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Case reports are offered to illustrate a modified psychoeducational approach to single-family therapy and multiple-family therapy with families with Huntington's disease. Single-family therapy was especially helpful in solving problems related to specific family developmental crises and to shifts in family roles and hierarchies resulting from the progressive worsening of Huntington's symptoms. The mobilization of hope and altruism and a lessening of the sense of isolation and helplessness in coping with the illness were better facilitated by the multiple-family group. The participation of families at different stages of the illness in a process of emotional exploration, however, tended to threaten defenses, such as partial denial, which were useful in coping with the progressive course of the illness. The recent discovery of a genetic marker for the disease dramatically increases the need to attend to these issues in Huntington's disease families.Huntington's disease (Huntington's chorea) is a neuropsychiatric disorder genetically transmitted in a fully penetrant autosomal dominant manner to 50 percent of the offspring of afflicted patients (5). Manifestations of the disease result from loss of neurons in certain brain areas, especially the basal ganglia and cortex (8); often, the loss of neuronal cells appears as atrophy of these areas on computerized axial tomographic scans of the patient's brain (4). The clinical presentation includes steadily worsening abnormal involuntary movements (which may involve the limbs and trunk in violent spasms), a progressive dementia, and a variety of psychiatric symptoms. Of 30 patients studied by Caine and Shoulson (2), 28 had psychiatric conditions

Several aspects of marital functioning were associated with subsequent relapse to opiate abuse in 17 married addicts. The addicts and spouses were evaluated in a task-oriented interview and rated using the Beavers Timberlawn Family Assessment instrument. The global health-pathology ratings on this instrument indicated that most couples had rigid patterns of interacting, rather than a chaotic lack of structure or a flexible, negotiated partnership. Within this range of rigid functioning, higher ratings were associated with longer times drug-free (up to 18 months with a mean of 7 months). On the seven subscales of the Beavers', five were significantly correlated with the time drug-free: effective and clear leadership, closeness between the spouses, a nonhostile mood, empathy, and efficient negotiation and problem solving. The subscales associated with drug abstinence were quite different for a group of seven single ex-addicts participating in the same outpatient program, but living with their parents. For these single ex-addicts three subscales were correlated with the time drug-free: parental reaction to separation strivings, the open expression of thoughts and feelings, and empathy. This difference in the subscales associated with abstinence for married versus single addicts suggested some specificity in the characteristics of family structure and interaction that may be related to drug abstinence.

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