Couples Therapy

undergoing any procedure. Undergoing cosmetic

surgery involves a large commitment on the part of
both the patient and the physician. One should carefully consider the options before making this decision.
SEE ALSO: Body image, Liposuction

Suggested Resources
Website: www.plasticsurgery.org

JANET BLANCHARD

Couples Therapy All individuals have a basic

need to form attachments and develop meaningful relationships. At the same time, we also have a basic need
to be separate and develop our individual potential.
Balancing these conflicting needs is the central issue of
intimate relationships and helping couples establish or
reestablish that balance is the central issue for couples
therapy. This is addressed by understanding how the
couple manages, respects, and accepts differences.
Accepting differences supports individual development
and frees partners to be truly intimate by reducing the
inevitable power struggles which emerge when changing a partner takes precedence over acceptance.
Couples therapy can address the needs of married
couples, same-sex couples, premarital couples, or couples in a committed relationship who have chosen not
to marry. It is indicated when one or both partners feel
their needs are not being met in the relationship, yet
want to see if their relationship can succeed. Couples
therapy is not indicated if domestic violence is an issue.
The issues that couples bring to therapy can include
finances, sex, infidelity, addiction, parenting, communication, difficulty in resolving conflict. They can also be
related to external events such as job loss, illness, or
family crisis. Often couples come for counseling at transition points in their lives such as the birth of child, job
change or move, or midlife crisis.
There are many models of couples therapy. Most
couples therapists operate from a primary theoretical
model but draw on other practice models to meet the
needs of a particular couple. Structural Therapy developed by Salvadore Minuchin views a couple as a system
that operates by its own rules and repetitive patterns.
Structural therapists describe the conflict between attachment and individuality as an issue of boundaries and

assess how strong the boundaries are around the couple

and around each individual. A boundary that is too rigid
around a couple does not allow for individual growth.
Boundaries that are too rigid around each partner undermine attachment. The goal of the therapy is to help the
couple shift the rules and patterns of their system that
keep their boundaries rigid and prevent a balance that
meets each partners needs.
Intergenerational Therapy as developed by Murray
Bowen considers the impact of extended family across
generations on the couple relationship. How families
historically have managed togetherness and individuality affects succeeding generations ability to couple.
Goals of therapy are to help the couple through insight,
understand their family of origin issues so they are less
likely to repeat them.
Cognitive Behavioral Therapy as developed by
such theorists as Albert Ellis and Neil Jacobson focuses
on cognitions and beliefs. The cognitive therapist helps
the couple pinpoint how they act toward each other to
try to control each other in order to get their needs met.
The goals are to increase cognitive awareness of their
destructive behavior and the beliefs that support that
behavior and to improve their problem-solving skills.
Solution-Focused Therapy as developed by Steve
DeShazer and his colleagues proposes that a couple
does not need to understand a problem to develop a
solution for it. The focus of the work is identifying
strengths and resources to be adapted to create a solution. Goal setting is central to the approach and is
accomplished by identifying specific behaviors and
interactions that the couple would like to increase.
These behaviors are determined by examining the couples previous attempts at developing solutions and
focusing on what has worked.
Object Relations Therapy as described by Rubin
and Gertrude Blanck views becoming a couple as a
developmental phase with the goals of establishing sexual relations, establishing a new level of intimacy, separating from parents, and increasing the opportunity for
developing autonomy. Object relations therapists focus
on what each partner internalized about significant relationships in their families and how/what they learned
impacts how they interact with and attach to their intimate partner. Understanding and insight are necessary
to meet the goal of separating what was previously
internalized from the present relationship.
Couples therapists may be licensed social workers,
counselors, psychologists, or psychiatrists. Because
couples therapy is a subspecialty of therapy, couples

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Crystal Methamphetamine
therapists should have additional training and experience in working with couples. The American
Association of Marriage and Family Therapists (AAMFT)
provides referral information.
Insurance does not generally pay for couples therapy. One partner must usually be identified as a patient
with a mental health diagnosis in need of therapy. The
other partner then participates in the therapy which is
billed as conjoint therapy. Each partner in couples therapy needs to be prepared to examine his or her own
role in the relationship problems.
SEE ALSO: Cognitive-behavioral therapy, Divorce mediation,
Psychoanalysis

Suggested Reading
Blanck, R., & Blanck, G. (1968). Marriage & personal development.
New York: Columbia University Press.
Bowen, M. (1985). Family therapy in clinical practice. New York:
Jason Aronson.
DeShazer, S. (1985). Keys to solutions in brief therapy. New York:
Norton.
Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle
Stuart.
Gerhart, D. R., & Tuttle, A. R. (2003). Theory based treatment planning for marriage and family therapists. Pacific Grove, CA:
Brooks/Cole-Thomson Learning.
Minuchin, S. (1974). Families and family therapy. Cambridge, MA:
Harvard University Press.

PHYLLIS D. HULEWAT

Crystal Methamphetamine Crystal methamphetamine, also known as meth, crystal, crank,

glass, ice, and speed, is a powerful stimulant that
can be inhaled, injected, smoked, or taken orally.
Methamphetamine is the most potent in the class of stimulant drugs called amphetamines. Chemically similar to
epinephrine (adrenaline), amphetamines are synthetic
drugs that produce stimulation of the central nervous system, inducing decreases in appetite, increased libido,
feelings of euphoria, alertness, and physical competence,
as well as anxiety and insomnia. Amphetamine was first
produced in 1887; methamphetamine was first synthesized from ephedrine (the active ingredient in the herb
ephedra) in 1893.
In the mid-20th century, physicians began to prescribe amphetamines for a variety of conditions, ranging from asthma and narcolepsy to attention deficit

disorder and obesity. Use of amphetamines increased

throughout the 1940s and 1950s; they were regularly
distributed to soldiers fighting on all sides during World
War II to enhance physical endurance and overcome
fatigue. In the postwar period, many women in the
United States and the United Kingdom used amphetamine as a means of combating depression, losing
weight, and as an aid to the monotonous daily completion of household chores, hence the label mothers
little helper. In Japan, epidemic abuse of methamphetamine left over from World War II eventually resulted in
the passage of the Stimulants Control Law in 1951. In
the United States, amphetamine and methamphetamine
increased in popularity throughout the 1960s and a substantial black market emerged in California. Its growth
was given an unintended boost by the Controlled
Substances Act of 1970, which greatly constricted the
legal means of obtaining amphetamines.
In the 1970s, the distribution of illegal methamphetamine in the United States was largely associated
with motorcycle gangs. However, methamphetamine is
no longer associated solely with gangs. Since the late
1990s, hundreds of methamphetamine labs have been
raided by local and federal law enforcement in both
urban and rural areas, where poverty, unemployment,
and the demands of industrial and agricultural jobs
contribute to a demand for stimulant drugs.
Methamphetamine has also become integrated into gay
culture and the rave scene, where it is commonly
used to power all-night dancing sessions and to boost
sexual performance. Because methamphetamine can be
readily produced from commonly available ingredients,
it does not require import networks (although such networks are frequently involved with large-scale distribution). All methods of making methamphetamine
employ toxic chemical agents and some source of
ephedrine, such as over-the-counter cold medicine.
Methamphetamine labs vary greatly in size and efficiency, from mom and pop outfits that cook the drug
for personal use and local sale, to large-scale factories
that turn it out for mass distribution. Due to the volatile
chemicals involved, all of these pose potential health
hazards, not only to the individuals involved in production, but also to the surrounding community and the
natural environment.
Like cocaine, amphetamines produce an initial
pleasant feeling, or rush, caused by increased production of dopamine in the brain. This is followed by an
elevation of mood and energy, and a subsequent steep
decline. Methamphetamine use can result in drug

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