Forms of gambling,gambling involvement and problem gambling: evidence from a Swedish population survey

The purpose of this study was to explore the association between problem gambling (PG) and participation in different forms of gambling in order to elucidate relationships between PG, gambling involvement and gambling intensity. Using data from the first wave of the Swedish Longitudinal Gambling Study (Swelogs) (n = 4,991), the study tested four hypotheses, namely that (1) some forms of gambling are more closely associated with PG than other forms; (2) high gambling involvement is associated with PG; (3) gambling involvement is positively associated with the intensity of gambling; and (4) the relationship between gambling involvement and PG is influenced by the specific forms of gambling in which individuals participate. All four hypotheses were supported. More specifically, the study found that while many PGs regularly participate in multiple forms of gambling, half of PGs participate regularly in only one or two forms of gambling. The study concluded that some forms of gambling are more closely associated with problem gambling than other forms, and that gambling policy and regulation, as well as the development of responsible gambling initiatives, should focus on these forms.     

Close relationships research: a resource for couple and family therapists

This article describes the relatively new field of close relationships research, offering a representative list of topics studied by relationship researchers. Some of the common interests shared by both close relationships researchers and couple and family therapists are described, with the shared emphasis on relationships as an anchor for both fields. Some representative love theories are discussed, and Love Styles theory and research are presented in considerable detail. A clinical case example indicates how love styles research may be employed to advantage by couple therapists, and the utility of other close relationships theories and measures for therapy is briefly discussed.     

An Exploratory Study of Clinical Measures Associated with Subsyndromal Pathological Gambling in Patients with Binge Eating Disorder

Both binge eating disorder (BED) and pathological gambling (PG) are characterized by impairments in impulse control. Subsyndromal levels of PG have been associated with measures of adverse health. The nature and significance of PG features in individuals with BED is unknown. Ninety-four patients with BED (28 men and 66 women) were classified by gambling group based on inclusionary criteria for Diagnostic and Statistical Manual-IV (DSM-IV) PG and compared on a range of behavioral, psychological and eating disorder (ED) psychopathology variables. One individual (1.1% of the sample) met criteria for PG, although 18.7% of patients with BED displayed one or more DSM-IV criteria for PG, hereafter referred to as problem gambling features. Men were more likely than women to have problem gambling features. BED patients with problem gambling features were distinguished by lower self-esteem and greater substance problem use. After controlling for gender, findings of reduced self-esteem and increased substance problem use among patients with problem gambling features remained significant. In patients with BED, problem gambling features are associated with a number of heightened clinical problems.     

Pathological Gambling and Posttraumatic Stress Disorder: A Study of the Co-Morbidity versus Each Alone

This report is the first empirical study to compare pathological gambling (PG), posttraumatic stress disorder (PTSD), and their co-occurrence. The sample was 106 adults recruited from the community (35 with current PG; 36 with current PTSD, and 35 with BOTH). Using a cross-sectional design, the three groups were rigorously diagnosed and compared on various measures including sociodemographics, psychopathology (e.g., dissociation, suicidality, comorbid Axis I and II disorders), functioning, cognition, life history, and severity of gambling and PTSD. Overall, the PG group reported better psychological health and higher functioning than PTSD or BOTH; and there were virtually no differences between PTSD and BOTH. This suggests that it is the impact of PTSD, rather than comorbidity per se, that appears to drive a substantial increase in symptoms. We also found high rates of additional co-occurring disorders and suicidality in PTSD and BOTH, which warrants further clinical attention. Across the total sample, many reported a family history of substance use disorder (59%) and gambling problems (34%), highlighting the intergenerational impact of these. We also found notable subthreshold PTSD and gambling symptoms even among those not diagnosed with the disorders, suggesting a need for preventive care. Dissociation measures had mixed results. Discussion includes methodology considerations and future research areas.     

Impact of problem gambling on financial,emotional and social well-being of Singaporean families

Problem gambling has a profound impact on family members. While this has been previously documented, this paper reports on the first study to consider the extent of this impact in Asian societies where the family continues to be a very important basis for social organization. This study, based on in-depth interviews with 50 Singaporeans with a family member who is a problem or pathological gambler, examines how their financial, emotional and social well-being is impinged upon by gambling. The enormous losses of savings, property and lifestyle, the emotional tensions based on constant harassment from moneylenders, the threats of suicide by the gambler and the distancing of social networks place family members of problem gamblers in a vulnerable state. The qualitative data in this paper fleshes out the lived experience of family members and reveals the extent to which the family is mobilized in Asian societies to cope with problem gambling. While the impact of problem gambling on families is similar across societies, routine mobilization of the extended family and the greater role of public shame and embarrassment in dictating Asian families' responses underscore the need for specialized services in these societies to assist family members to better cope with the financial, emotional and social strains caused by problem gambling.     

Dyadic Research in Marriage and Family Therapy: Methodological Considerations

With training that emphasizes relationship systems, marriage and family therapists are uniquely attuned to interpersonal dynamics, interdependence, and the influence of relationships on individuals’ perceptions, beliefs, and attitudes. While recent statistical advances have contributed to a proliferation of resources designed to introduce researchers to dyadic data analysis, guidelines related to the methodological aspects of dyadic research design have received less attention. Given the potential advantages of dyadic designs for examining couple and family relational and therapeutic processes, the purpose of this article is to introduce marriage and family therapy researchers to dyadic research methodology. Using examples from our own research, we discuss methodological considerations and lessons learned related to sampling, measurement, data collection, and ethics. Recommendations for future dyadic research are provided. Video Abstract     

Clients' relational conceptions of conjoint couple and family therapy quality: a grounded formal theory

Based upon a qualitative metasynthesis of 49 articles centered on clients' experiences of their conjoint couple and family therapy, the investigators constructed a grounded formal theory of Clients' Relational Conceptions of Conjoint Couple and Family Therapy Quality. The theory suggests from pretherapy conceptions to posttherapy reflections, clients' perceptions of conjoint couple and family therapy quality appear to consist of clients' constructed meanings regarding a series of interrelated relationships between clients and their therapists and therapy environments, between clients and themselves, between clients and other family members, and between process and outcome both inside and outside therapy. Within and across these relationships, clients appear to focus on expectations, connections, balance, and change when evaluating the quality of their clinical experiences. Based upon this theory, the investigators recommend that researchers continue to explore this clinical phenomenon and that therapists regularly seek clients' conceptions of quality in therapy.     

The influence of sex,temperament, risk-taking and mental health on the emergence of gambling: a longitudinal study of young people

There are a host of complex and interlinked psychological, social and biological factors involved in the development of problem gambling (PG). While existing research, which is predominantly cross-sectional, shows that emerging adulthood is a critical period for PG, the early risk factors for PG are currently unknown. Here, we recruited a sample of 156 early adolescents with no history of PG (mean age 12.6 years) and longitudinally followed them up into late adolescence (mean age 18.9 years) to investigate the role of sex, risk-taking behaviour and changes in temperament and psychiatric symptoms in the evolution of risky gambling behaviour. There were sex-independent effects of temperament and risk-taking behaviour, with greater developmental increases in temperamental frustration (i.e. negative affectivity), greater developmental decreases in temperamental attention (i.e. effortful control) and greater involvement in risky behaviours, such as alcohol use, predicting greater likelihood of being in the risky gambling group. In addition, there were sex-dependent effects whereby higher levels of baseline aggression in females and lower levels of the same in males were more predictive of risky gambling. These findings highlight how sex-dependent and independent factors across the early- to mid-adolescent period influence the occurrence of gambling later in life.     

Pathological Gambling and Couple: Towards an Integrative Systemic Model

This article is a critical literature review of pathological gambling focused in the family factors, particularly in the couple dynamics. Its main goal is to develop an explicative integrative systemic model of pathological gambling, based in these couple dynamics. To achieve that aim, a bibliography search was made, using on-line data bases (e.g., EBSCO Host) and recognized books in pathological gambling subject, as well as in the systemic approach in general. This process privileged the recent works (about 70 % of the reviewed literature was published in the last decade), however, also considered some classic works (the oldest one dates back to 1970). The guiding focus of this literature search evolves according to the following steps: (1) search of general comprehension of pathological gambling (19 references), (2) search specification to the subject “pathological gambling and family” (24 references), (3) search specification to the subject “pathological gambling and couple”(11 references), (4) search of systemic information which integrates the evidence resulted in the previous steps (4 references). The developed model is constituted by different levels of systemic complexity (social context, family of origin, couple and individual) and explains the problem as a signal of perturbation in the marital subsystem vital functions (e.g., power and control) though the regularities of marital dynamics of pathological gamblers. Furthermore, it gives theoretical evidence of the systemic familiar intervention in the pathological gambling.     

Does gambling type moderate the links between problem gambling,emotion regulation,anxiety, depression and gambling motives

The aim of this study is to assess the link between emotion regulation, depression, anxiety and gambling motives among a population of regular gamblers, distinguishing between strategic and chance game players. We recruited 287 regular gamblers online, including both problem (PG) and non-problem gamblers (NPG). All participants completed online questionnaires to screen for problem gambling (SOGS) and to assess emotion regulation (ERQ), anxiety and depression (HADS) and gambling motives (GMQ-F). In this sample, 33.4% of participants were PG. PG scored significantly higher than NPG on the GMQ-F (except for the social subscale) and HADS, but not in ERQ. Gamblers who played both strategic and chance games displayed more frequent and severe gambling problems and had higher depression and anxiety scores than those playing only strategic games. Overall, enhancement and financial motives and depression significantly predicted PG. Finally, the study found that gambling type moderates the relationship between problem gambling and expressive suppression, depression and gambling motives. The results show the intricate relationship between gambling motives and psychiatric symptoms (in particular, depression) in PG. Mixed and strategic gamblers share common motives, but coping, financial and enhancement were stronger among PG. Finally, they emphasize the differences between different types of gamblers.     

Negative Mood States or Dysfunctional Cognitions: Their Independent and Interactional Effects in Influencing Severity of Gambling Among Chinese Problem Gamblers in Hong Kong

Gambling-related cognitions and negative psychological states have been proposed as major factors in the initiation and maintenance of problem gambling (PG). While there are a substantial number of studies supporting the role of cognitive dysfunctions in the initiation and maintenance of PG, very few empirical studies have explored the specific role of negative psychological states in influencing PG behaviours. In addition, very few studies have examined the interaction effects of cognitive dysfunctions and negative psychological states in exerting influence on PG behaviours. Therefore, the present study aims to examine the main and interaction effects of gambling-related cognitions and psychological states on the gambling severity among a group of problem gamblers in Hong Kong. A cross-sectional research design was adopted. A purposive sample of 177 problem gamblers who sought treatment from a social service organization in Hong Kong completed a battery of standardised questionnaires. While gambling-related cognitions were found to exert significant effects on gambling severity, negative psychological states (i.e. stress) significantly moderated the relationship between gambling cognitions and gambling severity. In essence, those participants who reported a higher level of stress had more stable and serious gambling problems than those who reported a lower level of stress irrespective of the level of gambling-related cognitions. The findings of the moderating role of negative emotions in the relationship between cognitive distortions and severity of gambling provide insight towards developing an integrated intervention model which includes both cognitive-behavioural and emotion regulation strategies in helping people with PG.     

Complex Couples: Multi‐Theoretical Couples Counselling with Traumatised Adults Who have a History of Child Sexual Abuse

One of the major ways child sexual abuse can have an impact on individuals is in their later ability to have and maintain fulfilling couple relationships. Survivors may experience avoidance behaviours that become problematic in their adult intimate relationships. If couple therapists fail to focus on these traumatic imprints, the therapy may founder. This paper proposes that a multi‐theoretical approach enables the couple therapist to deal with the complex problems such couples present including sexuality and intimacy concerns. Such an approach integrates trauma theory, attachment theory, feminist principles, body‐oriented psychotherapy, and systemic couple therapy.     

An integrative intervention for promoting recovery from extramarital affairs

The discovery or disclosure of an extramarital affair can have a devastating impact on partners, both individually and on the relationships. Research suggests that affairs occur relatively frequently in relationships and are a common presenting problem in couple therapy. However, despite their prevalence, there is little empirical treatment research in this area, and most therapists describe this problem as one of the more difficult to treat. In this study, we used a replicated case-study design to explore the efficacy of an integrative treatment designed to help couples recover from an affair. Six couples entered and completed treatment. The majority of these couples were less emotionally or maritally distressed at the end of treatment, and the injured partners reported greater forgiveness regarding the affair. Details of the intervention, suggested adaptations of the treatment, and areas for future research are discussed.     

Gambling Type,Substance Abuse,Health and Psychosocial Correlates of Male and Female Problem Gamblers in a Nationally Representative French Sample

Many studies carried out on treatment-seeking problem gamblers (PG) have reported high levels of comorbid substance use disorders, and mental and physical health problems. Nevertheless, general population studies are still sparse, most of them have been carried out in the United States or Canada, and gender differences have not always been considered. Thus, the aim of this study was to describe the type of games, and psychological and physical correlates in male and female PG in a nationally representative French sample. The total sample studied involved 25,647 subjects aged 15–85 years, including 333 PG and 25,314 non-problem gamblers (NPG). Data were extracted from a large survey of a representative sample of the French general population. They were evaluated for sociodemographic variables, gambling behavior, type of gambling activity, substance use, psychological distress, body mass index, chronic disease, and lack of sleep. Overall, there were significant differences between PG and NPG in gender, age, education, employment and marital status, substance use disorders (alcohol, tobacco, cannabis, cocaine and heroin), psychological distress, obesity, lack of sleep and type of gambling activity. Although male and female PG had different profiles, the gambling type, especially strategic games, appeared as an important variable in the relationship between gender and problem gambling. This research underlines the importance of considering gender differences and gambling type in the study of gambling disorders. Identifying specific factors in the relationship between gender, gambling type and gambling problems may help improve clinical interventions and health promotion strategies.     

Towards Developing a Family Therapy for Melanesia

Our principal objective is to call the attention, primarily of Australian‐New Zealand family therapists, to the relevance and the urgency of developing, promoting and providing family and/or couple therapy in the Melanesian context. We emphasise the need to take into consideration Melanesian worldviews, values and social systems. We discuss a traditional ‘mediation‐reconciliation ritual’ model of solving family or couple conflicts, and also point to some of the immediate situations in which a family therapist could intervene. A few recommendations are also made for how the academic context could be utilised to develop Melanesian family therapy.     

Therapist effects on dropout in couple therapy

Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university‐based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.     

Relationships Between Perceived Family Gambling and Peer Gambling and Adolescent Problem Gambling and Binge-Drinking

The study systematically examined the relative relationships between perceived family and peer gambling and adolescent at-risk/problem gambling and binge-drinking. It also determined the likelihood of at-risk/problem gambling and binge-drinking as a function of the number of different social groups with perceived gambling. A multi-site high-school survey assessed gambling, alcohol use, presence of perceived excessive peer gambling (peer excess—PE), and family gambling prompting concern (family concern—FC) in 2750 high-school students. Adolescents were separately stratified into: (1) low-risk, at-risk, and problem/pathological gambling groups; and, (2) non-binge-drinking, low-frequency-binge-drinking, and high-frequency-binge-drinking groups. Multinomial logistic regression showed that relative to each other, FC and PE were associated with greater likelihoods of at-risk and problem/pathological gambling. However, only FC was associated with binge-drinking. Logistic regression revealed that adolescents who endorsed either FC or PE alone, compared to no endorsement, were more likely to have at-risk and problem/pathological gambling, relative to low-risk gambling. Adolescents who endorsed both FC and PE, compared to PE alone, were more likely to have problem/pathological gambling relative to low-risk and at-risk gambling. Relative to non-binge-drinking adolescents, those who endorsed both FC and PE were more likely to have low- and high-frequency-binge-drinking compared to FC alone or PE alone, respectively. Family and peer gambling individually contribute to adolescent at-risk/problem gambling and binge-drinking. Strategies that target adolescents as well as their closely affiliated family and peer members may be an important step towards prevention of harm-associated levels of gambling and alcohol use in youths.     

Exploring the influence of the attachment organizations of novice therapists on their delivery of emotionally focused therapy for couples

Clinicians' own internal resources for understanding relationships--that is, their attachment organizations--have been found to influence the process and outcome of treatment. The current study addressed whether the attachment organizations of novice couple and family therapists were associated with couples' experiences of their therapists, therapeutic alliance, session impact, and emotionally focused couple therapy (EFT) fidelity (i.e., especially as related to targeting and working with attachment needs and overt and underlying emotions). Novice couple and family therapists delivered EFT, an attachment-based approach, to couples in a simulated session and an embedded multicase study design guided a cross-case analysis. Findings indicated that secure therapists, when compared to their insecure peers, were more competent at working with attachment needs, as well as the overt and underlying emotions of their clients. Secure therapists perceived themselves as being more skilled in emotion regulation, which may have contributed to their abilities to remain attuned to their clients' attachment needs and emotional expression, even in the face of emotional arousal in session. Couples of insecure therapists also reported greater alliance splits. Future research is needed to further explore the dyadic influences of both therapists' and clients' attachment organizations, as well as the training and supervision practices these findings implicate.     

Family Social Work: The Past and the Present

SUMMARY

It is easy to blame the dysfunction of a family member on his or her behavioral patterns. I use the title, “It's the Relationship, Stupid!” not to talk down to family therapists, but to remind myself that the source of dysfunction is usually family relationships, especially the marriage relationship. This article gives several case studies for practical application of therapy techniques that focus on developing the “WE” of the family unit. One practical technique that I developed is a communication typology. The married couple (and family members) are divided into “Painters” and “Pointers.” This typology explains much of the conflict and mis-communication that leads to the breakdown of the “WE.” This article also presents dysfunction within the individual as a relationship problem and introduces the concept of the “spirit” of the individual as expressing the relationship the person has with self.