Couple Therapy and Spirituality and Religion

Abstract

The current state of the art of the integration of couple therapy with spirituality and religion is presented. Each of three waves of this integration identified in this article have seen an increase in the literature in this area, although only a limited amount in each wave has addressed couple therapy specifically. In the first wave, from 1990–1994, articles set forth arguments for why spirituality should be integrated in therapy. During the second wave, 1995–1999, publications focused on the ways that including spirituality in therapy can enhance as well as harm the therapeutic process. In the third wave, 2000-present, attention has shifted away from whether to include spirituality to how it should be included, and the literature of this period features many practical interventions and suggested guidelines for integrating spirituality and religion into therapy and training. The article concludes with recommendations for further developing the integration of spirituality and religion into couple therapy models, research, and training.     

A Solution-Based Approach to Couple Therapy

Abstract

Couples often present for counseling as a last resort. As relationships in crisis may not last it is important that treatment be time-effective. Solution-based therapies have been described as brief and time-effective and applied effectively to working with couples. This article presents a case example demonstrating the application of a solution-based approach to therapy with a married African-American couple entering therapy to resolve their relationship difficulties that lead to the initiation of divorce proceedings. The processes of reducing blame and conflict, creating hope and solution building utilizing solution-based interventions are discussed, as well as the treatment outcomes.     

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.     

The Effectiveness of Couple Therapy

Abstract

Most theories and methods about couple dierapy are developed and tested in Anglo-Saxon countries. In this clinical study, we tested these theories and methods within a Swedish public health context. We assessed the outcomes of 131 couples (262 individuals) using the Dyadic Adjustment Scale (DAS) and the Family Climate (FC) survey. Initially, the couples displayed severe marital distress and a dysfunctional family climate. Both marital satisfaction and family climate improved considerably, which confirmed the effectiveness of these methods in a Swedish context.     

Integrating Sex Therapy Interventions with Couple Therapy

This conceptual/clinical paper presents a couple, integrative, psychobiosocial model of assessment, treatment, and relapse prevention for common sexual dysfunctions. The goal is to encourage couple therapists to integrate sexual permission-giving, scientifically and clinically relevant sexual information and guidelines, and specific sexual suggestions/interventions into their couple work. The artificial barriers between couple and sex therapy is to the detriment of couples who need to address intimacy and sexuality problems.     

The Efficacy of Behavioral Couples Therapy and Emotionally Focused Therapy for Couple Distress

Twenty treatment outcome studies, 13 of which evaluated behavioral couples therapy (BCT) and seven of which evaluated emotionally focused therapy (EFT) were reviewed, leading to the following conclusions. BCT leads to short and long-term gains for moderate to severe couple distress. In the long term BCT probably leads to no better outcomes than its constituent components—behavioral exchange training and communication and problem solving skills training. Addition of a cognitive therapy component to BCT or the use of a variety of treatment formats does not improve the efficacy of BCT. Integrative couples therapy and insight-oriented marital therapy may be more effective than BCT, but studies supporting this conclusion require replication. EFT leads to short and long-term gains for mild to moderate couple distress. Addition of a cognitive therapy component to EFT does not enhance its efficacy. EFT may be more effective than problem solving therapy and less effective than integrated systemic therapy, but the two studies supporting this conclusion require replication.Michael Byrne, PhD, is a Clinical Psychologist, Midland Health Board, Ireland; Alan Carr, PhD, is Director of the Clinical Psychology Training Programme, Department of Psychology, Arts Building, University College Dublin, Belfield, Dublin 4, Ireland (alan.carr@ucd.ie). Marie Clark, PhD, is Lecturer, Department of Psychology, University of Surrey, United Kingdom.     

Differences in Dropout Rates Among Individual, Couple, and Family Therapy Clients

The premature dropout of clients from therapy is an inefficient expenditure of mental health resources. This study examined differences in dropout rates among individual, couple, and family therapy clients. Data came from archived records at a marriage and family therapy clinic at a university in the United States. Results indicated that there were no significant differences in dropout rates, despite the use of multiple measures of dropout. Thus, from a mental health services perspective, administrators and clinicians can expect that dropout rates will remain fairly consistent across treatment modalities.     

Relational Drawings in Couple Therapy

In couple therapy sessions, partners often get into long and drawn-out discussions, heavy with pain, resentment, and blame. It is vital for the therapist to avoid becoming entangled in these escalating interactions. In this article, as one way of avoiding these interactions, a protocol is proposed of using relational drawings in couple therapy for opening space for new stories. This approach is strongly rooted in extensive therapeutic experience, as well as in dialogical ideas. Not the content of the partners' imagery is central, but rather the dialogical exchange about the drawings. In particular, the focus of the therapist is on the partners' interactions, their hesitations and their surprises. Working in this way opens space for the partners to reflect on what they experience as crucial in their bond. The protocol is illustrated with two detailed case examples.     

Problem Definition in Marital and Family Therapy: A Qualitative Study

This paper describes findings from a grounded theory study on the process of constructing problem definitions by marital and family therapists. Coding of the observations and interviews resulted in two meta-problem definition processes. In the first meta-process clinicians kept their definitions internal to themselves during the therapy session. In contrast, the second meta-definition process involved clinicians bringing forth their internal problem definitions and incorporating them into the therapeutic conversation. Implications for existing conceptualizations and marital and family therapy practice and supervision are discussed, as well as suggestions for further consideration.     

Emotionally Focused Couple Therapy

Abstract

Working with couples who are both survivors of emotional abuse and are currently in an emotionally abusive relationship can be particularly challenging for the clinician. This article focuses on Emotionally Focused Couple Therapy as a recommended practice approach for clients who are caught in emotionally abusive patterns with one another. The article reviews relevant literature on this approach and illustrates the specific interventions applied lo an emotionally abusive couple.     

Integrating Social Information Processing and Attachment Style Research with Cognitive-behavioral Couple Therapy

The majority of the empirically validated interventions for relational distress focus primarily upon improving behavioral functioning, particularly couples’ communication patterns in conflict situations. However, although communication is highly predictive of relationship distress and later divorce, research on the effectiveness of premarital and marital interventions based on communication training has shown limited results. Therefore, although the skills-based approaches can be effective in treating relational discord and instability, they also often neglect another potentially powerful mechanism in the development of relational distress: the social cognitions and/or schemata regarding relationships that individuals carry into their marriages that stem from negative attachment experiences. Thus, this article describes how blending information gleaned from attachment style research with the body of literature addressing social information processing can enhance current methods for the treatment of relational discord. The existing research on adult romantic attachment styles is placed within a social-cognitive information processing framework and a case study demonstrating the utility of this approach with difficult couples is described.     

Parent Expectancies for Child Therapy: Assessment and Relation to Participation in Treatment

Two studies examined parents' pre-treatment expectancies for their child's psychotherapy among children (N = 405, ages 2–15) referred for oppositional, aggressive, and antisocial behavior. Study I focused on the development of a measure to assess expectancies. The results indicated that the measure was internally consistent. Moreover, socioeconomic disadvantage and ethnic minority status, severity of child dysfunction, child age, and parental stress and depression were significant predictors of lower parent expectancies for child therapy. Study II examined the relation of parent expectancies and participation in therapy. The results indicated that parent expectancies predicted subsequent barriers to treatment participation, treatment attendance, and premature termination from therapy. Overall, these findings have implications for the study of expectancies for therapy, for identifying families at risk for premature termination from treatment, and for the development of interventions designed to increase parent participation in child therapy.     

Learning Emotionally Focused Couple Therapy: Four Clinicians' Perspectives

This study examined the experiences of four clinicians learning emotionally focused couple therapy (EFT). Two group interviews, separated by 6 years, explored topics that included emotion, gender, model differences, personal practitioner impact, and the long-term influence of EFT training on clinical work. Emotion emerged as a major theme, with three subthemes at each phase. Phase 1 results indicated an increase in personal awareness of emotions, a positive impact on close personal relationships, and challenges for males in learning to elicit and use emotion. Phase 2 results, 6 years later, revealed that focusing on emotions remained salient and that EFT continues to influence the work of each clinician to varying degrees. Limitations, future research suggestions, and clinical implications are discussed.     

Benchmarking Community-Based Couple Therapy: Considering Measurement Reactivity

Couple therapy has been shown to be effective in randomized clinical trials; however, results from naturalistic couple therapy have been less consistent. This study utilized a benchmarking approach to compare the effectiveness of couple therapy in a community-based setting with findings from efficacy treatments, such as treatment within randomized clinical trials. The current study is the largest couple therapy sample published to date (N = 3,347 couples). Clients in couple therapy were asked to provide initial and weekly ratings of symptomology on the Outcome Questionnaire (OQ-45.2). We found that treatment effect sizes found at community clinics were smaller than efficacy studies (i.e., the benchmark). However, when taking into account measurement reactivity, the effect sizes were comparable. This is the first benchmarking study for community-based couple therapy, allowing for meaningful comparisons and understanding of outcomes in real-world couple therapy. Implications for the field are offered in terms of evaluating community-based psychotherapy studies with benchmarking for couple therapy. Results of this study provide clinicians and researchers a way to meaningfully compare couple therapy outcomes, accounting for differences in community-based practices and randomized clinical trials. This benchmark also underscores the impact of measurement sensitivity, an issue commonly overlooked in psychotherapy research and practice.     

Factors That Predict Premature Termination Among Mexican-American Children in Outpatient Psychotherapy

The role of demographic variables, acculturation, and therapy attitudes and expectations in predicting treatment dropout for Mexican-American families who presented for mental health treatment for a young child at a community mental health center was examined. Univariate analyses indicated that less educated parents who felt that they should be able to overcome their child's mental health problems on their own, and who felt that emotional and behavioral problems should be handled by increasing discipline were more likely to terminate prematurely. In addition, parents who perceived more barriers to treatment and expected their child to recover quickly were more likely to drop out of treatment after attending just one session. Measures of household income, acculturation, therapist–client ethnic match, perceptions of stigma, and expectations of therapist directiveness were not related to treatment dropout. When multivariate analyses were examined, parental education, perceived barriers to treatment, and belief in increased discipline remained significant predictors of treatment dropout, and client–therapist ethnic match became a significant predictor of dropout. Results are discussed in terms of implications for culturally-sensitive interventions.     

The Relationship Between Dropout and Outcome in Naturalistic Cognitive Behavior Therapy

Dropout from psychotherapy is frequent and limits the benefits patients can receive from treatment. The study of factors associated with dropout has the potential to yield strategies to reduce it. This study analyzed data from a large sample of adults (N = 1,092) receiving naturalistic cognitive behavioral therapy (CBT) to test the hypotheses that dropouts, as compared to completers, had (1) higher symptom severity at treatment termination, (2) a slower rate of symptom change during treatment, and (3) a higher odds that the therapist rated treatment as ending for reasons related to poor outcome. Results showed that although dropouts ended treatment with higher symptom severity than completers, dropouts and completers did not differ in their rate of symptom change during treatment, suggesting that dropouts had higher symptom severity at termination because they received fewer sessions of treatment, not because their symptoms changed at a slower rate. Dropout was also associated with a higher odds of having a therapist-rated termination reason indicating a poor outcome, suggesting that dropout is more likely if patients are dissatisfied with some aspect of the therapy outcome or process. These findings suggest that strategies for monitoring and enhancing patient satisfaction with the process and outcome of treatment may help patients stay in treatment longer and end treatment with fewer symptoms than if they had dropped out.     

A Cross-Cultural Perspective on Couple Differences

SUMMARY

This paper challenges the idea that differences between partners in couple relationships are inherently problematic. A “cross-cultural” perspective on differences in couples that considers partners' reactions to difference as the problem is presented. Couples therapy from a cross-cultural perspective begins with a detailed' assessment of perceived differences, reactions to differences, the context in which the differences have developed, and the purposes they serve. Therapeutic tasks involve managing maladaptive reactions to differences, learning to accept differences, and co-designing a common couple culture.     

Couple Therapy and Addictions

Abstract

Therapies for alcoholism, substance abuse, and other addictions traditionally focus on characteristics of individuals such as behaviors, thoughts, and emotions. These kinds of programs tend to target problems inside the abusing person rather than a relational system. Treatments that are more recent locate the problems within systems of people. Regardless of the locus or cause of the abuse or addiction, seen as arising from disease processes, systemic dynamics, or other mechanisms that lead to unfortunate habits and behaviors, utilizing the individual's partner or family in therapy has become an important part of successful treatment. This article reviews models of couple treatment for alcoholics and substance abusers in terms of initiation into treatment, primary treatment, and relapse prevention.     

Love in Action: An Integrative Approach to Last Chance Couple Therapy

This article presents an integrative approach to the special challenges of therapy with couples on the brink of dissolution or divorce—who often describe this therapy as their “last chance.” In some, one partner is considering ending the relationship, and in others, both partners are considering ending it. Often, these couples have had prior dissatisfying experiences in couple therapy. Four types of last chance couples are described: high‐conflict couples; couples in which partners have differing goals for their lives or different timelines for reaching shared goals; couples in which one or both partners have acted in a manner that violates the values, expectations, emotional comfort, or safety of the other; and couples in which there has been a gradual loss of intimacy. The Therapeutic Palette, a multiperspectival, theoretically eclectic integrative approach, is enlisted as a general framework for selecting and sequencing use of particular theories and their associated practices, based on the three “primary colors” of couple therapy: time frame/focus, level of directiveness, and change entry point. An additional complementary framework, the creative relational movement approach, is proposed to provide an integrative frame encompassing both language‐based and action‐based practices, suggesting that meaning is held and expressed as much through interaction or “relational motion” as it is through language. Principles of change are described. Due to the couple's level of crisis and desire for immediate evidence of possible improvement, priority is given to action‐based interventions in early stages of therapy, by engaging couples in “experiments in possibility.” Typical action approaches are described. An extended vignette follows.