence report, and a brief summary (two to three sentences) on the adversary, scope, and nature of the potential threat. Although this is the opening section of the report, you may wish to complete it last in order to accurately capture the analysis of the body of your report. (This section is the summary so be sure this section is brief. Additional relevant details should be written in their respective sections of the report.)
II. Adversary, Motivation, and Jurisdiction
Summary
Accurately summarize the intelligence collected from the SARs to date, focusing on the “who, what, when, where, why, and how” of the threat situation. Information should be annotated with dates and times from relevant SARs, and information from each date should be provided in a separate paragraph, from inception to most recent. Your summary should focus on connecting the dots, with as much detail as needed to present all the relevant intelligence. It should highlight information that would be of particular relevance for the law enforcement agency doing follow-up in understanding the potential threat. (If it makes it easier, you can format your first section as follows:
A. Who
B. What
C. When
D. Where
E. Why
F. How
Adversary
Determine who the adversary is for this potential threat. It may be an individual or a group. You should identify the names of suspects (if known) and also the type of adversary. For example, is the adversary an international terrorist group, a domestic terrorist group, an organized crime, a local or international gang, drug traffickers, an extremist or militia group, a hacker, or a white-collar criminal? Support your answer using relevant information from the SARs.
Range
Analyze the range of the adversary’s operations. Are their activities focused within one city or state or across multiple states? Support your answer with relevant information from the SARs.
Motivation
Analyze what is known about the adversary’s motivation and how that might affect their choice of target (individual or location). Might it affect whether they choose one target or many, the type of target they select, or the location of the attack? Support your answer with relevant information from the SARs.
Jurisdiction
Based on your analyses in Parts A–C above, determine which agency has jurisdiction in following up on the potential threat. For example, should local or state law enforcement follow up? Should federa.
Running Head PROJECT 31DISCUSSION5Project 3.docxglendar3
Running Head: PROJECT 3 1
DISCUSSION 5
Project 3
Problem statement:
The specific problem to be addressed is how McDonald's is going to deal with a decrease in demand in the wake of COVID-19 pandemic. The general problem to be addressed is how fast-food chains and food outlets are changing their operations during the pandemic of Corona Virus in the world, especially in the United States (Daniel, 2016).
You must always list your general problem statement first. Provide context for that statement. Then present your specific problem statement and provide context for that statement. Per the assignment instructions you should list your research questions following your problem statements.
The method selected for research:
To conduct research on the above-stated problem stated, the right methodThe research method that will be adopted in conducting the proposed research will be the mixed method approach a combination approach withwhich includes both quantitative and qualitative methodologies. A quantitative approach will help understand the insights into what is triggering a certain behavior in participants. While on the other hand, quantitative study is important to figure out the proportion of customers who is are not availing their previous interest in fast food and epically McDonald's (Apuke, 2017). But dueDue to the lockdown and social distancing, going in the market and conducting research is out of option. The suitable technique is to develop a flexible approach where both primary and secondary sources are sued. For secondary resources, the reports by McDonald's' Company and other institutions regarding the change in the food industry will be a suitable option. For primary data collection, developing an online survey is the safest option. For the qualitative study, online interviews can be scheduled. Both structured and unstructured interviews can be planned. Similarly, panel discussion over video calls is also a safe option. Through a mixed approach data for both quantitative and qualitative questions can be gathered (Yoshikawa & Kalil, 2008). Comment by Terrance Woods: What does this mean? Poor word choice. Consider rephrasing Comment by Terrance Woods: Word choice
Per the assignment instructions you were required to “include the justification as to why other methods would not be appropriate”. You failed to do that here.
Research question
Qualitative Research Question:
1. How the fast-food business of McDonald's in the United States is getting affected by the pandemic of COVID-19? Comment by Terrance Woods: I provided you with feedback in your Project 2 submission regarding this research question. My exact feedback was - This questions is not well-articulated. Reword for clarity. You failed to address the feedback received and merely presented the same question in this submission.
Quantitative research question:
2. How many Americans have stopped buying McDonald's because of coronavirus threat in the United States? Comment by.
Running head: PROBLEM STATEMENT 1
PROBLEM STATEMENT 3
Problem statement
Name:
Institution:
Date:
There is a critical need for a good instructional design because it is a multipurpose learning tools that not only serves instructional designers but also learners of all ages. According to Clark (2016), e-learning courses need to be integrated with instructional methods which align with high-quality research.” The implication is that the process of designing instructional designs should involve careful planning, preparing and researching in order to achieve high quality learning outcomes. In this regard, those responsible for designing must identify their strategic purpose as it predetermines the goals, objectives, expected outcomes, and resource allocation of the entire instruction model.
The main approach involves studying the critical elements in the design phases of an instructional model which enhances the learning experience of learners based on evidence-based literature. This is because humans apply appropriate cognitive processes to learn and thus instruction must adopt similar cognitive processing (Clark, 2016).The main purpose is therefore to emphasize the importance of good instructional design in enhancing the quality of education among instructors and learners. The objective involves highlighting the goals of an instructional program, the instructional objectives, relevant instructional materials and design assessment which rationalize the need for a good instructional design with the goal of engaging both learners and instructors. After all, learning is a process that requires the active participation of the learners (Reigeluth, 1987). This research study seeks to identify answers to two questions: a) What are the critical elements that build up a strong foundation for a good instructional design and b) what value do these elements offer to the learners and instructor who are the main consumers of learning instructional designs.
References
Clark, R.C. (2016). E-learning and the science of instruction: proven guideline for consumers and designers of multimedia. Walden University Library.
Regeiluth, C.M. (1987). Instructional Theories in Action: Lessons Illustrating Selected Theories and Models. Walden University Library.
Running head: PROBLEM STATEMENT 1
PROBLEM STATEMENT 6
Need working title
Problem statement
Tangela Jones
Walden University
11/10/18
Need section heading
There is a critical need for a good instructional design because it is a multipurpose learning tools that not only serves instructional designers but also learners of.
Running head MUSIC AND GENDER WOMEN PORTRAYAL IN RAP 1.docxglendar3
Running head: MUSIC AND GENDER: WOMEN PORTRAYAL IN RAP 1
MUSIC AND GENDER: WOMEN PORTRAYAL IN RAP 15
Music and Gender: Women Portrayal in Rap Music
Student’s Name:
Course:
Music and Gender: Women Portrayal in Rap Music
The introduction of rap music in the 1980s was welcomed with a lot positivity. However, this genre of music has on many occasions been considered as being controversial. Rap music has been accused of advancing messages and themes that deal with sexism, violence, gender stereotyping and materialism. Previous studies on rap music have indicated the content found in rap music promotes negative behavior. Moreover, research has shown that rap music videos generally differ in their portrayals of men and women in music videos. Males are often cast in positive light compared to females who are depicted in positions that portray them as a submissive gender to males.
The scope of this research narrows down on rap music produced from the years 2016 to 2018.The songs selected for this research are songs with lyrics that have misogynistic themes on women. Rap songs are observed in normalizing, objectifying, glorifying, victimizing and even exploiting women. Moreover, the rap songs are observed in defaming women through using innuendos and stereotypical language which portray misogynistic and sexist perspectives. The main area of focus for this paper is on the kind of nouns that are used in rap music to refer to the concept of woman and ways in which these nouns depict women. It is critical for this project to investigate the lyrics and its representations, as rap music has in the past years been under criticism for increasingly presenting a negative and controversial image of women in the society. A theological perspective on these issues is undertaken at understanding and criticizing the misogynistic and sexist culture of rap music generally.
Men in rap music have a higher probability of perpetuating violence on women. A review done on the common rap images found out that women were more likely to be dressed in images which portrayed them in provocative ways, especially in videos that had sexual content. Research has suggested that the perpetuation of gender in the media is a theme which has been occurring for eons of time[footnoteRef:1]. Specifically, music and gender and the portrayal of women in rap music has not been extensively studied previously. It is essential to consider the differences of gender in rap music and the portrayal of women in this genre of music. [1: Ronald Weitzer and Charis E Kubrin, “Articles Misogyny in Rap Music A Content Analysis of Prevalence and Meanings,” accessed October 23, 2018, https://doi.org/10.1177/1097184X08327696.]
Although scholars have attempted examining the interactions between rap music and religion, there has been a gap in regard to how artists frame religious messages within their lyrics. However, this lack of sufficient research does not reflect on the continued .
Running head Museum Focus1Museum Focus.docxglendar3
Running head: Museum Focus
1
Museum Focus
4
Museum Focus
Linda Dotson
Walden University
Interdisciplinary Experience: Sustaining Quality of Life in the City
Professor Paige Parker
September 15, 2018
Question 1
Brief introduction of Ohio City
Ohio is a great city named after the Ohio River in the 18th century. The area was disputed by the France and Great Britain. After the dispute, it established its own territories. This territory included the land where west of Pennsylvania in United States and the northwest of the Ohio River. The area covered more than 260,000 square miles (Turner, & Bogue 2010).
The History of Ohio City that has led to construction of Museums.
The area remained as a hunting ground by the Iroquois after the dispute. Later, some American groups began to migrate to the area. Later there was a seven years war between the Europeans, British and France. They all wanted to colonize the area. Unfortunately, the British worn and after the win, they ordered French settlers to leave the area. It is evident that the war brought about the breakdown of ethnicities.
How museum focus has been of great importance to the citizens of the city
The area is known for its landscape, mountains, rivers and minerals. This makes Ohio City to be a great city suitable for great museums. It is evident that, Ohio City creates the best environment for a museum with the theme of History and Natural History to be built. For instance, Miami River is known to be a great river. Many people admire visiting the area just to see the river. This creates the best conditions to build a museum. People within the city can also visit the museum and get to enjoy the benefits of the museums.
How people from outside the city benefit from the construction of the museums.
People outside Ohio City can also visit the museums. These museums will offer the history of the river to its visitors. They will also address an increasing array of issues in the dynamic environment (Edson, 2017).
Question 2
Permanent Exhibition.
Modern museum are designed to have a permanent exhibit, in this case the museum must have enough collections and classification of a field of knowledge for research and for display purposes. This will enlighten the visits about the history of Ohio City. The history stored in this museum will also be of great use to students as they will learn a lot in these museums,
References
Edson, G. (2017). Museum management. In Encyclopedia of Library and Information Sciences(pp. 3185-3198). CRC Press.
Turner, F. J., & Bogue, A. G. (2010). The frontier in American history. Courier Corporation.
If you can do it send confirmation at [email protected]
If you can do it send confirmation at [email protected]
Assessment Details and Submission Guidelines
Trimester
T2 2018
Unit Code
MN603
Unit Title
Wireless Networks and Security
Assessment
Individual
Type
Assessment
Design and implementation of secure enterprise wireless network
Tit.
Running head: MODULE 3 - SLP 1
MODULE 3 – SLP 2
Module 3 – SLP
Elizabeth Davis
Trident International University
Dr. Sharlene Gozalians
13 May 2019
Module 3 – SLP
In a bid to control the prevalence of diabetes among the African Americans, it is important to examine a number of attributes of culture that can empower a person towards changing a behavior. The factors may be positive, existential, and negative. Existential factors may be not harmful but need to be acknowledged. The importance of a family cannot be ignored especially because of the support they provide to diabetic patients. Family is therefore a positive cultural value which will assist in managing diabetes disease. This paper therefore seeks to address how each of the PEN-3 model’s three factors within the dimension of cultural empowerment applies to the African American group.
It is important to explore by identifying several cultural beliefs and practices that are positive, existential and negative. Positive factors are likely to lead to an improvement by reducing the prevalence of diabetes among the African Americans. Existential factors are existing cultural values and beliefs that may have no harmful health consequences. Cultural practices that may act as barriers in controlling the prevalence of diabetes among the African Americans are the negative factors. Example of these negative practices includes poor nutrition leading to obesity.
Positive Factors
The positive factors which will influence management and control of diabetes among the African Americans include spirituality and family. For example, talking about a family affair with diabetes will make a great impact in controlling diabetes among the African Americans. This is because it will create awareness of how to handle and deal with diabetes. Spirituality will have a positive impact in controlling the prevalence of diabetes among the African Americans. African Americans who have spiritual faith are likely to engage in activities which will reduce the prevalence of the disease.
Existential Factors
Existential factors include faith healing. A belief in faith healing is a factor which is likely to reduction in prevalence of diabetes among the African Americans. Individuals who are religious are likely to visit religious leaders to seek healing and intervention. Many individuals confess that they got healed after being prayed for by the Pastors and other religious leaders. This is attributed to believing in faith healing.
Negative Factors
Consumption of “comfort foods” is common in the diet of the African Americans. These foods contain high fat, sugar, and calorie contents. Example of negative cultural factors includes unhealthy traditional foods. Poor nutrition among the African Americans is more l.
Running Head PROGRAM EVALUATION PLAN1PROGRAM EVALUATION.docxglendar3
Running Head: PROGRAM EVALUATION PLAN 1
PROGRAM EVALUATION PLAN 2
PROGRAM EVALUATION PLAN
Name:
Tanisha Hannah
Institution:
Strayer University
Class:
EDU 571 Evaluating School Programs
Professor:
Antony Jacob
Date of Submission:
February 19, 2020
Program evaluation plan (part 2)
In order to ensure that the “gender equity for girls in math” education program which applies to master’s level students is efficient in fulfilling the outlaid goals, the goal based approach of evaluation should be applied in evaluating the effectiveness of the program. The major objective of this education program is to empower the girl child and to ensure that there are increase female students taking courses in mathematics at higher education levels (Markovits & Forgasz, 2017). In this case therefore, the evaluators has to establish if the establishment of this program will promote the positivity and capability of girls to take courses in Mathematics and to increasingly love the subject even in the lower classes so as to portray an increased number in the number of girls pursing this course in the masters level.
The goal based approach of evaluation will help the school evaluator to be able to determine how they can ensure that all the institutions are able to empower the girl child and encourage them to increasingly perfect their skills in mathematics in order to see a reflection of changes in the higher education levels (Sarouphim & Chartouny, 2017). This evaluation technique will help the education program creators to determine if the program is efficient in attaining the set objects through checking the outcomes of the implementation of the program over certain period of time.
The gender equality for girls in Math is a program that is anticipated to help the girl children be able to resolve their issues that result from fear and insecurities which cause them to undermine their power and be left behind by the boy child in regard to prosperity in Mathematics (Ganley.et.al, 2018). Therefore, the evaluators will have a role of determining the broader impacts of this approach as well as investigate what greater good is served as a result of this program. This will include identify the consequences that the program will have on other courses which most female students major in and how the male students will be affected by the program. The goals based evaluation method will help establish the objectives which can be added in the program to make it have optimal results to both girls and boys as well as ensure that other courses that are male dominated portray gender equality (Stoehr.et.al, 2017).
The major areas where the evaluators will assess include; the goals of the program, the outcomes of the program as well as the consequences. The main questions concerning these areas will be; what are the objectives of the program? How will the program be able to meet these goals? How do the goals of the program align with the activities involved.
Running head: PROGRAM EVALUATION 1
PROGRAM EVALUATION 5
Program Evaluation
Student’s Name
Institution
Program Evaluation
Application of Social Cognitive Theory in Information Science and Education
Social cognitive theory first started as a social learning theory by Albert Bandura for application in psychology. Jenkins, Hall, and Raeside (2018) asserted that, regarding the deployment of social cognitive theory in understanding information seeking behavior and use, the social cognitive theory had been used to explore significant areas. Such areas like consumption of social media content, information retrieval skills in the academic field, information retrieval skills at the workplace, information literacy in the educational field and day to day life information seeking. For instance, Kim (2010) used the theory to explore expectation differences in students of different genders when using university library website resources. With regards to knowledge sharing, Jenkins et al. (2018) found that social cognitive theory has been used to explore various fields like blogging and knowledge management systems.
In the field of education, Erlich and Russ-Eft (2011) reviewed the application of social cognitive theory to academic advising for assessment of student learning. Specifically, the researchers applied the social cognitive theory concepts of self-regulated learning as well as self-efficacy for the study. This medium is because these concepts have been successfully applied to education. The idea that learners should be able to recognize, create as well as choose their career plans for successful navigation through their college life contains the elements of self-efficacy concept and self-regulated learning. For instance, Erlich and Russ-Eft (2011) indicated that the confidence in achieving academic plans at a given level could be an indication of a student’s ability to perform academic planning activities at a complex level, which is a demonstration of increased efficacy. Learner’s self-regulated learning skills may help in understanding the learning mechanisms by which a learner acquired the strategies and tactics for performing academic planning activities with independence and sophistication.
Program Timeline
Project Goal
Related Objective
Activity
Duration
To promote awareness about breast cancer prevention
By 2020, increase to 75% proportion of African American women who understand the importance of annual clinical breast exams
Identify the population who underutilize clinical breast exams
January 1, 2020-January 31, 2020
Develop a media campaign to educate African American women about the benefits of early breast cancer detection
February 1,2020-March 30, 2020
Train faith-based organization members on how to educate their congregations about the.
Running head PROGRAM EVALUATION 6PROGRAM EVALUATIONPr.docxglendar3
Running head: PROGRAM EVALUATION
6
PROGRAM EVALUATION
Program Evaluation
Insert Your First & Last Name
Capella University
COUN 5280 – Introduction to School Counseling
Professor: Dr. Erin Berry
Month, Year
Setting up the format for an APA style paper
· Begin by setting your cursor at the first, beginning space of the first page of your paper and creating all of your margins at 1”. You do this by going to File>Page Set Up>Margin Tab and set at 1 inch for all 4 sides, Top, Bottom, Right, and Left.
· To set spacing to true Double: First, highlight the entire document text, or choose Select All. Then go to Format>Paragraph>Indents and Spacing Tab and in the box that says Line Spacing: select Double from the pull down menu. Make sure the ‘before’ and ‘after’ boxes are set at 0 pt, and not at Auto. Double Spacethroughout the document and see rules in APA Publication Manual, 6th Edition. APA is about saving space… no gaps or quadruple spacing, so the document is consistent and easy to read.
· The font is Times New Roman, 12 pt. Use the same size and typeface throughout, including the paging and Running heads.
(REMOVE THIS INSTRUCTION PAGE WHEN SUBMITTING PAPER)
Start your introduction here. APA 6th edition does not use a heading title for the introduction because its position in the paper identifies it as the introduction. Open your paper with a nice foreword to introduce your response to the unit 7 discussion. You also want to set the reader up about the four general topic areas you will present . At this point, you may respond to the assignment in an outline fashion or take a narrative approach. An example of an outline form is provided. Please review the rubric carefully! There is still an expectation to support your ideas with the literature.
I. School specific needs
In this section you will examine your understanding of identified gaps or specific needs for Model Middle School.
· Included in this section should be an analysis that addresses academic career, personal-social and developmental needs. A strong analysis is demonstrated when the ideas presented in this section are supported by specific examples and scholarly literature.
· A strong program analysis takes into consideration the ways in which student development is fostered through stakeholder collaboration (e.g., school, family and community). Additionally, the measures used to demonstrate accountability are reviewed. Be sure these two ideas clearly addressed in your outline.
II. Program outline
Strong action plans demonstrate critical thinking through the discussion of reasonable assumptions, drawing inferences or making predictions while exploring the potential risks and benefits of the plan. Make sure specific examples are provided! For example, the plan may include group counseling for an academic issues because intervention is supported in the literature.
· In this section, you will describe the specific program of services you plan to provide to .
Running head PROGRAM DESIGN 1PROGRAM DESIGN 2.docxglendar3
Running head: PROGRAM DESIGN 1
PROGRAM DESIGN 2
Program Design to Promote Social Goals in American K12 Schools
January 15th,2018
Program Design to Promote Social Goals in American K12 Schools
Explanation of Each Initiative
The three main initiatives of promoting social goals in school will include: promoting moral and character education, improving children’s health and nutrition, and creating school communities through extracurricular activities, after school programs, and school spirits (Rissanen et al. 2018). Comment by Evelyn Young: The 3 initiatives are clearly stated. Although did Rissanen et al. propose these 3 initiatives to promote social goals in schools? If these are your arguments, take credit for them. No need to give credit to Rissanen et al. for formulating the thesis for your paper.
I think that your paper could have used an introduction followed by the thesis statement.
Explanation of Each Initiative
Moral education is meant to promote good conduct among school-going children, not just within their immediate social relationships, but also in their dealings with their fellow citizens. This initiative is premised on the need for students to possess clear ideals and judgments on what action are right and what are wrong, including the determination of students’ conduct through a constant reference to those ideals. Moral education will be offered as a social goal to enlighten students on a system of rules and norms that regulate the social interactions of people on concepts of welfare, such as harm, trust, justice, and rights. For some students, issues related to values, personal feelings, and societal norms are constructs for discussions and are as such viewed as being influenced by the manner in which morality taught or experienced in schools, churches, and social institution settings. Moral education will be meant to reduce criminal and deviant behaviors among students. Moral character is required in schools because many parents do not teach their children morality issues.
The health and nutrition initiative is meant to improve the physical and mental well being of students. This initiative has the potential to improve the quality of students’ urban life, strengthen the ability of poor children to excel in their studies, and to compensate them for the substandard home and school environments spawned by competitive, inequitable social order. Health and nutritional initiatives will be strengthened through planning and introducing curriculum on nutrition with educational activities. These will include physical activities, which are combined with the farm to school programs that motivate students to consume healthy diets. Indeed, the hybrid school-based nutritional programs have major influence on attitudes, beliefs, and behaviors associated with fruits and vegetable consumption diffused throughout a bigger urban community (Dudley Cotton & Peralta, 2015). This hybrid intervention includes combining district stra.
Running head PROFICIENCY LEVEL ANALYSIS1PROFICIENCY LEVEL AN.docxglendar3
Running head: PROFICIENCY LEVEL ANALYSIS 1
PROFICIENCY LEVEL ANALYSIS 4
Proficiency Level Analysis
ESL-433
6/16/19
Proficiency Level Analysis
Grouping Strategy for Ms. Jensen
The arrangement of the student in the class should be based on their proficiency level while factoring the different capabilities of each student. The teacher should ensure that the both fast learners and slow learners are catered in terms of understanding how to handle their comprehension capabilities. The class has three categories of student, basic, intermediate and proficient.
Cooperative Learning
Cooperative grouping is based on the differences among the children in terms of their learning abilities. Li & Lam (2013) states that cooperative grouping is best suited for situations where students have learning abilities which are differing. The grouping technique is implemented following the analysis of the heterogeneous factors such that students should be grouped depending gender, economic background, culture, race and ethnicities. The ranking of students should follow the descending order starting with the highest to the lowest. To make a ranking legend, the teacher should use L for low achiever, M for medium achievers and H for highest achievers. The grouping should include at least one student from each category for the purposes of achieving diversity. The grouping system should however be done without involving the students as such could encourage discrimination. The issues of gender should be defined effectively to avoid the majority of gender in any of the group.
Rationale for Placement
The strategy is important and useful for the given case because students have different abilities and proficiency. The grouping strategy also promotes involvement of all students since the group is designed in manner which facilitates individual contribution. Tsay & Brady (2012) states that the cooperative grouping is important since it allows for the development of critical thinking skills and communication skills.
Conclusion
Ms. Jensen’s class has students with different abilities and varying English proficiency. Cooperative grouping is effective for 7th grade children since it allow them to exchange information amongst themselves while encouraging collaborative learning. Students are more likely to improve their self-esteem and moralization to study English tasks since group composition allows individual contribution and peer discussions.
References
Li, M. P., & Lam, B. H. (2013). Cooperative learning. 2015-01-20]. http://www. ied. edu. hk/aclass/l'heories/cooperative learning course writing_LBH% 2024June, pdf.
Tsay, M., & Brady, M. (2012). A case study of cooperative learning and communication pedagogy: Does working in teams make a difference?. Journal of the Scholarship of Teaching and Learning, 10(2), 78-89.
Ms. Jensen's 7th Grade Class AZELLA Scores
Student Name
Reading Label
Writing Label
Listening Label
Speaking Label
Aryanna
P.
Running head PROFESSIONAL CAPSTONE AND PRACTICUM1PROFESSIONA.docxglendar3
Running head: PROFESSIONAL CAPSTONE AND PRACTICUM 1
PROFESSIONAL CAPSTONE AND PRACTICUM 5
Falls and Related Injuries
Nanah Kamara Comment by Nelson, Emily Jeanette: Please see my comments in your previous assignment about how to format your title page.
GCU
Falls and Related Injuries
Nurses, being the initial contacts for patients in any most health facilities and the fact they interact or engage with patients more when compared to other providers of care constitute a critical component of the healthcare system. Consequently, nurses play a much huge role in making sure that the healthcare system provides not only safe care but also and care of high standard or quality (Sato, Hase, Osaka, Sairyo & Katoh, 2018). However one of the major healthcare or nursing issue over the years is the fall and associated injuries which have proved not only difficult for healthcare providers and facility to manage. The purpose of this essay is to… Comment by Nelson, Emily Jeanette: Reference needed
For instance, and according to DuPree, Fritz-Campiz & Musheno, (2014), Unintentional falls constitute the highest cause of non-fatal injuries among people over 65 years in the US. Moreover, one in every three individuals above 65 years falls at least one time in a given year. In addition, injuries from falls cause the highest number of accidental deaths among people 65-year-old and above (Tricco, Thomas, Veroniki, Hamid, Cogo, Strifler & Riva, 2017). Such statistics coupled with the extent of the costs associated with fall call for proper intervention to reduce falls and their associated injuries. For instance, the government spends billions of dollars on fall and their associated injuries on treating falls. The prevention of fall would provide increased funds for investment in other social programs aimed at improving both healthcare and addressing social or communal problems (Zakrajsek, Schuster, Wells, Williams & Silverchanz, 2018).
In addition, falls and their related injuries are responsible for almost 15% of the recorded hospitalization. This increases the burden of healthcare providers especially given the numerous stressors like staff shortage, huge workloads, leadership problems and personal factors among others. An increase in falls and associated injury, therefore, is detrimental to the provision of quality care as captured under the healthy 2020 program goal of reducing deaths that result from falls. Comment by Nelson, Emily Jeanette: Reference needed Comment by Nelson, Emily Jeanette: Reference needed
Despite this, falls are very complex and difficult to manage or prevent. Given the implications that falls bear on the patients, the healthcare providers and the healthcare system as a whole (Joseph, Henriksen & Malone, 2018), there has been increased There has been an increased research focus towards fall prevention and reduction strategies. As a result, there exist a significant amount of literature regarding the reduction and prevention of falls..
Running head PROFESSIONAL DEVELOPMENT PROPOSAL PROGRAM .docxglendar3
Running head: PROFESSIONAL DEVELOPMENT PROPOSAL PROGRAM 1
PROFESSIONAL DEVELOPMENT PROPOSAL PROGRAM 3
Professional Development Proposal Program
BUS520
Strayer University
November 9, 2018
Executive Summary
Professional Development Proposal Program
The need for organizational efficiency is driving the need for understanding the competency of individuals that generate effectiveness. The emotional intelligence capabilities help explain considerable as well as significant variances in accepting and predicting performance in capability studies. Emotional intelligence is the ability to monitor personal feelings and emotions visa vie other people’s feelings and emotions and use the information to guide personal thinking and actions. Management can rely on employees’ emotional building blocks to not only enhance their performance, but also their job satisfaction levels. The most important emotional intelligence building blocks that enhance employee performance and job satisfaction are social skills, self-awareness, self regulation, self motivation and empathy. Managers will use emotional intelligence to identify the positive and negative reinforcement of motivation to enhance employee morale within the organization. Positive reinforcement motivation tools are the rewards given to employees for exemplary performance while negative reinforcement is the penalty or punishment for poor performance.
Leaders can use the concept of emotional intelligence to enhance their social skills and decision-making skills in management. Emotional intelligence plays a critical role in helping persons requiring social skills to help them deal with social situations. Given that building strong relationship is one aspect of effective leadership, there is need for organizational leaders to build capacity in social skills for better organizational performance. Leaders can also utilize the concept of emotional intelligence to enhance their decision-making skills. Emotionally intelligent decision makers rely on self-awareness and self-management to determine their appropriate duties in decision making process. Decision makers use these skills to determine whether they have the necessary orientation to a problem.
Emotionally intelligent leaders strive for the establishment of effective teams to help realize organizational and team goals. Effective teams have clear purpose and goals, engage in consensus decision making, shared leadership and embrace open communication. To develop effective teams, departmental managers must define the team’s purpose and goals, define the roles for each group member and quickly identify and resolve conflicts. Finally, there is need to develop both extrinsic and intrinsic reward systems for employee motivation and improved performance.
Professional Development Proposal Program
Introduction
The need for organizatio.
Running Head Process Recording TemplateProcess Recording Temp.docxglendar3
Running Head: Process Recording Template
Process Recording Template
Process Recording Template
Student Name: Shaneka Ratchford Date of Contact: 6th Dec 2018
Session number or Contact number: Location of the client interview: Mrs. Michelle Rowell’s house
Verbatim dialogue
Assessment of client
Student impression/ feeling / thoughts/ reactions
Identify skills /theory/ conceptual framework
Social work intern:
Hello Madam, I am pleased to meet you
I am a little bit nervous since I have not gained so much confidence in the field study, but I want to deliver good results I start with the greetings to start the conversation in and make my client feel at ease.
Invites her in the conversation
Client:
Hello, am also pleased to meet you. Call me Mrs. Rowell.
She greeted me in a friendly way and seemed to be at ease
Social work intern:
As we had agreed, I have come in your house for a pre-assessment and see your readiness. Are you ready for this?
I look at the client, she is not looking at me, I take a deep breath to ease my nervousness
I used closed-ended method requiring a yes or no answer to start the dialogue
Client:
Yes, I am ready
She is confident and seems very ready and nodded in acceptance
Social work intern:
It must be very difficult accepting that you cannot bear children biologically? You must have thought about adopting a child for a long time?
I feel confident now that my client looks like I could now see she has full confidence with me
I deploy open-ended tactic to kick-start the conversation
Client:
It has been a tough time for me, this is one of the reasons I ended up being divorced by my husband of many years
Her face changes and she looks very thoughtful
Social work intern:
I am sorry for this ma’am, everything will be fine
I feel sorry for her
I deploy empathy to make her feel more
Client:
Thank you for your concern
Her face brightens again
Social work intern:
You believe that you can be able to take care of the child alone bearing in mind you seem to ambivalent about a child below the age of ten? Please tell me more about that?
I try Showing some concern
I try engaging her to get clarifications of what she exactly wants
Client:
As I earlier told you I am working, I would like a child who is a little bit grown up since I will not be at home at all times due to work commitment
The client looks uncomfortable at this point since she starts fidgeting
Social work intern:
How will you handle this alone
She Seems confident
I try digging more from her
Client:
It is a difficult task as I have said, but since I have been working as a teacher for many years, I have a lot of experience in parenting
She smiles as she explains her passion with children.
Social work intern:
Now that your mind is set in the adoption of a school going child, how will you handle the discipline of the child?
I feel she is fit for the task
I want to understa.
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The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
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Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
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Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
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Running Head MUNCHAUSEN SYNDROMEMunchausen SyndromeKr.docx
1. Running Head: MUNCHAUSEN SYNDROME
Munchausen Syndrome
Krystina Joseph
Columbia College
Munchausen Syndrome Article Review
Introduction
The Munchausen Syndrome Article explains about the
Munchausen Syndrome, which is a rare fictitious disorder which
involves the frequent hospitalization together with an
intentional display of signs of sickness and pathological lying.
In this regards, the management needs the security history
taking with collaboration with the sound clinical processes
which entails organicity exclusion in addressing the
psychological problems. It is worth noting that a case which is
presented having unusual symptoms of same dimensions are as
well discussed. The case in this regards brings the finer nuances
in the assessment of the entity (Prakash., et al 2014).
Research Question
Based on the abstract of the article, it can be denoted that the
research question of the article is the need to understand more
on the Munchausen Syndrome as well as the symptoms and
therefore the need to ensure that such issues are solved by
having a sound clinical process to handle the problem. The
2. problem for the case as well was to find out what caused the 19-
year-old housewife to vomit pink substance.
Findings
The findings depict that the 19-year-old housewife was
suffering from a factitious disorder, also termed as the
Munchausen syndrome. The psychometry performed also
showed that there is an elevation of scales of anxiety together
with hysteria. Consequently, being managed in an empathetic as
well as non-confrontational manner, the psychotherapy was
intended to improve the positive coping abilities while at the
same time improving the interpersonal relationships which had
been imparted (Prakash., et al 2014).
Research Methods Used
The methods used involved observations and clinical
assessments. Observations were done by checking regularly the
presence of the bloodstained vomits as well as the asthenia and
any forms of skin allergy. This was carried out to ensure that
the patient had no issues. The observations, as well as little
conversation, showed that there were no cases of psychiatric
illnesses for the patient in the past. Further, the assessment
entails involves the systematic examinations which were
performed within the normal limit. The psychiatric evaluation
was performed together with ward observations which were
intended at revealing the comfortability of the patient while in
the hospital (Prakash., et al 2014).
The credibility of the Source of Information
To know the credibility of sources, the authors are scrutinized
where their qualifications and their areas of experience assessed
to understand whether the information provided is related to the
topic at hand. For this article, it can be denoted that all the
information provided is credible. This is because all the four
authors who contributed to the article have sufficient skills and
knowledge pertaining to health-related disorders, and thus, their
pieces of information are very accurate and thus helpful.
The relevance of the Article
The information contained in the article talks about the
3. factitious syndrome which the 19-year-old housewife is likely
to be suffering from. Fist, the article talks of the conditions as
well as the symptoms which helps in understanding more about
the disorder. Additionally, the article explains on the various
activities which are carried out in the hospital in diagnosing the
disorder very well so that the required medications are provided
(Prakash., et al 2014). This article is therefore relevant since it
explains on the factitious disorder sufficiently.
Refine of Original Question
From all the information provided. I will not change the original
question since the original question still explains that the article
is the need to understand more on the Munchausen Syndrome as
well as the symptoms and therefore the need to ensure that such
issues are solved by having a sound clinical process to handle
the problem. The problem for the case as well was to find out
what caused the 19-year-old housewife to vomit pink substance.
Conclusion
To sum up, it can be denoted that psychometry performed also
showed that there is an elevation of scales of anxiety together
with hysteria. Consequently, being managed in an empathetic as
well as non-confrontational manner, the psychotherapy was
intended to improve the positive coping abilities while at the
same time improving the interpersonal relationships which had
been imparted. Methods of research used as well entails
Observations were done by checking regularly the presence of
the bloodstained vomitus as well as the asthenia and any forms
of skin allergy. This was carried out to ensure that the patient
had no issues. The observations, as well as little conversation,
showed that there were no cases of psychiatric illnesses for the
patient in the past. Further, the assessment entails involves the
systematic examinations which were performed within the
normal limit.
Reference
Prakash, J., Das, R. C., Srivastava, K., Patra, P., Khan, S. A., &
Shashikumar, R. (2014). Munchausen syndrome: Playing sick or
4. sick player. Industrial psychiatry journal, 23(1), 68.
Term Paper Guidelines
Objective
You will write a research paper that uses your text and scholarly
articles to address the topic questions below. Your paper should
be written in APA format with 3-5 pages of text. It should also
include a reference page, title page and abstract (the page count
does not include those pages).
Topic: The Therapeutic Alliance
The general topic of your paper is the therapeutic alliance in
family therapy. Choose a more specific topic within that
concept. Some possible examples might be:
· If you and your family were in therapy, what type of working
relationship would you want to have with the clinician, why,
and how would your choice of relationship get you to your
goals?
Working with PTSD in families.
Guidelines
· Use your text and at least one professional/peer-reviewed
journal article.
· Papers should be written using APA format and style
standards. A link to a popular APA format and style guide is
included under the Research Paper module in the Content area.
· Do not use direct quotations in this paper. Paraphrase your
sources to demonstrate your understanding of the material and
cite these sources properly. Papers with direct quotations may
be dropped a letter grade. Listing a source on the reference page
is not sufficient to address proper citation of sources. In-text
citations are required. Note: To paraphrase, you must put your
source’s material in your own words. Do not use material word-
for-word from your sources without using quotation marks and
5. citing them, otherwise this will be considered a form of
plagiarism.
· Papers should be double-spaced with 12-point font. Do not
have any more than a double space at any point in the paper,
such as between paragraphs or on either side of a heading.
· Organization of the paper, as well as grammar, spelling and
punctuation also will be considered in grading.
The role of relationships and families in healing
from trauma
Gabriela López-Zeróna and Adrian Blowb
The effects of trauma and its treatment have a central role in
health dis-
cussions in that trauma exposure is associated with an array of
mental
health issues, including depression, anxiety, and substance
abuse. Treat-
ment approaches are varied, but most empirically based
protocols are
individually focused, targeting intrapersonal difficulties.
Although these
protocols are critical, they do not directly address the
relationship diffi-
culties that may arise for survivors. In addition, limited
empirical evi-
dence supports using systemic approaches in trauma treatment.
This
article addresses this issue by summarizing the most salient
individual
and relational evidence-based trauma protocols and by
providing a
6. description of common factors among these approaches, while
also chal-
lenging the field to generate more research that emphasizes
systemic
interventions as a core consideration in treatment. A case study
is
included to illustrate the global relevance and benefit of
systemic trauma
approaches.
Practitioner points
• Trauma should be treated as an event that affects everyone in
the
family and is nested in societal and cultural contexts.
• Close relationships can maintain or exacerbate problems, but
they can also be a powerful source of healing.
• Systemic protocols that not only address intrapersonal
difficulties,
but also focus on survivors’ relationships are critical for healing
in
the aftermath of trauma.
Keywords: trauma; evidence-based practices.
a Doctoral student in the Couple and Family Therapy Program,
Department of Human
Development and Family Studies, Michigan State University,
Room 408, Human Ecology
Building, 552 West Circle Drive, East Lansing, MI 48824, USA.
E-mail: [email protected]
b Associate Professor, Couple and Family Therapy Program,
Department of Human
Development and Family Studies, Michigan State University.
7. VC 2016 The Association for Family Therapy and Systemic
Practice
Journal of Family Therapy (2017) 39: 580–597
doi: 10.1111/1467-6427.12089
The concept of trauma has received a great deal of clinical and
research attention over the past few decades. Globally, exposure
to
trauma is a chronic problem, as many individuals are exposed to
at
least one traumatic event over the course of their lifetime.
Traumatic
exposures can occur in a number of contexts including war,
family or
intimate relationship violence, motor vehicle accidents, natural
disasters and criminal events, or through life-threatening
illnesses.
Millions of individuals worldwide are affected by the aftermath
of
exposure to a traumatic event (Breslau, 2009).
Even though there is a growing body of research on the
interperso-
nal effects of trauma, most of the treatment focuses on the
individual
who directly experiences the traumatic event (van der Kolk,
2003)
and there is scant research assessing the outcomes of trauma
treat-
ment of couples and families (Lebow and Rekart, 2013).
Although
sorting out the intrapersonal chaos caused by traumatic
experiences
8. is essential for healing, trauma is also a relational event that
affects the
individual survivor’s inner state and their web of close
relationships
(Kerig and Alexander, 2012, Matsakis, 2013). Positive family
support
is often central to the survivor’s recovery environment
(Herman,
1997). Close relationships may provide the necessary support
that
can allow traumatized individuals to reconnect with themselves
and
others and engage in a healing process (Figley and Figley,
2009).
As Johnson (2002) asserts, ‘the nature of the recovery
environment
play[s] a part in determining the long-term effects of traumatic
events’ (p. 26). In a review of studies of post-traumatic stress
disorder
(PTSD) Guay et al. (2006) conclude that the presence of social
support
is a key moderator in the development and treatment of post-
trau-
matic stress. However, it is not only the presence of social
support
that is important but also the quality of the recovery
environment
(Matsakis, 2013). Bracken et al. (1995) encourage clinicians to
contex-
tualize survivors’ experiences and consider the importance of
the
reconstruction of social, economic and cultural networks to
facilitate
healing and recovery. Negative interactions experienced in
close rela-
9. tionships increase the risk of developing or worsening PTSD.
In this article we summarize the most salient individual, group
and
relational evidence-based treatment approaches for trauma, and
dis-
cuss the importance of including family members in treatment.
We
also challenge the field of systemic interventions to provide
more
research and advocacy that will result in systemic interventions
becoming a core consideration in treatment of trauma survivors
and
their partners and family members. We begin our discussion by
Relationships and families in healing from trauma 581
VC 2016 The Association for Family Therapy and Systemic
Practice
providing an in-depth (although vivid) case study that illustrates
the
benefit of a systemic-oriented intervention.
Clinical case example
The following clinical example provides an illustration of
trauma and
differing outcomes, depending on whether a systemic or
relational
perspective is a part of treatment. This clinical case, based on
real-life
events, illustrates how the need for research and advocacy over
sys-
10. temic or relational trauma research is a top global public health
issue.
The case presents a graphic occurrence of trauma to which
people all
over the world are exposed, especially in countries ravaged by
pov-
erty, drug trafficking and war. As clinicians, it is important to
consider
that trauma is not an experience that happens only to the
individual,
but an event that influences every member of the family.
Alana Martin, aged 45, contacted a local mental health
practitioner seek-
ing counselling services after an extremely violent traumatic
event. The
Martin family lives in a small city in a Central American
country ridden
with violence and drug trafficking. James, aged 14, was
kidnapped from
his basketball practice one afternoon. Two men attacked and
murdered
his driver, a close family friend. James was taken away and held
in a
remote, secluded location. The kidnappers contacted his
parents, Mike
and Alana, a few hours later, asking for ransom money. Eddie,
aged 10,
James’ younger brother, was immediately removed from his
home and
sent to stay with an aunt in another city for his safety due to the
possibility
of subsequent kidnappings in these types of situations. Mike
and Alana
tried to reason with the kidnappers, asking them for enough
time to
11. attempt to gather the money for ransom. Their pleas were met
with
threats and increased pressure to deliver the money in its
entirety soon.
The couple pleaded for their son’s safety and promised to
deliver the
money as soon as possible. That night Mike and Alana had a
huge marital
argument after Mike blamed Alana for the kidnapping, claiming
she had
overlooked some common safety protocols. The next morning
they
received a small package with a piece of one of James’ toes.
Alana and
Mike both had severe panic attacks and were taken to the
emergency
room. Subsequently the Martins were able to secure the cash
they needed
and paid the ransom. James was returned to his family shortly
after.
Three months later, Alana is seeking counselling for her son
James, wor-
ried about his reintegration process after such a traumatic event.
James
has been reporting nightmares, flashbacks, trouble sleeping and
difficul-
ties in school. He has also refused to talk to his family about his
experi-
ence, saying that he would much rather just focus on the
positives in life.
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12. If Alana contacts a mental health practitioner who
conceptualizes
the experience of trauma and its subsequent treatment as an
individ-
ual process, the therapist might identify James as the client
present-
ing for treatment. The therapist might gravitate towards using
an
evidencebased approach centred on reducing the post-traumatic
stress symptoms and the integration of the traumatic event into
James’ narrative. Undoubtedly, based on the extensive body of
work
supporting exposure therapies for the treatment of trauma,
James
will experience relief and healing. His improvement might also
indi-
rectly positively impact on his family’s overall coping after
such a trau-
matic event. This kind of treatment would focus in the traumatic
event itself and the related thoughts, emotions, and internal
struc-
tures related to the trauma.
On the other hand, if the mental health practitioner adopts a
contextualized and relational treatment of trauma, the therapist
might
consider the entire Martin family as the client and involve
Alana, Mike,
and Eddie in treatment as well. Based on the discussion offered
by this
article, a relational approach to this traumatic event might
integrate
everyone’s experience, offer reconnection, and coach family
members
13. to adequately support James and each other. The traumatic event
had
a significant effect on everyone in the family, not only James.
As it turns
out, Eddie became afraid to venture out into the world. He grew
more
isolated and refused to take part in extramural activities at
school.
Alana incessantly blamed herself for what happened to James
and
began drinking more alcohol as a way to cope. In addition,
marital
arguments between Mike and Alana increased. The therapist’s
effort to
create a safe and affirming family environment is essential for a
process
of healing after such a violent traumatic event. This relational
trauma
treatment would address James’ symptoms individually to offer
coping
tools, while also guiding the family in their attempts to support
each
other and cope with the impact of trauma on each person and the
fam-
ily as a whole. The therapist would facilitate conversations to
help the
family talk together about the trauma for the first time. This
would be
a significant addition to the healing process for everyone,
fostering
safety and reconnection. These types of conversations are
emotional,
and require skill on the part of the therapist to keep all family
members
engaged and focused, while also helping them take a non-
blaming
14. stance. In addition, a skilled therapist with a systemic focus
would also
be able to address the marital and gender role issues
manifesting in
this family. An individually oriented approach for James would
miss
out on an opportunity for healing for everyone involved in the
system.
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Trauma and its effects
Susan Johnson (2002) defines trauma as an event that occurs
‘when a person is confronted with a threat to the physical
integrity of
self or another, a threat that overwhelms coping resources and
evokes
subjective responses of intense terror, helplessness, and horror’.
(p. 14)
Traumatic stress is viewed as a mind-body condition, linking
physi-
ological and emotional responses (Van der Kolk, 2000).
As the clinical case example above illustrates, traumatic
experien-
ces often involve interpersonal violence. Herman (1997) refers
to
these experiences as violations of human connection. Even if
15. trau-
matic experiences do not involve interpersonal violence, they
often
evoke reactions of fear, terror, and helplessness (Foy et al.,
2001).
These experiences tend to violate an individual’s assumption
that the
world is a safe place making it a challenge to hold the traumatic
reality
in consciousness (Herman, 1997). As a result, survivors often
experi-
ence a profound sense of alienation and disconnection (van der
Kolk,
2003), impacting on their intrapersonal functioning and
relation-
ships. These emotions may cause survivors to feel isolated and
ques-
tion whether they are safe in the company of others or whether
others are really available to support them (Foy et al., 2001;
Matsakis,
2013). The disruption in interpersonal trust paired with the
conse-
quences of victimization, such as isolation and disconnection,
can
have a deep negative effect on the survivor’s overall quality of
life. In
order to hold a traumatic reality in consciousness and engage in
a
meaning-making process, an affirming and protective social
context
is necessary (Figley and Figley, 2009; Hawkins and Manne,
2013). For
a survivor, that context is created through relationships with
friends,
family, partners, and the community (Herman, 1997; Walsh,
2007).
16. Significant advances in the study of psychological trauma have
been made in the past few decades. PTSD is characterized by
intru-
sive re-experiencing symptoms, elevated arousal, and avoidance
behaviours (American Psychiatric Association, 2013). With the
grow-
ing understanding of the biological aspects of PTSD, it has
become
clear that exposure to trauma can produce long-lasting effects in
a
survivor’s endocrine and nervous systems. Individuals with
PTSD are
more likely to experience gastrointestinal problems, asthma, and
hypertension than those who do not have PTSD or elevated
PTSD-
type symptoms. PTSD can also become a chronic condition that
is fre-
quently comorbid with other mental health issues, such as
depression,
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anxiety, and substance abuse (McLean and Foa, 2011). Further,
as
illustrated in the case of the Martin family, trauma and PTSD
does
not affect only the individual who experienced it but it impacts
on
and disrupts the lives of all the members of a family system
(Lebow
17. and Rekart, 2013).
Given the pervasive nature of PTSD and the individual and
societal
impact of trauma exposure, there is a growing body of research
and
treatment protocols for the treatment of trauma. Several
psychotherapy
approaches with strong empirical evidence have been developed
in the
past several decades to help with trauma recovery. However,
most of
these protocols are individually focused and do not directly
address sur-
vivors’ interpersonal struggles or take into account their
cultural back-
grounds or context. Recently there have been efforts to address
this
issue. For instance, in the UK, the National Institute of Clinical
Excel-
lence recommended interpreting trauma protocols to ensure
compe-
tent and culturally appropriate services for survivors of diverse
cultural
backgrounds and dominant languages (d’ Ardenne et al., 2007).
Fur-
ther, there has been an increased recognition of the effects of
trauma in
survivors’ relationships and family functioning. In medical care
in Vet-
erans Affairs settings in the USA, couple and family therapists
are slowly
becoming a valued part of the treatment of PTSD (Figley and
Figley,
2009).
18. Prominent individual therapy approaches
Although treating PTSD with pharmacology has accumulated
sup-
port, the Institute of Medicine considers trauma-focused
cognitive
behavioural therapy (TF-CBT) the first-level treatment for
traumatic
stress disorders (Institute of Medicine, 2008). The main goal in
TF-
CBT is for clients to face their traumatic memories instead of
avoiding
them, while also confronting thought patterns that reinforce the
avoidance of traumatic memories. The three most studied and
uti-
lized trauma protocols are exposure therapy, cognitive
processing
therapy (CPT), and eye movement desensitization therapy
(EMDR).
Exposure Therapy. Through repeated exposure to feared stimuli,
expo-
sure therapy promotes the extinction of the anxiety responses.
Expo-
sure therapy for the treatment of PTSD is based on the
behavioural
principle of fear acquisition. Treatment generally involves the
repeated confrontation of the feared thoughts, objects, or
situations
Relationships and families in healing from trauma 585
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19. in order to reduce problematic fear and anxiety responses, such
as
physical and emotional avoidance (Carr, 2005; McLean and Foa,
2011). Prolonged exposure (PE) is the most widely used
exposure
therapy protocol due to its strong empirical support for the
reduction
of PTSD intrapersonal symptoms. PE incorporates
psychoeducation,
imaginal and in vivo exposure to feared stimuli, and training in
con-
trolled breathing (McLean and Foa, 2011).
Neuner et al. (2004) developed narrative exposure therapy
(NET), a
variant of EP, to address PTSD symptoms in survivors of mass
violence
and torture. NET draws from EP’s basic techniques and adds a
narra-
tive component. The narrative element aims to contextualize
trauma
as part of the survivor’s experience (McPherson, 2012). NET
places
emphasis on the reconstruction of the trauma memory by
incorporat-
ing a detailed narration of the traumatic events (Adenauer et al.,
2011).
Several researchers have found evidence to support the use of
NET for
the treatment of PSTD among survivors of mass violence
(Adenauer
et al., 2011; Neuner et al., 2004).
CPT. While CPT is not as well-researched as Exposure Therapy,
it
20. has been shown to be effective in the treatment of PTSD
symptoms
(Bradley et al., 2005), particularly for combat veterans with
chronic
PTSD (Monson et al., 2012). CPT is similar to PE in its use of
expo-
sure and psychoeducation but adds a written narrative form of
expo-
sure to change the survivor’s maladaptive thoughts over the
traumatic experience.
EMDR. EMDR is a CBT approach that involves exposure and
cogni-
tive processing with added simulation, usually in the form of
saccadic
eye movements (Solomon and Shapiro, 2008). The approach
begins
with the identification of symptoms that become triggered by
trau-
matic memories and focuses on reprocessing those traumatic
events
while also focusing on present triggers. Although there is some
debate
over the necessity of eye movements, EMDR treatment studies
have
found this protocol to be as effective as exposure therapy and
CPT
for the treatment of PTSD (Rogers and Silver, 2002).
The overall basic goals across individual trauma therapy
approaches are twofold: firstly, they aim to restore affect
regulation,
specifically with feelings of fear and anger. Secondly, trauma
therapy
interventions aim to integrate the traumatic experiences into an
empowered sense of self in order to engage in a meaning-
21. making
process (Figley and Figley, 2009; Johnson, 2002). Although
these are
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two crucial elements in the survivor’s healing process, it is
difficult to
actively address the role of the healing environment and the
survi-
vor’s ability to re-establish connections with others in the
context of
individual therapy. Not addressing the systemic or relational
context
in which a survivor exists has several risks. Most notably, the
changes
that occur to the survivor may cause stressful occurrences in
their
context. For example, a survivor may become more assertive
because
of effective treatment. This newfound assertiveness may then
create
conflict in relationships so they shift or change. Interventions
that
bridge this process are very helpful. Another risk is not
providing the
survivor with the necessary social support they need to sustain
recov-
ery from trauma. Having a supportive array of intimate, family,
and
community relationships provides the needed support for
22. survivors
to sustain a recovery process. To cope with their trauma
survivors
often turn to substance use and other types of self-harming
behav-
iour. These coping strategies can sabotage effective trauma
recovery.
The usefulness of a systemic approach is clear In the case of the
Mar-
tin family, as shown above. Changing the systemic relationship
con-
text in which a survivor lives is a critical component of
sustained
recovery (Guay et al., 2006; Johnson, 2002). It is thus clear that
other
systemic or relational modalities are necessary to address the
complex
interpersonal issues that may arise in the aftermath of trauma.
Group therapy approaches
Group therapy is a widely utilized treatment for trauma
survivors, par-
ticularly with child sexual abuse (CSA) survivors and
adolescent survi-
vors of trauma (Classen et al., 2001; Saltzman et al., 2013).
However,
relatively few randomized controlled trials have examined the
efficacy
of group psychotherapy for trauma specifically. The existing
body of
research does suggest that group therapy is effective in reducing
depression, PTSD symptoms and dissociation, and improving
interper-
sonal skills and quality of life (Classen et al., 2001). Group
therapies
23. offer a safe space for the normalization of responses and
processing of
trauma among others who have similar experiences, giving
survivors
the opportunity to establish bonds and connections with others
(Foy
et al., 2001). Common across group intervention protocols is a
clear
emphasis on contextualizing symptoms and using the group
environ-
ment to decrease stigma and increase normalization and social
support.
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Some studies report positive treatment effects for adults,
children
and adolescent survivors in group therapy protocols. However,
there is
no clear evidence of the superiority of any particular group
theoretical
approach or structure (Foy et al., 2001; Schnurr et al., 2003).
While the
case study example did not include group therapy as an
intervention,
it would have been useful for the individual in increasing
support and
in providing a safe place to process the traumatic experiences.
From a
systemic perspective, this approach on its own has limitations.
24. Couple and Family Therapy approaches
Trauma theorists agree that survivors need a safe place in order
to
stabilize the inner chaos caused by traumatic experiences and
work
on decreasing problematic trauma responses. Supportive
environ-
ments and people are indeed necessary to engage in this work;
however, Johnson (2002) posits that in order to be resilient in
the face
of trauma, survivors do not only need a sense of community,
they also
need ‘close attachment bonds’ (p. 27). Monson et al. (2012) also
say
that intimate relationships can play an important role in
recovery
from post-traumatic stress and its comorbid intrapersonal and
interpersonal impairments.
Henry et al.’s (2011) research finds that couple relationships are
affected when there is a history of trauma in one or both
partners. In
their study, participants identified a wide range of issues that
affected
their relational functioning including boundary issues, intimacy
prob-
lems and confusion about roles in the relationship, among
others.
The researchers suggest that not addressing these symptoms in
treat-
ment may exacerbate both the individual and relational distress
trauma survivors and their families may be experiencing. In the
case of
the Martin family, the traumatic event directly happened to the
cou-
25. ple’s son; however, the event was so extreme, that it severely
impacted
on the couple’s relationship as well as on individual
functioning. Not
addressing how such a violent event affects the couple
relationship
may exacerbate individual and relational distress.
Although there is a dearth of literature exploring relational
trauma
interventions, some treatment protocols have demonstrated it
has
positive results, for instance, in the use of CBT for couples in
which
one of the partners is a combat veteran diagnosed with PTSD
(Mon-
son et al., 2012). The CBT protocol for couples included
psychoedu-
cation about the ‘reciprocal influences of PTSD symptoms and
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relationship functioning’ (p. 702), strategies to create a shared
sense
of safety, and problem solving and decision-making skills.
Research-
ers found that this protocol ameliorated PTSD symptoms as well
as
relationship satisfaction.
Emotionally Focused Therapy (EFT) is an attachment-based
26. cou-
ple therapy that emphasizes the role of affect and emotion in
thera-
peutic change (Johnson, 2002). Trauma survivors often
experience
difficulty re-establishing connections, and research indicates
that con-
nection and safety are critical in trauma healing (Herman,
1997).
There is some empirical support for EFT’s treatment of general
cou-
ple distress and Johnson (2002) asserts that EFT’s attention to
estab-
lishing and maintaining a safe and secure attachment bond
between
partners is vital in creating a healing environment in the
aftermath of
trauma.
A recent study examined the effectiveness of EFT in couples
where
one of the partners was a survivor of CSA (Dalton et al., 2013).
The
study’s findings suggest that the link between childhood trauma
and
marital outcomes could be mediated by the ability to form
secure
attachments with others (Whisman, 2006). Participants in
Dalton
et al.’s (2013) study demonstrated an increase in relationship
satisfac-
tion over time and an improvement in marital functioning. The
results suggest that EFT offers a viable option for helping
clients
reconnect with significant others and further their progress in
recov-
27. ery and healing.
Kerig and Alexander (2012) propose the integration of trauma
com-
ponents to Functional Family Therapy (FFT), an evidence-based
model, in the treatment of traumatized youth involved in the
juvenile
justice system. The authors indicate it is importance to address
the
effects of these traumatic experiences in the context of the
family sys-
tem. Families can foster sources of resilience such as
connectedness,
affection, and bonding, essential for trauma healing. Trauma-
focused
FFT frames the traumatic experience in relational terms that
recognize
that all family members are affected by trauma, even if only one
mem-
ber directly experienced the traumatic event.
Multi-family group interventions based on behavioural and
skill-
building components have strong empirical support in
enhancing
family functioning and connection (McFarlane et al., 2004).
Although there are limited empirically supported interventions
for
distressed families exposed to trauma or living in traumatic con-
texts, Kiser et al. (2010) proposed a multi-family group
intervention
that builds on families’ resources to enhance the coping
mechanisms
Relationships and families in healing from trauma 589
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and protective factors that may mediate the effects of trauma
expo-
sure. This trauma-focused intervention based in empirically
sup-
ported treatment components has positive effects on post-
traumatic
symptoms.
The approaches described all include family or relationships as
a
part of the treatment for trauma survivors. Their broad goals are
to
increase positive support and connection among family
members,
create safety, and reduce negative interactional cycles. These
approaches have a growing body of evidence showing their in
reduc-
ing the effects of trauma symptoms in survivors in some cases.
As in
the case of the Martin family, a traumatic event, may even have
severe
repercussions on other members of the family. A treatment
approach
that attends to the needs of all family members while fostering a
sup-
portive and safe environment is essential to reconnection and
healing.
Unique elements among relational trauma interventions
We reviewed systemic treatments with an eye on their
29. commonalities
in strategies and change mechanisms. Families often avoid
discussing
trauma, leaving survivors and family members feeling isolated
and
disconnected from vital sources of support (Coulter, 2013).
Although
there are a limited number of relational interventions for
trauma, the
existing protocols contain two unique elements that are rarely
addressed through individually focused therapy alone, primarily
because the latter attend mostly to the intrapersonal impact of
trauma.
The first core element of relational interventions for trauma is
the
psychoeducational component aimed at enhancing each family
mem-
ber’s understanding of how trauma affects individual and family
func-
tioning (Coulter, 2013; Kerig and Alexander, 2012; Monson et
al.,
2012). This education serves to normalize the experiences of
family
members and to address issues of communication over
symptoms and
coping. Further, those conversations can provide an opportunity
for
members to co-create the meaning of the experience, facilitating
heal-
ing (Coulter, 2013). A contextualized and relational approach to
treat-
ing the Martin family would provide opportunities for the
family to
talk about how the trauma affected each individual in the
family, nor-
30. malizing individual responses while fostering reconnection.
Psycho-
education offered in the context of a relational treatment
provides a
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way to increase a sense of competency and normalcy, improve
coping
strategies, and increase support among family members (Rabin
and
Apel, 2013).
Closely related is the second significant element in relational
approaches for trauma: attention to a process of reconnection
and
bonding within the system. Catherall (1999) discusses the
impor-
tance of facilitating the family’s support of the traumatized
member
by helping the entire system to function as a team in dealing
with
the aftermath of trauma. The interaction between the individuals
who directly experience trauma and the rest of the family is
recip-
rocal in nature (Coulter, 2013), suggesting a strong potential for
the
family to affect the course of recovery. This reconnection
process
would support the Martin family and others like it, not only by
increasing the positive social bonds in the family but also by
31. allow-
ing the family to grow in step with the survivor, who invariably
experiences significant life changes because of effective trauma
treatment.
Post-traumatic growth (PTG)
An important part of expanding our understanding of trauma
and its
aftermath is recognizing that survivors often report experiences
of
positive change in their struggles with adversity. In the last few
deca-
des, the trauma literature has used different terminologies to
describe
this phenomenon, such as PTG (Tedeschi and Calhoun, 1996)
and
adversity-activated development (Papadopoulos, 2007).
Tedeschi and
Calhoun (1996) describe PTG as ‘positive psychological change
expe-
rienced as a result of the struggle with highly challenging life
circum-
stances or traumatic events’ (p. 1). As a result of PTG,
individuals
often report a greater appreciation for life, changes in life
philosophy,
changes in their self-view, including a greater sense of personal
strength, and an enhancement in their personal relationships.
Papa-
dopoulos (2007) proposed a ‘trauma grid’ to identify the various
con-
sequences of traumatic experiences at the individual, family,
community and societal levels in order to address the effects of
trauma more appropriately by avoiding oversimplification and
polarization.
32. These potential experiences of positive change and growth have
a
profound impact on survivor’s close relationships. Thus, the
inclusion
these relationships in treating trauma seems profoundly relevant
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when considering the influence of the individual’s environment
in
their recovery, healing and growth processes. As an individual
grows,
relationships change and grow as well. Following a traumatic
event,
particularly one that involves violence, as in the case of the
Martin
family, safety within relationships needs to be restored as a part
of the
recovery process. Fostering tolerance within families of the
survivor’s
erratic fluctuations from instances of closeness to moments of
distance
during the recovery process is critical for successful recovery.
It is
within the safety of relationships and close connections that
survivors
are able to reintegrate the trauma information into a cohesive
narra-
tive, leading to growth and healing.
33. Most of the research on PTG has focused exclusively on
individual
experiences, without paying much attention to the impact of
their
social supports (Büchi et al., 2009). However, in a study of
couples
coping with cancer, Kunzler et al. (2014) found that support
from an
intimate partner plays a critical role in a patient’s adjustment.
The
study shows that couples not only share the burden of a cancer
diag-
nosis, they may also share the potentially positive benefits.
These
findings suggest that the influence of a couple’s joint benefit
and
growth experience may be a powerful force in recovery and
adjust-
ment. Büchi et al. (2009)’s study on grief processes in couples
after
the death of their premature baby shows that the emotional
exchange
between partners after their loss may be vital for a process of
shared
and concordant grief. The results of the study suggest that in
con-
cordant grief processes both partners also share a process of
growth.
A systemic approach to understanding the negative, positive and
neutral psychological effects of trauma is vital to explore
whether
PTG is not only an individual experience, but can also be a
relational
occurrence. More research is needed to understand the
complexity
34. of this phenomenon, including the interactive effects on
individual
and relational PTG.
Challenge to the field of systemic or relational therapies
Trauma survivors often experience a sense of betrayal and
distrust in
the wake of traumatic events. It is, therefore, appropriate to
concep-
tualize trauma as a family event, something that affects the
individual
who directly experiences the traumatic event and their most
intimate
relationships in social and cultural contexts. Further, as Bracken
(2001) asserts, if contextual issues are central in determining
how
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trauma is experienced, developing supportive environments
condu-
cive to healing and reconnection is essential. Although
individualized
approaches that address problematic traumatic stress symptoms
are
necessary, wider systemic approaches that incorporate the
possibility
of experiencing individual and relational growth following the
trau-
matic event and that emphasize the individual’s environment
35. and
relationships are fundamental for healing.
Noted trauma experts such as Herman (1997), Bracken et al.
(1995),
Bracken (2001) and Johnson (2002), suggest that connection
with
others is at the heart of trauma healing. Recovering from trauma
involves helping the survivor reorganize their intrapsychic
world
through the creation of new safe and affirming interpersonal
connec-
tions. However, there is limited empirical support for trauma-
focused
group approaches. Similarly, there are few studies that explore
couple
therapy and family therapy trauma-focused modalities, even
though
the initial evidence is very promising. Emotional attachment is
consid-
ered as one of the primary protection mechanisms against
feelings of
hopelessness and meaninglessness (McFarlane and Van der
Kolk,
1996). It therefore seems clear that improving individuals’
closest rela-
tionships and understanding how those relationships can be a
source
of strength and healing can be a crucial element in addressing
the
problems that affect trauma survivors’ physical and mental
health.
When discussing the effects of trauma, theorists, clinicians, and
researchers all agree that the presence of post-traumatic stress
primar-
36. ily affects the individual’s ability to process traumatic
experiences
(Boss, 2006; Herman, 1997; Van der Kolk, 2000). As noted
earlier, this
individual process affects and is affected by relationships.
However,
barriers remain for relational or systemic-oriented treatments to
become fully integrated into widely used trauma-focused
treatment
protocols. This is because, even though there is research
pointing to
the initial efficacy of these interventions as a core and
adjunctive treat-
ment, not enough efforts have been made to increase the scope
of this
research or to prioritize its importance globally. In addition,
there is a
need for increased advocacy efforts to publicize these
interventions
worldwide as core healing strategies. There is a need for further
research to expand our understanding of how trauma manifested
within couple and family relationships and how treatment
interven-
tions can address these challenges in a strength-based,
supportive envi-
ronment that facilitates healing. Further, McLean and Foa
(2011)
found that most therapists do not use evidence-based treatments
for
PTSD due to a lack of training. These findings call for the
better
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37. dissemination of protocols, particularly for clinicians working
with
trauma in the context of couple or family therapy.
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717
JRRDJRRD Volume 49, Number 5, 2012Pages 717–728
Couple/family therapy for posttraumatic stress disorder: Review
to
48. facilitate interpretation of VA/DOD Clinical Practice Guideline
Candice M. Monson, PhD;1–2* Alexandra Macdonald, PhD;3
Amy Brown-Bowers1
1Ryerson University, Toronto, Ontario, Canada; 2Department of
Veterans Affairs (VA) National Center for PTSD,
Women’s Health Sciences Division, Boston, MA; 3VA National
Center for PTSD, Behavioral Science Division, and
Boston University School of Medicine, Boston, MA
Abstract—A well-documented association exists among Vet-
erans’ posttraumatic stress disorder (PTSD) symptoms, family
relationship problems, and mental health problems in partners
and children of Veterans. This article reviews the recommenda-
tions regarding couple/family therapy offered in the newest
version of the Department of Veterans Affairs (VA)/Depart-
ment of Defense (DOD) VA/DOD Clinical Practice Guideline
for Management of Post-Traumatic Stress. We then provide a
heuristic for clinicians, researchers, and policy makers to con-
sider when incorporating couple/family interventions into Vet-
erans’ mental health services. The range of research that has
been conducted on couple/family therapy for Veterans with
PTSD is reviewed using this heuristic, and suggestions for
clinical practice are offered.
Key words: caregiver burden, clinical practice guidelines,
cognitive-behavioral therapy, couple/family therapy, emotion-
ally focused couple therapy, mental health, PTSD, rehabilita-
tion, strategic approach therapy, Veterans.
INTRODUCTION
To their credit and our benefit, Veterans and their fami-
lies have been the predominant contributors to our knowl-
edge about the role of posttraumatic stress disorder (PTSD)
symptoms in family functioning and vice versa. This
49. research documents a clear and convincing association
between PTSD symptoms and a range of family problems
(see Monson et al. [1] for review). In addition, Veterans’
PTSD symptoms have been associated with a myriad of
individual mental health problems in spouses and children
(see Renshaw et al. [2] for review). Yet, research on couple/
family therapies for Veterans with PTSD has lagged behind
individual psychotherapy treatment outcome efforts. This is
in spite of research showing that Veterans desire greater
family involvement in their treatment (e.g., Batten et al. [3])
and the presence of significant mental health problems in
Veterans’ loved ones who may individually profit from
family therapy. In addition, treatments for PTSD do not
necessarily improve couple and family functioning (e.g.,
Abbreviations: BCT = behavioral couple therapy, BFT =
behavioral family therapy, CBCT = cognitive-behavioral con-
joint therapy, CPG = Clinical Practice Guideline, CSO = con-
cerned significant other, DOD = Department of Defense, DTE =
directed therapeutic exposure, EFCT for Trauma = emotionally
focused couple therapy for trauma, LMC = lifestyle manage-
ment course, PTSD = posttraumatic stress disorder, RCT = ran-
domized controlled trial, SAFE = Support and Family
Education (Program), SAT = strategic approach therapy, VA =
Department of Veterans Affairs.
*Address all correspondence to Candice M. Monson, PhD;
Department of Psychology, Ryerson University, 350 Victoria
St, Toronto, ON M5B 2K3 Canada; 416-979-
Email: [email protected]
http://dx.doi.org/10.1682/JRRD.2011.09.0166
718
50. JRRD, Volume 49, Number 5, 2012
Glynn et al. [4]; Lunney and Schnurr [5]; Monson et al.*)
and negative family interactions have been associated with
poorer individual cognitive-behavioral treatment outcomes
[6–7]. To further treatment and research efforts in this area,
this article reviews the recommendations regarding couple/
family therapy offered in the newest version of the
Department of Veterans Affairs (VA)/Department of
Defense (DOD) VA/DOD Clinical Practice Guideline for
Management of Post-Traumatic Stress. [8] and then pro-
vides a heuristic for clinicians, researchers, and policy
makers to consider when incorporating couple/family
interventions into Veterans’ mental health services. Then,
the range of research that has been conducted on family
therapy for PTSD with Veterans is reviewed using this
heuristic and suggestions for clinical practice are offered.
METHODS
Recommendations regarding couple/family therapy
offered in the newest version of the VA/DOD Clinical Prac-
tice Guideline for Management of Post-Traumatic Stress
were reviewed. Review of the empirical studies on which
these guidelines were based resulted in the development
of a heuristic that organizes these interventions based
on an interaction of their stated focus of improving
(1) relationship functioning and/or (2) PTSD. Following
this, a literature search was done on couple/family inter-
ventions for PTSD using PsychInfo, MEDLINE, ERIC
(Education Resources Information Center), and Google-
Scholar databases. The following search terms were used:
couple therapy, conjoint therapy, family therapy, interper-
sonal, PTSD, and trauma.
RESULTS
51. Couple/Family Therapy
In the clinical practice guideline (CPG) , family therapy
was given an overall “Insufficient” rating for the treatment
of PTSD; this rating indicates “The evidence is insufficient
to recommend for or against routinely providing the inter-
vention. Evidence that the intervention is effective is lacking
or poor quality, or conflicting, and the balance of benefits to
harms cannot be determined” [8, p. 202]. The supporting
evidence offered for this conclusion includes three studies:
Devilly [9], Glynn et al. [4], and Monson et al. [10]. Upon
review of these studies, the CPG summarizes that “BFT
[behavioral family therapy] did not significantly improve
the PTSD symptoms and was inferior to other psychothera-
pies” [8, p. 144]. The level of evidence was rated as “I = At
least one properly done RCT [randomized controlled trial],
“and the quality of evidence was rated ‘fair-poor.’” The
CPG concludes “There is insufficient evidence to recom-
mend for or against Family or Couples Therapy as a first-
line treatment for PTSD. Family or Couples therapy may be
considered in managing PTSD-related family disruption or
conflict, increasing support, or improving communication”
[8, p. 118].
Although we agree with the ultimate overall “I” rat-
ing and subratings of level and strength of evidence, we
disagree with the conclusion drawn from the studies
reviewed. In addition, there are other studies not consid-
ered in the CPG that we believe are important to consider
when drawing a conclusion about the benefits and costs
of couple/family therapy for PTSD, which we systemati-
cally review in the next section. Our concerns with the
conclusion offered from the literature reviewed in the
52. CPG are outlined here.
Glynn et al. conducted one of the most rigorous tests
of family therapy for PTSD to date [4]. In their study, they
used an additive research design to test the incremental
utility of a specific BFT focused on improving communi-
cation and problem-solving skills [11]. In this trial, the
provision of BFT followed an individually delivered
psychotherapy, directed therapeutic exposure (DTE),
which focused on repeated narrative trials and cognitive
restructuring of two traumatic memories [12]. Forty-two
Veterans and one of their family members (89% conjugal
waiting list. Outcomes reported were clinician-rated PTSD
symptoms and patient and family member reports of fam-
improved more than those assigned to the waiting list on
what the authors refer to as “positive” PTSD symptoms
(i.e., reexperiencing, hyperarousal) but not the “negative”
symptoms of PTSD (i.e., avoidance, numbing) or social
showed statistically significantly more improvements in
*Monson CM, Macdonald A, Vorstenbosch V, Shnaider P,
Goldstein
ESR. Changes in social adjustment with cognitive processing
therapy: effects of treatment and association with PTSD
symptom
change. J Trauma Stress. 2012. In press.
http://www.rehab.research.va.gov/jour/2012/495/pdf/VADODcli
nicalguidlines495.pdf
http://www.rehab.research.va.gov/jour/2012/495/pdf/VADODcli
nicalguidlines495.pdf
http://www.rehab.research.va.gov/jour/2012/495/pdf/VADODcli
nicalguidlines495.pdf
53. 719
MONSON et al. Couple/family treatments for PTSD
interpersonal problem-solving than did participants who
received DTE only. When interpreting the results of this
trial, note that BFT followed individual DTE; BFT alone
was not directly compared with DTE.
The two other studies on which the CPG was based
were uncontrolled trials that did not include randomization
or a control or comparison condition. They generally did not
include methodologically rigorous elements of controlled
psychotherapy studies, such as independent and blinded cli-
nician assessment of PTSD symptoms, assessment of
longer-term outcomes, fidelity to treatment assessment,
or reliability assessment of clinician assessors. Devilly
described the results of a program evaluation study of Aus-
tralian combat Veterans and their partners who participated
in an intensive weeklong residential group intervention that
included psychoeducation about PTSD and symptom man-
agement techniques [9]. At follow-up, both Veterans and
their partners reported statistically significant reductions in
anxiety, depression, and general stress; Veterans reported a
significant reduction in PTSD symptoms. Small and nonsig-
nificant improvements were also observed for anger and
quality of life, but not for relationship satisfaction.
The other study tested an early version of cognitive-
behavioral conjoint therapy (CBCT) for PTSD [13], which
is designed to simultaneously ameliorate PTSD symptoms
and enhance relationship functioning. In a sample of seven
couples in which one member of the couple was a male
Vietnam Veteran with PTSD, Monson et al. found statisti-
54. cally significant and large effect size improvements in clini-
cians’ and partners’ ratings of Veterans’ PTSD symptoms
from pre- to posttreatment [10]. The Veterans reported
moderate effect size improvements in PTSD and statisti-
cally significant and large improvements in depression,
general anxiety, and social functioning. Wives reported
large effect size improvements in their relationship satisfac-
tion, general anxiety, and social functioning [14].
Based on a review of these three studies (and other
studies completed to date), no couple/family therapy has
ever been directly compared with another psychotherapy
for PTSD. Thus, given the available evidence, it is not
possible to conclude that couple/family therapy alone is
inferior to other therapies as indicated in the CPG. More-
over, Devilly [9] and Monson et al. [10] found significant
improvements in PTSD symptoms as a result of a partner-
involved treatment. We think a more accurate conclusion
might be that some evidence suggests that the class of
cognitive-behavioral couple interventions may improve
PTSD symptoms and intimate relationship functioning.
Heuristic for Understanding Treatment Targets
The CPG’s recommendation regarding couple/family
therapy underscores one consideration when evaluating
couple/family treatments for PTSD: What is the treatment
target? Is it improvements in family functioning? PTSD
symptoms? Both? To further policy, practice, and research
in this area, we offer a heuristic to consider when making
decisions about how to incorporate family members into
Veterans’ treatment (Figure). This heuristic organizes
interventions based on an interaction of their stated focus
of improving (1) relationship functioning and/or (2) PTSD.
All the interventions discussed in this article fall into the
broader category of couple/family therapy in that they
55. address the close relational system in which the individual
exists. Our heuristic expands Baucom et al.’s [15] prior
conceptualization of empirically supported couple and
family interventions for marital distress and adult mental
health problems by considering the range of concerned
significant others (CSOs) such as parents, siblings, close
friends, and extended family who might be considered
“family” by the patient and included in treatment to
enhance its efficacy (i.e., not just focused on couple dis-
tress). Drawing on research in the substance use disorder
literature documenting the use of CSOs in treatment
engagement [16], we also consider interventions that are
not designed to explicitly improve PTSD or another mental
health condition or relationship functioning, but may be
used to enhance treatment delivery by increasing engage-
ment or facilitating the provision of other treatments.
The specific objectives and hoped-for outcomes of
these interventions differ based on the way that family is
Figure.
Heuristic for understanding target of different couple/family
inter-
ventions for posttraumatic stress disorder (PTSD).
720
JRRD, Volume 49, Number 5, 2012
included; the interventions differ based on their focus on
the relationship and/or PTSD symptoms. In addition,
some of these interventions have also yielded improve-
ments in family members’ health and well-being. Some
56. interventions specifically target the marital- or romantic
relationship within the family (i.e., couple therapy), while
others include other family members. We have attempted
to refer to the format (i.e., couple or family) of therapy as
described in the publications by the authors. The mini-
mum inclusion criterion for review was objective data
analyzed at the group level; theoretical writings and indi-
vidual case studies were not included in this review.
First, as demonstrated in the lower right-hand quad-
rant of the Figure, family members may be used to
engage Veterans in assessment and treatment or to edu-
cate them about PTSD and the rationale of evidence-
based treatments. In this way, improvements in PTSD
symptoms or relationship functioning are not the targets
of the intervention; rather, engagement and/or education
are the goals. These interventions may include strategies
taught to CSOs to increase the likelihood of Veterans
seeking treatment for PTSD and its common comorbidi-
ties and/or education provided to CSOs about the symp-
toms of PTSD and the rationale for various evidence-
based treatments.
Second, family members may be involved in what we
term “generic family therapy” with the Veteran. This
approach has the parsimonious goal of improving relation-
ship functioning. Improvements in relationship functioning
may, in fact, improve a Veteran’s PTSD symptoms and the
health and well-being of family members by decreasing the
stress in their interpersonal environment. However, the
objective of the family members’ inclusion is to improve
the relational milieu in which the Veteran and his or her
family exist and does not specifically target the mecha-
nisms thought to maintain the individual disorder.
Third, family members may be involved in partner-
57. assisted interventions in which the family members serve
as a surrogate coach or therapist for the Veteran. These
interventions aim to promote the Veteran’s treatment by
educating family members about the rationale for therapy
so that they can actively support the Veteran in treatment
or enhance therapies typically delivered in an individual
format. Relational issues are not the focus of these inter-
ventions; supported delivery of the individual interven-
tions is the goal.
Fourth, family members may be included in disorder-
specific family therapies, which are therapies that have
been specifically developed to simultaneously improve
relationship functioning as well as PTSD. In this way,
relationship functioning and individual-level symptoms
of PTSD are simultaneous targets for the interventions.
To be maximally efficient in the therapy, the interven-
tions are generally developed to target mechanisms
known to contribute to the development and maintenance
of PTSD and relational distress.
Efficacy of Interventions by Type of Involvement
Strategy
The Table includes a summary of evidence regarding
treatment efficacy related to the stated treatment target
(i.e., individual PTSD outcome and/or relationship adjust-
ment outcome). Consistent with the description above, we
begin with those interventions designed to improve treat-
ment engagement in assessment and treatment of PTSD or
knowledge about PTSD.
Education Program
58. The Support and Family Education (SAFE) Program is
a multisession educational program for families dealing
with a wide range of mental illnesses (e.g., PTSD, major
depression, bipolar disorder, schizophrenia) [17]. The inter-
vention involves various family members (e.g., spouse,
parent, siblings) in 14 sessions of educational material
covering a range of topics for loved ones of a person with a
mental illness and 4 sessions of skills training in problem-
solving and minimizing stress. Because this is an educa-
tional program, the material is provided in once monthly
90 min workshops and attendance is based on family mem-
ber interest. In a 5 yr program evaluation, Sherman et al.
reported that participant satisfaction was 18.2 out of a pos-
sible score of 20 (highest satisfaction) [18]. Caregivers
attended a mean of 6.3 sessions; Sherman et al. noted that,
given the monthly meeting schedule, they had a high rate of
retention [18]. PTSD-focused sessions were the most well-
attended sessions within the series, and 53 percent of care-
givers of a loved one with PTSD attended more than one
session. Finally, Sherman and colleagues reported positive
correlations between the number of sessions attended and
the understanding of mental illness, awareness of VA
resources, and ability to engage in self-care activities.
Negative correlations were found between the number of
sessions attended and caregiver distress. No data regarding
patient PTSD or other mental health outcomes for the fam-
ily members or Veterans were reported.
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MONSON et al. Couple/family treatments for PTSD
Table.
Couple/family interventions for posttraumatic stress disorder
59. (PTSD).
Intervention Brief Description Key Citation
Education and Engagement
Support and Family Education
(SAFE) Program
SAFE Program is multisession educational program for families
dealing
with wide range of mental illnesses (e.g., PTSD, major
depression, bipolar
disorder, schizophrenia). Program welcomes various family
members
(e.g., spouse, parent, siblings). Includes 14 sessions of
educational mate-
rial covering range of cogent topics for loved ones of person
with mental
illness and 4 sessions of skills training in problem-solving and
minimizing
stress. Material is provided in once monthly 90 min workshops
and atten-
dance is based on family member interest. Little objective data
reported on
SAFE program; however, family members reported high
satisfaction with
program in one study and anecdotal reports indicate skills
learned helped
participants’ families.
Sherman, 2003 [17];
Sherman et al., 2006 [18]
Engagement No empirical data on interventions specifically
targeting concerned sig-
nificant others to facilitate treatment engagement.
60. Not applicable
Generic Couple/Family Therapy
Therapy (BCT/BFT)
In randomized clinical trial, Glynn et al. tested version of BFT
following
individual cognitive-behavioral therapy [4]. This family
treatment
included (1) psychoeducation on PTSD that explicitly addresses
relatives’
expectations and coaches them on recognizing and reinforcing
intermedi-
ate gains in service of long-term progress and (2) skills training
in
communication (i.e., constructive expression of feelings and
empathic
listening), problem-solving, and anger management training.
BFT was
delivered in 8 weekly 2 h sessions. Those receiving BFT and
individual
therapy evidenced significantly better interpersonal problem-
solving skills
than those receiving individual therapy only. BCT tested in
other studies
included goals of increasing positive interactions, improving
communica-
tion, teaching problem-solving skills, and enhancing intimacy in
intimate
partners. These studies have generally revealed significant
improvements
in relationship functioning, but less effects on individual PTSD
symptoms.
Glynn et
61. Sweany, 1987 [40]
K’oach Program K’oach program was monthlong, extensive,
multifaceted treatment pro-
gram developed in Israel. Wives of male Veterans were included
at several
points during program to learn communication skills, cognitive
coping
skills, and reinforcement methods to support husbands’ positive
behavior.
Wives and family members participated in “family day” that
included
entertaining activities and increased positive interactions.
During last 2 wk
of program, Veterans and wives participated in three couple
groups during
which they discussed common problems, improved
communication and
problem-solving skills, and promoted Veterans to view their
partners as
sources of support. These groups continued after treatment and
served as
self-help group. Little empirical research has been reported on
efficacy of
program. Some evidence that K’oach program improved
relationship
functioning, but not Veterans’ PTSD symptoms.
Rabin & Nardi, 1991
[26]; Solomon et al.,
1992 [27]
Partner-Assisted Interventions
Lifestyle Management Course
62. (LMC)
LMC is intensive, structured group intervention for Veterans
and their partners
that consisted of 5 d of courses in residential setting led by
counselors experi-
enced in treating Veterans with PTSD. Intervention is based on
cognitive-
behavioral principles and conceptualizations of PTSD and was
delivered to
both members of couple simultaneously. Topics covered
included education
about PTSD, relaxation/meditation, self-care, diet and nutrition,
alcohol use,
stress management, communication, anger management, and
problem-
solving. In one study, program was shown to reduce anxiety,
depression, and
stress in both Veterans and their partners and PTSD symptoms
in Veterans.
Has not been shown to improve relationship satisfaction.
Devilly, 2002 [9]
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Currently, no published research that we are aware of
has investigated the use of CSOs to engage Veterans with
PTSD into treatment. Given the number of barriers that
exist for Veterans with PTSD to present for assessment and
treatment [19] and the number of CSOs who want to help
but may not know the best way to help and/or may “help”
in inadvertently detrimental ways (e.g., accommodation or
63. codependent behaviors), this is an important way of utiliz-
ing family members in order to enhance service delivery.
We are aware of at least one national effort, called “Coach-
ing Into Care,” that is a telephone-based support service
designed to help family members of Veterans encourage
distressed Veterans to access their VA healthcare benefits.
The focus of the service is specifically in cases of mental
health issues. The intervention is designed to provide sup-
port to family members and help them plan and implement
an informed, noncoercive approach when talking with a
troubled Veteran about seeking or resuming VA mental
health care. Initial program evaluation data suggest a modest
increase in the engagement of the Veteran in mental health
care after one or several telephone coaching sessions [20].
Generic Couple/Family Therapy
Behavioral couple/family therapy. In this article, we use
the acronym BCT when referring to studies involving cou-
ples only and BFT for those studies involving a range of
Intervention Brief Description Key Citation
for Trauma)
EFCT for Trauma is short-term (12 to 20 sessions), experiential
intervention
with focus on identifying and processing emotions connected to
traumatic
experiences. Treatment also aims to understand how these
emotions are
related to broader attachment behaviors and styles and how they
affect rela-
64. tional processes and communication. EFCT for PTSD is divided
into three
main stages that focus on (1) stabilizing family through
assessment, identifi-
cation, and sharing of negative interaction patterns; (2) building
relational
skills in couple through acceptance and communication; and (3)
integrating
therapeutic gains and planning through development of coping
strategies
and positive interaction patterns. Study of adult female sexual
abuse victims
and male partners found improvements in PTSD symptoms and
clinically
significant improvements in half the couples’ relationship
satisfaction.
Johnson, 2002 [28];
MacIntosh & Johnson,
2008 [29]
(SAT)
SAT is 10-session intervention aimed at reducing effortful
avoidance and
emotional numbing symptoms of PTSD. SAT combines partner-
based anxi-
ety reduction, behavior exchange, and stress inoculation
techniques to gradu-
ally increase couples’ exposure to anxiety-producing, avoided
situations and
positive emotional exchanges. Three broad treatment phases are
(1) motiva-
tional enhancement and psychoeducation about PTSD,
65. specifically avoid-
ance symptoms and their effect on relationships; (2)
relationship
enhancement and increased emotional intimacy; and (3) partner-
assisted
anxiety reduction using graded exposures. Initial results from
uncontrolled
trial found improvements in behavioral avoidance and emotional
numbing;
no data reported regarding relationship satisfaction effects.
Sautter et al., 2009 [30]
Cognitive-Behavioral Conjoint
for PTSD)
CBCT for PTSD is designed to simultaneously improve
individual PTSD
symptoms and enhance intimate relationship functioning. CBCT
for PTSD
consists of fifteen 75 min sessions comprising three phases: (1)
education
about PTSD and its effect on relationships and safety building,
(2) com-
munication skills training and couple-oriented in vivo exposures
to over-
come behavioral and experiential avoidance, and (3) cognitive
interventions aimed at changing problematic trauma appraisals
and beliefs
that maintain PTSD and relationship problems (i.e., trust,
power/control,
and emotional and physical closeness). Data from uncontrolled
trials with
Veteran and community samples and initial results from
randomized con-
66. trolled trial of range of traumatized individuals provide
evidence for
improved PTSD symptoms, improved relationship satisfaction
(especially
in partners), and enhanced partner mental health and well-being.
Monson et al., 2005 [6];
Monson et al., 2004 [10];
Monson & Fredman,
2012 [13];
Monson et al., 2011 [32];
Schumm et al., 2011*
*Schumm JA, Fredman SJ, Monson CM, Chard KM. Cognitive-
behavioral conjoint therapy for PTSD: Initial findings for
Operations Enduring and Iraqi Freedom
male combat veterans and their partners. Am J Fam Ther. 2012.
In press.
Table. (cont)
Couple/family interventions for posttraumatic stress disorder
(PTSD).
723
MONSON et al. Couple/family treatments for PTSD
family members. Whether applied to couples or families
more broadly, behavioral couple/family therapy (BCT/BFT)
generally involves behavioral exercises to increase positive,
reinforcing exchanges in couples and families, as well as
communication skills training (i.e., sharing thoughts and
feelings, problem-solving) [21]. Some interventions include
67. a cognitive focus on partners’ maladaptive standards and
attributions applied to the relationship and to each other
[22]. BCT has been identified as an efficacious practice for
general couple distress according to American and Canadian
Psychological Association Treatment Guidelines [23–24].
Two completed RCTs have tested variants of generic
BCT/BFT with PTSD patients. Both were conducted with
samples of male combat Veterans and their family mem-
bers. As previously reviewed, in another published RCT
including BFT after DTE, Glynn and colleagues found
improvements in interpersonal problem-solving than
those who did not receive BFT [4].
Three other uncontrolled studies have examined group
BCT with Veterans. Cahoon reported the results of a 7 wk
group BCT focused on communication and problem-
solving training for male combat Veterans and their female
partners [25]. Group leaders reported statistically signifi-
cant improvements in Veterans’ PTSD symptoms and cop-
ing abilities, and female partners reported significant
improvements in marital satisfaction and problem-solving
communication. The Veterans did not report improvements
in problem-solving or emotional communication skills.
K’oach program. Results have been reported from the
Israeli K’oach program, an intensive treatment program
for male combat Veterans with PTSD in which wives were
included at several points during the program [26–27].
This program included psychoeducation about PTSD,
plus communication and problem-solving skills training
for the couples. Minimal outcome data have been reported
on this intervention; however, 68 percent of the male Vet-
erans and their wives reported relationship improvements.
Consistent with the focus of the intervention, no decreases
68. in Veterans’ PTSD symptoms were observed.
Partner-Assisted Interventions: Lifestyle Management
Course
As discussed, Devilly described the results of an
uncontrolled study of Australian combat Veterans and
their partners who participated in an intensive weeklong
residential group intervention that included psychoeduca-
tion about PTSD and symptom management techniques
[9]. At follow-up, both Veterans and their partners
reported significant reductions in anxiety, depression,
and general stress and Veterans reported a significant
reduction in PTSD symptoms. Small improvements were
also observed for anger and quality of life but not for rela-
tionship satisfaction.
Disorder-Specific Interventions
Emotionally focused couple therapy for trauma. Emo-
tionally focused couple therapy for trauma (EFCT for
Trauma) is a short-term (12 to 20 sessions), experiential
intervention with a focus on understanding and processing
emotions that are connected to the traumatic experience and
broader attachment behaviors and styles that affect relational
processes and communication [28]. EFCT for Trauma is
divided into three main stages that focus on (1) stabilizing
the couple through the assessment, identification, and shar-
ing of negative interaction patterns; (2) building relational
skills in the couple through acceptance and communication;
and (3) integrating therapeutic gains and planning through
development of coping strategies and interaction patterns.
Qualitative case studies are reported in Johnson [28].
A study of 10 couples, including an adult female who
69. had suffered child sexual abuse, provides initial support for
the efficacy of EFCT for Trauma [29]. In this study, the
couples completed between 11 and 26 sessions of therapy
and completed assessments at pre- and posttreatment. The
authors report that all the participants experienced at least
one standard deviation worth of improvements on a
clinician-administered measure of PTSD and half the
participants self-reported clinically significant improve-
ments in PTSD symptoms. Also, half the participants
self-reported clinically significant improvements in rela-
tionship satisfaction. Three couples who reported decreased
satisfaction and increased emotional abuse terminated
their relationships during the course of therapy. The
authors suggest that EFCT for Trauma may not be appro-
priate for couples in which emotional abuse exists.
Strategic approach therapy. Strategic approach therapy
(SAT) is a 10-session manualized BCT developed by
Sautter et al. [30] to target the avoidance/numbing symp-
toms of PTSD. Findings from six Veteran couples who
completed the intervention include significant improve-
ments in these symptoms according to patient, partner,
and clinician ratings. Significant improvements also
occurred in the Veterans’ total PTSD symptoms, but not
reexperiencing or hyperarousal symptoms. Relationship
adjustment also significantly improved [31].
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Cognitive-behavioral conjoint therapy for posttraumatic
stress disorder. CBCT for PTSD is designed to simulta-
neously address individual PTSD symptoms and relation-
70. ship problems [13]. CBCT for PTSD consists of fifteen 75
min sessions comprised of three phases: (1) treatment and
education about PTSD and its impact on relationships and
increasing safety, (2) communication-skills training and
dyad-oriented in vivo exposures to overcome behavioral
and experiential avoidance, and (3) cognitive interventions
aimed at changing problematic trauma appraisals and
beliefs most relevant to the maintenance of PTSD and rela-
tionship problems (i.e., trust, power/control, and emotional
and physical closeness). Three uncontrolled studies with
Vietnam Veterans (Monson et al. [10]), Iraq and Afghani-
stan Veterans (Schumm et al.*), and community members
(Monson et al. [32]) and their romantic partners indicate
improvements in PTSD symptoms and their comorbidities
and some evidence of relationship improvements in couples
who may or may not be clinically distressed at the outset of
therapy (this is not an inclusion criteria for the therapy).
A wait-list controlled trial of CBCT for PTSD is
nearly complete. This trial includes a sample of individuals
with a range of traumatic events, including combat trauma,
and different types of intimate couples (i.e., married,
cohabitating, noncohabitating, same sex). The most recent
results from this trial indicate significant improvements in
PTSD and comorbid symptoms from pre- to posttreatment
that are maintained at 3 mo follow-up. These improve-
ments are on par with or slightly better than those found
with individual treatments. Additional benefits of the
therapy are significant improvements in relationship satis-
faction (e.g., Monson [33]). CBCT for PTSD is undergo-
ing initial testing for a range of CSOs and delivery in
multi-CSO groups.
DISCUSSION
Some evidence exists that educational groups are
71. associated with family members’ greater knowledge
about Veterans’ mental health symptoms, VA resources,
and decreased caregiver burden. There is not yet pub-
lished research on interventions designed to incorporate
CSOs to enhance engagement and retention in PTSD
assessment and treatment. As expected given the target of
the intervention, two RCTs of generic BCT or BFT with
Veterans and their families have yielded improved rela-
tionship functioning, but provide variable evidence
regarding significant improvements in PTSD symptoms.
A partner-assisted BCT provides evidence for improve-
ments in some symptoms of PTSD, but no evidence yet
establishes its efficacy for improving relationship satis-
faction. With regard to disorder-specific couple therapy,
some data support the efficacy of EFCT for Trauma in
couples, including a female partner with a history of
childhood sexual abuse; no group-level data for Veterans
with PTSD are available yet. Three uncontrolled trials
and results from an ongoing RCT of CBCT for PTSD
indicate that this therapy ameliorates PTSD symptoms,
enhances intimate relationship satisfaction, and improves
partners’ individual mental health and well-being.
CONCLUSIONS AND FUTURE DIRECTIONS
Our most recent military engagements have been met
with greater understanding of the multiple effects of PTSD
on the individual and the Veteran’s larger family unit.
Appreciating the toll that PTSD and its comorbidities can
have on family functioning, the VA was provided authority
by Public Law 110–387, “Veterans’ Mental Health and
Other Care Improvement Act,” in 2008 to include mar-
riage and family counseling as a service for family mem-
bers of all Veterans eligible for care. As a result, clinicians
with expertise in couple and family therapy have been
72. hired and training and dissemination efforts have been ini-
tiated to increase staff capacity to deliver evidence-based
couple/family interventions. This represents an important
step in providing Veterans and their family members with
access to a range of interventions to improve their indi-
vidual and relationship functioning.
We have presented a heuristic to help guide clinicians
in their PTSD treatment planning and provision. Although
there are no algorithms or empirically derived decision
trees to identify the treatment or treatment category most
appropriate for a given client, some general guidelines from
our own thinking and practices may be useful in treatment
planning. For example, if the Veteran has been unwilling to
engage in treatment and the goal is to engage the Veteran or
educate the CSO, the education/engagement interventions
*Schumm JA, Fredman SJ, Monson CM, Chard KM. Cognitive-
behavioral conjoint therapy for PTSD: Initial findings for
Operations
Enduring and Iraqi Freedom male combat veterans and their
part-
ners. Am J Fam Ther. 2012. In press.
725
MONSON et al. Couple/family treatments for PTSD
may be most appropriate. In some situations, generic cou-
ple/family therapy may be the treatment of choice. If Veter-
ans with PTSD are engaged in trauma-focused treatment
for PTSD, do not wish for their CSO to be integrated into
that treatment, and they or their CSO are experiencing rela-
tionship distress, adjunctive generic couple/family therapy
73. may be included in the treatment plan. Decreasing ambient
stress caused by the Veteran’s distressed relationships and
enhancing social support may improve individual treatment
outcomes (e.g., Price et al. [34], Tarrier et al. [7]). Generic
couple/family therapy may also be pursued if the Veteran is
unwilling or not yet ready to engage in trauma-focused psy-
chotherapy for PTSD and is experiencing relationship dis-
tress. As reviewed, the skills taught in evidence-based
generic couple/family treatments (e.g., conflict manage-
ment, cognitive interventions) may have more diffuse
effects in improving PTSD and decreasing the stress on the
Veteran and CSO, thereby improving individual and rela-
tional functioning.
Partner-assisted interventions may be selected when
the Veteran is involved in individual therapy and the thera-
pist wishes to selectively include a supportive CSO to
maximize treatment delivery (e.g., facilitating in vivo expo-
sures to trauma-relevant cues). One cautionary note about
this method of CSO inclusion comes from the partner-
assisted agoraphobia treatment research [35]. We do not
recommend partner-assisted interventions in cases in which
the Veteran and CSO are experiencing relationship distress
because of the potential for increased conflict associated
with the CSO acting as surrogate therapist or coach.
Finally, in light of the accumulating evidence for the
efficacy of PTSD-specific couple/family interventions to
efficiently achieve multiple treatment outcomes, we rec-
ommend these treatments as a stand-alone option when-
ever a Veteran with PTSD and a partner are willing to
engage in them. Some may be inclined to present these
interventions when there is relationship distress. It is
important to note that the existing disorder-specific inter-
ventions for PTSD have been tested in a range of satisfied
couples (i.e., relationship distress has not been an inclu-
74. sion criteria), with partners diagnosed with multiple
comorbidities, to document benefits in individual and rela-
tional functioning. That said, if there is PTSD-maintaining
behavior within the relationship between the Veteran and
CSO (e.g., CSO accommodates avoidance behavior,
which serves to maintain PTSD symptoms) or relationship
distress, disorder-specific interventions may be especially
indicated. In addition to achieving multiple outcomes,
these treatments may confer additional service delivery.
For example, Veterans have reported that if not for their
CSOs’ involvement, they would not have engaged in
PTSD treatment. Again, these are recommendations based
on clinical experience and some data; further research
regarding these recommendations is needed.
The “family” portion of the “couple/family” label has
been relatively neglected in research on PTSD interven-
tions. More research is needed on interventions that apply
to broader family functioning and the effects of parental
mental health problems on children to better intervene at
the “family” level. In addition, while a significant propor-
tion of Veterans are married and have children, a sizable
minority are not in committed romantic relationships and
some are in committed same-sex relationships. We need
to consider inclusion of a broader range of Veterans’ close
others when striving to enhance engagement, assessment,
and treatment of PTSD.
Other important and growing demographic groups to
consider in couple/family treatment for PTSD are female
Veterans, aging Veterans who may present for the first time
with PTSD or have changes in their PTSD presentation, and
recently returning Veterans. Most of the research to date on
Veterans and couple/family treatments for PTSD has investi-
gated male Veterans with PTSD and their female partners.
75. Research on Vietnam Veterans and the most recent cohort of
Veterans suggests that female Veterans also have a myr-
iad of family problems and, in fact, may be especially at risk
for relationship problems and divorce (e.g., Gold et al. [36],
Karney and Crown [37]). Furthermore, the developmental
transition of retirement has been linked with relationship
distress, as well as the appearance of PTSD symptoms [38].
Retirement is also a time when other age-related physical
conditions and their treatment may increase relationship dis-
tress or exacerbate PTSD symptoms (e.g., cardiovascular
incidents, cognitive changes). Finally, returning Veterans of
recent conflicts are in great need of effective interventions
that address interpersonal conflict in order to prevent further
deterioration of relationships and development of chronic
PTSD. Research already has documented rising reports of
interpersonal relationship distress among these Veterans
[39] and their expressed interest in greater family
involvement in PTSD treatment (e.g., Batten et al. [3]).
Questions also remain regarding the most effective
aspects of the interventions we have reviewed. As the
field identifies efficacious treatments, future dismantling
studies may provide evidence about the essential compo-
nents of these interventions. In addition, more research is
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JRRD, Volume 49, Number 5, 2012
needed on the most optimal mode of delivery (e.g., con-
joint therapy delivered to individual dyads, in a group of
dyads, via telehealth methodologies, paired with indi-
vidual therapy).
We are delighted with the growing awareness and