The medical model traditionally emphasizes individual biological disease and is often unable to attend to the many ways illness impacts families and couples. Due to the focus on the biological process of disease, couples often struggle with the relational experience of illness. Quantitative research has provided ample evidence that couples coping with chronic illness from a relational orientation experience more positive outcomes than couples that cope individually. In this study, 25 therapy videos were analyzed with particular attention to how couples with liver disease work in therapy to shift to a relational illness orientation. Analyzed through a feminist lens, the results identify barriers to reciprocal caregiving: (a) autonomy discourse, (b) illness-related power, and (c) gendered power. Specific interventions that therapists employed to counterbalance the barriers were also identified: (a) emphasizing shared and relational processes, (b) counterbalancing the illness-related power, and (c) intervening in the taken-for-granted gendered power processes through therapist leadership. These main counterbalancing practices are further deconstructed into a number of in-the-moment actions that therapist utilize. For example, under the first category of emphasizing shared and relational processes, therapist introduce relational engagement as an alternative possibility, set relational goals, and emphasize the shared process of liver disease. Implications suggest that training, supervision, and practice need to address the importance of employing techniques that recognize and counterbalance (a) the influence of Western cultural values of autonomy, (b) illness-related power that organizes the couple system, and (c) the impact of gendered power on couples processes. Keywords: Couple therapy, relational coping, gendered power, chronic illness, clinical process research, Medical family therapy

LLU Discipline

Marital and Family Therapy


Counseling and Family Sciences


School of Behavioral Health

First Advisor

Knudson-Martin, Carmen

Second Advisor

Hernandez, Barbara Couden

Third Advisor

Huenergardt, Douglas

Fourth Advisor

Williams-Reade, Jackie

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Couples Therapy; Interpersonal Relations - Psychology; Liver Diseases - Psychology; Disease Management - Psychology; Cross-Sectional Studies; Caregivers - Psychology; Stress - Psychological

Subject - Local

Relational Experience; Reciprocal Caregiving; Autonomy Discourse; Illness-related Power; Gendered Power



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives

Included in

Counseling Commons