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Objective: To describe the development of the Thought Disorder Questionnaire (TDQ), including data on reliability and validity, and to explain the questionnaire's feasibility and diagnostic accuracy., Methods: The TDQ has 6 scales, each with 10 items (on a scale from 0 [for never] to 4 [for always]). The 6 scales measure content of thought, control of thought, orientation, perception, fantasy, and symptoms., Results: The TDQ is a reliable 60-item, self-report questionnaire that measures the quantity and quality of disordered thinking in patients with mental disorders. It has established reliability and validity., Conclusion: The TDQ's clinical and research utility remains to be determined.

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.

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 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.

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.

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.

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.

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.

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.

Recent research has suggested that the absence of an intimate, confiding relationship may be a vulnerability factor in the development of depression in women living under adverse circumstances. This study demonstrates a significant association between severity of depression and deficiencies of marital intimacy; depressed patients with the lowest levels of marital intimacy failed to improve at one month follow-up, while 36% of the spouses of the depressed patients had symptoms of non-psychotic emotional illness. The depressed patients and their spouses' perception of their marital intimacy differ, but these differences appear not to be solely related to the spouse's depression.

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 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.

The quality of sex and marital intimacy may be related to each other in ways which are not clearly understood. Some theorists have suggested that they vary positively with each other. Others have suggested an independent relationship. Two hundred and fifty couples in the community completed the Waring Intimacy Questionnaire (WIQ). Included in the WIQ is a qualitative assessment of sexual communication and fulfillment in the marriage. Weak positive correlations between sex and total intimacy were found for both husbands (r = .41) and wives (r = .39). A principal components factor analysis revealed separate factor structures for husbands' and wives' data. For the women, a single factor (intimacy) included strong loadings from all facets of intimacy defined. Their degree of sexual fulfillment was included in this factor. For husbands, on the other hand, a second factor (sexuality) accounted for 12.7% of the variance. These results suggest that discrepancies between previous studies may be a function of clinical populations being investigated, or an effect of averaging husbands' and wives' data. The results are discussed in terms of their clinical implications.

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.

Developed eight independent content scales to assess components of marital intimacy (Conflict Resolution, Affection, Cohesion, Sexuality, Identity, Compatibility, Autonomy, and Expressiveness). The measures were designed to be relatively free from social desirability and acquiescent responding (N = 248). Test retest and internal consistency reliabilities were high and sexual bias was not indicated.

A review of recent studies of family interaction as a causal factor in the development of schizophrenia suggests a paucity of evidence supporting this point of view. However, research has suggested family variables may influence the course and outcome of schizophrenia. The impact of schizophrenia on the family has recently received more attention. Some research has identified differences between families of schizophrenics and the families of other diagnostic groups and controls. Whether these studies are beginning to influence the theory and practice of family therapy is discussed. Recent studies suggest the combination of long-acting medication and 'psychosocial' interventions may reduce the relapse rate of schizophrenia in the short term. This research suggests that family therapists must re-evaluate their role in the management of schizophrenia.

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.

Examined the relationship between marital intimacy and self-disclosure from a multidimensional framework within a sample of 10 clinical and 10 nonclinical married couples. The linear combination of various parameters of self-disclosing behavior was able to account for 71.7% (R = .853) of the variance in intimacy ratings derived from a structured interview. Results are discussed in terms of both the role that self-disclosure plays in the development of marital intimacy and its therapeutic benefits and limitations in marital therapy.

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.

Ninety married couples in the general population received a structured interview to assess their level of intimacy. The couples also completed self-report questionnaires to assess non-psychotic emotional illness and marital adjustment. High levels of intimacy were associated with martial adjustment. Low ratings of marital intimacy were significantly associated with non-psychotic emotional illness and psychiatric help-seeking. These findings are discussed in relationship to recent studies which explore the role of lack of marital intimacy as a vulnerability factor in the development of non-psychotic emotional illness. Implications for treatment of non-psychotic emotional illness in married individuals is briefly discussed.

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.

Cognitive family therapy is a new short-term psychotherapy which facilitates self-disclosure. The paper defines self-disclosure and differentiates cognitive self-disclosure from self-exposure and emotional self-disclosure. The relationship of cognitive self-disclosure in facilitating marital intimacy is developed. A case history is presented which describes the therapeutic process and suggests possible future research to understand what constitutes the specific change process in Cognitive family therapy. Data from an uncontrolled outcome study involving eleven families is discussed. Results from objective self-report tests given prior to treatment and at follow-up are examined, with the outcome suggesting that cognitive family therapy merits further evaluation.

Study of social bonds suggest a causative role for their deficiency in the oetiology of non-psychotic emotional illness. The literature suggests that marital maladjustment is associated with certain neurotic and psychophysiological disorders; martial maladjustment is one type of deficient social bond which may influence symptom selection and perpetuation in non-psychotic emotional illness. Specific types of marital maladjustment, including lack of marital intimacy, are described as both vulnerability factors and perpetuating variables in specific non-psychotic emotional illnesses.

Examined differences in the self-disclosing patterns of 10 clinical and 10 nonclinical couples in a structured interview using the Self-Disclosure Coding System (SDCS), a behavioral content analysis system designed to assess the basic parameters of disclosing behavior. A discriminant function analysis revealed that two SDCS variables, (1) time spent talking; and (2) judged degree of congruence between verbal content and affective manner of presentation, could discriminate the two groups and would classify correctly 70% of the couples. These results suggest that it is not what clinical couples say, but how they say it that will distinguish them from nonclinical couples.

The early concepts of family influences in the development of schizophrenic illness have been reviewed. The empirical research which these concepts generated has failed in large measure to confirm many of these hypotheses, but has demonstrated reliable and valid differences between families of schizophrenics and those of patient and non-patient controls. However, these empirical findings have had little impact to date on family therapy as it is practised, and the failure to confirm theoretical concepts from psychoanalysis, systems, and communication theories has not led to a re-examination of family therapy and its theoretical basis. The author suggests that the empirical research on family influences in schizophrenia and particularly those factors which precipitate and perpetuate schizophrenic symptomatology can be applied to evaluation of schizophrenics and their families, specific family therapy with families of schizophrenics, and particularly suggest that evaluative research on the effectiveness of family therapy in schizophrenia will be necessary for family therapy to become more than a highly fascinating and experimental technique in the total management of schizophrenic patients.

Recent studies of marriage focusing on the development of marital intimacy and its role in the family as it influences emotional and physical health are reviewed. Marital pathology is increasingly presented in diverse and often covert ways to almost all physicians. Specific suggestions for the detection of marital discord in medical practice and its management will be presented.

Most of the elderly with psychiatric disorders are unknown to mental health facilities and untreated by psychiatrists. Many of this population may be under the care of family physicians. Psychiatric illness in the elderly patient often goes unrecognized. Physicians' attitude and training create the possibility that treatable illnesses are misdiagnosed as irreversible dementia. A more optimistic approach to the treatment and prognosis of mental disorders in the aged is warranted.