Structural couplings between individual development and the epigenesis of family relations in schizophrenia: An eight-year follow-up

The aim of this research was to study individual development along with the epigenesis of family relations in an eight-year follow-up of schizophrenia. The five epigenetic phases described by Wynne are attachment/caregiving, communicating, joint problemsolving, mutuality, and intimacy. Results showed that the critical level of epigenesis was the communicating level; its resolution was statistically significantly connected to good prognosis concerning individual parameters. The mother-child dyad was usually epigenetically the most developed dyad in the family. We think this study gives a new paradigm for understanding connecting interconnections between individual and family dynamics in schizophrenia and valuable information for planning the integrated and need-specific treatment of schizophrenia and evaluating the course and prognosis of schizophrenia.This study was carried out at the Clinic of Psychiatry of the University of Turku, Finland, and financially supported by the Academy of Finland. The head of the project was Professor Yrjö O. Alanen. We have also been in cooperation with and received valuable constructive criticism from Professor Lyman C. Wynne, whose theoretical model we applied in this study. Ms. Birgitta Nolvi's secretarial work was greatly appreciated.     

Factorial and construct validity of the revised short form integrative psychotherapy alliance scales for family, couple, and individual therapy

The Integrative Psychotherapy Alliance model brought an interpersonal and systemic perspective to bear on theory, research, and practice on the psychotherapeutic alliance. Questions have been raised about the independence of the theoretical factors in the model and their operationalization in the Individual, Couple, and Family Therapy Alliance Scales. This paper presents results of a confirmatory factor analysis of the scales that delineated at least three distinct interpersonal factors as well as shorter versions of the three scales to facilitate their use in research and practice. The paper also presents the results of a study testing each factor's association with client retention and progress over the first eight sessions in individual and couple therapy. At least two of the interpersonal factors were uniquely associated with progress in individual and couple functioning. Implications of the results for theory, research, practice, and training in individual, couple, and family therapy are elaborated.     

The Findings of a Cochrane Meta-Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice

The association between depressive symptoms and distressed intimate relationships supported the assumption that couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. This issue was addressed by a Cochrane meta-analysis assessing the evidence from clinical trials of couple therapy for depression in comparison with individual psychotherapy, drug therapy, and no/minimal intervention, including fourteen studies with 651 participants. No study was found free of bias and the quality of the evidence was low, with major problems of small sample sizes, missing outcome data, selective reporting, lack of information on random sequence generation and allocation concealment, recruitment of people not representative of clinical practice, and allegiance bias. The meta-analysis showed that both couple therapy and individual psychotherapy improved depressive symptoms at end of treatment and after 6 months or longer, with moderate effect sizes, without any difference between the two treatments. Couple therapy was more effective in reducing couple distress. This effect was larger in studies with distressed couples only and should be considered as relevant in its own right. Couple therapy is a viable option for the treatment of a depressed partner, especially in discordant couples. Future research should address several issues left open to provide a sound empirical foundation for clinical practice.     

Internal working models of caregiving and security of attachment at age six

This study describes the relation between internal working models of caregiving, child attachment, and maternal behavior in the home. Thirty-two mothers of 6-year-old children were observed in the home and subsequently interviewed regarding experiential and affective dimensions of parenting. Interviews were examined in order to assess the quality of the mother's thinking regarding two dimensions of caregiving (secure base, competence) which we hypothesized to be related to attachment security. Results indicated a strong correspondence between internal working models of caregiving and child mental representations of attachments as measured from the child's response to a laboratory reunion. The correspondence between mental representations of caregiving and maternal behavior in the home was limited. Representation ratings were most strongly associated with competence-supporting behavior. Implications for infant mental health research and program evaluation are discussed.     

A dyadic exploration of attachment and caregiving in long‐term couples

This cross‐sectional study explored associations between attachment style and caregiving patterns in 125 couples with children in the United Kingdom. The Actor–Partner Interdependence Model was used to model for both actor (own) and partner attachment effects on caregiving. Attachment was measured along the dimensions of avoidance and anxiety, and caregiving was measured along the dimensions of proximity, sensitivity, cooperation, and compulsion. Results indicated that different combinations of individual and partner attachment scores predicted different dimensions of caregiving. Own attachment scores best predicted caregiving proximity, cooperation, and compulsion, whereas own and partner attachment predicted caregiving sensitivity. The implications of the findings, limitations, and suggestions for future research are discussed.     

Holding and Facilitating Interactive Regulation in Couples with Trauma Histories

I discuss theoretical models of individual development in a dyadic system and their importance for couple therapy. These models are based on early infant research about the dyadic system created between caregiver and child and include ideas about self-regulation and mutual regulation. These related and overlapping theories are also relevant to the use of couple therapy with partners who have histories of early trauma. Traumatized individuals tend to use avoidant, disorganized, or ambivalent strategies of stress regulation, as opposed to secure and responsive ones. These strategies cocreate problematic interactive patterns in their couple relationships. It is therefore important to establish a therapeutic atmosphere of empathy, responsiveness, and trust that facilitates the partners' capacity to change their interactive patterns. This therapeutic atmosphere serves as a model for the partners that aims to promote more secure attachment, understanding, and growth.     

Placement of responsibility and moral reasoning in couple therapy

Within the past two decades there has been a growing awareness of the importance of moral and ethical judgements in family and couple therapy. In this article we provide a detailed analysis of placements of responsibility related to blame in one couple therapy session. We suggest that it is important to study therapeutic interaction in situ , when searching for an understanding of moral reasoning in couple therapy and an ethical evaluation of the practice. A detailed analysis of discursive tools used by clients and therapists makes it possible to look at moral reasoning in action as it unfolds within the flow of therapeutic conversation. The findings are discussed in relation to two discourses of moral justification: autonomy and relationality. The principle guiding the therapists' actions in the studied conversation could be called 'relational autonomy'.     

Do primary care psychological therapists ‘think family’? Challenges and opportunities for couple and family therapy in the context of ‘Improving Access to Psychological Therapies’ (IAPT) services

Very little couple or family work takes place in primary care despite the advantages offered by the context. This pilot study investigated the experiences of primary care adult therapists regarding the place of families in their clinical work. Semi‐structured interviews with seven therapists were analysed using interpretative phenomenological analysis. The findings tentatively suggest that primary care psychological therapists ‘think family’ primarily from the perspective of their main therapeutic model when offering individual therapy. Some study participants questioned the appropriateness of their family/context focus. Family members were extremely rarely seen together. Facilitating factors included supervision and training. Barriers to family work were both external (the work setting) and internal (beliefs about it). The impact of the current dominance of cognitive behavioural therapy in National Health Service adult psychological therapy services and the development of Improving Access to Psychological Therapies (IAPT) services on the provision of couple and family therapy are discussed. Some challenges and opportunities presented by IAPT for couple and family therapy are explored.     

Young adult couples’ behavioral and physiological responses to the infant simulator: A preliminary illustration of coparenting

This exploratory application of the infant simulator with two couples is designed to illustrate individual reactivity and coparenting behaviors in young couples in serious relationships who do not yet have children. A 35-min protocol with standardized onsets and offsets of inconsolable baby cries was used to capture partner’s individual behavioral and physiological responses as well as the couple’s joint efforts to soothe the crying baby. Task feasibility was demonstrated by couples’ persistent and wide-ranging efforts to calm the baby including rocking, feeding, changing, talking to the baby, and singing. Within-person fluctuations in ongoing heart rate (HR) and electrodermal activity (EDA) through the protocol suggested evidence of heightened physiological reactivity during baby crying compared to silence. During bouts of crying, higher HR also was evidenced when participants took the lead in caregiving as contrasted with assisting or busying themselves in another task. Behavioral observations indicated that this task elicited examples of coparenting behaviors including cooperation, support, undermining, and negotiating the division of labor. These preliminary pilot data demonstrate the potential of infant simulator paradigms with couples who are not yet pregnant but envision being future parents, and set the stage for future research to identify how individual and couple characteristics might impact reactions to shared baby caregiving.     

Dialectical and hermeneutical psychology

Dialectical and hermeneutical contributions to psychology are reviewed separately for the countries Denmark, Finland, Norway, and Sweden. Then, selected contributions are presented more extensively from the areas of family, socialization, and therapy; behavior therapy; educational psychology; research methods; and general psychology. Particularly in the area of family and socialization, dialectical and hermeneutical approaches have contributed to the application of, and reflection upon, therapy as a research method. The impact of dialectical and hermeneutical thought on Scandinvian psychology is too diverse to talk about any specific school, in either of the two traditions. Some main points of emphasis are, though: the qualitative study of individual cases, particularly through therapy; the focus on the internal unity of individual acts with the historical and material context of the act; the impact of the dominating mode of production upon every sphere of human life; the focus on issues of interpretation, particularly the relation of appearance and essence; and the conception of the object of psychology as a developing individual in a historical world.     

Low-level relationship aggression and couple therapy outcomes.

Increasing evidence supports the efficacy of conjoint therapies that focus on intimate partner violence for couples who engage in mild to moderate physical aggression but want to preserve the relationship and end the aggression. However, there has been no examination of how this population responds to couple therapy that does not have a specific focus on aggression. This lacuna in the research literature is of concern because couples with a history of low-level aggression often seek couple therapy, but couple therapy without a focus on violence is thought to potentially exacerbate aggression. In the current study, the authors examined the efficacy of non-aggression-focused behavioral couple therapy for couples with and without a history of mild physical aggression. One hundred thirty-four couples, 45% of whom had experienced low-level aggression in the year prior to therapy, completed up to 26 sessions of couple therapy and 2 years of follow-up assessments. Results demonstrated no significant differences in relationship and individual outcomes by history of aggression. In addition, couples maintained very low levels of physical aggression during and after treatment and showed reductions in psychological aggression when relationship and individual functioning improved.     

The avoidance cocoon: Examining the interplay between attachment and caregiving in predicting relationship satisfaction

In the present research, we examined the hypothesis that low avoidance enables the activation of the caregiving system, and therefore, among people low in avoidance, caregiving would affect relationship satisfaction, whereas among people high in avoidance, caregiving would not affect relationship satisfaction. One‐hundred seventy‐nine Israeli adults, currently involved in romantic relationships, participated in Study 1, in which we examined whether attachment avoidance moderated the associations between caregiving and relationship satisfaction. In Study 2, we sought to replicate this finding in a sample of Israeli couples (N = 194). Finally, in Study 3 (N = 44), we examined links between attachment, caregiving, and relationship satisfaction over a period of 1 year among Israeli married couples. Results indicated that caregiving deactivation and/or hyperactivation predicted lower relationship satisfaction, yet only among people low in avoidance or among people whose partners were low in avoidance. Results are discussed in relation to the important interplay between behavioral systems on individual and dyadic levels. Copyright © 2014 John Wiley & Sons, Ltd.     

A safe haven: an attachment theory perspective on support seeking and caregiving in intimate relationships

This study used an attachment theoretical framework to investigate support-seeking and caregiving processes in intimate relationships. Dating couples (N = 93) were videotaped while one member of the couple (support seeker) disclosed a personal problem to his or her partner (caregiver). Results indicated that when support seekers rated their problem as more stressful, they engaged in more direct support-seeking behavior, which led their partners to respond with more helpful forms of caregiving. Responsive caregiving then led seekers to feel cared for and to experience improved mood. Evidence for individual differences was also obtained: Avoidant attachment predicted ineffective support seeking, and anxious attachment predicted poor caregiving. Finally, couples in better functioning relationships engaged in more supportive interactions, and participants' perceptions of their interaction were biased by relationship quality and attachment style.     

Effectiveness of Couple Therapy in Practice Settings and Identification of Potential Predictors for Different Outcomes

Even though couple therapy is efficacious, there is no improvement in up to 50% of the couples. Also effect sizes found in effectiveness studies in real-world settings are considerably lower than those found in efficacy studies. There is a need to understand more about couple therapy effectiveness in practice settings and the factors responsible for different outcomes. A German nationwide study on the effectiveness of couple counseling including 554 couples applied the same methodology as two earlier studies in the same field. A remarkable consistency was found over the three independent studies in the burden with individual and relationship distress as well as in the rates of improvement. This supports the insight that the improvements reached through couple therapy in practice settings are only about half of the effect sizes reached in efficacy trials. Additionally this study investigated 64 factors, which were found to be influential for relationship quality and stability in earlier studies, for their impact on outcome. Factors present at initiation and termination of therapy were found, which correlate significantly with outcome and with separation of the couple in the follow-up. These factors could be included in prediction models for improvement and separation of the couple. The implications for the practice of couple therapy and for future research are discussed.     

Optimizing the alliance in couple therapy

The complexity of the relation between alliance and outcome in couple therapy was investigated in a study of 47 couples in brief therapy. Self-rated alliance was measured after the first and third sessions using the couple version of the Working Alliance Inventory. The results indicated that the correlation between alliance and outcome was significantly stronger when the partners agreed about the strength of the alliance, when the male partner's alliance was stronger than the female's, and when the strength of both partners' alliance increased as therapy progressed. The authors suggest that a unique feature of couple therapy is that the partners have both a preexisting relationship with each other (allegiance) and an alliance with the therapist to balance.     

Asian American Intermarriage

SUMMARY

This paper describes the therapeutic process of an interracial couple: an Asian American woman and a White American man. The intent of this therapy was to broaden the conversational space and encourage the couple to explore the effects of cultural beliefs and practices on their relationship. The therapist introduced two approaches for evoking the couple's interest in sharing narratives about their individual and couple racial identity. One approach was to have the couple interview their partner's “internalized other.” The other approach used two research studies to stimulate conversation about outmarriage with Asian Americans. This case study offers an account of two different ways individual narratives and shared conversational space can be expanded.     

传递性关系推理的简约模型——诠释传递性关系推理的新理论

Wynne的简约模型是基于动物的传递性关系推理研究所提出的理论模型。该模型假设：个体的传递性关系推理是通过运用刺激的强化值来表征顺序信息,并比较所呈现刺激之间强化值的差异来实现的。研究文献证实简约模型能够说明在人类和其它动物的传递性关系推理研究中所发现的大多数标准化效应,因此其被视为迄今解释传递性关系推理问题最经济的模型。但该模型将人类高级认知活动采用动物的机械学习方式来解释的还原论倾向是值得商榷的,它所探讨的传递性行为是否是“真传递性关系推理”也有待进一步验证。