Client Perceptions of Couples Therapy: Helpful and Unhelpful Aspects

This article describes a qualitative study that investigated client perceptions of helpful and unhelpful aspects of couples therapy. A thematic analysis of interviews revealed among other themes, that couple participants associated helpful therapy experiences with (a) being given choices regarding ideas and ways of working that fit for them, (b) working with a therapist they trusted, and (c) developing new ideas about the couple relationship. Implications of this study for future research, practice, and training are described.     

Depression und Paarbeziehung

The close relationship between depressive disorders and couple relationships has been well proved empirically.Conflicts and problems within the couples'relationship can be a significant trigger for depression. In additition, the quality of the relationship is often markedly impaired by depressive disorders, in many cases far beyond the depressive phase.The couples'relationship also influences significantly the course of depressions, especially when the disorders are not yet chronic.The link between depression and couples'relationship seems to be stronger and more evident for women than for men. Furthermore there seem to be patterns of interaction in couples with a depressed partner, which differ from those in healthy or other clinical comparison groups or distressed couples without depression.These patterns need further exploration with regard to different subgroups of depressed patients and phases of depression.Couples' therapy has been proved to be effective in the treatment of depression on the symptomatic and on the relationship level.Conjoint assessment and counselling sessions with depressed patients and their partners should be conducted regularly.For patients suffering from an ‘anaclitic’,‘sociotropc’form of depression couples' therapy in a more narrow sense is usually indicated. In the treatment of depressives of the ‘autonomous’ ‘introjective’ type partners should be included into treatment for the assessment and the working through of specific conflicts concerning the relationship.     

Couple Enrichment Approaches

Abstract

Contemporary couple enrichment approaches are classified and select programs described. The research on their effectiveness is summarized and their usefulness as primary interventions or as adjunct interventions for couples in therapy is highlighted. Directions for future research and practice are suggested.     

Parental grief of a perinatal loss: A comparison of individual and relationship variables

Abstract

This study focuses on the comparison of individual variables of bereavement, depression, and stress with variables associated with the couple relationship, including cohesion, adaptability, communication, satisfaction, and partner support. In total, 24 couples completed self-report instruments within 2 weeks after a miscarriage. Mothers had significantly stronger grief reactions than fathers. Fathers and mothers perceived their relationships similarly as highly functional. Except for mothers' depression and their satisfaction with the couple relationship, the correlations between individual and relationship variables were rather weak. Implications of the results for family professionals are discussed.     

Intimate Relationships and Psychopathology

Relationship functioning and individual mental health and well-being are strongly associated with one another. In this article, we first review the cross-sectional and longitudinal associations between relationship discord and various types of psychopathology, We then review findings suggesting that relationship discord is associated with poorer outcome for individual-based treatments for psychopathology and that, generally, relationship discord does not improve following individual-based treatments for psychopathology. Finally, we present a model for conceptualizing work with couples in which one partner has a psychiatric disorder and review the efficacy of couple-based interventions in the treatment for psychiatric disorders, with a focus on substance-related, mood, and anxiety disorders.     

Danger or Opportunity

SUMMARY

Countertransference is the sine qua non of all human relationships. The manner in which the couples therapist deals with countertransferential feelings can have a powerful impact as either a force for healing or a force for destruction. Based on the tenets of Integrity Therapy, this paper offers a philosophical and clinical examination of countertransference in couples therapy. Focusing on the areas of rigid adherence to therapeutic dogma, emotional expression at all costs, negative countertransference and projective identification, teaching unauthentic ways of interacting, and co-therapy issues, this paper explores the ways in which traditional dynamic, humanistic and emotionally centered couple therapies can both therapist and patient into a betrayed of self and of the couple relationship.     

The Dynamic Interplay Between Satisfaction With Intimate Relationship Functioning and Daily Mood in Low‐Income Outpatients

Substantial research supports bidirectional links between intimate relationship discord and individual psychopathology, including depressive symptoms. However, few studies have utilized daily diary methods to capture the micro‐level processes underlying the association between couple discord and depression, particularly among populations that are at elevated risk for both interpersonal and individual dysfunction. To address this gap, we examined whether daily changes in satisfaction with relationship functioning were associated with daily changes in negative affect and positive affect over the span of 2 weeks among mental health outpatients of low socioeconomic status. Participants were 53 low‐income outpatients from community mental health clinics who completed a semi‐structured interview about the quality of their intimate relationships followed by 14 daily reports of positive and negative mood and satisfaction with relationship functioning across several domains. Growth curve analytic techniques revealed the hypothesized bidirectional relations. Decline in satisfaction with relationship functioning predicted escalation in negative affect and deterioration in positive affect over 2 weeks, and deterioration of mood predicted declining satisfaction with relationship functioning. This study extends existing knowledge about couple dysfunction and individual psychopathology by highlighting the immediate nature of this dynamic process as it unfolds over time.     

Using Contextual Therapy to Treat Depression with Couples

Abstract

Though depression is one of the most common presenting problems treated by systemic therapists, there have been relatively few attempts to describe how specific systemic therapy models can be applied to treat couples dealing with depression. In this paper, we discuss how contextual therapy can be used to treat depression in couples therapy. We identify multidirected partiality as an intervention and as a characteristic. We introduce letter writing and internalized other interviewing as contextual interventions that help to facilitate partiality and understanding between clients. A clinical vignette illustrates our discussed concepts.     

Clinical Issues with Gay Male Couples

SUMMARY

Although gay male couples share with all couples three essential tasks of couplehood-creating boundaries in order to form a couple identity, negotiating closeness and distance, and accommodating to their individual differences-gay male couples face special complications in each task. These complications, examined herein, are largely the result of the marginalization gay men experience from living in a homophobic culture, and male gender acculturation that makes male-to-male intimacy difficult. A model of brief couple therapy for gay men is presented that is designed to honor, as well as challenge, the relationship the men have co-constructed and specifically addresses the difficulties men have in maintaining intimate bonds. A case study illustrates the treatment of clinical issues presented by male couples.     

Couples treatment for major depression: critique of the literature and suggestions for some different directions

Current couples approaches to the treatment of depression show considerable promise for some couples, but have substantial room for improvement – in terms of efficacy as well as applicability and acceptability to a broader population. Although conjoint approaches have been shown to be efficacious in reducing couple distress and are possibly efficacious in ameliorating depression that co-occurs with couple distress, methodological problems hamper generalization from the published findings. Therefore, it is not clear that most depressed persons are likely to benefit from currently available conjoint formats. Most basically, there may often be obstacles that prevent or delay partner involvement, highlighting the need for treatments that can enhance relationship functioning without relying on a conjoint format. Existing treatment delivery systems may also fail to reach a considerable segment of the population. Developing a more flexible set of options for implementing couple-focused treatment, as well as rethinking dominant assumptions about depression, may be integral to extending the viability of couples therapy for depression.     

Feminist Issues in Couple Therapy

Abstract

The authors reviewed the feminist couple therapy literature from 1995 to 2006. They summarized this large body of work into several key themes. The first revealed that feminist couples therapists are continuing to discuss and deconstruct gender issues in couple therapy. The second showed that feminists believe that therapists should be educated both academically and personally about culture and diversity so as to support couples in their therapy around their own issues of diversity as well as learning to deal with issues of social justice as a couple. In the third theme, the authors introduced readers to feminists' emphasis on connection and empathy within couple and sex therapy. And, in the fourth, the authors explored feminists' work with power in couple therapy as they applied to couple therapy in general as well as around the specific topics of: balancing family and work and therapy for familial violence.     

Relationship Patterns and Role of Religion in Elderly Couples with Chronic Illness

ABSTRACT

This study was designed to explore the various relationship patterns and the role religion plays as a coping resource for elderly couples in which at least one spouse has a chronic illness. Elderly couples were interviewed and also completed marital satisfaction and couple communication inventories. Five different relationship patterns emerged from the data: active couples, short-term caregivinjg couples, long-term caregiving couples, survival couples, and live-in caregiver couples. Various aspects of religion emerged as an important coping resource among the different relationship patterns. Ideas and questions for research and practice, generated by the study, are presented.     

Emotionally-focused therapy and treatment as usual comparison groups in decreasing depression: A clinical pilot study

Abstract

Decades of research have shown that depression can have deleterious effects on couple relationships. Emotionally-focused therapy (EFT; Johnson, 2004 Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. East Sussex, UK: Brunner-Routledge. [Google Scholar]) is an empirically validated form of couple therapy, which has shown effectiveness in reducing depressive symptoms in couples where the wife has depression. The aim of the current pilot study was to examine the extent to which EFT and the comparison treatment as usual (TAU) therapy group decrease depressive symptoms in distressed couples. Results show that both groups were effective in decreasing depressive symptoms, with EFT showing a clinically significant reduction. Clinical implications and future research are discussed.     

Specificity of the Association between Marital Discord and Longitudinal Changes in Symptoms of Depression and Generalized Anxiety Disorder in the Irish Longitudinal Study on Ageing

This longitudinal study was conducted to evaluate actor and partner effects of marital discord on changes in symptoms of depression and generalized anxiety disorder (GAD) in a large population sample of Irish adults (N = 1,445 couples), adjusting for the potential confounds of quality of other social relationships and other psychopathology symptoms. The Actor–Partner Interdependence Model was used to examine actor and partner effects of marital discord on changes in symptoms of depression and GAD at a 2‐year follow‐up. Additional models examined these associations adjusting for family and friend discord and symptoms of the other type of psychopathology (depressive or GAD symptoms). Actor effects of marital discord on depressive and anxiety symptoms were greater for men than for women. There were significant, positive actor effects of marital discord on depressive symptoms for husbands and wives, which remained significant when adjusting for family and friend discord and GAD symptoms. There were significant, positive actor effects of marital discord on GAD symptoms for husbands, which remained significant when adjusting for family and friend discord and depressive symptoms. Results demonstrate that longitudinal associations between marital discord and depressive symptoms (for wives and husbands) and GAD symptoms (for husbands) are incremental to other rival explanations (family and friend discord and the other set of symptoms). Findings provide evidence for a potential causal association leading from marital discord to symptoms of depression and GAD.     

Core Energetic Couples Therapy

SUMMARY

Core energetics is a method of psychotherapy that seeks the integration of all aspects of humanity: the emotional, physical, mental, and spiritual. Based on a deep understanding of the ways in which energy and consciousness work together, the therapy, developed by John C. Pierrakos, MD, invites couples to experience their inner truth and to identify their universal life goals and core feelings. Core energetics emphasizes wholeness and unification without loss of individuation for the couple. This article describes core energetics as it is used in couples work; the theory, therapeutic stance, methods of diagnosis, and energetic techniques are discussed, as well as the focus on sexuality and Spirituality.     

Marital satisfaction and depression: a replication of the Marital Discord Model in a Latino sample

The Marital Discord Model of Depression maintains that marital discord is an important antecedent in the development of depression. Although empirical evidence supports this premise, none of this research has been done with Latinos. The purpose of this study was to test the longitudinal relationship between marital satisfaction and depression among 99 Brazilian women. Using structural equation modeling, results indicated that marital satisfaction was a strong predictor of depression 2 years later. Marital satisfaction was also related to cooccurring depression. These results provide evidence that the Marital Discord Model of Depression is an appropriate theoretical model for the conceptualization of marital discord and depression with Latina women and suggest the potential utility of using couples therapy for treating depression among this population.     

Facets of the Dance

Summary

This paper explores five differentiated facets of relationship involved in coupling and couples therapy. These are the person-to-person aspect, the transferentia! aspect, the working alliance, the reparative aspect, and the transpersonal aspect. It is suggested that these five facets tend to be present in most permanent couples relationships in varying degrees and at different times. This integrative framework is offered to assist couple and couples therapists in the assessment, treatment, and growth of mature, loving human relationships.     

Personhood of the Therapist in Couples Therapy

SUMMARY

Integrity Therapy (Lander, 1986; Lander & Nahon, 1992a, 1995a; Mowrer, 1961b, 1964a) views the personhood of the therapist as the very essence of therapy. By meeting the deepest part of the therapist with the deepest self of individuals in therapy, a healing process unfolds which opens up the healing potential of both the individuals and the couple. This article offers couple therapists and other mental health professionals an Integrity Therapy perspective of the personhood of the therapist and its therapeutic potential for helping couples in distress to reclaim their personhood. Two aspects of the Integrity Therapy approach which play a critical role in enhancing therapists' use of their personhood in the therapeutic process are explored: (a) the use of therapist self-disclosure, and (b) therapists' awareness and therapeutic use of counter-transference issues.