The "coming of age" of couple therapy: a decade review

Interventions for Couples

Because relationship discord and dissolution are common and costly, interventions are needed to treat distressed couples and to prevent distress among vulnerable couples. We review meta-analytic evidence showing that 60-80% of distressed couples benefit from behavioral and emotion-focused approaches to couple therapy, but we also note that treatment effects are weaker in actual clinical practice than in controlled studies, dissipate following treatment for about half of all couples, and may be explained by factors that are common across models. Meta-analyses of prevention programs reveal reliable but smaller effects, reflecting a need to know more about whether and how communication mediates effects, about how risk and diversity moderate effects, and about how technology-enabled interventions can reduce attrition in vulnerable populations. Interventions for couples are improving and expanding, but critical questions remain about how and for whom they work.

Trajectories of Interracial Heterosexual Couples: A Longitudinal Analysis of Relationship Quality and Separation

Minimal research has examined interracial couples' relationship satisfaction and dissolution patterns over time. Using dyadic data across 8 years, we examined potential differences in relationship quality trajectories through latent growth curve modeling with 1,336 couples as well as differential risks for relationship dissolution through logistic regression between same-race and interracial relationships using a different subset of 2,370 couples. Results indicated that women in interracial relationships were significantly lower in initial relationship quality than women in same-race relationships. Further, interracial couples of Black-Hispanic partnerings were twice as likely to separate across 8 years than same-race couples. These results suggest that despite interracial relationships not substantively differing from same-race couples in trajectories of relationship quality, specific Black-Hispanic interracial couples are at a higher risk of eventual separation.

The Role of Psychoeducation in Trauma Recovery: Recommendations for Content and Delivery

Providing trauma psychoeducation remains a highly popular intervention despite the fact that little remains known about how effective such information provision is for improving participant outcomes. In this article the author outlines recommendations that can be identified from available research on how to provide psychoeducation for trauma recovery. The author also describes suggested content areas and material to include in this psychoeducation, highlighting the importance of conducting trauma psychoeducation in a culturally-sensitive, human-centered, and relationship-focused manner which emphasizes the value of building resiliency in response to trauma.

A Video Recall Study of In-session Changes in Sentiment Override

This study examines in-session changes in sentiment override over the first three sessions of couple therapy. Couples viewed a video recording of therapy sessions immediately after each of the first three sessions and continuously rated their level of sentiment override. Ninety-eight changes were randomly chosen for analysis. Three talk turns prior to each change was coded using the Family Relational Communication Control Coding System. Results show that changes in sentiment override occur frequently. Repeated incidents of communication control were related to negative change in sentiment override for females. Repeated incidents of being left out of the conversation were related to negative changes in sentiment override for females and positive changes for males.

Predicting Key Change Events in Emotionally Focused Couple Therapy

In emotionally focused couple therapy (EFT), the blamer-softening event helps individuals express and respond to partners' unmet attachment needs. This study examined the impact of this event in relation to attachment at intake and changes in marital satisfaction from pre- to posttherapy. Thirty-two couples were provided an average of 21 sessions of EFT. Hierarchical linear modeling revealed that the occurrence of a softening event significantly predicted increased marital satisfaction. Furthermore, the occurrence of a softening event significantly moderated the relationship between attachment avoidance at intake and change in marital satisfaction from pre- to posttherapy. For couples who had a softening event, partners with higher levels of attachment avoidance were less likely to have positive changes in marital satisfaction.

Up and down or down and up? The process of change in constructive couple behavior during Traditional and Integrative Behavioral Couple Therapy

Observed positive and negative spouse behavior during sessions of Traditional (TBCT) and Integrative Behavioral Couples Therapy (IBCT) were compared for couples with successful outcomes and their unsuccessful counterparts. One hundred and thirty-four married chronically and seriously distressed couples (on average in their forties and 80% Caucasian) were randomly assigned to TBCT or IBCT. Trained observers made ratings of 1224 segments from approximately 956 sessions sampled from the course of up to 26 sessions. Multilevel modeling was used to examine change over time. TBCT treatment responders demonstrated a boost-drop pattern, increasing in constructive behaviors early (more positive behaviors and less negative behaviors) but decreasing later. IBCT responders demonstrated an opposite, drop-boost pattern, decreasing in constructive behaviors early and increasing later. Patterns were significant for positive behaviors (p < .05) and approached significance for negative behaviors (p = .05). In both treatments, nonresponders showed a significant pattern of decline in positive and increase in negative behaviors over time, although a trend (p = .05) indicates that TBCT nonresponders initially declined in negative behaviors. This study helps clarify the different process of change in two behavioral couple therapies, which may assist in treatment development and provide a guide for therapists in considering behavioral markers of change during treatment.

Behavioral couple therapy: building a secure base for therapeutic integration

Behavioral couple therapy (BCT), one of the two most empirically supported approaches to the treatment of couple discord, has undergone enormous changes in its four decades-long clinical and conceptual history. The evolution of thought about what maintains couple disaffection and distress and what can be done about it from a behavioral perspective is reviewed. These changes are considered in the larger context of the field of behavior therapy, noting shifts within BCT that parallel the three "waves" of development within that field. Integrative behavioral couple therapy (IBCT), the most visible and influential of the several BCT approaches, is examined, with particular attention to its functional-contextual base and the nature and role of functional analysis in clinical case conceptualization. It is argued that continuing enhancement and refinement of IBCT as an integrative therapeutic method will require greater flexibility in the techniques that are used and increased attention to the self of the IBCT therapist.

Experiences of Marriage and Family Therapists Working with Intimate Partner Violence

The purpose of our study was to explore the experiences of marriage and family therapists in working with violent couples. In particular, we focused on therapists' questions and feelings of competency pertaining to violence assessment and treatment, the difficulties they face during their practices, and the factors that affect their practice. Data for this study was collected via a focus group that lasted approximately an hour. The participants included five marriage and family therapists. A set of questions were used to explore experiences of therapists who were working with clients who are experiencing domestic violence. The research team recorded the answers to these questions as well as associated discussion. A grounded theory approach was used to analyze the data. Six themes were derived from the coded data: acknowledgment and reliance on systemic foundations, therapist factors, assessment, treatment considerations, sex of batterers, and training in Marriage and Family Therapy programs.

The psychological architecture of the stable couple relationship

This article is a critical review of mainstream psychological theory on heteronormative “Western” coupledom from the 1930s, focusing on the ideological notion of stability as a foundation for successful romantic partnerships. Theorized qualities of couple stability and associated subjectivities are broadly discussed in relation to the psychologies of attachment, commitment, trust, intimacy, and monogamy. It is argued that these central facets of coupledom, as a microcosm of the sociopolitical realm, work to stabilize and regulate relationships according to static versions of wholeness and certainty. Promissory of an illusionary order that is devoid of perceived chaos, the stabilizations of couple relationships are critiqued as limiting transformative possibility. Aspects common to process philosophy and chaos theory are discussed as laying ontological ground for a relational system that is not structured by way of a misplaced foundational stability. Current research and theory around practices of open non-monogamy are addressed in regard to this.

Research on the treatment of couple distress

This article reviews the research on couple therapy over the last decade. The research shows that couple therapy positively impacts 70% of couples receiving treatment. The effectiveness rates of couple therapy are comparable to the effectiveness rates of individual therapies and vastly superior to control groups not receiving treatment. The relationship between couple distress and individual disorders such as depression and anxiety has become well established over the past decade. Research also indicates that couple therapy clearly has an important role in the treatment of many disorders. Findings over the decade have been especially promising for integrative behavioral couples therapy and emotion-focused therapy, which are two evidence-based treatments for couples. Research has also begun to identify moderators and mediators of change in couple therapy. Finally, a new and exciting line of research has focused on delineating the principles of change in couple therapy that transcends approach.

Techniques for framing questions in conducting family meetings in palliative care

Objective:

Family therapy has developed several approaches to framing questions within family meetings, but few of these techniques have been adapted for palliative care. We focus on the application of questioning techniques from systemic family therapy to palliative care. More specifically, we describe and give examples of the model of asking questions developed by Karl Tomm (1988) through its application in Family Focused Grief Therapy (FFGT), a preventive intervention delivered to high-risk families during palliative care and bereavement.

Methods:

First, the type of questions used across the course of therapy is explored based on the interventive questioning model. Then, a case example is provided to demonstrate the use and adaptation of this model in a palliative care setting.

Results:

At the beginning of therapy, the most frequent questions were linear and circular, moving around the family to build up a picture of events from everyone's perspective. As for the frequency of reflexive and strategic questions, these increased as the therapy progressed, bringing the family to new perspectives. The case example fleshes out the importance of each type of question, all of which have a proper place in the course of therapy.

Significance of results:

These illustrations highlight the value of having a model of questioning styles to guide the clinician when exploring palliative care issues, such as care provision, coping and grief, intimacy, and discussing death. This framework could be useful in guiding supervisors, trainees, and clinicians seeking to build skills and optimize their interventions in a palliative care setting.

Eficácia psicoterapêutica: terapia de família e o efeito "Dodô"

Este trabalho tem por objetivo rever, de modo crítico, os estudos sobre eficácia psicoterapêutica dos modelos e das escolas de terapia em geral e de terapia de família em particular, desenvolvidos sobretudo nos EUA. Discute-se o desenvolvimento do conceito de eficácia psicoterapêutica. Aborda-se o impacto da hipótese "Dodô" (Luborsky, Singer & Luborsky, 1975), que se refere à similitude de resultados dos métodos psicoterapêuticos. São revistos os resultados de estudos meta-estatísticos e discutidas suas implicações epistemológicas e metodológicas, relacionando-as com o desenvolvimento do campo da psicoterapia. Constata-se a necessidade do desenvolvimento de pesquisas que envolvam métodos mistos, quantitativos e qualitativos.

Outcomes in couple therapy: reduced psychiatric symptoms and improved sense of coherence

In Sweden, only a few empirical studies of couple therapy have been performed. This is the hitherto most comprehensive assessment of clinical treatment. Effectiveness of treatment is reported and compared with non-clinical ratings. Initially the couples displayed marital distress, many psychiatric symptoms, dyadic interactions characterized by high criticism and a low sense of coherence. In Sweden, couple therapy is primarily aimed to reduce marital distress and does not focus on individual disorders. It should be seen as innovative that overall psychic symptoms (Global Symptom Index, GSI) as well as depressive symptoms were reduced (more than one standard deviation) for both women and men to the extent of 50-55%. Normal values were attained by 73-78%. Of those who initially identified a low sense of coherence, 22% of the women and 37% of the men improved (more than one standard deviation). Normal values were attained by 68-70%. The treatment was relatively short, which meant that, with relatively limited treatment, it was also possible to attain relatively significant improvements in all dimensions of psychiatric symptoms.

Is Bowen theory valid? A review of basic research

In the last 15 years, a substantial number of studies have tested the theoretical validity of Bowen family systems theory. A review of this basic research provided empirical support for the relationship between differentiation and chronic anxiety, marital satisfaction, and psychological distress. Bowen's assumption that couples with the same level of differentiation marry was not supported. His specific theories of sibling position and triangulation also received little empirical support. Research on multigenerational transmission has generally ignored Bowen's theoretical perspective, and more research needs to test Bowen's claim that his theory is universal. In addition, researchers still need to examine the effect of differentiation on child functioning, physical health problems, and adaptability.

Toward a mini-theory of the blamer softening event: tracking the moment-by-moment process

In this article we present the results of a discovery-oriented task analysis research study identifying specific therapist behaviors that facilitate softening events in emotionally focused therapy (EFT) for couples. Therapy sessions conducted by an expert EFT therapist were examined. Six therapist content theme shifts were identified and specific interventions were delineated within each using an EFT coding scheme (EFT-CS) created for this study. This study extends the theoretical understanding of the softening process--a key change event in an empirically validated couples therapy approach--and provides a detailed clinical map for the training of therapists.

The revolution in couple therapy: a practitioner-scientist perspective

This article offers an overview of the expanding field of couple therapy, focusing on what the author considers to be new and even revolutionary in this field. In terms of outcome research, this article suggests that differential treatment effects are discernable. Emotionally focused therapy (EFT) appears to demonstrate the best outcomes at present. The most significant differences between research studies and everyday clinical practice may be the levels of therapist supervision rather than the essential nature of clients. The manualization of treatment is also viewed positively in this review. Areas of growth are the mapping of the territory of distress, understanding the process of change, couple therapy as an effective intervention for "individual" disorders, and the integration into couple therapy of clinical research, such as the research on gender and responses in therapy, and research on adult attachment. Practitioner-scientists can contribute to this evolving field by systematic observation and by reminding researchers of the need for clinical relevance. Couple therapy is now integrating description, prediction and explanation. As a result, theory, practice and systematic investigation are beginning to create a coherent whole.

Emotionally focused interventions for couples with chronically ill children: a 2-year follow-up

Couples with chronically ill children are particularly at risk for experiencing marital distress. The study presented here is a 2-year follow-up of a randomized control trial that assessed the efficacy of Emotionally Focused Therapy (EFT) in decreasing marital distress in a sample of couples with a chronically ill child. Thirteen couples with chronically ill children who received treatment were assessed to determine if the significant improvement in relationship distress observed at posttreatment and 5-month follow-up would be maintained at 2-year follow-up. Results demonstrated that improvements in marital functioning were not only maintained but, in some cases, enhanced at the 2-year follow-up. This uncontrolled follow-up study provides initial evidence of the longer-term benefits of EFT.

The different faces of intimate violence: implications for assessment and treatment

Current research about violence in intimate relationships suggests that at least two qualitatively distinct types of violence exist. This new knowledge challenges the dominant conceptualization of intimate violence as solely a manifestation of patriarchal male dominance. Following a review of the research and analysis of illustrative clinical examples, a conceptual framework is presented that assists couple therapists in answering three salient questions: What type of violence am I most likely to be working with? How can I assess the differences between types of violence? And how might I proceed with treatment for different types of violence?

The history of couple therapy: a millennial review

In this article, we review the major conceptual and clinical influences and trends in the history of couple therapy to date, and also chronicle the history of research on couple therapy. The evolving patterns in theory and practice are reviewed as having progressed through four distinctive phases: Phase I--Atheoretical Marriage Counseling Formation (1930-1963); Phase II--Psychoanalytic Experimentation (1931-1966); Phase III--Family Therapy Incorporation (1963-1985); and Phase IV--Refinement, Extension, Diversification, and Integration (1986-present). The history of research in the field is described as having passed through three phases: Phase I--A Technique in Search of Some Data (1930-1974), Phase II--Irrational(?) Exuberance (1975-1992), and Phase III--Caution and Extension (1993-present). The article concludes with the identification of Four Great Historical Ironies in the History of Couple Therapy.

Hiring consumer-providers: barriers and alternative solutions

The hiring of consumers as providers of mental health services has steadily increased over the last decade. This article, based on the literature and two round table discussions, explores three prevalent barriers (i.e., dual relationships, role conflict, and confidentiality) and proposes alternative solutions to each.

Using eye movement desensitization and reprocessing to enhance treatment of couples

Eye Movement Desensitization and Reprocessing (EMDR) as a clinical technique may enhance treatment effectiveness when applied within a couple therapy approach that is emotionally and experientially oriented. Clinical experience indicates that EMDR-based interventions are useful for accessing, activating, tolerating, and reprocessing the intense emotions that often fuel dysfunctional couple interactions. Using EMDR within conjoint sessions to reprocess negative emotions can amplify intimacy, increase connection, and subsequently lead to a change in problematic relationship patterns.

Pulling on the heart strings: an emotionally focused approach to family life cycle transitions

Transitions through the family life cycle can be stressful because they challenge attachment bonds between family members. Open communication and the processing of primary attachment emotions are crucial when family systems change. When family members are insecurely attached, such open communication is difficult, and people tend to get stuck in absorbing states of secondary defensive affect. Emotionally focused therapy (EFT) can be particularly helpful by encouraging family members to express primary emotions. This expression then fosters renegotiation of bonds and the clarification of attachment needs and concerns. Case examples illustrate how EFT can be applied to each family life cycle stage.