Canadian Psychiatric Association

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Guest Editorial
Modern Views of Autism

Eric Fombonne


In Review
Autism Spectrum Disorders: Early Detection, Intervention, Education, and Psychopharmacological Management

Susan E Bryson, Sally J Rogers, Eric Fombonne


Diagnosis and Epidemiology of Autism Spectrum Disorders
Lee Tidmarsh, Fred R Volkmar


Genetic and Neurodevelopmental Influences in Autistic Disorder
Rob Nicolson, Peter Szatmari


Original Research
Attitudes of Senior Psychiatry Residents Toward Persons with Intellectual Disabilities

Hélène Ouellette-Kuntz, Philip Burge, David B Henry, Elspeth A Bradley, Pierre Leichner


The Efficacy of 2 Different Dosages of Methylphenidate in Treating Adults With Attention-Deficit Hyperactivity Disorder

Rachelle Bouffard, Lily Hechtman,, Klaus Minde, Fiorella Iaboni-Kassab


Delirium in Hospital: an Underreported Event at Discharge

Louis T van Zyl, Paul R Davidson


Brief Communication
Removing Barriers to Treatment of First-Episode Psychotic Disorders

Derek J Scholten, Ashok K Malla, Ross MG Norman, Terry S McLean, Elizabeth M McIntosh, Chris L McDonald,, Michael Eliasziw, Kathy N Speechley


Book Reviews

Couple Therapy with Gay Men.
Reviewed by
Peter Moore, MD, FRCPC

What Forever Means After The Death of a Child.
Reviewed by
Philip Cheifetz, MD, FRCPC

Fighting for Mental Health: A Personal View.
Reviewed by
Paul Grof, MD, FRCPC

Understanding the Mind: The Nature and Power of the Mind. 2nd ed.
Reviewed by
Scott Bishop, PhD, CPysch Zindel Segal, PhD, CPsych

Letters to the Editor

Response of Catatonic Schizophrenia to Amisulpride: A Case Report

Medication Noncompliance Among Psychiatric Outpatients In Iran

Diogenes Syndrome in a Pair of Siblings

Treatment Option for Seasonal Affective Disorder

Factitious Anemia and Magnetic Resonance Imaging Abnormalities

Pregnancy and Respiratory Nocturnal Panic Attacks

Book Review

Psychotherapy 2929_Greenan2.JPG - 4553 Bytes

Couple Therapy with Gay Men. David E Greenan, Gil Tunnell. New York, London: The Guilford Press; 2003. 214 p. US$30.00.

Reviewer rating*: Excellent

Review by: Peter Moore, MD, FRCPC
Toronto, Ontario

Seeing 2 men in a tender kiss is cause for most people to flinch. Guys don’t do that. Guys obey their gender script. Guys work at being strong and competitive, not soft and mushy—and certainly not with other guys.

Many boys, although not yet certain they’re gay, are sure that they don’t like their assigned rough-and-tumble role. They also know, or soon learn, that shirking this role risks shame and danger. For most, faking is the way to survive. Unique among minorities, gay youths carry their shameful secret isolated, without support from family or friends, and always fearful of being unmasked. By their teenage years, they’ve faked their way to polished inauthenticity. What then is their chance for a healthy connection with the one they long to love—their chance for an honest and intimate partnership? It is slim. Further, if the loved one does come along, who honours their union?

This welcome book explores man-to-man love and the sabotage that awaits, both by a homophobic society and by the men themselves. It also offers hope for abandoning sabotage and for building in its place strong, self-respecting, and respectful partnerships.

Eight aptly structured chapters lead the reader through “The Marginalization of Gay Couples” and the “Implications for Man-to-Man Closeness from Growing Up Gay.” A distillation of these first 2 chapters has already been offered in this review’s introductory comments. The third chapter, “Structural Family Therapy,” presents the authors’ 3-stage model for family therapy which, as they remind us, is what couple therapy really is: a couple is a family. The model explains “1) how to join with the couple, 2) how to create enactments, so the therapist can observe the couple’s complementary roles that maintain their presenting problem, and 3) how to unbalance and expand the couple’s preferred style of relating to each other.”

Joining with the couple depends on the men’s growing trust in the therapist’s respect that same-sex spouses are as valid as wives and husbands, that gay and straight unions both falter, and that both need work. However, few gay men have learned this work. When conflict arises, they often point to the other as the troublemaker. An early task for the therapist is to reframe the one-sided claim “he never pulls his weight” with a view that encompasses each partner’s harmful contributions. When the therapist asks “How can I help you as a couple?” the couple’s relationship as a viable system, a family system, is endorsed. Exploring this system, the therapist begins to identify the couple’s dynamics—the complementary behaviours that lead them repeatedly to a clumsy dance. Learning different dance steps, in fact, is the metaphor that the authors use for how the therapy progresses. Throughout the therapy, the challenge “you can do better” is reinforced.

The clumsy dance, of course, is the mutual invention of both partners. Creating an enactment exposes their invention. Seated facing each other, the couple discusses a recent troubling incident. From this discussion (enactment), complementary patterns emerge. One man, for example, is bossy, while the other is rebellious. The therapist’s asking “What brings out his bossiness?” challenges the rebel to analyze his own role in the dyad. A similar challenge is offered to the other: “How have you made your partner into a rebel?” Such questions encourage the partners to struggle for new, more adaptive ways of communicating.

New, too, is the task of unbalancing. To substitute helpful patterns for damaging ones calls for imaginative leaps. If we stay with the bossy–rebellious model, the therapist might ask the bossy one “Can you tell him what you appreciate about him?” and the rebel “Could you tell him what would draw you closer to him?” If it is understood that gay men’s own homophobia makes them wary of trusting other men, then it is understandable that they shrink from man-to-man connectedness. However, connectedness gives them a permission never known before—permission to love another man and, in loving him, to feel safety in showing dependent, vulnerable, and tender feelings.

Of the last 2 chapters, the penultimate is a moving case study of 2 men who, as they learn to unbalance their old ways, discover new ways of relating to each other as 1 partner is dying. Here we see demonstrated the principles that were laid out earlier in the book. We especially see the therapist’s sensitivity, both for intervening when appropriate and for keeping quiet when the couple needs to do the work themselves. Creating intensity and asking the men to help each other, the therapist avoids taking sides while consistently offering gentle encouragements. This chapter provides a convincing picture of the authors’ highly effective model—a model that, in its seeming simplicity, is deftly elegant.

The final chapter looks to a future when gay unions gain the same status as heterosexual marriages. The same tolerance demanded by life in our burgeoning multicultural world must apply in deconstructing the reflex bias still activating society’s homophobia. Yet, gay men themselves are biased. Their task is to honour themselves enough to take up the challenge to build health into their partnerships—the health that all partnerships need if they are to thrive and to deepen.

*Reviewer Rating Scale/ Échelle d’évaluation du réviseur

Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé


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