Toward a Metacommunicational Framework of Couple Interactions

A multi-level, metacommunicational framework to understand couple interactions is presented. Five interactional levels are defined following a mode of abstraction that parallels the theory of logical types; case examples are offered of couples interacting at each of the levels. The clinical implications of the framework, as a metaphor for understanding transactional processes, are discussed with an emphasis on the pragmatics of working with punctuational diffferences, developing therapeutic strategies, measuring progress, and setting goals for therapy with couples.     

Intimacies: An Integrative Multicultural Framework for Couple Therapy

Implicitly or explicitly, our ideas about intimacy are the most fundamental notions giving direction to the process of couple therapy. Yet, as a field, we have spent little time conceptualizing intimacy and even less time considering the diversity of priorities and meanings couples bring to our offices. In Part One, Varieties of Intimacy, I describe a kaleidoscope of contexts—socio‐historical, cultural, gender, life cycle, and developmental—that inform our ideas and expectations for intimacy in couples’ relationships. I highlight different spheres in which intimacy may take place such as the emotional, sexual, intellectual, or familial. I propose a starting point in which the therapist, in a collaborative manner, helps the partners articulate their yearnings and priorities in order to negotiate a shared vision. In Part Two, Conceptualizing Intimacy, I suggest an experiential definition that gives room for each partner's subjective meanings, yet consider diverse relational processes that may need to be addressed for a resilient ebb and flow of intimate experiences. In Part Three , Sexual Intimacy, I outline conditions in which sex is more likely to be experienced as intimate rather than nonintimate. Finally, in Part Four, I describe Therapeutic Principles to guide the therapist in taking couples from reactivity to dialogue to negotiations of intimacy. The integrative framework proposed here discourages monolithic a priori notions of intimacy and highlights instead: nuanced meanings, relational processes to be considered differentially, present and past emotional blocks, and a flexible clinical approach to foster conditions for the creation and resilience of intimate experiences.     

Applying Psychoanalysis to Couple Therapy: The Treatment of a Couple with Sexualized Persecutory Internal Objects Resulting from Trauma

The application of psychoanalytic theory and technique to the treatment of couples has been relatively overlooked despite the long history of concern by psychoanalysts with the role of marriage in individual development and suffering. This paper uses an example of marital and sex therapy to illustrate the application of psychoanalytic object relations theory to couple therapy, and describes the way that in-depth treatment of the couple's persecutory object relations that follow severe trauma can be effectively conducted. The paper concludes with a brief discussion of issues of shame and guilt in psychoanalytic theory and their relevance to this couple.     

Video Game Therapy: Application of the Couple and Family Technology Framework

The couple and family technology framework outlines how technology affects couple and family relationships. This framework has been applied to understanding the impact of technology on infidelity, contributed to our understanding of online gaming issues in couple relationships, and sexting. The purpose of this paper is to outline how to implement video gaming as a disciplinary tool for youth congruent with the couple and family technology framework. Specifically, we identify the elements of video games that can be applied as an intervention in family treatment with youth in a token economy. This proposed technique focuses on utilizing technology (and specifically video games) as a strategy to improve youth’s behavior. Consistent with the couple and family technology framework, this paper outlines how accessibility, affordability, accommodation, and approximation can be used to improve behavior as well as improve parent–child relationships. Implications are included.     

Psychoanalytic Couple Therapy: Classical Style

In this essay, the core concepts of psychoanalysis are set forth as the context for the application of classical psychoanalytic theory to the practice of couple therapy. Infantile sexuality and aggression are shown to have a powerful role in the interpersonal lives of family members. The repetition compulsion structures marital interaction and intergenerational dynamics. The intrapsychic emphasis of classical ego-psychology is viewed in the interpersonal arena, and the author suggests adding to the Oedipus and Narcissus myths a myth that resonates with this shift in emphasis. In introducing the “Pygmalion–Galatea process,” the author captures the universal attempt to change the psychic dynamics of the other or others. This ultimately mutual process begins with the infant's mirroring of its caretakers—which includes language acquisition. Much of human interaction is fueled by subsequent attempts to create others in our own images of them and by their reactive compliance or resistance to that dynamic. Three case illustrations are presented to show how these phenomena manifest themselves in marital interaction and in dreams.     

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.     

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.     

Dropping Out of Couple Therapy

Abstract

Current literature on dropouts in marriage and family therapy includes few studies that focus exclusively on couple therapy and only a limited number of qualitative studies. Clients' perceptions of premature termination are seldom considered. This qualitative case study describes, from both the clients' and the therapist's perspectives, one couple's experience of dropping out of couple therapy after three, sessions. Findings from this case study are compared with existing literature and a fourfold typology of dropouts is proposed. We offer recommendations for future research of dropouts in couple therapy.     

Identification as a Focal Point in Couple Therapy

It is impossible to speak meaningfully about a couple's relationship without giving full consideration to the way the partners' childhood experiences have influenced their identities. Each partner is affected by his or her relationships with both parents and by intimacy beliefs shaped through observations of the parents' marriage. Often, unconscious identifications underlie the interactions that lead distressed couples to seek therapy. This paper explores two concepts that can assist therapists in repairing the present in the context of the past—projective identification and disidentification. Consideration is given to the power of the parents' marriage and to identifications based on individual parents.     

Proxemics in Couple Interactions: Rekindling an Old Optic

Utilizing as a lens the interpersonal implications of physical interpersonal distances in social contexts (a set of variables present during the professional discourse during the 1960s and 1970s, to then fade away), this article explores interactive process displayed by the protagonic couple in Bela Bartok's opera “Bluebeard Castle,” an exercise aimed at underlining the value of maintaining proxemics as an explicit level of observation for clinical practice and interpersonal research.     

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.     

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.     

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.     

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.     

Random Thoughts on Couple Therapy in a Postmodern Society

The postmodern period in psychoanalysis has had a considerable impact and influence on the psychotherapeutic process in both psychoanalysis and psychotherapy. The paradigm shift, reflected in the work of the intersubjectivists, rationalists, and social constructivists, has shifted emphasis from a one-person psychology to a two-person psychology. Implications for treatment are numerous. The change in emphasis affects not only how individual treatment is conducted but also couple therapy and group therapy. In considering the impact of these recent changes, the author notes the wide range of influences that inform her couple and group therapy. Although the current paradigm shift offers much, it seems to be an extension of earlier influences from self psychology, motivational systems, and attachment theory and of findings from neuropsychology. The author concludes that her couple work has also been intuitively informed by the implicit experience of the intersubjective field of group therapy.     

New Sexism in Couple Therapy: A Discursive Analysis

The persistence of gender inequality in postindustrial societies is puzzling in light of a plethora of changes that destabilize it, including shifts in economy, legislation, and the proliferation of feminist politics. In family relations, such persistence manifests as a disconnect between couples aspiring to be more egalitarian yet continuing to enact traditional gender roles and hierarchies. There is an emerging consensus that gender inequality persists because of people's continued reliance on sexist ideology or gendered assumptions that constitute women as innately distinct from and inferior to men. Sexist ideology changes its form to accommodate to changing socio‐economic conditions. Contemporary forms of sexism are old ways of legitimizing male power articulated in new and creative ways, often by incorporating feminist arguments. To effectively recognize and address “new sexism,” scholars and practitioners require new, innovative research frameworks. Our objective in writing this article is two‐fold. First, we seek to advance discursive (i.e., focused on language in use) approaches to the study of sexism. Second, we present the results of a discursive analysis of “new” sexist discourse in the context of couple therapy. The study provides preliminary evidence that, despite endorsing egalitarian norms, couples studied continue to rely on gender binaries and remain entrenched in old‐fashioned patterns of gender inequality. Implications of these results for the practice of couple therapy and for future research are discussed.