Nursing Reviews

Thought stopping technique
Assertive thinking is sometimes inhibited by repetitive negative thoughts of which the mind refuses to let go. Individuals with low self worth may be obsessed with thoughts such as “I am too ugly”, “I know he had never want to go out with me”, “I know I never be able to do this job well”etc. This type of thoughts rosters the beliefs that one’s individual rights do not deserve the same consideration as those of others and reflects nonassertive communication and behavioral response patterns. Thought stopping techniques was developed by psychiatrist Joseph Wolpe and are intended to eliminate intrusive, unwanted thoughts.
Method
Thought stopping is a covert techniques used to treat recurring negative or self –defeating thoughts. Thoughts of death, losing control, low self- worth, overeating and unrequited love are among problems that have been treated with these techniques. Thoughts stopping typically progresses from overt to covert control. The purpose is to block the undesired thought and redirect the client’s attention.
In a practice setting with closed eyes, an individual concentrates on unwanted recurring thoughts. Once the thought is clearly established in the mind he or she should aloud: STOP. This action will interrupt the thought and it is actually removed from the awareness. The individual then immediately shift the thoughts to one that is considered pleasant and desirable.
It is possible that the unwanted thought may recur soon, but with practice the length of time between recurrences will increase until the unwanted thought is no longer intrusive. Obviously one cannot go about his or her daily life shouting, STOP in public places. After a number of practice sessions, the technique is equally effective if the word stop is used silently in the mind.
Thought stopping is an excellent way to eliminate negative self-talk. This simple technique involves using a verbal or physical trigger to halt undesirable thinking. The most popular trigger is the word “STOP,” said out loud or to yourself. You might even try screaming “STOP” inside your head. You can also clap your hands, snap your fingers, squeeze your eyes tightly shut, think of a large red stop sign, or pop your wrist with a rubber band. Whichever you choose, your trigger allows you to break free from unproductive and debilitating thinking. Remember, that one should be consistent in your use of thought stopping. Use it every time you have irrational thoughts. As you continue to use this technique, you’ll gain control of your thinking and notice the frequency of your negative self-talk decreasing.

What is thought stopping?
Thought stopping is the:
• Process by which you are able to cease dwelling on a thought bothersome to you.
• Procedure used to stop thoughts that are cues to acting impulsively or compulsively.
• Process by which you are able to break the power of the cues that lead you into addictive or binge-like behavior.
• Substitution of a healthy thought for an unhealthy thought.
• Act of deliberately turning to cues that break unhealthy patterns or habits.
• Ability to discontinue obsessing on an idea, image, thought, fear or stimuli that is a cue for unhealthy behavior.
• Practice of using mental energy in a positive way.
• Technique used to reduce the negative impact of stress, unhealthy emotional cues, and fears.
• Stress-reduction technique that eliminates the overwhelming impact of stress and/or crisis events.

How does thought stopping work?
In thought stopping you could use one of the following or a combination of them:
• Replace one thought for another, i.e., the thought of eating is replaced by the thought of exercising.
• Hear “stop'’ literally or figuratively whenever a negative or unhealthy thought arises, e.g., the desire for a cigarette appears and “stop'’ is immediately heard.
• Are able to break an obsessive, unhealthy thought pattern by substituting a healthy thought pattern.
• Are able to replace a negative or unhealthy image with a positive visual image.
• Find you divert or detour your mind from unhealthy or negative thoughts.
• Clear your mind of all unnecessary and unhealthy thoughts that create stress or cues for acting out in unhealthy ways.
What are some thought stopping techniques?

Thought Replacement: when an unwanted thought enters, immediately replace the thought with a healthy, rational one.
Yelling ‘STOP'’: on thinking the unwanted thought, immediately yell STOP. The yell can be out loud or only in the mind. Continue to yell STOP until the unwanted thought ceases.
Substituting a Healthy Thought Pattern: if you have a tendency to think irrationally due to irrational beliefs, you can develop a rational pattern of thinking by challenging every thought that comes to mind, asking: Is this a rational thought? If not, what is irrational about it? What would be a rational replacement for this thought?

Replacement Visual Image: if you have a tendency to visualize negative images, replace these negative images by positive, healthy images.
Aversive Replacements: if you have a tendency to think of an unhealthy behavior in an acceptable manner, immediately replace these acceptable images with more honest images, i.e., thoughts of alcohol, drugs, junk foods can be replaced by the words “poison,'’ “unhealthy,'’ “disgusting,'’ “barf'’ or “killers.'’ Thoughts of cigarettes can be replaced by “cancer sticks'’ or “coffin nails.'’
Irrational thinking which blocks you from letting thought stopping work for you
• It’s OK if I just think about it and do nothing about it.
• What’s the harm of thinking about it?
• People will never know if I just think about it for a little while.
• I’ve denied myself so much, why can’t I just think about it once in a while?
• You can’t condemn me for thinking.
• I never thought about it before I acted so why should I avoid thinking about it now?
• It is too much of a battle to fight these thoughts. It’s easier to give in and then start over again in the morning.
• What difference does it make if I think about it?
• It seems so silly to control my mind from having thoughts about it.
• This feels like brainwashing and I think brainwashing is bad.
• I don’t have time to do this.
• I don’t need this in order to be successful in achieving recovery.
• This is another far-out psychological gimmick-too stupid to try.

Directions for thought stopping

First: Use relaxation training and breathing exercises to get yourself relaxed. It is important that you be at ease to stop a recurring thought.

Second: Record the word stop in alternating 1, 2, and 3 minute intervals on a 30 minute tape. Using the stop tape in a relaxed state, think your unwanted thought and every time you hear stop, discontinue the thought. Go back to the thought again and cease the thought only when you hear stop. Do this for 30 minutes every night for two weeks or until you can consistently discontinue the thought when you hear stop.

Third: After you are trained to arrest your thought using the stop tape, you are ready to try arresting your thought by yelling stop out loud. Think of your unwanted thought for 30 minutes and yell stop to discontinue the thought. Once you arrest the thought, go back to thinking about it for awhile, then yell stop again. Do this for 30 minutes each night for two weeks or until you are able to consistently discontinue the thought by yelling stop.

Fourth: After you have trained yourself to stop thoughts by yelling stop, you are ready to train your thoughts to end by whispering stop. For thirty minutes, repeat the process of dwelling on your unwanted thought, but this time whisper stop to halt them. Do this 30 minutes nightly for two weeks or until you are able to consistently discontinue the thought by whispering stop.

Fifth: After you have trained yourself to discontinue unwanted thoughts by whispering stop, you are ready to train your thoughts to discontinue by thinking the word stop. Repeat the process of dwelling on your thought for 30 minutes, but this time simply think stop to discontinue unwanted thoughts. Do this for 30 minutes nightly for two weeks or until you are able to consistently discontinue unwanted thoughts by thinking the word stop.
Sixth: The technique of either taping, yelling, whispering, or thinking stop can be effective in discontinuing unwanted thoughts. Ideally you could get to the point where simply thinking stop would work; however, use whichever mode works best for you and keep practicing. Remember to start the process in a relaxed state.

Bibliography  Stuart GW. Laraia MT. Principles and practice of psychiatric nursing. 1st edn. Noida. Mosby publishers.2001
 Townsend MC. Psychiatric mental health nursing. 3rd edn. Philadelphia. FH Davis publishers.

Introduction
Family has long been recognised as a fundamental unit of social organisation in the lives of humans. The significance of family factors in the maintenance as well as the treatment of mental disorders has been established by many studies. Family therapy is any intervention that focuses on altering the interactions among family members and attempts to improve the functioning of the family as a unit of individual members of the family. The term ¡¥family therapy’, coined by the American psychiatrist Nathan Ackerman in the 1950s, covers a variety of approaches and is practised by a variety of professionals. Family psychopathology reflects recurring, problematic interactional patterns among family members. Several or all of the family members take part in this treatment. Usually both parents are involved, often together with a child whose problems have made the family to seek help.

History
The origins of family therapy are vague. The beginning of family interventions can be traced to the Child-guidance and marriage counseling movements in early 1900s. Sigmund Freud (1909/1977) was the first among to include a parent in the psychotherapy of a child. Freud explained about marital and family relationships and their possible roles in both individual normal development and psychopathology. Freud’s description of unconscious processes like introjection, projection, and identification explained how individual experiences could be transmitted across the generations in a family. Freud’s successors, Anna Freud, Melanie Klein, and Donald Winnicott, elaborated and modified his formulations.

The Aims of Family Therapy
The aim of the treatment is to alleviate the problems hat led to the disorder in the identified patient and improve family functioning. Family therapy is advised not only to resolve problems and difficulties but also to teach the family to solve further impasses by itself, to communicate more clearly with one another, to develop strategies for avoidance of conflicts, to accept another¡¦s handicaps and differences without blaming and scapegoating, and to foster functional processes for appropriate balancing of competing values such as family cohesiveness and individuation, balanced separateness and togetherness, stability and flexibility (Bodin, 1984).

Models of Intervention
Many models of family therapy exist, none of which superior to others. Whatever the methods, family therapist have the following goals for the family: (a). improved communication, (b) improved autonomy for each member, ©. improved agreement about roles, (d). reduced conflict, and (e).reduced distress in the member who is the patient

1. Psychodynamic methods
These methods use concepts taken from the psychoanalytical treatment of individual patients. it is assumed that current problems in the family originates in the separate past experiences of its individual members, particularly those of t he parents. Present problems arise in part from unconscious conflict within individual members. Family members need to gain insight in these conflicts in order to change their behaviour. The therapist¡¦s goal is to help members to gain these insights into their own unconsciousness, and into the ways in which one person¡¦s problems may interlock with those of other. The therapist does this by examining the relationship between himself and the different family members to throw light on the conscious aspects of the problems. The therapist may give interpretations but is not directive.

2. Bowen Model
Murray Bowen called his model family systems. Here the person¡¦s differentiation form his family of origin., their ability to be their true selves in the face of familial and other pressures that threaten the loss of love or social position. Problem families are assessed on two levels: the degree of their enmeshment versus the degree of their ability to differentiate and the analysis of emotional triangles in the problem for which they seek help. An emotional triangle is defined as a three-party system arranged so that the closeness of two members expressed as their love or repetitive conflict tends to exclude the third. Emotional cross currents can happen when the excluded person tries to join one of the other. The therapist¡¦s role is, first , to stabilise or shift the ¡§hot¡¨ triangle and second to work with the most psychologically available family members, individually if necessary , to achieve enough personal differentiation so hat the hot triangle does not recur. Therapist has to keep his neutrality. Bowen also originated the ¡¥genogram¡¦.

3. Structural family model
The term family structure refers to a set of unspoken rules that recognise the ways in which family members relate to one another. Some rules determine the hierarchy in the family. Some rules determine cooperation in the family. Rules also determine the boundaries: sometimes these are broken, for example when an unhappy wife involves her son involves her son in the problems with her husband. In structural family therapy, hypotheses are presented to the family in a paradoxical way: for example, ¡¥you seem to be very dependent on your wife: what does she do to make you feel less competent?¡¦ Some interventions may increase family tension in the short term until a new set of rules is established.

4. General Systems model
It is based on the General systems theory originally developed by Von Bertalanffy (1962). It is the study of the relationships between and among interacting components of a system that exists over time. The family is construed similarly as a system. Families have external boundaries and internal rules. Every member presumed to play a role (spokesperson, persecutor, victim, rescuer, symptom bearer, nurturer), which is relatively stable, but which member each role may change. Some families scapegoat one member by blaming him or her for the families problems. The general systems model overlaps with some of the other models, particularly Bowen and Structural models.

5. Eclectic Methods
Comprehensive review of outcome research suggests that many models equally effective in most situations. But levels of effectives vary with variety of clinical problems. But often a combined approach is used in practice.

Indications for family therapy
Family therapy is a mode of psychological treatment, and does not constitute a unitary approach. The problem in relating can involve a couple, a parent¡Vchild dyad, siblings, or any member of the family.
Six categories can be listed as indication of family therapy:

1. The clinical problem manifests in explicitly family terms, i.e. family dysfunction. For example, a marital conflict dominates; with repercussions for the rest of the family; or tension between parents and an adolescent child dislocates family life with everyone get involved in the prevailing conflict. Here family therapy is the treatment of choice.

2. The family has experienced a major stressful or disruptive life event, which has led or is leading to dysfunction. These events are either predictable or accidental and include, for instance, accidental or suicidal death, severe financial embarrassment, diagnosis of a serious physical illness, the unexpected departure of a child from the home, and so forth. As such, any family equilibrium that previously prevailed has been disturbed; the ensuing disequilibrium becomes associated with family dysfunction and/or the development of symptoms in one or more members.

3. Continuing demanding circumstances in a family are of such a magnitude as to lead to poor or inappropriate adjustment. The family’s resources may be stretched to the hilt; external sources of support may be scanty or unavailable. Typical situations are chronic physical illness, persistent or recurrent psychiatric illness, and the presence in the family of a frail elderly member.

4. An identified patient may have become symptomatic in the context of a poorly functioning family. Symptoms are an expression of that dysfunction. Depression in a mother, an eating problem in a daughter, alcohol misuse in a father, on family assessment, are adjudged to reflect underlying family difficulties.

5. A family member is diagnosed as having a specific conventional condition such as schizophrenia, agoraphobia, obsessive¡V compulsive disorder, or depression-the complicating factors are the adverse reverberations in the family stemming from that diagnosis. For example, the son with schizophrenia taxes his parents in ways that exceed their ¡¥problem-solving’ capacity; an agoraphobic woman insists on the constant company of her husband in activities of daily living; a recurrently depressed mother comes to rely on the support of her eldest daughter. In these circumstances, family members begin to respond maladaptively towards the diagnosed relative, which paves the way for deterioration of his condition, manifest as chronicity or a relapsing course.

6. Thoroughly disorganized families, faced by many problems, are viewed as the principal target of help. E.g. one member abuses drugs, another is prone to violence, and a third manifests antisocial behaviour.

Contraindications for family therapy
These are more straightforward than indications.
1. The family is unavailable because of geographical dispersal or death.
2. There is no shared motivation for change. One or more family members may wish to participate, but their chances of benefiting from a family approach are likely to be less than if committing themselves to individual therapy. (Need to distinguish here between poor motivation and ambivalence; in the latter, the assessor teases out factors that underlie the ambivalence and may encourage the family’s engagement.)
3. The level of family disturbance is so severe or long-standing, or both, that a family approach seems prognostically futile. For example, a family that has fought bitterly for years is unlikely to engage in the constructive purpose of exploring their patterns of functioning.
4. Family equilibrium is so precarious that the inevitable turbulence arising from family therapy is likely to lead to decompensation of one or more members; for example, a sexually abused adult may do better in individual therapy than by confronting the abusing relative.
5. The patient is too incapacitated to withstand the demands of family therapy. The person in the midst of a psychotic episode or someone buffeted by severe melancholia is too affected by the illness to engage in family work.

Structure & Composition of Therapy
o Family therapy may be conducted with:
o one patient or client present (e.g., Bowen family systems therapy),
o may be limited to the nuclear family (e.g., behavioral, psychoanalytic), or
o may even be transgenerational (e.g., structural, symbolic-experimental):
o combined therapies (e.g., individual and family) are more common.
o Most family therapy is conducted by a single therapist, though co-therapy (especially of one male and one female therapist) is somewhat common in training centres, and is even preferred in some family therapy approaches (e.g., contextual, symbolic-experiential).
o The length of family therapy ranges from ideal courses of fewer than ten visits (e.g., Mental Research Institute brief therapy) to up to dozens of visits (e.g., Bowen family systems) or even hundreds (e.g., psychoanalytic) over several years.
o Most family and couple therapy lasting 10 to 20 sessions over a period of less than 6 months.
o Family therapy is typically conducted in private offices and clinics but not uncommonly takes place on hospital wards and even in family homes.

The Process of Family therapy
Steps in the process of family therapy include: assessment and goal-setting, formulation of hypothesis, working phase, evaluation, termination. These steps may overlap as hypotheses can be formulated during the process of assessment. Similarly, evaluation and assessment can be done anytime during working phase.

1. Assessment and Goal-Setting
Family assessment, an extension of conventional individual psychiatric assessment, adds a broader context to the final formulation. It has four phases.
* History from the patient
* A provisional formulation concerning the relevance of the family
* An interview with one or more family members, and
* A revised formulation.

A. History from the patient
The most effective way to obtain a family history is by constructing a family tree. Apart from showing the family structure, it allows further information to be added summarising important events and a wide range of family features. Personal details can be recorded for each family member such as age, date of birth and death, occupation, education and illness, as well as critical family events (for example, migration, crucial relationship changes, notable losses, and achievements), and the quality of relationships.

Following questions gives more information:
o Who knows about the problem?
o How does each of them see it?
o Has anyone else in the family had similar problems?
o Who have you found most helpful, and least helpful thus far?
o What do they think needs to be done?

The presenting problem and changes in the family
Questions aimed at understanding the current context include:
o What has been happening recently in the family?
o Have there been any changes (e.g. births, deaths, illness, losses).
o Has your relationship with other family members changed?
o Have relationships within the family altered?’

B. The wider family context
* Questions about the family’s response to major events can be posed: for example, ¡¥How did the family react when your grandmother died? Who took it the hardest?
* Relationships should be explored at all levels, covering those between the patient and other family members and between those other members themselves.
* Conflicted ties are particularly illuminating. Understanding the roles’ taken by members is also useful: ¡¥Who tends to take care of others? Who needs most care? Who tends to be the most sensitive to what is going on in the family?’

C. The family in problem maintenance
Interactions revolving around the patient’s illness may act to maintain it.
* First, the illness becomes a way of ¡¥solving’ a family problem.
o E.g. Anorexia nervosa in a teenager due to attend a distant university may lead to her abandoning this plan since she feels unable to care for herself. Were she to leave, parental conflict would become more exposed and her mother, with whom the patient is in coalition against her father, would find herself unsupported. The illness therefore keeps the patient at home and enmeshed in the parental relationship, and also provides a focus for shared concerns and an ostensible sense of unity.
* Maintenance of the illness does not solve a family problem, but may have done so in the past.
o In the previous example, the father’s mother died 9 months later. His wife subsequently expressed feelings of closeness, feelings not experienced by him for years; their relationship gradually improved. Both parents, however, continued to treat their daughter as incapable of achieving autonomy, reinforcing her own uncertainty about coping independently if she were to recover.

D. The family interview
* A non-judgemental stance is important.
* Introductions are made in the initial phase.
* Names and preferred modes of address are clarified.
* The therapist then explains the meeting’s purpose, details of which may crucially influence future family participation.
* The therapist invites everyone to share their views about the nature and effects of problems they have encountered.
* The therapist may have an idea about how the identified patient’s problems relate to family function, and can test it out by asking probing questions and observing interactions.
* This idea is characteristically kept private since it is unhelpful for a hypothesis to be put forward prematurely.
* Triadic relationships can be scrutinized both through questioning (what does A do when B says this to C?) and observation (what does A do when B and C reveal tensions?).
* A third person may be asked to comment on what two others convey to each other when a particular event occurs.
* The discussion then extends to all spheres of family life: beliefs, traditions, rules, and values.
* Concerns are attended to and the members strengths and efforts acknowledged.
* The interview concludes with a summary of what has emerged.
* Arrangements are made for a follow-up session.

E. Revised hypotheses formulation
* Since more information becomes available at each level, the initial formulation can be revised as necessary.
* The five observational levels of structure, transitions, relationships, patterns of interaction, and global family functioning are re-examined in terms of the family as reactive, resourceful, or problem-maintaining.
* Appropriate interventions can be planned, at least for a follow-up session. We can now turn to the course of typical family therapy.

Working Phase
Based on the theoretical orientation of the therapist, intensity of the problem and information gathered in the assessment phase, therapy progresses. There can be altercations among the members, but the therapist should intervene only when required. Observation of the interaction of family members help the therapist to verify the information already gathered. Depending on the assessment made in the initial session, therapist can decide on the number of sessions.

Termination
A regular review of goals help the therapist in planning the final phase. If objectives are clear and the process is moving towards the termination is easy. Follow up may be required on regular basis.
Role of the family therapist
Beels and Ferber, among the first observers to consider various roles for family therapists, divided them into ‘conductors’ and reactors’.
* The therapist as a conductor is represented in the work of practitioners like Satir, Bowen, and Minuchin. Satir emphasises on communication, the family therapist is a teacher who shares expertise in optimal communication by setting goals and the direction of treatment. The therapist is an explicit authority, who intervenes actively in implementing change.
* The therapist as reactor plays a different role by resonating with, and responding to, what the family manifests. Therapists in the psychoanalytical tradition belong to this group. Typically, the therapist shares observations about patterns of interaction and relating that emerge during the sessions.
Problems encountered in therapy
* Family treatment does not always succeed. Indeed, deterioration may occur, albeit in a small percentage of cases.
* What common difficulties are encountered?
o Missed appointments may punctuate the course of therapy, often linked to turbulent experiences between sessions or apprehension about what a forthcoming session may reveal.
o Like any psychotherapy, drop-out is possible. On occasion, this is appropriate in that the indication for family therapy was misconstrued. In other circumstances, drop-out is equivalent to failure and may derive from such factors as therapist ineptitude, unearthing of family conflict which they cannot tolerate, and inappropriate selection of family therapy based on faulty assessment.
o The family’s dysfunction may be so intractable that it proves impervious to change, the family may lack the psychological sophistication required, members may retreat in the face of change because of insecurity..
o Dependency becomes a problem as the family discards any vestige of autonomy and encounters a greater security when relying on the authority of the therapist
o Finally, part of the family may harbour a secret that threatens the principle of open communication between members

Marital (Couple) Therapy

The term marital therapy implies treatment for husband and wife. Couples or marital therapy is a form of psychotherapy designed to psychologically modify the interaction between two persons who are in conflict with each other on a variety of parameters-social, emotional, sexual, or economic. The problem is conceived as resulting from the way partners interact, and treatment is directed to that direction. The stages through which marriage passes: first living together, then bringing up children, and finally readjusting when children leave home. At any of these stages marital conflicts may emerge. The goals include alleviation of emotional distress and disability and to promote the level of well-being of both partners together and of each as an individuals.

Types of therapies
1. Individual therapy
Here the partners may consult different therapists, who do not necessarily communicate each other. The goal of the therapy is to strengthen each partner¡¦s adaptive capacities. At times only one of the partners may be in treatment.
2. Individual Couple Therapy
In individual couple therapy, each partner is in therapy, which is either concurrent with same therapist or collaborative, with each partner seeing a different therapist.
3. Conjoint Therapy
The most common method in couple therapy, either one or two therapist treat the partners in joint sessions.
4. Group Psychotherapy
Group usually consists of three to four couples and one or two therapists. The couple identify which each other and recognise that others have similar problems, each gain support and empathy from fellow group members of the same or opposite sex.
Indications
o Problems in communication between partners are a prime indication for couples therapy.
o Conflicts in one or several areas, such as partner¡¦s sexual life
o Difficulty in establishing satisfactory social, economical, parental or emotional roles implies that the couple needs help.
Contraindications
o Patients with severe psychosis, particularly with paranoid element
o Marriages in which one or both partners really want to divorce
Effectiveness of Family Therapy and Couple Therapy
¡V Schizophrenia
o Research has demonstrated unequivocally the effectiveness of a range of psychoeducational and behavioral treatment methods that teach family members about schizophrenia, and emphasize the reduction of expressed emotion and the enhancement of skills for coping with stress. These psychosocial methods are used in conjunction with medication.
¡V Mood Disorders
o Psychoeducational methods have recently shown promise in the family treatment of bipolar I disorder as well as schizophrenia.
* Substance Abuse
o family therapy for opiate addicts showed that a decrease in drug use and related behavior problems, and increased social functioning.
* Anxiety Disorders
o The inclusion of the spouse of the patient with agoraphobia in therapy sessions, appears to lead consistently to lower dropout rates and more reliable practicing of exposure. In addition, spouse involvement in cases that are accompanied by marital distress may help to reduce marital tension, which in turn may make symptomatic spouses less anxious overall.
* Marital Discord
o Since as many as 40 to 50 percent of the reasons for adults seeking mental health services may involve marital dissatisfaction, marital conflict constitutes a significant condition.
* Sexual Dysfunction
o Conjoint couples sex therapy is well established as the treatment of choice for common sexual dysfunction as premature ejaculation, vaginismus, primary female orgasmic disorder, and secondary erectile dysfunction. On the other hand, ejaculatory inhibition, primary erectile disorder, secondary orgasmic dysfunction, and problems of inhibited sexual desire are not so effectively dealt with by conjoint therapy.
Childhood Conduct Disorders
o Behavioral Parent Training -places central emphasis on learning¡Vtheory-based contingency management procedures, in which parents are taught essential parenting skills for providing appropriate consequences for desirable and undesirable child behaviors
o Delinquency and Substance Abuse
Other Indications
o Dealing with the process of marital separation and divorce, addressing the complexities of remarriage and stepfamily life, crises of mid-life adaptation, extramarital affairs, cross-cultural transitions, and chronic non-psychiatric conflict

Conclusion
Family therapy and couple therapy has developed substantially since the 1950s. the effectiveness of these method of treatment has been proven through many studies. Current practitioners do not strictly adhere to any theoretical approaches, rather an eclectic approach is mostly used.

References
Books
1. Ackerman, N.W. The psychodynamic of family life. Basic Books, New York, 1958.
2. Bowen, M. Family therapy in clinical practice. Aronson, New York.1971, 1981.
3. McGoldrick, M. and Gerson, R.. Genograms in family assessment. Norton, New York, 1985.
4. Bloch, S., Hafner, J., Harari, E., and Szmukler, G. The family in clinical psychiatry. Oxford University Press, 1994.
5. Satir, V. Conjoint family therapy. Science and Behaviour Books, Palo Alto, CA,1967.
6. Beels, C. and Ferber, A. Family therapy: a view. Family Process, 8, 280¡V332. 1969.
7. Wolberg, L.R.. The techniques of psychotherapy ,4th Edn. Harcourt Brace Jovanovich, New York, 1988.
8. Videbeck, SL. Psychiatric Mental heath Nursing 2nd edition. LWW Philadelphia 2004.
9. Gelder M., Gath D., Mayou R., Owen P. Oxford Textbook of Psychiatry. Third Edition. Oxford University Press. New delhi 2000.
10. Gurman LS. LEBOW, JL. Family and couple therapy. In.Saddock BJ &. Sadock VA Eds. Comprehensive textbook of psychiatry. 7th ed Vol.2. baltimore: Lippincott Williams & Wilkins. 200:2356.
11. Videbeck, SL. Psychiatric Mental heath Nursing 2nd edition. LWW Philadelphia 2004.
Journals
12. Gurman, A. and Kniskern, D. (1978). Deterioration in marital and family therapy: empirical, clinical, and conceptual issues. Family Process, 17, 3¡V20.
13. Jenkins, H. (1989). Precipitating crises in families: patterns which connect. Journal of Family Therapy, 11, 99¡V109.

Unani medicine was developed as a healing system by an Arab physician Abu Sina (Avicenna). This system is widely recognized and practiced in India. It was introduced into India in the 7th century A.D. and was well developed as a system during the Mughal period. Apart from the literary works done on the Unani medicine during this period, several hospitals were also established by Mughal emperors and nobles in various parts of the country(1).
Unani medicine is very close to Ayurveda. Both are based on theory of the presence of the elements (in Unani, they are considered to be fire, water, earth and air) in the human body. These elements are present in different fluids and their balance leads to health and their imbalance leads to illness.
Mental health has much emphasis in the Unani medicine. This system has eight specialized branches as:• internal medicine (Moalijat), gynecology including obstetrics and pediatrics, diseases of the head and neck, toxicology, psychiatry, rejuvenation therapy including geriatrics, sexology, regimental therapy, dietotherapy, and hydrotherapy.
Najabuddin Unhammad (1222 A. D), an indian Unani physician, described seven types of mental disorders viz. :-Sauda-a- Tabee(Schizophrenia); Muree Sauda (depression); Ishk ( delusion of love); Nisyan (Organic mental disorder); Haziyan (paranoid state); Malikholia-a-maraki (delirium). Psychotherapy was known as Ilaj-I-Nafsani in Unani Medicine(2).
Drugs of mineral origin, especially gems, are extensively used in Unani Medicine, both as single drugs and as compound formulations. Jawahir Mohra (JM) is an anti-stress Unani preparation, containing a few herbal and animal ingredients also. Therefore, the present investigation indicates that the gem-containing Unani compound JM has significant anti-stress activity of a non-specific type against diverse stressors. This could be due to adaptogenic activity of the preparation. The study also shows that the gems in JM contribute significantly to its anti-stress activity (3).
Myristica fragrans Houtt. (nutmeg) has been mentioned in Unani medicine to be of value in the management of male sexual disorders. The present study thus provides a scientific rationale for the traditional use of nutmeg in the management of male sexual disorders(4).
Silver was used in ancient medicinal systems like unani for the treatment of neuropsychiatric disorders. Kushta Nuqra, a Silver preparations used in Unani-Tibb showed anticataleptic, anti-anxiety and anti-aggressive properties along with growth promoting effects without gross or subtle toxicities, weight loss, sedation, motor deficit, or ill effects on cognitive functions (5).
Traditional gold preparations used in Unani are found to be having anti-cataleptic, anti-anxiety and anti-depressant effects with wide margin of safety (6).

References
1. Ahmad G., Amin KM, Khan NA, Tajuddin .The anti-stress activity of a gem-containing Unani formulation against diverse stressors. J Ethnopharmacol. 1998 Jan;59(3):187-93.
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