Development of the Marital Self-disclosure Questionnaire (MSDQ).

This research describes the development of the Marital Self-Disclosure Questionnaire (MSDQ), a brief, self-report measure of the quantity and quality of marital self-disclosure. Consisting of 40 true-false items, the MSDQ provides a global index of marital self-disclosure as well as assesses four facets of self-disclosure between spouses: Relationship, Sex, Money, and Imbalance. Results indicate that the MSDQ scales are reliable, and preliminary data suggest that the MSDQ may have validity for distinguishing among groups hypothesized to differ in terms of marital distress and self-disclosure. Further evaluation of the MSDQ for its clinical and research utility appears to be warranted.

Boundary violations and personality traits among psychiatrists.

OBJECTIVE: To demonstrate that sexual abuse of patients by psychiatrists can be due to a variety of contributors, which may include therapists' psychopathic and narcissistic personality styles. METHOD: Data from a prospective cohort of residents training in psychiatry were examined to evaluate the personality traits of 2 psychiatrists subsequently convicted of boundary violations. RESULTS: The 2 psychiatrists who lost their licenses were identifiable at the beginning of their residency training as individuals with significant character pathology. CONCLUSIONS: For some psychiatrists, repetitive sexual abuse of patients represents one aspect of an ongoing pattern of exploitative relationships. The professional and ethical implications of these findings as they relate to early identification for those at risk are considered.

PIP: This study examined the contributing factors leading to sexual abuse of patients by psychiatrists, which may include therapists' psychopathic and narcissistic personality styles. Data from a prospective cohort of residents training in psychiatry were examined to evaluate the personality traits of two psychiatrists subsequently convicted of boundary violations. Results showed that the two psychiatrists had antisocial attitudes and behaviors, as well as a defensive cognitive-perceptual style. Their pathologic characters were identifiable at the beginning of their residency. It is, therefore, concluded that for some psychiatrists, repetitive sexual abuse of patients represents one aspect of an ongoing pattern of exploitative relationships. The professional and ethical implications of these findings, as they relate to early identification for those at risk, are considered.

A critical review of marital therapy outcome research.

OBJECTIVE: This review critically examines conceptual and methodological issues of outcome research designed to evaluate the efficacy of marital therapy (MT). Behavioural marital therapy (BMT), cognitively orientated marital therapy (COMT), emotionally focused marital therapy (EFMT), and insight-oriented marital therapy (IOMT) have provided evidence for efficacy. METHOD: The initial literature search involved the use of the MEDLINE and Psychlit CD-ROM data bases. A secondary literature search based on citations in articles discovered in the initial search was also conducted. Three broad categories involving the delineation of the client sample, study design considerations, and determination of treatment effects were addressed to investigate the quality of evidence concerning the efficacy of MT. RESULTS: None of the 4 approaches has proven superiority in efficacy, and the research does not provide evidence for the superiority of any one approach in distinct types of marital discord. There is some evidence to indicate that future outcome research should avoid the use of "waiting list control groups," since their use appears to be neither ethical nor humane in marital discord research. CONCLUSIONS: The authors suggest that the concept of treatment efficiency may be more clinically relevant to outcome research. A gold standard for "efficiency" would suggest that a marital therapy approach should produce subjective and objective improvement in 50% of eligible couples, and this improvement should be maintained in half of these couples at the one-year follow-up assessment. This standard would be comparable to the data on the 4 effective approaches described in this review.

The psychobiology of first-episode schizophrenia.

OBJECTIVE: To examine research and clinical interest in the first episode of schizophrenia. Pathobiological features have been shown to be a consequence of the disorder rather than the effects of chronicity, drug treatment or institutionalization. There is increasing evidence that ventricular enlargement is a robust finding and hypofrontality on PET and SPECT is associated more with symptomatology than with neuroleptic treatment. RESULTS: Neuroleptic threshold studies suggest that lower daily dosages and onset of medication may be the most important response prediction parameters. CONCLUSION: The role of novel antipsychotics in the treatment of first-onset schizophrenia merits investigation for lower rates of extrapyramidal syndromes and tardive dyskinesia. To reduce relapse rates, psychiatrists need to introduce practice standards employing those biopsychological features in the management of first-episode schizophrenia.

The role of marital therapy in the treatment of depressed married women.

The absence of a close, confiding relationship has been identified as a vulnerability factor to depression for women under adverse circumstances. Marital discord has also been identified as a risk factor in initiating and sustaining depression in women. Recent research has suggested that marriages with a depressed spouse are associated with lack of intimacy and decreased self-disclosure. This paper reviews three controlled outcome studies which demonstrate that marital therapy in combination with antidepressant medication is not indicated for hospitalized women with major affective disorder but either alone or in combination with antidepressants, marital therapy is a viable treatment for outpatient women who are suffering from depression.

The influence of therapeutic self-disclosure on perceived marital intimacy.

This study examines the effect of therapeutic changes in a couple's self-disclosure behavior and its impact on their perception of their marital intimacy. Twenty couples participated in 10 weekly sessions of structured self-disclosure. The Self-Disclosure Coding System was used to rate audiotapes of the second and ninth sessions. Two rates, blind to treatment condition, demonstrated high interrater reliability on measures of changes in: 1) amount of self-disclosure; 2) whether self-references were positive, negative, or neutral; 3) depth of disclosures; and 4) rate of self-reference. Spouses, who were rated as disclosing in greater depth and referring to themselves in a more positive manner, perceived increased intimacy in their marriages as a consequence of therapy. The role of self-disclosure between spouses as a specific technique in marital therapy merits further study.

Criterion validity of two methods of evaluating marital relationships.

A structured interview and a self-report questionnaire designed to measure the quality and quantity of marital intimacy are examined by evaluating their relationship to a measure of marital adjustment. Conceptual and methodological questions regarding different techniques that measure marital quality are presented. The study suggests both techniques have established criterion validity. Advantages and disadvantages of both methods are discussed, and suggestion for future research are made.

Self-disclosure of personal constructs.

Sidney Jourard's (19) description of the role of self-disclosure in marriage is reviewed. George Kelly's (20) theory of personal constructs is described in an effort to explain the complexity of successful marriages and strong families. A kind of marital therapy based on the technique of self-disclosure and the rationale that couple pathology results from erroneous personal constructs is described. The idea that these faulty schemas largely derive from the observation of and experience with one's parents' marriage is discussed. The self-disclosure of personal constructs may provide a distinctive approach to family therapy.

The etiology of nonpsychotic emotional illness.

Two hundred and fifty couples in the general population completed self-report questionnaires which measured life events, personality, marital intimacy, and symptoms of nonpsychotic emotional illness. Path analysis was utilized to explain the development of symptoms of nonpsychotic emotional illness. Personality traits of neuroticism and extroversion explained most of the variance of symptoms of nonpsychotic emotional illness. Life events played a much smaller but significant role and marital intimacy was a nonsignificant factor. The data support a proneness model for the etiology of nonpsychotic emotional illness.

A randomized clinical trial of cognitive marital therapy.

Thirty-three couples with severe marital discord referred to a psychiatric outpatient department were randomly assigned to Cognitive Marital Therapy or a control group. Cognitive Marital Therapy is a brief, structured couple therapy, which involves spouses in reciprocal self-disclosure of personal constructs. The control group received the same number of sessions of self-disclosure from a programmed marital enhancement text. Personal distress, marital adjustment, marital quality, and aspects of self-disclosure were measured before and after treatment. Symptoms of depression as well as somatic and compulsive complaints showed significant improvement in both groups. The wives exhibited a trend suggesting that they were making more self-disclosures to their spouses after counseling. No discernable differences in outcome were found between the marital therapy group and the control group. Marital intimacy and marital satisfaction did not improve significantly over the course of 10 therapy sessions. This study suggests that the role of self-disclosure in marital therapy needs further clarification.

Thought disorder: current assessment, techniques, and future trends.

The early accounts of thought disorder were based primarily on abnormalities in the speech patterns of schizophrenic patients. Researchers have attempted to study and assess this phenomenon based on the verbal behaviors of individuals believed to experience disordered thinking. However, verbal dysfunction may not be the most accurate means of assessing thought disorder in psychiatric patients. A review of studies which have attempted to examine aspects of schizophrenic symptomatology suggests that the self-report technique may be a viable alternative for assessing disordered thought. Schizophrenic patients are able to give accurate accounts of experiences relating to their illness. We believe that the self-report technique may provide a reliable method for thought disorder assessment. Based on this assumption, we are currently in the process of developing a self-report scale which assess 13 constructs we believe to be associated with thinking. In a small sample of subjects, the questionnaire was able to differentiate schizophrenic subjects from normals.

DSM-III in residency training: results of a Canadian survey.

The authors surveyed directors of residency training as well as residents across Canada to determine the extent to which DSM-III has been incorporated into the Canadian psychiatric residency training programs, how this has been accomplished, and the respondents' assessment of certain effects of DSM-III on residency training. This study is a replication of an earlier study done by another team in the United States. Our study indicates that, in most cases, the attitude towards DSM-III was positive: 100% of respondents described the system as useful or somewhat useful in the training settings. The most frequently selected positive features were its value as a common language, an aid in differential diagnosis, its empirical approach and specificity or clarity of the criteria. The criticisms frequently centred on the DSM-III's potential to induce a false impression of all encompassing theoretical knowledge, to be misused in a mechanistic manner as a "cookbook", and on the DSM-III's inadequacy with some patients (for example, children, neurotic disorders, and personality disorders).

The role of marital intimacy in psychiatric help-seeking.

Epidemiological studies have shown that most people with diagnosable psychiatric illnesses do not seek professional help. Symptoms of non-psychotic emotional illness, interpersonal relationship quality and personality traits have demonstrable associations. The influence of these factors on help-seeking was examined by comparing 57 psychiatric outpatients with a community sample of 90 symptomatic individuals on self-report measures of marital intimacy, life events, and personality, while controlling for symptomatology. Compared to non-patients, outpatients reported less intimacy in their marriages across a variety of relationship dimensions on the Waring Intimacy Questionnaire, and scored higher on the Psychoticism scale of the Eysenck Personality Questionnaire. Marital Intimacy level proved to be the best single predictor of patient and non-patient status, suggesting that help-seeking behaviour may be partly motivated by unsatisfactory marriages. The detection of low marital intimacy in these help-seekers might be an indication for prescribing marital therapy.

Dysthymia: a randomized study of cognitive marital therapy and antidepressants.

Preliminary data from a randomized study of the effectiveness of combined marital therapy and antidepressant medication in the treatment of dysthymic married women is presented. The study compares doxepin with placebo, and a marital therapy designed to enhance intimacy through facilitating self-disclosure between spouses with a more supportive and educational therapeutic approach. After ten weeks of combined treatment, the dysthymic women show statistically significant improvement on all the depression measures as well as on the intimacy scale. A trend is developing for greater reduction of depressive symptomatology in the group treated with self-disclosure. The evidence appears to suggest the possibility that the presence of a patient's husband as a supportive figure may of itself be a potent therapeutic manoeuvre in the treatment of dysthymic women.

The criterion validity of the Waring Intimacy Questionnaire in a psychiatric inpatient sample.

The Waring Intimacy Questionnaire (WIQ) is a 90-item self-report instrument for assessing the quality and quantity of marital intimacy. It provides a profile of the marital relationship on eight subscales as well as providing a Total Intimacy score. The WIQ is shown to have the internal structure predicted by its underlying conceptual model. In this study, it was administered to a psychiatric inpatient sample along with the Marital Satisfaction Inventory (MSI), the Short Marital Adjustment Test (SMAT), and the Dyadic Adjustment Scale (DAS). Results suggested that the WIQ demonstrated criterion validity with respect to these other instruments.

Types of marital intimacy and prevalence of emotional illness.

Epidemiological research has demonstrated that married individuals generally experience better emotional health than the single, divorced and widowed. The married populations in these studies were not evaluated on the basis of the quality of their marital relationships. Research on the interpersonal quality of marital relationships in the general married population has rarely been reported in the psychiatric literature. A sample of the general married population (n = 250 couples) completed a self-report questionnaire which measures the quality and the quantity of intimacy in marriage. Four types of marital patterns were operationally defined by total intimacy score, pattern of scale profile, and social desirability scores. The relative frequencies of these types of marriages are reported. The prevalence of symptoms of non-psychotic emotional illness in one or both spouses in the four categories of marriage is reported. Thirty-one percent (31%) of the couples report marriages with absent and/or deficient intimacy. Couples with "absent and/or deficient" marital intimacy had a significantly higher proportion of spouses with symptoms of non-psychotic emotional illness. This study suggests that previous research may have confounded the variables of marital status and marital quality in the study of psychiatric disorder. These studies may have under-estimated the positive effect of an "optimally" intimate relationship.