Providing Relationship Interventions to Same-Sex Couples: Clinical Considerations,Program Adaptations,and Continuing Education

Despite remarkable similarities to different-sex couples in terms of core relationship processes and outcomes, same-sex couples differ from different-sex couples in important ways, including relational strengths (e.g., more egalitarian) and challenges associated with their sexual minority identity (e.g., discrimination). Given that most cognitive-behavioral relationship interventions have been designed for and tested on different-sex couples, clinicians wishing to serve same-sex couples will need to make appropriate adaptations to these interventions in order to remove heterosexist bias and sensitively meet the unique needs of same-sex couples. Further, clinicians should strive to be culturally competent in serving this population by developing knowledge of same-sex couple dynamics and issues, and by building a sense of comfort working with these families, which may involve addressing personal biases. The current paper seeks to provide an introduction to same-sex couple relational processes, and offers clinical recommendations and intervention adaptations to better serve this population. Some examples will refer to the development of the Strengthening Same-Sex Relationships programs, culturally sensitive relationship education programs specifically designed for and successfully piloted with male and female same-sex couples.     

Intimate partner violence in the military: Treatment considerations

While considerable research has examined the prevalence of IPV in civilian couples, much less information is available on married or cohabitating couples in which one or both parents are active duty soldiers or veterans of foreign wars. In this review, we explore various aspects of the partner violence phenomena among military personnel (i.e., active duty and veterans) and their implications for intervention. We highlight (a) the scope of the problem, (b) discuss domestic violence as defined by the Department of Defense (DoD), (c) list prevalence rates of IPV among military families, (d) identify correlates of IPV, and (e) discuss treatment options for providers working with these couples. We also discuss the barriers to intervention and their implications for victims, perpetrators, and providers. Conclusions and recommendations for future research directions are also briefly discussed.     

Remarital Issues in Couple Therapy

Abstract

Remarriage and cohabitation after divorce are becoming societal norms. Given the increasing numbers of these couples, mental health professionals will encounter them in their clinical practice. There are unique issues associated with remarriage (e.g., role and boundary ambiguity, unrealistic expectations) that can hinder the family reorganization process and exacerbate typical communication problems experienced by couples. Therefore, therapists must have knowledge of these challenges to provide the most effective treatment. A brief overview of the remarriage and stepfamily literature, and recommendations for clinicians are presented.     

Gender issues in the treatment of welfare couples: A feminist approach to marital therapy of the poor

This article presents a treatment model for work at home with couples in poor families on welfare that incorporates a feminist view targeting sex-role attitudes and behaviors as a central goal. A case study is presented to illustrate these principles. The work is based on both in-depth interviews with 13 Israeli couples on welfare and clinical impressions gained from the treatment of 30 Israeli couples on welfare. Poor couples are analyzed in terms of gender issues and the relationship of these issues to mental health, couple functioning, and couple interaction within the helping profession.Irit Barnea, Hannan Rosenberg, and Moshe Sens contributed to research and treatment with the couples described in this paper.     

Family-Centered Care for Military and Veteran Families Affected by Combat Injury

The US military community includes a population of mostly young families that reside in every state and the District of Columbia. Many reside on or near military installations, while other National Guard, Reserve, and Veteran families live in civilian communities and receive care from clinicians with limited experience in the treatment of military families. Though all military families may have vulnerabilities based upon their exposure to deployment-related experiences, those affected by combat injury have unique additional risks that must be understood and effectively managed by military, Veterans Affairs, and civilian practitioners. Combat injury can weaken interpersonal relationships, disrupt day-to-day schedules and activities, undermine the parental and interpersonal functions that support children’s health and well-being, and disconnect families from military resources. Treatment of combat-injured service members must therefore include a family-centered strategy that lessens risk by promoting positive family adaptation to ongoing stressors. This article reviews the nature and epidemiology of combat injury, the known impact of injury and illness on military and civilian families, and effective strategies for maintaining family health while dealing with illness and injury.     

Family Systems and Ecological Perspectives on the Impact of Deployment on Military Families

The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent–child) within military families. In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones. In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.     

The Uses of Emotion Maps in Research and Clinical Practice with Families and Couples: Methodological Innovation and Critical Inquiry

We explore how “emotion maps” can be productively used in clinical assessment and clinical practice with families and couples. This graphic participatory method was developed in sociological studies to examine everyday family relationships. Emotion maps enable us to effectively “see” the dynamic experience and emotional repertoires of family life. Through the use of a case example, in this article we illustrate how emotion maps can add to the systemic clinicians’ repertoire of visual methods. For clinicians working with families, couples, and young people, the importance of gaining insight into how lives are lived, at home, cannot be understated. Producing emotion maps can encourage critical personal reflection and expedite change in family practice. Hot spots in the household become visualized, facilitating dialogue on prevailing issues and how these events may be perceived differently by different family members. As emotion maps are not reliant on literacy or language skills they can be equally completed by parents and children alike, enabling children's perspective to be heard. Emotion maps can be used as assessment tools, to demonstrate the process of change within families. Furthermore, emotion maps can be extended to use through technology and hence are well suited particularly to working with young people. We end the article with a wider discussion of the place of emotions and emotion maps within systemic psychotherapy.     

Implementation and Dissemination of Military Informed and Evidence-Based Interventions for Community Dwelling Military Families

Community dwelling military families from the National Guard and Reserve contend with deployment-related stressors in relative isolation, living in communities where mental health providers may have little knowledge of military culture. When they are community residents, active duty service members and families tend to live in close proximity to their military installations. This article will focus primarily on the challenges to quality mental health care for reserve component (RC) families. Where studies of RC families are absent, those of active component (AC) families will be highlighted as relevant. Upon completion of a deployment, reintegration for RC families is complicated by high rates of symptomatology, low service utilization, and greater barriers to care relative to AC families. A paucity of providers skilled in evidence-based treatments (EBTs) limits community mental health capacity to serve RC military families. Several emergent programs illustrate the potential for better serving community dwelling military families. Approaches include behavioral health homes, EBTs and treatment components, structured resiliency and parent training, military informed schools, outreach methods, and technology-based coping, and psychoeducation. Methods from implementation science to improve clinical skill acquisition and spread and sustainability of EBTs may advance access to and quality of mental health treatment and are reviewed herein. Recommendations related to research methods, military knowledge and treatment competencies, and transition to a public health model of service delivery are discussed.     

Family measurement techniques

Abstract

This is the first issue in which the Family Measurement Techniques section appears in The American Journal of Family Therapy. I hope that you, the readers of the journal. will find it helpful in your clinical work with couples and families. In each issue, instruments, procedures and assessment techniques will be reviewed by clinicians who have expertise in the areas of marital/family measurement and evaluation. Reviewers have been asked to consider two issues: instrument construction and clinical utility. Instrument construction deals with the theoretical underpinnings of the technique or procedure, the adequacy with which major theoretical concepts and constructs have been operationalized, the sampling procedures used in instrument construction, and the reliability and validity of the measurement technique. Clinical utility deals with issues of importance for practicing therapists, for example, length of time required for administration and scoring, degree of expertise or training needed for administration and interpretation, and overall clinical utility of the measure.

I hope that the information provided in these reviews will make it easier for the busy practitioner to select instruments for use in assessment, diagnosis and outcome evaluation.     

Helping military families through the deployment process: Strategies to support parenting

Recent studies have highlighted the impact of deployment on military families and children and the corresponding need for interventions to support them. Historically, however, little emphasis has been placed on family-based interventions in general, and parenting interventions in particular, with returning service members. This paper provides an overview of research on the associations between combat deployment, parental adjustment of service members and spouses, parenting impairments, and children's adjustment problems, and provides a social interaction learning framework for research and practice to support parenting among military families affected by a parent's deployment. We then describe the Parent Management Training-Oregon model (PMTO(?)), a family of interventions that improves parenting practices and child adjustment in highly stressed families, and briefly present work on an adaptation of PMTO for use in military families (After Deployment: Adaptive Parenting Tools, or ADAPT). The article concludes with PMTO-based recommendations for clinicians providing parenting support to military families.     

Intercultural Therapy with Latino Immigrants and White Partners

SUMMARY

Interethnic and interracial marriages of Latinos and White Americans are on the rise and will continue to reshape the identities of individuals, couples, families, and communities. Clinicians working with these intercultural couples find no systematic training to address what is becoming a significant segment of our society. Couple therapists, however, cannot be culturally competent and effective based solely on knowledge of some dimensions of a couple's cultural backgrounds. Using clinical and theoretical ideas, the author defines clinical work with these couples as an explicit intercultural exchange. Our task as clinicians requires a rethinking of our conversations with these couples. It involves a caring therapeutic approach that is sustained on relational and systemic levels, and intercultural conversational skills inspired by clinical and other literatures that are explicitly dedicated to work with cultural difference and the “other.”     

Impact of Social Networking Sites on Children in Military Families

Youth in military families experience a relatively unique set of stressors that can put them at risk for numerous psychological and behavior problems. Thus, there is a need to identify potential mechanisms by which children can gain resiliency against these stressors. One potential mechanism that has yet to be empirically studied with military youth is social networking sites (SNSs). SNSs have gained significant popularity among society, especially youth. Given the significance of these communication tools in youths’ lives, it is important to analyze how SNS use may affect military youth and their ability to cope with common military life stressors. The current review examines the potential positive and negative consequences associated with SNS use in coping with three common stressors of youth in military families: parent deployment, frequent relocation, and having a family member with a psychological or physical disability. By drawing from SNS and military literature, we predict that SNS use can be a positive tool for helping children in military families to cope with stressors. However, certain SNS behaviors can potentially result in more negative outcomes. Recommendations for future research are also discussed.     

A Psychological Support for Peacekeeping Soldiers and their Families: A Preliminary Model

Being a military family can be challenging, and the demands placed on soldiers and their families can become very complex. Military deployments are part of a soldier's military career that cannot be avoided and have the potential to influence military families directly. Separation within a military family is an inherent consequence of military deployments. Military deployments consist of various phases. Each phase has unique emotional and psychological challenges attached to it. These challenges can significantly influence every member in the military family. It is therefore imperative that the military, soldier and military families be sensitized around these phases and their unique challenges. A model is proposed to empower military families in the face of deployment.     

Cast of characters work: Systemically exploring the naturally organized personality

Cast of Characters Work conceives of the personality as a naturally organized unique group of characters who, together, function in an internal system. All characters bring their own histories, perceptions, feelings, beliefs, and behaviors to life's situations. Their survival strategies and interrelationships are felt as anxiety, conflict, ambivalence, or confidence. Heightening awareness of these multiple, simultaneous events increases access to the actual living process. The complex inner world of individuals, couples, and families can be precisely explored by working directly with each character and their relationships. Objectives are accountability and more functional, flexible, and satisfactory arrangements among characters internally and in couples and families.Also in private practice at 2 Pine Circle, Urbana, IL 61801.     

Expanding the Therapy Paradigm with Queer Couples: A Relational Intersectional Lens

North American and global cultures in general—and the field of Couple and Family Therapy in particular—have made significant strides toward recognizing and validating LGBTQ identities and relationships. However, clinical assessment and conceptualization of queer couples still lack the complexity needed to encompass the issues involved in treatment. Existing literature provides clinicians a basic understanding of queer couples and the dynamics that make them unique from nonqueer couples. However, much of this knowledge has been normed on White middle‐class couples and has rarely included couples with transgender or bisexual members. This article invites clinicians and researchers to apply a feminist model of intersectionality to understand queer couples. Our proposed intersectional lens considers multiple axes of identity and power and their interrelationships (Crenshaw, 1989, 1991). We argue that intersectionality is important for understanding all identities, whether privileged or marginalized (Falicov, 2003). This application of the concept of intersectionality is unique in its relational focus, emphasizing how partners’ complex individual identities overlap with and intersect with one another. Additionally, this lens considers how the therapists’ and clients’ multidimensional identities intersect. Three case studies are presented to illustrate application of the intersectional lens. In each case, exploring the partners’ multiple social locations, their influences on one another, and the therapist's intersections of identity all proved critical to the direction of therapy.     

The Significance of Military Contexts and Culture for Understanding Family Well-Being: Parent Life Satisfaction and Adolescent Outcomes

Formal systems and informal networks are presumed to be significant contexts that affect military families. Their effects on both parents and adolescents in active duty military families are examined (N = 236 families). Social organization and contextual model of family stress theories are employed as frameworks for the analyses of how dimensions of military culture influence parents’ life satisfaction, as well as key developmental outcomes of their adolescents (for example, mental health). Key findings from our analyses included a positive relationship between parents support from military leaders and fellow soldiers and parental well-being findings revealed the importance of civilian parents’ satisfaction with military life on adolescent outcomes for families that have experienced stressful military contexts. These findings provide support for the significance of multiple contexts for understanding resilience among military members and their families.     

Family and couples therapy with gay and lesbian clients: acknowledging the forgotten minority

Family and couples therapy in the main concentrates on heterosexual clients, and has thus been described as limited in its outlook, or discriminatory. It is argued that family and couples therapy is at present not offered to gay and lesbian clients because of an absence of appropriate referrals, the inability of therapists to recognize the sexual orientation of their clients, a belief that skills held by therapists are not appropriate for this client group, or because of the homophobia of the therapist. It is suggested that family and couples therapy should be more readily available for gay and lesbian clients, and a number of different issues which these families might face are discussed. This includes problems associated with the gay adolescent and the gay or lesbian parent, as well as the gay or lesbian couple. It is concluded that established forms of intervention are effective with gay clients, provided that the specific needs and problems of the gay and lesbian community are addressed by the therapist.     

African American Couples in the 21st Century: Using Integrative Systemic Therapy (IST) to Translate Science into Practice

The complexity of the African American community in the United States continues to evolve. The growing number of professional African Americans who grew up in the postcivil rights era combined with the persistent reminders of inequity paints a complex backdrop for understanding African American relationships. The majority of our knowledge about African American couples disproportionately comes from nonclinical social science fields such as sociology and demography. Unfortunately, the scholarly literature on how to work with African American couples is relatively scant. This paper seeks to add to this limited literature by providing clinicians and scholars with a proposed set of issues to consider when conceptualizing and treating African American couples. In particular, the complexity and nuance needed to work with African American couples are best done by using an integrative model. Thus, this paper will discuss how the Integrative Systemic Therapy (IST) model is particularly well suited for working with African American couples. This paper will summarize the science on African American marriages with a focus on salient factors such as gender, SES, and trust, which will then be translated into clinical practice by utilizing a case example. The case example will be of a middle‐class couple in order to delineate the challenges and the growing heterogeneity of African Americans. The article will conclude with a commentary on the evolving heterogeneity of African Americans, which sheds light on how an integrative perspective is important for disentangling and embracing the growing complexity of African American couples.