No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Evidence-based couple therapy: Current status and future directions
Abstract
Several approaches to couple therapy produce large and clinically significant reductions in relationship distress. However, 25 to 30 per cent of couples show no benefit from couple therapy. Adapted forms of couple therapy can effectively treat some psychological disorders and enhance adjustment to physical health problems. The specific mechanisms underlying the effects of couple therapy on relationship distress are unclear. Current attempts to enhance the efficacy of couple therapy have three foci: (1) identifying the common factors that might account for change across approaches, (2) integrating different approaches to address specific needs of particular partners and couples and (3) monitoring the progress of couples during therapy and using that information to modify couple therapy as required. Given the high prevalence of relationship distress and its association with other problems, clinicians should routinely screen for relationship distress in adults. Couple therapy needs to be considered as the focus, or part of the focus, of treatment for a wide range of adult emotional and behavioural problems.
... The present study suggests that physical health, race, and financial status were significant predictors of relational satisfaction. In a U.S. national survey, couple relationship problems were the most frequently cited causes of acute emotional distress (Snyder & Halford, 2012;Swindle et al., 2000). MedFTs can help couples trying to increase their relationship satisfaction, as they understand the biology behind physical health ailments and also have the training to anticipate how social contexts may change relationship dynamics (McDaniel et al., 1992). ...
... MEdFTs have utilized a variety of treatments to relieve couple relationship distress that are supported by research (Snyder & Halford, 2012). For example, the two appreciations intervention asks couples to participate in a feasible and commonly enjoyable activity where they can immediately experience some positive change and become agents in their own change (Zrenchik, 2015). ...
... Adapted forms of couple therapy can also treat some individual psychological disorders and enhance adjustment to physical health problems (Snyder & Halford, 2012). For instance, MFTs use a biopyschosocial approach that helps couples understand connections between marriage, depression, and health . ...
Relationship satisfaction is a subjective and global evaluation of a romantic relationship based on a sense of happiness, contentment, and fulfillment felt by a partner. Prior research demonstrates that relationship satisfaction can help mediate difficult life situations and stress and may contribute to a partner’s well-being and health. However, the literature examining partner-specific sources of relational satisfaction are lacking. Through a medical family therapy lens, this study examined women’s reported physical health’s impact on relational satisfaction. A total of 555 women in romantic relationships completed a survey with questions from the Medical Outcomes Study 20-Item Short-Form Health Survey and the Relationship Assessment Scale. A hierarchical linear regression indicated that physical health, race, and financial status were significant predictors of relational satisfaction. Findings highlight the importance of physical health’s impacts on relational satisfaction and provide clinical implications and future directions on strengthening couples’ relational satisfaction.
... Review and meta-analysis studies since 1990 have shown that systemic family and couples therapies are more effective than individual treatments for different problem areas (Heatherington, Friedlander, Diamond & Escudero, 2014). When the literature is examined, it is reported that marital adjustment, values, adaptation to work and social support increase between couples when systemic approaches are applied, and relational stress, psychiatric disease rates and domestic violence decrease in individuals (Aguilar-Raab et al., 2017;Carr, 2014;Leff 2000;Mert, 2015;Snyder & Halford, 2012;Stratton, Silver, Nascimenton, McDonell, Powell & Nowotny, 2014). ...
... In our study, it was seen that marital adjustment increased significantly in both men and women at the end of therapy. This result is consistent with the research showing that systemic couple therapy increases marital adjustment in women and men and provides improvement for the problem areas in the relationship (Dunn & Schwebel, 1995;Lebow, Chambers, Christensen & Johnson, 2012;Sardoğan & Karahan, 2005;Snyder, 2012;Stith, Rosen & McCollum, 2003). Couples were supported to realize the things that go better in their lives, focus on small but achievable goals instead of big changes in line with their goals in the therapy process. ...
... About half of the divorces take place in the first 7 years of marriage (Carr, 2014). Review studies show that evidence-based couple therapy, which lasts approximately twenty sessions for 6 months, is effective on many couples (Lebow, 2012;Snyder, 2012). Metaanalysis studies examining couple therapies reported that couples receiving therapy on average duration showed better family functioning than controls (Shadish & Baldwin, 2003). ...
... A recent survey (Norcross, Pfund, & Prochaska, 2013) of psychotherapists indicated that couple therapy is a therapeutic format that will likely reach maximum growth in the coming decades, surpassing individual, family, and group therapy (Gurman, Lebow, & Snyder, 2015). Several research studies attest to the efficacy of couple therapy (e.g., Lebow, Chambers, Christensen, & Johnson, 2012;Shadish & Baldwin, 2003;Snyder, Castellani, & Whisman, 2006;Snyder & Halford, 2012;Sprenkle, 2003) and show that this efficacy does not depend on the therapist's theoretical orientation (e.g., Davidson & Horvath, 1997;Gurman & Fraenkel, 2002;Pinsof & Wynne, 1995;Snyder et al., 2012;Wesley & Waring, 1996). ...
... A recent survey (Norcross, Pfund, & Prochaska, 2013) of psychotherapists indicated that couple therapy is a therapeutic format that will likely reach maximum growth in the coming decades, surpassing individual, family, and group therapy (Gurman, Lebow, & Snyder, 2015). Several research studies attest to the efficacy of couple therapy (e.g., Lebow, Chambers, Christensen, & Johnson, 2012;Shadish & Baldwin, 2003;Snyder, Castellani, & Whisman, 2006;Snyder & Halford, 2012;Sprenkle, 2003) and show that this efficacy does not depend on the therapist's theoretical orientation (e.g., Davidson & Horvath, 1997;Gurman & Fraenkel, 2002;Pinsof & Wynne, 1995;Snyder et al., 2012;Wesley & Waring, 1996). ...
... Moreover, like insight-oriented (Snyder et al., 1991), psychodynamic (Siegel, 1992(Siegel, , 2004 and multigenerational approaches (Andolfi, 2002(Andolfi, , 2015Bowen, 1985;Framo, 1976), CMT stresses the importance of the reconstruction of the partners' individual histories and the creation of links between each partner's relational model and the current couple relationship. Furthermore, CMT, like insight-oriented and multigenerational approaches, recognizes that to appreciate the potential for the couple to have a more functional relationship, it is necessary to clarify how and why each partner originally expected that the other partner would be more affectively attuned than previous caregivers, but still ended up experiencing the couple relationship as a repetition of the old traumatic experiences with the caregivers (Andolfi, 1999;Snyder et al., 1991Snyder et al., , 2012. Moreover, the application of CMT to couples shares with structural model (Minuchin, 1974) and with multigenerational approaches (Andolfi, 2002(Andolfi, , 2015 the belief that within each couple there are individual and dyadic resources that the therapist should identify and strengthen. ...
This article proposes an adaptation to couple therapy of the Plan Formulation Method, an empirically validated and clinically useful assessment procedure for planning case-specific psychotherapy interventions. According to Control-Mastery Theory (CMT), individuals who seek psychotherapy have an unconscious plan, which comprises goals, obstructions, tests, traumas, and insights. The Plan Formulation Method was developed to reliably formulate individual psychotherapy cases. To apply this method to couples therapy, we have added two components: dysfunctional relationship patterns (vicious relational circles) and resources (virtuous relational circles). Each component will be explained with the help of a clinical case. We discuss the implication of the use of the Plan Formulation Method for couples and compare some of the tenets of CMT applied to couples with the main approaches to couple therapy.
... The couple's plan represents a method of assessment and intervention in the work with conjugal and parental dyads, which is useful both to the therapist -especially to the young therapist -to orientate himself in the clinical work, both to the researcher, to understand the dysfunctional dynamics underlying individual and dyadic suffering. Control-Mastery Theory; Terapia di coppia; Piano di coppia; Metodo per la Formulazione del Piano della Coppia Control-Mastery Theory; Couple Therapy; Couple's Plan; Plan Formulation Method for Couples Sebbene numerosi dati di ricerca attestino l'efficacia della terapia di coppia sia nel miglioramento della qualità della relazione tra i partner sia nella diminuzione della sintomatologia e della sofferenza individuale (Gollan e Jacobson, 2002;Lebow, Chambers, Christensen, e Johnson, 2012;Shadish e Baldwin, 2003;Snyder, Castellani e Whisman, 2006;Snyder e Halford, 2012;Sprenkle, 2003) -il che la rende preferibile a un non trattamento -, tra il 25/30% delle coppie non mostra benefici dopo la psicoterapia (Snyder et al., 2012) e, in generale, il follow up a 2 anni ha indicato, in linea con i risultati relativi alle psicoterapie individuali brevi, una notevole riduzione degli effetti positivi della terapia congiunta (Christensen, Atkins, Berns, Wheeler, Baucom e Simpson, 2004;Jacobson, Schmaling e Holtzworth-Munroe, 1987;Snyder, Wills e Grady-Fletcher, 1991). A tal proposito, tuttavia, alcuni studi hanno rilevato che le terapie che si focalizzano sulla connessione tra le problematiche attuali e le esperienze del passato (Insight Oriented Couple Therapy) piuttosto che rimanere ancorati al qui e ora (Behavioral, Cognitive o Emotional Focused Couple Therapy) garantiscono miglioramenti più stabili (Snyder et al., 1991;Snyder et al., 2012). ...
... Control-Mastery Theory; Terapia di coppia; Piano di coppia; Metodo per la Formulazione del Piano della Coppia Control-Mastery Theory; Couple Therapy; Couple's Plan; Plan Formulation Method for Couples Sebbene numerosi dati di ricerca attestino l'efficacia della terapia di coppia sia nel miglioramento della qualità della relazione tra i partner sia nella diminuzione della sintomatologia e della sofferenza individuale (Gollan e Jacobson, 2002;Lebow, Chambers, Christensen, e Johnson, 2012;Shadish e Baldwin, 2003;Snyder, Castellani e Whisman, 2006;Snyder e Halford, 2012;Sprenkle, 2003) -il che la rende preferibile a un non trattamento -, tra il 25/30% delle coppie non mostra benefici dopo la psicoterapia (Snyder et al., 2012) e, in generale, il follow up a 2 anni ha indicato, in linea con i risultati relativi alle psicoterapie individuali brevi, una notevole riduzione degli effetti positivi della terapia congiunta (Christensen, Atkins, Berns, Wheeler, Baucom e Simpson, 2004;Jacobson, Schmaling e Holtzworth-Munroe, 1987;Snyder, Wills e Grady-Fletcher, 1991). A tal proposito, tuttavia, alcuni studi hanno rilevato che le terapie che si focalizzano sulla connessione tra le problematiche attuali e le esperienze del passato (Insight Oriented Couple Therapy) piuttosto che rimanere ancorati al qui e ora (Behavioral, Cognitive o Emotional Focused Couple Therapy) garantiscono miglioramenti più stabili (Snyder et al., 1991;Snyder et al., 2012). ...
... Negli ultimi vent'anni, nel tentativo di incrementare l'efficacia della terapia di coppia, si è assistito alla nascita di approcci integrati che coniugano i punti di forza di diversi modelli e che mirano ad implementare la consapevolezza dei membri della coppia sui propri contributi alla funzionalità della relazione (Snyder et al., 2012). Tali approcci attribuiscono importanza alla ricerca dei nessi tra le relazioni affettive sperimentate in famiglia durante lo sviluppo e la relazione attuale di coppia. ...
... Understanding relationship functioning and how it can be improved, whether through prevention, training, or psychotherapeutic interventions/programs, is a high value research goal [1][2][3][4]. This is particularly important given that healthy and happy relational functioning is a strong predictor of psychological and physical health, and better social and work functioning [5,6]. Among the variables and theories developed to understand relationship functioning, differentiation of self (DoS), the cornerstone construct of Bowen Family Systems Theory (BFST), has received increasing empirical support [7,8]. ...
... Prior research on couples shows the relevance of stress to relational functioning [5,6,30,31]. Couples can face numerous stressful events and situations over a lifetime. ...
Objectives In the current study, we examined the relationship between differentiation of self (DoS) and key relationship functioning variables among couples. This is the first study to test such relationships using a cross-cultural longitudinal approach (i.e., samples from Spain and the U.S.) while controlling for stressful life events-a key theoretical construct in Bowen Family Systems Theory. Methods A sample of 958 individuals (n = 137 couples from Spain, and n = 342 couples from U.S.) was used in cross sectional and longitudinal models to analyze the effects of a shared reality construct of DoS on anxious attachment, avoidant attachment, relationship stability, and relationship quality while considering gender and culture. Results Our cross-sectional results indicated that men and women from both cultures experienced an increase in DoS over time. DoS predicted increased relationship quality and stability and decreased anxious and avoidant attachment in U.S. participants. Longitudinally, DoS predicted increased relationship quality and decreased anxious attachment for Spanish women and men, while it predicted greater relationship quality and stability and decreased anxious and avoidant attachment of U.S. couples. Implications of these mixed findings are discussed.
... Couple therapy continues to show effectiveness and efficacy in promoting individuals' emotional and physical well-being, reducing relational distress, and improving couple relationship satisfaction and quality (Lebow et al., 2012;Markman et al., 2022;Roddy et al., 2020;Snyder et al., 2005). However, we still have 25% to 30% of couples in therapy who show no progress (Snyder & Halford, 2012). Considering this noticeable variability in outcomes, more studies are needed for expanding our knowledge on change factors and mechanisms in couple therapy (Heatherington et al., 2005;Johnson et al., 2017). ...
... Considering the limited understanding of emotion regulation in couples, with a clinical sample, this study aimed to clarify the associations between partners' emotion dysregulation dimensions and couple relationship satisfaction. Please note, albeit the presenting issues of couples in therapy might vary tremendously, one or more aspects of the couple relationship are usually compromised (Snyder & Halford, 2012). Thus, we chose couple relationship satisfaction as the outcome to study emotion dysregulation in couples. ...
Despite the pivotal role that emotion regulation is thought to occupy for individual and relational wellbeing, emotion regulation in couples has been surprisingly understudied. With a clinical sample consisting of 275 couples starting therapy from 2017 to 2022, this study sought to clarify the actor and partner effects of clinical couples' emotion dysregulation on relationship satisfaction. Our results showed that, for partners' emotion dysregulation dimensions, while impulse control difficulties, lack of emotional awareness, and limited emotion regulation strategies were negatively predictive of couple relationship satisfaction, nonacceptance of negative emotions had a positive association with relationship satisfaction. Further, compared with other dimensions of emotion dysregulation, female limited emotion regulation strategies were greater predictors of decreased female relationship satisfaction. We also found significant gender differences in partners' emotion dysregulation dimensions and relationship satisfaction. These results show the significance of addressing emotion dysregulation for both partners at intra‐ and inter‐personal levels simultaneously in couple therapy. Notably, the 275 couples in our sample did not report a clinically distressed relationship, though they attended at least one couple therapy session. Clinical implications and directions for future study are discussed. 尽管情绪调节被认为对个人和关系都起着关键作用，但有关伴侣情绪调节的研究，却令人惊讶的不足。本研究以 275 对在 2017 到 2022 年间参与治疗的伴侣为样本，试图阐明临床伴侣情绪失调对关系满意度的主体和客体效应。我们的研究结果表明，在伴侣的情绪失调维度上，虽然冲动控制困难、缺乏情绪意识和有限情绪调节策略对伴侣关系满意度有负向预测作用，但不接受负面情绪与关系满意度呈正相关。此外，与情绪失调的其他维度相比，女性的有限情绪调节策略是女性关系满意度下降的最大预测因素。我们还发现伴侣双方的情绪失调维度与关系满意度存在显着的性别差异。这些结果表明，在伴侣治疗中，同时处理伴侣双方内在和人际层面情绪失调的重要性。值得注意的是，我们样本中的 275 对伴侣，并没有显示临床困扰程度的关系，尽管他们至少参加了一次伴侣治疗。本文还讨论了研究结果的临床意义与未来研究方向。
... In Spain, some studies suggest an even higher percentage of distressed couples among the general population [4]. Couple distress is associated with marital dissolution; depression; anxiety; substance abuse; poor performance at work; cardiovascular, immune, and endocrine system health; and mortality [5]. The resulting parental conflict can also have a direct impact on children's academic performance, as well as on their social, emotional, and behavioral health [6]. ...
... Couple distress is common and is associated with decreased physical, mental, and emotional health as well as decreased job productivity [5]. While research has shown that couple therapy, broadly, and EFT in particular, are very effective in decreasing couple distress [10], this research has been conducted almost exclusively with English-speaking couples in the USA and Canada. ...
Background: Couple relationship distress is common and associated with poor physical, psychological, relational outcomes for both partners. Emotionally Focused Therapy for couples (EFT) is a short-term structured approach based on attachment theory that integrates a humanistic, experiential approach to restructuring emotional experience and a systemic structural approach to restructuring interactions. This model has been shown to be an effective treatment for couple distress. The supporting research, however, has only been conducted with English-speaking couples. Despite Spanish being the second-most spoken language and meaningful cultural differences between English- and Spanish-speaking countries, the efficacy of EFT has not been examined in this cultural context. This study will examine the efficacy of EFT in this particular context and advance the understanding of potential mechanisms of change.
Methods: We will use a multicenter randomized wait-list controlled design to examine the efficacy of EFT in a Spanish-speaking sample of moderately distressed couples. One hundred forty individuals in 70 couples in Argentina, Costa Rica, Guatemala, Mexico, and Spain will be randomly assigned to receive 19-21 sessions of EFT or be placed on a wait list. Outcomes on a range of relational and individual mental health variables will be assessed prior to random assignment, throughout treatment, and at the conclusion of treatment. Primary outcomes will include dyadic adjustment, couple satisfaction, and attachment. Secondary variables, such as loneliness, parenting, affective communication, and sexual satisfaction, will be included as potential mediators of the treatment effect. Couples in the treatment group will also be assessed at 3-, 6-, 12-, 18-, and 24-month follow-ups. Process variables such as the therapeutic alliance will also be assessed routinely in couples assigned to the treatment group. Couples in the waitlist will receive a psychoeducational program based on EFT after completing the study.
Discussion: This study will be the first RCT of Emotionally Focused Therapy in a Spanish-speaking context. The results of the study will inform researchers interested in whether treatments developed and tested in the US and Canada can be effective in differing cultural contexts. It may also point researchers and clinicians to areas where cultural adaptation is needed to improve efficacy.
Trial registration: NCT04277325; February 20, 2020.
... The goal of this study was to examine the effectiveness of reconsolidation therapy in a more naturalistic setting among a sample of individuals suffering in the aftermath of intimate partner betrayal. Romantic relationship distress is a frequent concern faced by mental health professionals, and betrayal events are among the top cited reasons for relationship dysfunction and breakdown Snyder & Halford, 2012). In this study, we not only demonstrated that romantic partner betrayal may precipitate an enduring adjustment disorder, but also that reconsolidation therapy using propranolol can reduce event-related stress symptoms, including intrusions, avoidance, and increased vigilance, as well as depression and anxiety, and improve certain domains of quality of life. ...
... Relationship distress is among the most common reasons for seeking mental health services, and betrayal events are among the main causes for relationship breakdown Snyder & Halford, 2012). As a result, mental health professionals may be frequently faced with betrayal-injured individuals in clinical practice. ...
Although mounting evidence indicates that some individuals betrayed by a romantic partner may develop an adjustment disorder, a trauma-and stressor-related disorder characterized by intrusions, avoidance, and failure to adapt, there currently exists no systematic individualized treatment. Considering trauma-and stressor-related disorders as etiologically rooted in the emotional memory of a distressing life event, reducing the salience of this memory may provide a positive therapeutic outcome. Pre-clinical evidence has demonstrated that administering propranolol, a noradrenergic beta-blocker, prior to the reactivation of an emotional memory can interfere with its reconsolidation, i.e., the restabilization of memory to long-term storage. In clinical populations with posttraumatic stress disorder, this procedure, referred to as reconsolidation therapy, attenuates symptoms of traumatic stress. However, no research to date has investigated whether reconsolidation therapy can be extended to other stressor-related disorders. The first two manuscripts of this dissertation present the rationale, methods, and results of a clinical trial aimed at investigating the effectiveness of reconsolidation therapy to treat adjustment disorders stemming from romantic partner betrayal. Results from ANCOVAs revealed that compared to a no-treatment waitlist control condition (n = 29), reconsolidation therapy (n = 30) produced a significant reduction in event-related stress symptoms, including intrusions, avoidance, and increased vigilance, as well as general psychological distress, including symptoms of depression and anxiety, as measured with the Impact of Event Scale-Revised and the Hopkins Symptom Checklist-25, respectively. The final manuscript presents a qualitative investigation of the meaning and experience of romantic betrayal among individuals with an adjustment disorder. Thirteen participants who completed the larger trial were interviewed using the McGill Illness Narrative Interview. Findings revealed that romantically betrayed individuals often use the trauma metaphors and prototypes to make sense of their experience with betrayal. Yet almost all participants did not identify their reaction as traumatic stress and were hesitant to use that idiom. However, framing the experience of betrayal as an emotional memory of the event, that can be attenuated, provided participants with a plausible framework for explaining their symptoms, as well as a treatment solution, which led to a sense of validation and relief. This thesis is the first to investigate the broader application of reconsolidation therapy to treat psychiatric disturbances rooted in a painful life-experience.
... CBCT has enjoyed more controlled outcome studies than any other therapeutic modality, and has become readily accepted and practiced by marriage and family therapists in recent years. One reason for this is that this approach has demonstrated considerable efficacy (Baucom & Boeding, 2013;Shadish & Baldwin, 2005;Snyder & Halford, 2012). In addition, although once viewed as a primarily linear, individually oriented modality, CBCT is now seen as compatible with systems thinking in that it presupposes that the thoughts, emotions, and behaviors of one partner affect the other, and the thoughts, emotions, and behaviors of the second partner simultaneously affect the first (Baucom, Epstein, Kirby, & LaTaillade, 2010;Dattilio, 2005a). ...
... The role of emotion in marital satisfaction is somewhat unclear, as there is conflicting research on the topic. Emotion-oriented therapeutic approaches such as Emotion-Focused Therapy have enjoyed considerable efficacy (Shadish & Baldwin, 2003;Snyder & Halford, 2012). Whereas some research demonstrates that expressions of negative emotions are harmful to marriage and increase marital ambivalence (Rauer & Volling, 2005), particularly for women (Bloch, Haase, & Levenson, 2014), other results suggest that such expression can actually promote marital quality (Fincham & Beach, 1999). ...
... To better understand the mechanisms of adult attachment, various empirically supported treatments for couples have been developed and tested in the last few decades [100][101][102][103][104][105]. The most prominent evidence base is for attachment-focused and communication enhancing models including emotionally focused couples therapy (EFcT), integrative behavioural couples therapy (IBCT) and the Gottman method. ...
This chapter focuses on the theoretical basis behind intergenerational attachment styles and how they present in romantic relationships. In this chapter, we review the conceptual literature on attachment styles, their development and maintenance across the lifespan. We also explore the role of mutual emotional regulation in disrupting relational distress and improving relationship functioning. We proceed to synthesise efficacy studies and evidence-based research on relational interventions with couples, most commonly presenting concerns in couples therapy and the role of couples therapy in improving romantic relationships across cultural contexts, gender and sexuality identifications. We summarise what has worked, with whom and why while reviewing the various measures and types of clinical interventions offered to couples and report on change scores in outcomes of attachment avoidance/anxiety, relational conflict, relationship functioning and partner satisfaction. Finally, the book chapter presents three case studies with South-Asian couples across diverse life stages, relationship statuses, gender identities and sexual orientations using attachment-based and emotion-focused interventions.
... As relationship conflict often originates from dyadic conflict (e.g., Humphrey et al., 2017;Jehn et al., 2012;Shah et al., 2021), we start our theory there. Dyadic relationship conflict has been shown to be productive in counseling-oriented research (for reviews, see Halford & Snyder, 2012;Lebow et al., 2012). It can reduce future conflict, strengthen the interpersonal bonds, and ultimately improve parties' satisfaction with their relationship. ...
... Only limited research has examined the effects of relationship education with same-sex couples, though some preliminary studies suggest these programs can enhance relationship quality and mental health (e.g., Buzzella et al., 2012;Pepping et al., 2020;Whitton et al., 2016). In contrast to relationship education, couple therapy is often more intensive and is designed to help distressed couples improve the functioning of their relationship, resolve ambivalence, and reduce distress (Snyder & Halford, 2012). Researchers need to conduct rigorous clinical research that examines the efficacy of couple-based interventions to address minority stress and couple conflict to improve relationship outcomes for same-sex couples. ...
Objective:
Same-sex couples face unique minority stressors that affect relationship functioning, yet remarkably little research has examined the mechanisms by which individual and partner experiences of internalized stigma affect relationships over time. Using actor-partner interdependence models, the present study examined the effects of internalized stigma on relationship satisfaction, and whether depressive symptoms and couple conflict mediated these effects. Hypotheses were tested cross-sectionally and prospectively across a 5-year period.
Method:
Participants were 330 same-sex couples (n = 660 individuals; Mage = 39.5 years, SD = 10.8) who were assessed annually over a 5-year period. There were 109 male couples, 216 female couples, and five couples in which one partner did not identify with these labels.
Results:
There was a significant actor effect of internalized stigma on lower relationship satisfaction cross-sectionally and prospectively, and significant indirect actor-actor and actor-partner effects of internalized stigma on satisfaction via couple conflict cross-sectionally and prospectively. Finally, there was a cross-sectional indirect actor-actor effect of internalized stigma on relationship satisfaction via depressive symptoms, though depressive symptoms did not mediate any effects over time.
Conclusions:
These findings highlight the importance of considering both individual and interpersonal mediators of minority stress, particularly when investigating partner effects of minority stress on relationship satisfaction. Implications for research and clinical practice with same-sex couples are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... For instance, communication between partners is viewed as a causal mechanism in cognitive-behavioral (Baucom et al., 2019;Dugal et al., 2018), interpersonal (Clulow, 2018) and emotionfocused (Vazhappilly & Reyes, 2018) therapies of relationship problems, suggesting that this is a construct of transtheoretical significance (Cordova et al., 2005;Halford et al., 2001). In their review of common mechanisms of change across different approaches to couples therapy, Snyder and Halford (2012) noted that decreasing dysfunctional patterns of interaction is a universal process that is not specific to a particular theoretical approach to couples therapy. ...
The quality of communication between romantic partners has consistently been found to be associated with relationship well-being and stability. Studies on sexual and nonsexual communication, however, have typically assessed communication skills and behaviors using self-report measures. The use of observational methods has several advantages, including the ability to capture and allow for the independent coding of both partners’ communication behaviors. With few exceptions, research applying observational methods has not distinguished between sexual and nonsexual communication behaviors. In the present study, we asked 126 young, mixed-sex couples to engage in sexual and nonsexual conflict discussions. The two 7-min discussions were videotaped and rated by trained coders on nine behavioral dimensions using an adaptation of the specific affect coding system (Gottman & Krokoff, 1989) and the system for coding interactions and family functioning (Lindahl & Malik, 2001). Coder ratings applied to the discussion as a whole. Analyses included factor analysis on the behavioral dimensions and multilevel modeling incorporating the actor–partner interdependence model (APIM). We found significant differences in how couples interacted during the two discussions, with more positive (affectionate and validating) and less negative behaviors during sexual discussions as compared to nonsexual discussions. In both women and men, expressions of positivity during the two types of conflict discussions were associated with higher relationship satisfaction. Gender differences were found in the association between negative behaviors during sexual discussions and relationship satisfaction, with men but not women’s negative behaviors being associated with lower relationship satisfaction. These findings point at distinct qualities of sexual communication and its association with couples’ relational well-being and contribute to a better scientific understanding, with clinical relevance, of sexual and nonsexual communication.
... Due to the shameful nature of stigma, it may also be difficult for individuals to acknowledge these experiences. Couple therapy often focuses on guiding discussions to elicit softer and more vulnerable emotions (Snyder & Halford, 2012), which could translate to these recommendations. Female same-gender couples may therefore benefit from learning skills to make these conversations feel safe, particularly when expressing vulnerable experiences of internalized shame. ...
... However, the efficacy of couple therapy is not absolute, and not all couples may benefit from it. For example, efficacy trials have demonstrated that in only half of the treated couples did both partners report improvements (Snyder et al., 2006) and that 30% of the couples improving after therapy remained romantically distressed (Snyder & Halford, 2012). ...
The literature has supported the broad importance of the coparenting relationship for the couple and for family. However, couple therapy research has overlooked couples of parents and coparenting as a target and an outcome of therapy. Therefore, this thesis aimed to explore the relevance of working on the coparenting relationship within couple therapy and observed the nature of changes related to this specific therapeutic work.
As a preliminary step, we reviewed and evaluated the efficacy of coparenting interventions within the broader framework of intervention programs for couples. Then, we focused on a couple therapy, and presented the Integrative Brief Systemic Intervention (IBSI) that systematically integrates therapeutic work on both the romantic and coparenting relationships. Finally, we conducted two process studies to identify the nature of the changes related to integrating coparenting work into the IBSI.
This thesis offers the first evidence of the relevance of working on coparenting within both prevention programs and IBSI. The process studies allowed us to describe the process unfolding when parents improved their coparenting satisfaction within the IBSI. This process comprised six steps and discriminated couples whose coparenting outcomes improved from couples who did not improve after couple therapy.
We finally discussed the implications of this research for both empirical literature and clinical practice.
... A trusting relationship is expected to have a certain degree of predictability, with expectations being created about fulfilling each partner's needs, and creating a balance between a necessary and sufficient degree of relational dependence and the autonomy of each partner (Coimbra de Matos, 2017;Finkel et al., 2017;Overall and Cross, 2019), contributing to stability, commitment, When targeting relational difficulties or conflicts, the benefits and effectiveness of therapeutic interventions (Snyder and Halford, 2012;Davila et al., 2017;Wiebe et al., 2017) are still insufficient to mitigate negative consequences, namely regarding dissolution of relationships, including divorce (Røsand et al., 2014;Pordata, 2020). This emphasizes the relevance of research in this field, to guide practice at the individual, family, and/or couple level, as well as help identify and characterize mechanisms and models that govern or allow to predict how relationships develop, evolve (Consoli et al., 2018;Farero et al., 2019), and are reconstructed (Limeira and Féres-Carneiro, 2019). ...
In romantic relationships, individual differences are determinant factors for relational quality. Specifically, romantic attachment (RA) and difficulties in emotional regulation influence each other and may have predictive potential for the perceived dyadic adjustment (DA) level. This paper aims to identify the developmental parallel between behavioral patterns built since childhood and the construction of the emotional regulation skills that characterize them. Our analysis was based on the attachment theory and the concepts of romantic relationship and DA. In this way, we sought to further the understanding of relationship dynamics, beyond the usual focus on a single element and on associative relationships, and by exploring other effects among the different dimensions of relational functioning. In particular, we explored the predictive ability of emotional regulation patterns (more flexible individual characteristics) in discriminating between RA styles (more perennial influences), and their impact on the quality of romantic relationships, in the anticipation of dyadic adjustment variations.
... Healthy interactions can provide happiness, social support, and cause fewer health issues [25,51]. But, stressful interactions such as conflicts may lead to deleterious consequences to physical and psychological health (e.g., depression, anxiety, and substance abuse) and may affect the relationship quality, happiness, and overall life satisfaction [12,17,23,49]. Moreover, stressful conversations at work can adversely impact productivity, job performance, and job satisfaction [53]. ...
Stressful conversation is a frequently occurring stressor in our daily life. Stressors not only adversely affect our physical and mental health but also our relationships with family, friends, and coworkers. In this paper, we present a model to automatically detect stressful conversations using wearable physiological and inertial sensors. We conducted a lab and a field study with cohabiting couples to collect ecologically valid sensor data with temporally-precise labels of stressors. We introduce the concept of stress cycles, i.e., the physiological arousal and recovery, within a stress event. We identify several novel features from stress cycles and show that they exhibit distinguishing patterns during stressful conversations when compared to physiological response due to other stressors. We observe that hand gestures also show a distinct pattern when stress occurs due to stressful conversations. We train and test our model using field data collected from 38 participants. Our model can determine whether a detected stress event is due to a stressful conversation with an F1-score of 0.83, using features obtained from only one stress cycle, facilitating intervention delivery within 3.9 minutes since the start of a stressful conversation.
... For instance, communication between partners is viewed as a causal mechanism in cognitive-behavioral (Baucom et al., 2019;Dugal et al., 2018), interpersonal (Clulow, 2018) and emotionfocused (Vazhappilly & Reyes, 2018) therapies of relationship problems, suggesting that this is a construct of transtheoretical significance (Cordova et al., 2005;Halford et al., 2001). In their review of common mechanisms of change across different approaches to couples therapy, Snyder and Halford (2012) noted that decreasing dysfunctional patterns of interaction is a universal process that is not specific to a particular theoretical approach to couples therapy. ...
... While the proportion of individuals who seek counselling specifically for relationship betrayals is unknown, relationship distress is one of the most frequent reasons for consulting mental health professionals, and betrayal plays a central role in perpetuating relationship distress (Amato & Previti, 2003;Scott, Rhoades, Stanley, Allen, & Markman, 2013;Snyder & Halford, 2012). Despite this, little is known about the phenomenological experience of romantic betrayal and its link to trauma-and stressor-related disorders, such PTSD or adjustment disorder, which has limited the development of individualized treatments. ...
According to a growing body of research, betrayal by a romantic partner is increasingly considered as a form of interpersonal trauma. Between 30% and 60% of betrayed individuals experience symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety to clinically meaningful levels. From a clinical perspective, this constellation of symptoms can be conceptualized as a stressor‐related adjustment disorder. Yet no qualitative research has examined the association between romantic betrayal and traumatic stress from the perspective of betrayed individuals. Face‐to‐face semi‐structured interviews were conducted with 13 participants who had completed a clinical trial for a new treatment for adjustment disorder stemming from betrayal. Data were analysed using thematic content analysis. Although betrayal was experienced as a shocking and destabilizing event, and participants used trauma or ‘feeling traumatized’ as a metaphor to describe their experience, few had constructed their reaction as traumatic stress. In fact, participants reported experiencing difficulties understanding the intensity of their experience. However, when exposed to external sources (e.g., books and interviews by psychologists and researchers) that used a trauma and PTSD framework to explain the effects of betrayal, participants reported feeling clarity, validation, and relief. Findings are discussed in light of theoretical and clinical implications.
This article is protected by copyright. All rights reserved.
... -Johann Wolfgang von Goethe Couple and marriage therapy (hereafter referred to as couple therapy) 1 is an essential health intervention shown to work across an impressive range of client concerns and client demographics. The field has accumulated a substantive body of outcome studies illustrating its efficacy (Snyder & Halford, 2012), especially for traditional and integrative behavioral couple therapy (T/IBCT; Benson & Christensen, 2016) and emotionally focused couple therapy (EFT; Johnson & Brubacher, 2016). Meta-analyses reflect that couple therapy produces large improvements in couple functioning and relationship satisfaction. ...
This study systematically reviewed extant couple therapy outcome studies (k = 111) through December 2018 to evaluate for implicit or explicit, inclusion or exclusion of gender and/or sexual minority individuals and identities. We evaluated sampling, participant demographic reporting, and language used in each manuscript for any reference or consideration given to participants' sexual and/or gender identity. Results indicate that couples have been historically presumed to be heterosexual and cisgender male or female without reported assessment. More recent inclusion and consideration of sexual minority individuals is limited and absent for nonmonosexual and gender minority individuals. These findings are contextualized in supplementary analyses of other sociocultural characteristics (e.g., race, age, length together). Suggestions are provided for affirmative consideration of the plurality of individuals' sexual and gender identities. Implications are discussed for research, training and practice of couple therapy with sexual and/or gender minority couples.
... While the proportion of individuals who seek counselling specifically for relationship betrayals is unknown, relationship distress is one of the most frequent reasons for consulting mental health professionals, and betrayal plays a central role in perpetuating relationship distress (Amato & Previti, 2003;Scott, Rhoades, Stanley, Allen, & Markman, 2013;Snyder & Halford, 2012). Despite this, little is known about the phenomenological experience of romantic betrayal and its link to trauma-and stressor-related disorders, such PTSD or adjustment disorder, which has limited the development of individualized treatments. ...
Romantic betrayal may precipitate an adjustment disorder in some individuals, an
event-related psychological disturbance that is characterized by anxiety, depression, and
posttraumatic stress disorder-like symptoms of intrusions, avoidance, increased vigilance, and failure-to-adapt. Although prior qualitative work suggests that romantic partner betrayal may be experienced as a “traumatic” event, no research to date has investigated the extent to which trauma theory is a reasonable explanatory model of symptoms and treatment from the perspective of injured individuals. This research aims to address this gap. Individual face-to-face in-depth interviews were conducted using the McGill Illness Narrative Interview with 13 participants enrolled in a clinical trial of reconsolidation therapy for
event-related stress symptoms. Data was analysed using thematic content analysis. Although participants used trauma metaphors and prototypes to describe
their betrayal experience, few identified their reaction as traumatic stress symptoms. Respondents attributed their symptoms to typical relationship dissolution, or burnout, yet admitted that the experience of betrayal was somehow more painful and invasive. Reframing their experience as rooted in the experience and memory of a critical life event provided participants with emotional clarity, validation, and relief that there was a brief and targeted solution. The emotional memory and reconsolidation frameworks of event-related
stress were perceived as a plausible explanatory model of symptoms and treatment,
respectively, for the effects of romantic partner betrayal. Results support the continued investigation of the pathogenic memory model of betrayal-related adjustment disorder.
... The co-occurrence of individual psychiatric problems and relationship difficulties is well documented (Beach & Gupta, 2005;Snyder & Halford, 2012). For instance, individuals who suffer from depressive symptoms often live in distressed relationships (Whisman, Whiffen, & Whiteford, 2009); couples in conflict have a ten times higher risk for experiencing depressive symptoms compared to non-conflict couples (Gabriel, Bodenmann, & Beach, 2016), and those who are depressed have a higher risk of also experiencing relational problems compared to the risk relationally distressed couples have of also experiencing depressive symptoms (Atkins, Dimidjian, Bedics, & Christensen, 2009). ...
This replication study examined the change over time and the relationship between depressive symptoms and dyadic adjustment during residential couple therapy and at one- and three-year follow-up. Mixed models were used in the analyses, and a disaggregation procedure was applied to examine the results on a between-person as well as on a within-person level. Overall, the results of the previous study were replicated. Significant improvement (p < .001) occurred on measures assessing relationship satisfaction and depressive symptoms from admission to discharge (effect sizes .47 to.72) and from admission to three-year follow-up (effect sizes .59 to .66). The within-person finding implies that when a person experiences more depressive symptoms than usual for him/her, subsequent dyadic adjustment is poorer than usual. Thus, our previous clinical implication suggestion is reinforced in this study: When treating couples suffering from co-existing relational and symptomatic distress, couple therapy should include the aim of lowering individual depressive symptoms.
... In Studies 3 and 4, we found that the Outcome expectation scale was positively correlated with the CSI-4 (Funk & Rogge, 2007), a brief measure of relationship satisfaction that is sensitive to progress in therapy (Snyder & Halford, 2012). Consistent with this finding, Self and Outcome correlated significantly with self-reported accessibility/responsiveness to one's partner (Study 3). ...
While it is known that client factors account for the largest proportion of outcome variance across treatment modalities, little is known about how clients' characteristics affect the process and effectiveness of couple therapy. To further knowledge in this area, we created a brief, practice-friendly measure, the Expectation and Preference Scales for Couple Therapy (EPSCT). Three self-report scales assess clients' Outcome expectations (e.g., I expect our relationship to improve as a result of couple therapy) and role expectations for Self (e.g., I expect to listen to my partner's concerns) and Partner (e.g., I expect my partner to blame me). Three Cognitive-Behavioral, Emotionally Focused, and Family Systems preference scales use a forced-choice format to measure the comparative strength of respondents' preferences for interventions broadly reflective of each approach. A large item pool was developed from relevant literature and clinical experience and refined based on face and content analyses with two panels of experienced couple therapists and researchers. Across four studies with 1,175 participants, the scales' internal consistency reliabilities were similar and their construct validity was supported with confirmatory factor analyses and significant correlations with several established measures, including expectation measures developed for individual psychotherapy and measures of attitudes toward professional help seeking and valuing personal growth. Across all studies, participants had stronger role expectations for themselves than their partners, although gender effects differed by sample. We discuss how to use the 15-item EPSCT in clinical practice and in future research as a predictor of couple therapy processes and outcomes.
© 2019 Family Process Institute.
... Therapeutic and preventive couple interventions have shown to be effective (e.g., Christensen, Atkins, Baucom, & Yi, 2010;Hawkins, Blanchard, Baldwin, & Fawcett, 2008;Shadish & Baldwin, 2003) but its efficacy could still be improved strongly, as only some couples benefit from the interventions (Fawcett, Hawkins, Blanchard, & Carroll, 2010;Snyder & Halford, 2012). One potential starting point to further improve couple interventions is to enlarge the understanding of the underlying mechanisms (Christensen, Baucom, Vu, & Stanton, 2005;Heatherington, Friedlander, Diamond, Escudero, & Pinsof, 2015). ...
Interpersonal affect regulation has shown to be important for couple's relationship functioning and individual's well-being. However, less is known about the prerequisites for interpersonal affect regulation and the different contexts of interpersonal affect regulation have mainly been investigated independently of each other. The current thesis investigates empathy as a prerequisite for interpersonal affect regulation in the context of dyadic coping and conflicts and proposes a general framework for interpersonal affect regulation processes in order to integrate findings from different research avenues of interpersonal affect regulation. Results of the empirical studies supported the importance of affective and cognitive empathy within the process of dyadic coping (study 1), provided evidence that men's cognitive empathy helps couples to maintain high levels of dyadic coping in the long- run (study 2), and suggested that men's cognitive empathy is associated with better conflict regulation (study 3). Additionally, conflict regulation predicted concurrent relationship satisfaction but did not predict change in relationship satisfaction across 4 years (study 3). In sum, these results support the notion that empathy plays a crucial role in different contexts of interpersonal affect regulation. Extending research about the role of empathy in interpersonal affect regulation might be a promising pathway to improve clinical interventions. Interpersonelle Affektregulation ist ein wichtiger Prädiktor von Partnerschaftsqualität und individuellem Wohlbefinden. Darüber hingegen, welche Faktoren interpersonelle Affektregulation ermöglichen, ist weniger bekannt und die verschiedenen Kontexte von interpersoneller Affektregulation wurden meist unabhängig voneinander untersucht. Diese Arbeit untersucht die Rolle von Empathie in interpersoneller Affektregulation im Kontext von dyadischem Coping und Konflikten und postuliert ein Rahmenmodell für interpersonelle Affektregulationsprozesse, das die Integration von Erkenntnissen aus verschiedenen Forschungsbereichen ermöglichen soll. Die Resultate der empirischen Studien bestätigten die Wichtigkeit von affektiver und kognitiver Empathie für den Prozess des dyadischen Copings (Studie 1), zeigten, dass kognitive Empathie der Männer Paaren dabei hilft, längerfristig hohes dyadisches Coping aufrechtzuerhalten (Studie 2) und zeigten, dass kognitive Empathie der Männer mit besserer Konfliktregulation einhergeht (Studie 3). Weiter sagte Konfliktregulation momentane Beziehungszufriedenheit vorher, nicht aber den Verlauf von Beziehungszufriedenheit über 4 Jahre (Studie 3). Zusammenfassend deuten die Befunde darauf hin, dass Empathie eine zentrale Rolle für interpersonelle Affektregulation in unterschiedlichen Kontexten spielt. Weitere Forschung über die Rolle von Empathie in interpersoneller Affektregulation könnte vielversprechender sein um klinische Interventionen zu verbessern.
Women veterans have unique life experiences and mental health needs, perhaps in part related to their high rates of exposure to traumatic events including military sexual trauma, combat trauma, and intimate partner violence. We review mental health difficulties among women veterans and describe related functional impairment. Evidence-based treatments are available, but barriers to care remain, including providers' lack of awareness of the unique needs of women veterans. Efforts are needed to increase access to evidence-based interventions, remove barriers to care, and improve provider competency working with this population to maximize clinical outcomes.
When experiencing mental health challenges, we all deserve treatments that actually work. Whether you are a healthcare consumer, student, or mental health professional, this book will help you recognize implausible, ineffective, and even harmful therapy practices while also considering recent controversies. Research-supported interventions are identified in this book and expanded upon in a companion volume. Chapters cover every major mental disorder and are written by experts in their respective fields. Pseudoscience in Therapy is of interest to students taking courses in psychotherapy, counseling, clinical psychology, and behavior therapy, as well as practitioners looking for a guide to proven therapeutic techniques.
Sexual intimacy is an essential experience to many romantic relationships, encompassing sexual identities, sexual desires, and sexual behaviors. Historically, people who identify as gay, lesbian, bisexual or questioning have been marginalized, tabooed, and illegalized in many societies, which have significantly shaped sexual minority (SM) couples’ views and experiences of sexual intimacy. When working with distressed SM couples, providing culturally sensitive and affirmative services is both necessary and effective considering the long-existing social stigma against sexual minorities and the imposed expectations by heterosexual norms. With the legalization of same-sex marriage in the U.S., working with SM couples is becoming an increasingly important practice in the U.S. However, many therapists receive little guidance in conceptualizing and treating SM couples and their experiences of sexual difficulties. The narrative therapy model has shown its theoretical advantages in working with couples with minority status, given its non-pathologizing stance in viewing minority experience. This paper proposes using a narrative couple therapy framework as a guide to help both therapists to explore sexual intimacy with SM couples. A case illustration is included.
Marriage timing has an important association with marital satisfaction and dyadic adjustment and very delayed first marriages are a small but significant subset. This article reports a study on the impact of a mobile phone-based spirituality app as compared to a relationship counseling app on couples who have entered marriages for the first time in their 50 s. Spirituality app users reported improvements in marital satisfaction and dyadic adjustment (Hedges’s g = 0.99–1.98, p < .01). Post-test gains were higher for dyads who had postgraduate/doctoral degrees or professional qualifications, who had entered the marriage out of choice, Hindus and Christians, and whose intervention compliance was higher (>60%). Multivariate analysis further suggested that Christian wives reported significant gains, however, this was not so for Christian husbands. Actor-partner interdependence models indicated a significant interdependence and association between outcome scores of husbands and wives. With an adequate emphasis on intervention compliance, the spirituality app would be effective with some modifications for those who enter the alliance enforced by circumstances, Muslim and Sikh participants, and the less formally qualified.
Couples therapy provides a multitude of roles for individuals in society, from helping couples address problem areas in their relationship, to addressing individual psychopathology. The current article provides a brief review of the history and theoretical orientations that have led to the development for current clinical standards for couples therapy. The article then provides a thorough review of the current treatment modalities that are commonly used in the couples therapy to address relationship discord and individual psychopathology, as well as discusses the ways in which these treatments work and their overall effectiveness.
Couples have a unique perspective to share about the therapy they receive. The current study uses a mixed-methods design to examine what couples report about most and least helpful elements of two behaviorally-based treatments tested in a large clinical trial of couple therapy. Results indicate that responses are highly variable and fall into five main themes, which are then compared between treatment conditions, genders, and outcome groups. One interesting finding is that all groups reported wanting more discussion of sexual issues. Findings are discussed in the context of common factors research, recent developments toward unified principles of change in couple therapy, and model-specific differences.
Objective
In couple therapy clients often suffer from a blend of individual psychiatric symptoms as well as severe relational distress. However, research is inconclusive on whether relational change predicts symptom change or vice versa. Because answers to this question could have important clinical implications on what to focus on in couple therapy at which time in treatment, more research is recommended.
Method
In this study, data collected before every therapy session were used to test whether changes in relational functioning predicted symptom functioning or vice versa. The study used a multilevel modeling approach, and the variables of interest were disaggregated into within‐ and between‐person effects.
Results
The results indicated that if an individual improved more than expected on relational functioning, this predicted more improvement than expected on individual symptoms. No significant reciprocal relationship was found between these variables.
Conclusions
The clinical implication is discussed, suggesting that an emphasis on relational improvement seems to be an important mechanism during couple therapy that may facilitate the change on individual symptoms in the long run.
Intimate couple relationship distress has high prevalence and a strong linkage to emotional, behavioral, and physical health problems in the adult partners and their offspring. The authors review findings regarding the effectiveness of couple therapy for relationship distress, as well as for mental and physical health problems. Moderators and mediators of couple therapy outcomes are discussed, along with implications for tailoring couple therapy to individual and relationship characteristics. A hierarchical pluralistic approach to couple therapy is proposed, including sample indicators of specific techniques at different levels of intervention. Enduring challenges for the field of couple therapy are identified—including those for clinical training and practice, clinical research, and effective delivery and dissemination.
Researchers have rapidly advanced knowledge in couple therapy. Recent years have seen the development of innovations in assessment, intervention, and the specific application of couple therapy models to a number of specific couple problems. Additionally, researchers have learned a great deal about specific processes in couple relationships and couple therapy. While these advancements are worthy of celebration, they also exist in a context where definitional and foundational elements of knowledge about couple therapy remain absent: How do we define successful couple therapy and thus a good couple therapist? What kind of training and experience is necessary to develop effectiveness in new couple therapists? As couple therapy expands into new technologies for the delivery of services, answering these questions becomes essential. Researchers and individual clinicians alike are called upon to be more explicit about the values that underlie their work.
Intimate couple relationship distress has high prevalence and a strong linkage to emotional, behavioral, and physical health problems in the adult partners and their offspring. The authors review findings regarding the effectiveness of couple therapy for relationship distress, as well as for mental and physical health problems. Moderators and mediators of couple therapy outcomes are discussed, along with implications for tailoring couple therapy to individual and relationship characteristics. A hierarchical pluralistic approach to couple therapy is proposed, including sample indicators of specific techniques at different levels of intervention. Enduring challenges for the field of couple therapy are identified—including those for clinical training and practice, clinical research, and effective delivery and dissemination.
Researchers have rapidly advanced knowledge in couple therapy. Recent years have seen the development of innovations in assessment, intervention, and the specific application of couple therapy models to a number of specific couple problems. Additionally, researchers have learned a great deal about specific processes in couple relationships and couple therapy. While these advancements are worthy of celebration, they also exist in a context where definitional and foundational elements of knowledge about couple therapy remain absent: How do we define successful couple therapy and thus a good couple therapist? What kind of training and experience is necessary to develop effectiveness in new couple therapists? As couple therapy expands into new technologies for the delivery of services, answering these questions becomes essential. Researchers and individual clinicians alike are called upon to be more explicit about the values that underlie their work.
Relationship education (RE) enhances couple functioning in different-sex couples, though less is known about the effects of RE for same-sex couples. This study investigates the preliminary effects of RE tailored for same-sex couples on couple relationship functioning and individual mental health. Twelve same-sex couples participated in a RE intervention, Rainbow CoupleCARE. There were significant improvements in mental health following the intervention, and trends for improved relationship functioning. There was a trend for increased identity affirmation, but no reduction in internalized homophobia. Consumer satisfaction was high. Results suggest that RE may enhance mental health and relationship functioning for same-sex couples.
Les résultats des thérapies de couples de parents peuvent être évalués sur deux dimensions principales : l’ajustement conjugal et l’alliance coparentale, cette dernière étant encore rarement prise en compte. Cet article s’intéresse à l’observation des interactions de couples de parents dans une tâche de résolution de problème coparental, comme plus-value pour l’évaluation. Les résultats montrent que la satisfaction conjugale et l’alliance coparentale de couples de parents (N = 34) évoluent au cours de la thérapie suivant deux profils : les couples en détresse qui s’améliorent et les couples prospères avant et après la thérapie. Des éléments d’observation concernant l’accord, la compétition et la résolution de problème sont en lien avec ces profils d’évolution des couples. Cette étude démontre que les données d’observation complètent avantageusement l’évaluation par questionnaire dans la mesure où elles sont valides du point de vue empirique tout en étant significatives et utiles pour le clinicien.
This article presents the development of an instrument measuring relationship satisfaction, based on the theory that separates ‘relationship quality’ from ‘satisfaction’ concerning the semantic meaning of the concepts, and to evaluate psychometric properties of the new measure. Two studies were conducted in order to investigate the psychometric properties of the new scale, with 372 and 1,185 participants taking part in Study 1 and Study 2 respectively. Results revealed that the new scale has two-factor structure, adequate internal consistency reliability, and convergent, discriminant and known-groups validity.
This invited paper is a review of the significance of couple relationships to the practice of all therapists. The article begins with a summary of the evidence on the centrality of committed couple relationships to the lives and wellbeing of adults, and the association of the quality of the parents’ couple relationship on the wellbeing of children. We argue that the well-established reciprocal association between individual problems and couple relationship problems means that all therapists need to pay attention to how a couple relationship might be influencing a client's functioning, even if the relationship is not the presenting problem. There is an outline the evolution of current approaches to behavioural couple therapy, and the current state of the art and science of couple therapy. We present an analysis of the evidence for couple therapy as a treatment for relationship distress, as well as couple-based treatments for individual problems. This is followed by a description of the distinctive challenges in working with couples and how to address those challenges, and recommendations about how to address the needs of diverse couple relationships. Finally, we propose some core therapist competencies needed to work effectively with couples.
The 1957 and 1976 Americans View Their Mental Health surveys from the Institute of Social Research were partially replicated in the 1996 General Social Survey (GSS) to examine the policy implications of people’s responses to feeling an impending nervous breakdown. Questions about problems in modern living were added to the GSS to provide a profile of the public’s view of mental health problems. Results were compared for 1957, 1976, and 1996. In 1957, 19% of respondents had experienced an impending nervous breakdown; in 1996, 26% had had this experience. Between 1957 and 1996, participants increased their use of informal social supports, decreased their use of physicians, and increased their use of nonmedical mental health professionals. These findings support policies that strengthen informal support seeking and access to effective psychosocial treatments rather than current mental health reimbursement practices, which emphasize the role of primary care physicians.
This article presents 3 different studies of in-session changes in emotionally focused couples therapy (EFT). Studies of in-session conflict events demonstrate both that couples’ conflict interaction at the end of treatment is more affiliative and interdependent than at the beginning of treatment and that peak session conflict interaction is deeper in level of experience and more affiliative than the interaction in poor session conflict episodes. In addition, events beginning with intimate, affective self-disclosure by one partner were found to involve greater affiliation in spouses’ responses to the self-disclosure than in a control event not involving self-disclosure. The possible change processes in EFT are discussed in light of these results.
Four-year follow-up data regarding marital status and marital accord were obtained for 59 couples receiving either behavioral (BMT) or insight-oriented (IOMT) marital therapy in a controlled outcome study. Although no significant group differences had been observed between the 2 treatment conditions at either termination or 6-month follow-up, by 4-year follow-up a significantly higher percentage of BMT couples had experienced divorce (38% for BMT couples compared with 3% for IOMT couples). Results are compared with previous outcome research in this area, and recommendations are made for further research.
Client-focused research systems have been developed to monitor and provide feedback information about clients' progress in psychotherapy as a method of enhancing outcome for those who are predicted to be treatment failures. In the current study, the authors examined whether feedback regarding client progress and the use of clinical support tools (CSTs) affected client outcome and number of sessions attended. Results showed that clients in the feedback plus CST group stayed in therapy longer and had superior outcomes. Nearly twice as many clients in the feedback plus CST group achieved clinically significant or reliable change, and fewer were classified as deteriorated by the time treatment ended. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Suggests directions for future research based on work completed by N. S. Jacobson (see PA, Vols 78:16162 and 71:21130), D. K. Snyder and R. M. Wills (see record
1989-26872-001) comparing insight-oriented and behavioral marital therapy, and a 4-yr follow-up study by Snyder et al (see PA Vol 78:16169). The issues covered include defining and assessing therapist competence, ways to enhance the scientific value of treatment manuals, and clinical issues relevant to comparing different models of marital therapy. Recommendations are provided regarding the measurement of therapist competence, the discontinuation of large-scale comparative outcome studies, various intramodel design strategies, and the intensive analyses of therapy process. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article presents the basis for, and the research on, emotionally focused couples therapy (EFT), now recognized as one of the most researched and most effective approaches to changing distressed marital relationships. Drawing on attachment theory and the research on interactional patterns in distressed relationships, we describe the theoretical context of EFT. We then outline the nature of the clinical interventions used in EFT and the steps hypothesized to be crucial to couple change. The central role of accessing and working with emotional issues in the relationship context is highlighted. Following this presentation, we review both the outcome and process research on EFT and present meta-anarytic data from randomized clinical trials to substantiate the clinical impact of EFT on couple adjustment. Finally, the empirical and clinical challenges facing EFT are summarized.
Couple therapists confront a tremendous diversity of individual and relationship difficulties characterizing couples in distress. This article describes a hierarchical model for structuring interventions from an informed pluralistic approach. Special consideration is given to affective reconstruction or interpretation of recurrent maladaptive relationship patterns evolving from developmental processes. Theoretical assumptions underlying affective reconstruction are presented along with specific therapeutic techniques and criteria for their implementation. Affective reconstruction of maladaptive relationship themes is contrasted with alternative psychodynamic and developmental approaches. The broader pluralistic approach advocated here is also contrasted with alternative integrative models. Discussion concludes with implications of an informed pluralistic approach for research and clinical practice.
Couple and family therapy (CFT) is challenging because multiple interacting working alliances develop simultaneously and are heavily influenced by preexisting family dynamics. An original meta-analysis of 24 published CFT alliance-retention/outcome studies (k = 17 family and 7 couple studies; N = 1,416 clients) showed a weighted aggregate r = .26, z = 8.13 (p < .005); 95% CI = .33, .20. This small-to-medium effect size is almost identical to that reported for individual adult psychotherapy (Horvath, Del Re, Flückiger, & Symonds, this issue, pp. 9-16). Analysis of the 17 family studies (n = 1,081 clients) showed a similar average weighted effect size (r = .24; z = 6.55, p < .005; 95% CI = .30, .16), whereas the analysis of the 7 couple therapy studies (n = 335 clients) indicated r = .37; z = 6.16, p < .005; 95% CI = .48, .25. Tests of the null hypothesis of homogeneity suggested unexplained variability in the alliance-outcome association in both treatment formats. In this article we also summarize the most widely used alliance measures used in CFT research, provide an extended clinical example, and describe patient contributions to the developing alliance. Although few moderator or mediator studies have been conducted, the literature points to three important alliance-related phenomena in CFT: the frequency of "split" or "unbalanced" alliances, the importance of ensuring safety, and the need to foster a strong within-family sense of purpose about the purpose, goals, and value of conjoint treatment. We conclude with a series of therapeutic practices predicated on the research evidence.
Using outcome data to monitor the progress of treatment and the therapeutic alliance, also known as "client feedback" or "patient-focused research," has yielded impressive results in individual psychotherapy. Client feedback has demonstrated reductions in premature terminations and improved psychotherapy outcomes. However, little research has been conducted using this paradigm with couples receiving therapy. The purpose of this study was to investigate whether the effectiveness of client feedback would extend to couple therapy. Results from a randomized couple clinical trial conducted in a naturalistic setting indicated that couples in a client feedback condition demonstrated statistically significantly more improvement compared with couples receiving treatment as usual and that improvement occurred more rapidly. Also, 4 times as many couples in the feedback condition reported clinically significant change by the end of treatment.
Compared the effects of communication skills training (CST) and cognitive therapy (CGT) in 32 severely distressed couples. Ss receiving CST showed significant improvement on main targets, the Communication Questionnaire, and a relationship beliefs inventory. CGT resulted also in significant improvements on these measures. On the direct behavioral observation measure, CST was superior to CGT. A direct comparison between both conditions indicated that CGT was more effective on the main targets, whereas CST was more effective on direct behavioral observation. (PsycINFO Database Record (c) 2004 APA, all rights reserved)
Outcome research has documented worsening among a minority of the patient population (5% to 10%). In this study, we conducted a meta-analytic and mega-analytic review of a psychotherapy quality assurance system intended to enhance outcomes in patients at risk of treatment failure.
Original data from six major studies conducted at a large university counseling center and a hospital outpatient setting (N = 6,151, mean age = 23.3 years, female = 63.2%, Caucasian = 85%) were reanalyzed to examine the effects of progress feedback on patient outcome. In this quality assurance system, the Outcome Questionnaire-45 was routinely administered to patients to monitor their therapeutic progress and was utilized as part of an early alert system to identify patients at risk of treatment failure. Patient progress feedback based on this alert system was provided to clinicians so that they could intervene before treatment failure occurred. Meta-analytic and mega-analytic approaches were applied in intent-to-treat and efficacy analyses of the effects of feedback interventions.
Three forms of feedback interventions-integral elements of this quality assurance system-were effective in enhancing treatment outcome, especially for signal alarm patients. Two of the three feedback interventions were also effective in preventing treatment failure (clinical support tools and the provision of patient progress feedback to therapists).
The current state of evidence appears to support the efficacy and effectiveness of feedback interventions in enhancing treatment outcome.
To follow distressed married couples for 5 years after their participation in a randomized clinical trial.
A total of 134 chronically and seriously distressed married couples were randomly assigned to approximately 8 months of either traditional behavioral couple therapy (TBCT; Jacobson & Margolin, 1979) or integrative behavioral couple therapy (IBCT; Jacobson & Christensen, 1998). Marital status and satisfaction were assessed approximately every 3 months during treatment and every 6 months for 5 years after treatment.
Pre- to posttreatment effect sizes on marital satisfaction were d = 0.90 for IBCT and d = 0.71 for TBCT, which were not significantly different. However, data through 2-year follow-ups revealed statistically significant superiority of IBCT over TBCT in relationship satisfaction, but subsequent data showed increasing similarity and nonsignificant differences in outcome. At 5-year follow-up for marital satisfaction relative to pretreatment, effect sizes were d = 1.03 for IBCT and d = 0.92 for TBCT; 50.0% of IBCT couples and 45.9% of TBCT couples showed clinically significant improvement. Relationship status, obtained on all 134 couples, revealed that 25.7% of IBCT couples and 27.9% of TBCT couples were separated or divorced. These follow-up data compared favorably to other, long-term results of couple therapy.
TBCT and IBCT both produced substantial effect sizes in even seriously and chronically distressed couples. IBCT produced significantly but not dramatically superior outcomes through the first 2 years after treatment termination but without further intervention; outcomes for the 2 treatments converged over longer follow-up periods.
Despite the overall efficacy of psychotherapy, dropouts are substantial, many clients do not benefit, therapists vary in effectiveness, and there may be a crisis of confidence among consumers. A research paradigm called patient-focused research--a method of enhancing outcome via continuous progress feedback--holds promise to address these problems. Although feedback has been demonstrated to improve individual psychotherapy outcomes, no studies have examined couple therapy. The current study investigated the effects of providing treatment progress and alliance information to both clients and therapists during couple therapy. Outpatients (N = 410) at a community family counseling clinic were randomly assigned to 1 of 2 groups: treatment as usual (TAU) or feedback. Couples in the feedback condition demonstrated significantly greater improvement than those in the TAU condition at posttreatment, achieved nearly 4 times the rate of clinically significant change, and maintained a significant advantage on the primary measure at 6-month follow-up while attaining a significantly lower rate of separation or divorce. Mounting evidence of feedback effects with different measures and populations suggests that the time for routine tracking of client progress has arrived.
Based on recent findings suggesting that marital discord is taxonic (i.e., that couples in discordant relationships differ qualitatively, and not just quantitatively, from couples in nondiscordant relationships), this study was designed to develop a brief screening measure for detecting the relationship discord taxon. A national, representative sample of 1,020 married couples completed the Marital Satisfaction Inventory--Revised. Data from this sample were used to create a 10-item screening measure. Using the cut scores from the original study that found evidence of taxonicity as a point of reference, the 10-item screen demonstrated good diagnostic performance in assessing the relationship discord taxon. Taxon classification based on the brief scale demonstrated good short-term stability. The scale is easily administered and scored, making it appropriate for use in clinical and research settings.
This study compared couples receiving two marital therapy approaches and a control group over a 10-week treatment period. Integrated systemic therapy (IST) and an emotionally focused approach (EFT) were both found to be superior to the control and to be equally effective in alleviating marital distress, facilitating conflict resolution and goal attainment, and reducing target complaints at termination. IST couples, however, showed greater maintenance of gains from termination to 4-month follow-up on marital satisfaction and goal attainment. Clients' perceptions of how change occurred and issues related to the use of a team of observers in IST are discussed.
This study compared the effects of behavioral marital therapy (BMT) and insight-oriented marital therapy (IOMT) on both interspousal and intrapersonal functioning in a controlled outcome study. A total of 79 couples seeking treatment for relationship distress were randomly assigned to BMT, IOMT, or a treatment-on-demand (TOD) waiting-list control group. Results indicated the significance in individual and relationship functioning. Both treatment approaches produced significant effects from intake to termination that were substantially maintained at the 6-month follow-up. Behavioral and insight-oriented therapies resulted in significant improvements in self-reports of global marital accord and, to a lesser extent, in the reduction of overall psychological distress and in the enhancement of self-concept, with no significant differences between treatment conditions. The magnitude of these effects in comparison with those reported in previous marital outcome studies and in more general psychotherapy research is discussed, and possible mechanisms for the equivalence of these technically divergent treatment approaches are explored.
Couple distress has a high prevalence as well as high comorbidity with a broad range of emotional, behavioral, and physical health problems. Marriage and relationship problems also influence individuals' response to treatment for a wide range of psychological disorders. Hence, clinicians need to be skilled in conducting clinical assessment involving relationships in order to provide effective interventions, whether working primarily with individuals, couples, or the broader family system. This article first introduces brief screening measures and clinical methods for diagnosing couple distress in clinical as well as research applications. It then conceptualizes and assesses couple distress for the purpose of planning and evaluating treatment. The article also reviews empirical findings regarding behavioral, cognitive, and affective components of couple distress, and specific techniques derived from clinical interviews, behavioral observations, and self-reports. Finally, it considers emerging technologies for assessing intimate relationships and makes recommendations for future research.
Couple therapists confront a tremendous diversity of individual and relationship difficulties characterizing couples in distress. This article describes a hierarchical model for structuring interventions from an informed pluralistic approach. Special consideration is given to affective reconstruction or interpretation of recurrent maladaptive relationship patterns evolving from developmental processes. Theoretical assumptions underlying affective reconstruction are presented along with specific therapeutic techniques and criteria for their implementation. Affective reconstruction of maladaptive relationship themes is contrasted with alternative psychodynamic and developmental approaches. The broader pluralistic approach advocated here is also contrasted with alternative integrative models. Discussion concluder with implications of an informed pluralistic approach for research and clinical practice.
This study presents analyses of data from the National Comorbidity Survey to assess the extent to which problems within marriage spill over to produce work loss. Results indicate that marital distress is positively associated with work loss—particularly among men in their first 10 years of marriage. Based on the average earnings of participants, work loss associated with marital problems translates into a loss of approximately $6.8 billion per year. These findings suggest that family interventions targeted at the prevention of marital problems may result in important psychosocial and economic benefits for business and society.
Although meta‐analyses affirm that various treatments for couple distress produce statistically and clinically significant outcomes, research findings also indicate that a large percentage of couples fail to benefit from treatment or subsequently deteriorate following current therapies. Based on these findings, we advocate potential advantages of integrative approaches to couple therapy. The clinical practice of integrative approaches to couple therapy requires conceptual and clinical decision‐making skills transcending those of any one theoretical modality and emphasizes the selection, sequencing and pacing of diverse interventions in a coherent manner. Principles of an integrative approach are explicated in a clinical case illustration.
Relationship functioning and psychopathology are strongly associated with one another. In this article we provide a selective review of the literature on relationship discord and the presence, incidence and individual‐based treatment of psychiatric disorders. We then present a model for conceptualizing couple‐based interventions with couples in which one partner has a psychiatric disorder, distinguishing between partner‐assisted interventions, disorder‐specific interventions and couple therapy interventions. Finally, we provide examples of how to employ these interventions with several psychiatric disorders (obsessive‐compulsive disorder, anorexia nervosa and depression) and selectively review the efficacy of couple‐based interventions in the treatment of psychopathology.
Across nearly all cultures, sharing a lifelong committed relationship with an intimate partner comprises an almost universal and strongly held ambition. Nevertheless, cross-national data reliably indicate a high prevalence of relationship distress and dissolution, with adverse emotional and physical health consequences for adult partners and their children. This introduction to the special section summarizes findings regarding the effectiveness of couple therapy for treating general relationship distress, couple-based interventions for individual mental or physical health problems, and couple relationship education programs aimed at helping couples sustain a healthy committed relationship. Within each of these approaches, evidence regarding potential mediators of interventions’ effectiveness is reviewed, and critical unanswered questions are highlighted. Discussion concludes with a brief introduction to each of the articles comprising this special section on universal processes in couple therapy and relationship education.
Research on divorce during the past decade has focused on a range of topics, including the predictors of divorce, associations between divorce and the well-being of children and former spouses, and interventions for divorcing couples. Methodological advances during the past decade include a greater reliance on nationally representative longitudinal samples, genetically informed designs, and statistical models that control for time-invariant sources of unobserved heterogeneity. Emerging perspectives, such as a focus on the number of family transitions rather than on divorce as a single event, are promising. Nevertheless, gaps remain in the research literature, and the review concludes with suggestions for new studies.
The purpose of this study is to examine the association between interparental conflict and parenting using meta-analytic review techniques. One-hundred and thirty-eight effect sizes from 39 studies are analyzed. The overall average weighted effect size is −.62, indicating a moderate association and support for the spillover hypothesis. The parenting behaviors most impacted by interparental conflict are harsh discipline and parental acceptance. Several moderating effects for subject and method characteristics are significant.
Empirical evidence shows that treatment failure is a significant problem and one that practitioners routinely overlook. A substantial minority of patients either fail to gain a benefit from the treatments offered to them, or they outright worsen by the time they leave treatment. Intervening in a timely fashion with such individuals cannot occur if practitioners are unaware of which cases are likely to have this outcome.
Prevention of treatment failure describes procedures and techniques that can be used by clinical practitioners and administrators to identify patients who are at risk for treatment failure. The book summarizes evidence that convincingly shows that a shift in routine care is needed, and that such a shift can be accomplished easily through integrating specific methods of monitoring patient treatment response on a frequent basis in routine care. Treatment response is placed in the context of historical views of healthy functioning and operationalized through the use of brief self-report scales. Providing alert-signals to therapists, along with problem-solving tools, is suggested as an evidence-based practice that substantially reduces patient deterioration and increases the chances of the return to normal functioning. The book also provides illustrations on how accumulated data resulting from monitoring patient treatment response can be used to improve systems of care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examined the association between changes in the interaction behaviors of 60 maritally distressed couples in their 30s and the effectiveness of behavioral marital therapy (BMT). Couple problem-solving behavior was coded using the Marital Interaction Coding System. Individual behaviors were assembled into 4 categories (problem-focused, avoidance, nonconstructive, facilitative) reflecting the function, rather than the valence, of the coded behaviors. Reductions in the proportions of spouse's behavior coded as nonconstructive were the only changes associated with BMT. Regarding patterns or sequences of behavior, BMT seemed to cause greater suppression of husbands' problem-focused behavior in response to the wives' nonconstructive behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This book expands the boundaries of cognitive-behavioral therapy and traditional notions of marriage in a framework that focuses on the behavior of individuals in relationships within the context of broader relationship patterns. For couples to derive maximum fulfillment from their relationships, an equal emphasis must be given to the role of positive behavior, cognitions, and emotions in relationship functioning. But because relationships are affected by the environment within which they exist, the authors look not only at the traditional realm of individual behavior but also at family systems, community influences, and life circumstances that may affect the clients' relationships, such as job loss or a death in the family. This contextual approach will help couples understand their individual differences, any unresolved personal issues and possible psychopathology, and individual and family needs. This book provides practical guidance for conducting couples therapy, from assessment through the final sessions. Chapters explore behavioral interventions, ways to modify cognitions, addressing emotions and individual psychopathology, and interventions for environmental demands. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To have a successful marriage, couples need to develop the ability to accept the unchangeable and change what can be changed. This realistic premise is at the heart of integrative couple therapy, the 1st approach to embrace both techniques for fostering acceptance and techniques for fostering change.
The book offers . . . clinical detail on how to develop a formulation encompassing the couple's disparate conflict areas, enhance intimacy through acceptance, build tolerance for difference, and improve communication and problem-solving. The clinical implications of diversity in gender, culture, ethnicity, class, and sexual orientation are taken into account, as are issues related to domestic violence, infidelity, depression, and drug and alcohol addiction.
Integrative couple therapy creates a context in which partners can accept in each other what cannot be changed, change what they can, and compassionately, realistically recognize the difference. [This book is intended] for every marital therapy student and practitioner. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Therapeutic alliance research in couple therapy using multiple perspectives and longitudinal data has been sparse. This study used structural equation modelling to explore relationships between changes in alliance and in progress from clients' and therapists' perspective in a fairly large sample of couples (N=195) during the initial stage of therapy at an on-campus training clinic. Self-rated alliance was measured after sessions 2 through 4 with the Working Alliance Inventory. There was very little change in alliance over the early sessions of therapy, and changes in alliance did not always account for changes in relationship satisfaction. Husbands' perceptions of satisfaction and alliance seem to play an important role in the dynamics of the therapeutic process. Findings suggest a reciprocal relationship between perceptions of alliance and progress in therapy when combining perceptions of therapists and couple clients. Clinical implications and future research are discussed.
The Kansas Marital Satisfaction (KMS) Scale is found to correlate substantially with both Spanier's (1976) Dyadic Adjustment Scale (DAS) and Norton's (1983) Quality Marriage Index (QMI), but not to correlate significantly more than those two scales with a variety of other satisfaction items designed to assess the discriminant validity of the KMS scale. Other characteristics of the KMS scale are similar to those reported in previous research and compare favorably with those of the DAS and the QMI, even though the latter scales contain more items than the KMS scale. It is concluded that the KMS scale may serve as a useful brief measure of marital satisfaction in future research with married couples.
The present study provides 2-year follow-up data for a comparison between a complete behavioral marital therapy treatment package (CO) and two of its major components, behavior exchange (BE) andcommunication/problem-solving training (CPT). Data are reported for 34 couples who were randomly assigned to one of these three treatments, completed the treatment to which they were assigned, and were available for the 2-year follow-up. The effects of therapy at the 2-year follow-up were evaluated using a global measure of marital satisfaction and a checklist of presenting marital problems. Statistically significant differences between the three treatments were not in evidence on any of the measures. However, couples in the CO treatment condition were most likely to be happily married and least likely to be separated or divorced. Attempts to identify variables which predicted long-term outcome were largely unsuccessful. Ananalysis based on standardized telephone interview indicated that, while neither therapist attributes nor maintenance of treatment-derived relationship skills were associated with long-term marital satisfaction, stressful life events subsequent to therapy termination were negatively related to marital satisfaction.
The purpose of this article is to present the conceptual model underlying RELATE, a relationship evaluation instrument, and to describe how this instrument can be used by instructors, clinicians, and therapists. The RELATE model contains measures of the 4 primary contexts of a couple's experience: the individual, the family, the culture, and the couple. The model includes some of the primary variables in Gottman's marital cascade and has been evaluated for reliability and validity. Examples of how to use the instrument and model are illustrated for couples, educators, and clinicians.
This investigation is the first controlled outcome investigation to evaluate the effectiveness of marital therapy which combines cognitive restructuring with commonly used behavioral marital therapy strategies. Twenty-four maritally distressed couples were assigned to one of two experienced marital therapists in one of three experimental conditions: behavioral marital therapy (BMT Alone); cognitive behavior therapy plus behavioral marital therapy (CBT+BMT); or a wait-list condition (WL). The results indicated that, overall, treatment was superior to the WL condition. Couples receiving both BMT Alone and CBT+BMT showed significant pretest to posttest improvements in overall marital adjustment and behavioral indices of change; only couples receiving CBT+BMT demonstrated consistent cognitive changes. However a direct comparison between BMT Alone and CBT+BMT indicated no significant differences between the two treatments. More detailed analyses found that approximately 50% of the couples receiving treatment moved into the nondistressed range of marital functioning by the end of treatment. Overall improvement was maintained at 6-month follow-up. Recommendations for future investigations are provided, encouraging movement toward more customized treatment for each couple.
The present study examined the generalization of treatment effects of a cognitive-behavioral treatment program for marital distress. Following a baseline phase, each of four couples received two phases of marital therapy within a multiple baseline across subjects design. The first phase of treatment was behavioral marital therapy (BMT) focusing on communication and problem solving skills. The second phase was cognitive-behavioral marital therapy (CBMT) which focused on conflict management skills in high risk interactive settings at home. Couples' communication was assessed in a training setting in the clinic and each of two generalization probe settings at home (a low risk and a high risk) setting. The BMT phase produced a clear reduction in communication negativity in the training setting which generalized to both the low and the high risk setting. The CMBT phase produced little additional changes in communication, however, it was associated with changes on a measure of positive and negative partner-referent thoughts.
The data from a behavioral marital therapy outcome study were analyzed in order to better understand the phenomena involved when spouses improve in their communication skills but do not improve in marital satisfaction. Three possible patterns of marital therapy outcome for the subset of subjects who improved in communication skills but not in marital satisfaction were proposed: (a) spouses who denied their distress at pretest, obscuring any subsequent improvement in marital adjustment ratings; (b) spouses who did not effectively apply their acquired skills to problem content areas in the marriage; and (c) spouses who made a thoughtful, positive decision to end the marriage. The first two of these three proposed patterns were present among the distressed couples being studied.
The current paper discusses general principles, therapeutic strategies, common factors, and domains commonly addressed in the treatment of couples who have a partner with a medical condition. Couple-based interventions for medical problems are contrasted with couple therapy and relationship education in that the emphasis is on assisting the patient in addressing the medical disorder, along with being attentive to the patient's partner and their relationship. Guidelines are provided showing how knowledge and understanding of medical disorders and couple functioning are integrated in order to conduct such interventions. Five common domains addressed during intervention are elaborated upon: (a) psychoeducation about the disorder, (b) sharing thoughts and feeling regarding the disorder, (c) making decisions focal to the medical disorder, (d) implementing relationship changes that are nonmedical but that result from the disorder, and (e) addressing relationship functioning unrelated to the disorder. The importance of empirically demonstrating the utility of each domain in future investigations is noted.
Systematic monitoring of individual therapy progress, coupled with feedback to the therapist, reliably enhances therapy outcome by alerting therapists to individual clients who are off track to benefit by the end of therapy. The current paper reviews the possibility of using similar systematic monitoring and feedback of therapy progress as a means to enhance couple therapy outcome, including what measures of therapy progress are most likely to be useful, how to structure feedback to be most useful to therapists, and the likely mediators of the effects of therapy progress feedback. One implicit assumption of therapy progress feedback is that clients unlikely to benefit from therapy can be detected early enough in the course of therapy for corrective action to be taken. As a test of this assumption, midtherapy progress was examined as a predictor of final couple therapy outcome in a sample of 134 distressed couples. Either a brief 7- or 32-item assessment of couple therapy progress at midtherapy detected a substantial proportion (46%) of couples who failed to benefit by the end of therapy. Given that failure to benefit from couple therapy is somewhat predictable across the course of therapy, future research should test whether systematic monitoring and feedback of progress could enhance therapy outcome.
The similarity in efficacy of evidence-based couple therapies suggests that it may be useful to identify those treatment principles they hold in common. Expanding on the previous description of a unified protocol for couple therapy (Christensen, 2010), this article outlines five common principles: (a) altering the couple's view of the presenting problem to be more objective, contextualized, and dyadic; (b) decreasing emotion-driven, dysfunctional behavior; (c) eliciting emotion-based, avoided, private behavior; (d) increasing constructive communication patterns; and (e) emphasizing strengths and reinforcing gains. For each of these five elements of the unified protocol, the paper addresses how and to what extent the most common forms of evidence-based couple therapy carry out this principle. Implications for clinical practice, treatment research, and basic research on intimate relationships are discussed.
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.