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By W. Giores. Carthage College.

This integrative contempo- rary approach is part of the new revolution in couple therapy cheap 100caps geriforte syrup with mastercard greenridge herbals, in which the terrain and repair of adult relationships is no longer a mystery but a charted domain where the couple therapist can guide and support couples in their struggle for a more secure bond buy 100 caps geriforte syrup with amex herbals for kidney function. Empirically supported couple and family interventions for marital distress and mental health problems. Toward a mini-theory of the blamer softening event: Tracking the moment-by-moment process. Emotionally focused interventions for couples with chronically ill children: A two year follow-up. The scientist-practitioner model in marriage and family therapy doc- toral programs. Pulling on the heart strings: An emotionally focused ap- proach to family life cycle transitions. Emotion-focused therapy for couples in the treatment of depression: A pilot study. Attachment in an organizational framework for re- search on close relationships: Target article. Bonds or bargains: Relationship paradigms and their signif- icance for marital therapy. Family therapy saves the planet: Messianic tendencies in the family systems literature. Emotionally focused couple therapy with trauma survivors: Strengthening attachment bonds. Introduction to attachment: A therapists guide to pri- mary relationships and their renewal. Attachment injuries in couple re- lationships: A new perspective on impasses in couple therapy. The development and implementation of an affect regulation and attachment intervention for incarcerated adolescents and their parents. Towards a developmental family therapy: The clinical utility of research on adolescence. The feminist/emotionally focused therapy prac- tice model: An integrated approach for couple therapy. CHAPTER 12 Strategic and Solution-Focused Couples Therapy Stephen Cheung OUPLES THERAPY IS very complex. Couples therapy must be sensitive to and simultaneously address a myriad of variables, such as the Cfirst person’s unique life challenges, personal developmental stage, and interpersonal style vis-à-vis those of the second person; the couple’s collective challenges; the couple’s progress in their developmental life cycle; the interaction between the couple; and the interaction between the first person and/or the second person with another outside the couple re- lationship. These variables all impact the couples and the way they per- ceive their problems and their resources to solve their problems (Berg & de Shazer, 1993; Berg & Miller, 1992; Carter & McGoldrick, 1999; Haley, 1973, 1987, 1990, 1996; Madanes, 1981, 1990, 1991; O’Hanlon & Weiner- Davis, 1989). From the inception of psychotherapy until recently, many therapists had a one-size-fits-all mentality toward couples therapy and individual therapy in general. In other words, therapists tended to believe that one kind of therapy would be suitable for all couples and that one type of therapy would adequately address all problems between these couples. However, in the twenty-first century, therapists, informed by modern and postmodern schools of therapy, are more humble and realis- tic, and have rejected the one-size-fits-all approach. Instead, they realize their own limitations and those of their favorite therapy approaches (Cheung, 2001; Corey, 2004; Ivey, D’Andrea, Ivey, & Simek-Morgan, 2002; Prochaska & Norcross, 2003). They further respect the phenomenal world of the individual and trust his or her ability to solve problems. In 194 Strategic and Solution-Focused Couples Therapy 195 this zeitgeist, this chapter presents strategic and solution-focused couples therapy (SSCT) and discusses how SSCT can be beneficially applied to couples. SSCT selectively integrates principles from two therapy ap- proaches: namely, strategic couples therapy (SCT) and solution-focused therapy (SFT). A brief review of the existing theoretical and clinical literature on SCT is first described. Next comes a brief review of the existing theoretical and clinical literature on SFT.

However order geriforte syrup 100caps online zip herbals, the contractility of the myocardium is also a function of the stroke volume that results from the heart wall tension produced during diastole and the force of contraction during systole geriforte syrup 100 caps visa herbals on demand shipping. It is both the rate and force of contraction of the myocardium that determine the oxygen demand or uptake (MVO2) of the heart (Froelicher and Myers, 2000). Hence, the per- formance of the ventricles is determined by the amount of pressure that can or needs to be created during systole. The systolic pressure therefore provides an indirect means of indicating the force of contraction. A practical index of myocardial strain has thus been described as the product of HR and systolic blood pressure and given the single term rate pressure product (RPP) or double pressure product (Gobel, et al. In this study, the use of systolic blood pressure in conjunction with HR provided a better index of MVO2 than HR alone. From a practical perspective, the concept of MVO2 and rate pressure product is best highlighted when comparing upper body and lower body exer- cise. This is due to the smaller vascular bed in the arms, compared to the legs, and the added isometric contractions in the thoracic region to provide a stabilising base for the shoulder joints and muscles. Therefore, if an individual exercises at his or her set target HR with Exercise Physiology and Monitoring of Exercise 57 the upper body, rather than with the lower body, the result will be a higher systolic pressure, giving rise to a greater rate pressure product or MVO2. For example, if a patient’s target HR is 120 beats·min-1, and during lower body exercise their systolic blood pressure is 150mmHg, then the rate pressure product will equal 18000 (120 ¥ 150). Knowing that upper body exercise will have a greater systolic blood pressure (perhaps 165mmHg), then at the same target HR of 120 beats·min-1 the rate pressure product would be 19800 (120 ¥ 165). This represents a 10% increase in myocardial oxygen demand, which is equivalent to raising a person’s HR by 7 to 10 beats·min-1 during lower body exercise, such as walking or cycling. This example shows that it would be wise to reduce the target HR by 5-to- 10 beats·min-1 during activities involving the arms. Furthermore, this may also prevent unnecessary muscular fatigue, as it has been shown that, for a variety of reasons, both healthy individuals and cardiac patients are metabolically less efficient during activities that involve the arms compared with the legs (Secher, 1993; Kang, et al. OTHER CONSIDERATIONS FOR HEART RATE MONITORING ASSOCIATED WITH CHANGES IN MYOCARDIAL PERFORMANCE Figure 3. For the healthy individual, although stroke volume reaches a maximum at about 50 to 60% of VO2max, myocardial performance is preserved as HR continues to rise towards maximal levels. In an attempt to preserve cardiac output, HR rises in an acceler- ating manner, which further decreases diastole and thus myocardial perfusion time. The risk of ischaemia is heightened and/or blood pressure does not rise to meet the circulation required for the aerobic demands of the muscles. Not only does the HR rate shorten diastole that can affect myocardial perfu- sion, but it can also reduce ventricular filling (Poulsen, 2001). Reduced ven- tricular filling leads to reduced stroke volume by way of the Frank-Starling mechanism, and hence myocardial performance may not match the circula- tory needs of the exercise being performed. The change in rate pressure product has also been demonstrated to behave similarly to ejection fraction (as seen in Figure 3. This finding corresponds with the original concept of the heart rate turn-point reported by Conconi, et al. However, some debate exists over its merits as a means of estimating the lactate threshold because the relationship may be strongly dependent on the exercise testing protocol used (Bodner and Rhodes, 2000). Nevertheless, from a myocardial perspective, there is no doubt in all these reports that at higher intensities, HR does not continue to rise in a linear fashion, which provides the evidence of a decreased myocardial performance. For the practitioner this means that encouraging patients to work at high HR is not prudent in the early stages of CR. For a few cardiac patients, over many years of progressive overload aerobic training, higher heart rates can be attained and are safe (Thow, et al. THE PRACTICALITIES OF SETTING TARGET HEART RATES From ETT results, the HRpeak can be used in either the %HRpeak or %HRRpeak (Karvonen HR reserve method) formulas. If a true maximal HR has been attained, then the annotation would be %HRmax or %HRRmax, respectively. When using the age-estimated maximal HR formula of 220 minus age (years) or the formula recommended by Tanaka, et al. The Karovonen heart rate reserve method for determining a target HR, which can be used from either an exercise test peak HR (HRpeak), a maximal HR (HRmax), or from the age estimated HRmax formulas above, is as follows: Target heart rate = %target ¥ (HRpeak/max - HRrest) + HRrest %target = the desired percentage (e.

Geriforte Syrup
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