Couple‐based Intervention for Depression: An Effectiveness Study in the National Health Service in England

This study represents an effectiveness study and service evaluation of a cognitive behavioral, couple‐based treatment for depression (BCT‐D) provided in London services that are part of the “Improving Access to Psychological Therapies” (IAPT) program in England. Twenty‐three therapists in community clinics were trained in BCT‐D during a 5‐day workshop, followed by monthly group supervision for 1 year. The BCT‐D treatment outcome findings are based on 63 couples in which at least one partner was depressed and elected to receive BCT‐D. Eighty‐five percent of couples also demonstrated relationship distress, and 49% of the nonclient partners also met caseness for depression or anxiety. Findings demonstrated a recovery rate of 57% with BCT‐D, compared to 41% for all IAPT treatments for depression in London. Nonclient partners who met caseness demonstrated a 48% recovery rate with BCT‐D, although they were not the focus of treatment. BCT‐D was equally effective for clients regardless of the clinical status of the nonclient partner, suggesting its effectiveness in assisting both members of the couple simultaneously. Likewise, treatment was equally effective whether or not both partners reported relationship distress. The findings are promising regarding the successful application of BCT‐D in routine clinical settings.     

Couple communication in stepfamilies

Effective communication is assumed to help sustain couple relationships and is a key focus of most relationship education programs. We assessed couple problem-solving communication in 65 stepfamily and 52 first-time-marrying couples, with each group stratified into high risk and low risk for relationship problems based on family-of-origin experiences. Relative to partners in first-time couples, partners in stepfamily couples were less positive, less negative, and more likely to withdraw from discussion. Risk was associated with communication in first-time but not stepfamily couples. Stepfamily couples do not exhibit the negative communication evident in high-risk first-time-marrying couples, and available relationship education programs that focus on reducing negative communication are unlikely to meet the needs of stepfamilies.     

Relationship enhancement with premarital dyads: A six-month follow-up

Abstract

The purpose of the present study was to assess the short-term and longterm effectiveness of relationship enhancement on the self-disclosure and empathy skills of premarital dating couples. Nineteen couples were given the Guerney Relationship Enhancement Program over an eight week period, while 18 other couples were given a lecture/discussion program on relationship development. Behavioral assessments of self-disclosure and empathy skill levels were taken prior to training, immediately following training, and six months after training. Results indicated that from both pretest to posttest and pretest to follow-up, the relationship enhancement couples, relative to the lecture/discussion couples, demonstrated a significant increase in both self-disclosure and empathy skill levels. Discussion centers on the implications of the durability of the skills learned as well as on suggestions for future research on skill generalization to social interactions with others.     

“Hold Me Tight”: The Generalizability of an Attachment-Based Group Intervention to Chinese Canadian Couples

“Hold Me Tight” (HMT) groups are an adaptation of emotionally focused therapy (EFT) for couples and have emerged out of 30 years of research into the efficacy and process of EFT. The goal of this study was to test the effects of a Chinese-language version of the HMT relationship enrichment program in a sample of Chinese Canadians. Twenty-three men and 23 women (N = 46) in committed couple relationships completed an HMT relationship education program with their partners in Toronto, Ontario, Canada. Results indicated statistically significant improvements in participants' satisfaction with their attachment relationships, in their attachment security, and in their family functioning. The implications of these findings are discussed in light of relevant cross-cultural literature on attachment and couple relationships.     

Community-referenced leisure skill clusters for adolescents with multiple disabilities

We evaluated the effectiveness of a training package used to teach student-selected community-referenced leisure skill clusters — ordering a pizza-to-go and renting a video from a local vendor — to two adolescents with multiple disabilities. The adolescents were taught the leisure skills (e.g., ordering the pizza) as well as related behaviors necessary to perform those leisure skills (e.g., using a phone, interacting with the delivery person, cutting and serving pizza, cleaning up). The students were taught functional skill clusters, problem-solving skills, and assistance-seeking skills. Training consisted of didactic instruction, feedback, a least intrusive prompting procedure for incorrect responses, and verbal praise and natural consequences for correct responses. Simulation training was conducted at school and in vivotraining was conducted in the local community. A multiple baseline design demonstrated the controlling effects of treatment. Also, follow-up probes conducted up to five months after treatment showed these students maintained treatment gains. Applied issues related to the efficiency of the training package, general and specific skills training, and factors influencing skill maintenance are discussed.     

Increasing accurate preference assessment implementation through pyramidal training

Preference assessments directly evaluate items that may serve as reinforcers, and their implementation is an important skill for individuals who work with children. This study examined the effectiveness of pyramidal training on teachers' implementation of preference assessments. During Experiment 1, 3 special education teachers taught 6 trainees to conduct paired-choice, multiple-stimulus without replacement, and free-operant preference assessments. All trainees acquired skills necessary to implement preference assessments with 90% or greater accuracy during the training sessions and demonstrated generalization of skills to their classrooms or clinic. During Experiment 2, 5 teachers who served as trainees in Experiment 1 trained 18 preschool teachers. All preschool teachers met the mastery criterion following training. Training teachers to implement preference assessments may increase teachers' acceptance and use of behavior-analytic procedures in school settings.     

Supporting Romantic Relationships During COVID-19 Using Virtual Couple Therapy

The novel coronavirus disease pandemic (COVID-19) has profoundly impacted people’s lives, resulting in economic turmoil, death and suffering, and drastic changes to everyday life. The adjustment and strain of such challenges can spill over into couples’ relationship processes, including how partners spend time together, talk to one another, and manage conflict. Drawing from our experiences conducting virtual couple therapy (VCT) in a university-based training clinic and community-based clinic, as well as themes from an informal survey of 29 couple therapy clinicians, the current paper discusses the unique challenges that couples face in therapy during COVID-19. Such challenges include renegotiating quality time together, navigating less personal space and time alone, experiencing individual anxiety and stress prompted by the pandemic, and increases in conflict. We discuss our clinical recommendations for addressing these challenges for couples and utilize clinical case examples to illustrate our points. Despite these challenges, we also comment on several positive aspects of COVID-19 on couple relationships. Guided by these considerations and recommendations, our observations suggest that clinicians can effectively support couples’ growth and progress using VCT during COVID-19.     

Interaction of sex role self-concept with relationship quality and relationship beliefs in married, heterosexual cohabiting, gay, and lesbian couples

The relation between sex role self-concept (masculine, feminine, undifferentiated, and androgynous) and both relationship quality and dysfunctional relationship beliefs was examined in 370 monogamous partners who represented four types of couples (married, heterosexual cohabiting, gay, and lesbian). Analyses used both the individual partner and the couple as the unit of analysis. The individual partner analyses revealed that relationship quality and relationship beliefs differed by subjects' sex role self-concept. Androgynous and feminine subjects reported higher relationship quality than masculine and undifferentiated subjects; androgynous subjects had fewer "disagreement is destructive" beliefs than feminine subjects; and androgynous subjects had fewer "partner cannot change" beliefs than undifferentiated subjects. The couple analyses revealed a relation between partners' sex role self-concept only for the heterosexual cohabiting couples. For these couples, masculine men tended to pair with feminine or undifferentiated women, and androgynous partners tended to pair together. Relative to other couples, couples in which one or both partners were androgynous or feminine reported the highest relationship quality, whereas couples in which one or both partners were undifferentiated or masculine reported the lowest relationship quality. These effects did not vary by type of couple. The study concluded that sex role self-concept is a robust factor in appraisals of relationship quality. Relative to masculine and undifferentiated individuals, androgynous and feminine individuals report greater positive relationship functioning.     

Couple therapy for military veterans: overall effectiveness and predictors of response

Despite the numerous challenges facing U.S. veterans and their relationships, there have been no examinations of the effectiveness of couple therapy for relationship distress provided to veterans. In the present study, 177 couples presenting for couple therapy at two Veteran Administration Medical Centers completed assessments of relationship satisfaction prior to therapy and weekly during therapy. Results revealed that the average couple showed significant gains in relationship satisfaction during treatment (d=0.44 for men; d=0.47 for women); gains were larger for couples beginning therapy in the distressed range (d=0.61 for men; d=0.58 for women) than for couples in the nondistressed range (d=0.19 for men; d=0.22 for women). Rates of premature termination were high, with 19% of couples completing fewer than three sessions and 62% rated as not completing a "full course" of therapy. Benchmarking analyses demonstrated that the average gains were larger than would be expected from natural remission and similar to previous effectiveness trials; however, average gains were smaller than those observed in couple therapy efficacy trials. Relationship, psychological, and demographic characteristics were generally unrelated to the amount of change in therapy after controlling for initial satisfaction. However, African American couples showed significantly larger gains than Caucasian, non-Hispanic couples. Thus, though yielding smaller effects than those shown in efficacy trials, the impact of couple therapy for veterans' relationship problems appears to generalize across various demographic, psychological, and relationship characteristics.     

Cooperation or Tension? Dyadic Coping in Cystic Fibrosis

Following a rise in the life expectancy of cystic fibrosis (CF) patients, many adults with CF form couple relationships. Yet, dyadic coping has not been previously examined in people with CF. This study examined how adults with CF and their partners cope as a couple with the illness, and what meanings each partner and the couple as a unit attribute to the experience. Seventeen adult CF patients and their partners participated in separate semi‐structured in‐depth interviews. Two main patterns of dyadic coping with CF were identified as follows: cooperation and tension. For couples in cooperation, the marital relationship served as a resource for adaptive coping. These couples were characterized by similarities in their perception of the place of CF in their lives and of their roles in the marital relationship. Couples in tension described the couple relationship as strained by difficulty of accepting the disease, proliferation of negative emotions, and a sense of burden and loneliness in the process of coping. Findings point to the importance of mutual empathy, clear and accepted division of roles between the partners, and open communication for facilitating coping as a couple.     

Mindful Mates: A Pilot Study of the Relational Effects of Mindfulness‐Based Stress Reduction on Participants and Their Partners

Very little is currently known about how increases in dispositional mindfulness through mindfulness training affect the quality of participants’ romantic relationships, and no previous studies have examined how increases in specific facets of mindfulness differentially contribute to relationship health. Additionally, even less is known about how an individual's development of mindfulness skills affects the relationship satisfaction of his or her romantic partner. Thus, the purpose of this pilot study was to examine associations between changes in facets of mindfulness and relationship satisfaction among participants enrolled in a Mindfulness‐Based Stress Reduction (MBSR) course and their nonenrolled romantic partners. Twenty MBSR participants and their nonenrolled partners (n = 40) completed measures of mindfulness and relationship satisfaction pre‐ and post‐enrolled partners’ completion of an MBSR course. Results indicated that enrolled participants significantly improved on all facets of mindfulness and relationship satisfaction, while nonenrolled partners did not significantly increase on any facet of mindfulness or relationship satisfaction. Moreover, enrolled participants’ increases in Acting with Awareness were positively associated with increases in their own and their nonenrolled partners’ relationship satisfaction, whereas increases in enrolled participants’ Nonreactivity were positively associated with increases in their nonenrolled partners’ (but not their own) relationship satisfaction. These results suggest that increasing levels of mindfulness (particularly specific aspects of mindfulness) may have positive effects on couples’ relationship satisfaction and highlight mindfulness training as a promising tool for education and intervention efforts aimed at promoting relational health.     

Addressing power in couples therapy: Integrating socio-emotional relationship therapy and emotionally focused therapy

Romantic relationships are more satisfying and fulfilling when power is balanced relatively equally between partners (Leonhardt et al., Journal of Family Psychology, 34, 2020, and 1). Yet, few couples therapy models explicitly outline how to confront relational power issues (Knudson-Martin & Huenergardt, 2015, Socio-emotional relationship therapy: Bridging emotion, societal context, and couple interaction, Springer). Emotionally Focused Therapy (EFT; Johnson, 2020, The practice of emotionally focused couple therapy, Routledge) is a well-established, evidence-based therapy modality that many therapists use with couple clients, yet despite its effectiveness, it does not provide direction for explicitly addressing and treating power differentials in couple relationships. In this paper, we explore the integration of EFT with Socio-emotional Relationship Therapy (SERT), a model overlay that acknowledges the impact of social discourse on enactments of power in intimate couple relationships. We first address the importance of understanding power in couple relationships, addressing power in couples therapy, and provide a brief overview of SERT and EFT. We then introduce an integration of the models intended to help therapists balance power, increase connection, and secure attachment bonds between romantic partners.     

Treatment‐as‐Usual for Couples: Trajectories Before and After Beginning Couple Therapy

Couple therapy has been shown to be a meaningful way to improve couples’ relationships. However, less information is known about couples’ functioning prior to entering treatment in community settings, as well as how their relationship functioning changes from initiating therapy onward. This study examined 87 couples who began community‐based couple therapy during a longitudinal study of couples in the military. The couples were assessed six times over the course of 3 years, including time points before and after starting couple therapy. Using an interrupted‐time series design, we examined trajectories across the start of couple therapy in relationship satisfaction, divorce proneness, and negative communication. The results demonstrated that couples’ relationship satisfaction was declining and both divorce proneness and negative communication were increasing prior to entering couple therapy. After starting couple therapy, couples’ functioning on all three variables leveled off but did not show further change, but previous experience in relationship education moderated these effects. Specifically, those who were assigned to the relationship education program (vs. control) demonstrated greater reductions in divorce proneness and greater increases marital satisfaction after starting therapy; however, they also started more distressed.     

Attachment style, excessive reassurance seeking, relationship processes, and depression

The authors examined the association between excessive reassurance seeking (ERS) in couple relationships and depression, hypothesizing that this association can be explained by attachment anxiety. In Study 1, 72 couples completed questionnaires about ERS, depression, attachment style, and relationship quality. In Study 2, 61 couples completed the same measures in addition to completing daily diary assessments for 14 days. In both studies, ERS was related to depression, but only because of its association with attachment anxiety. The association between attachment anxiety and depression was not mediated by either partner's relationship quality, even though partners noticed each other's ERS. Instead, relationship quality was related primarily to avoidant attachment. These findings were replicated at a daily level of analysis, where interesting details of the underlying processes were revealed. At least in young unmarried couples, depression is associated with attachment anxiety--and one of its facets, ERS--mostly for intrapsychic reasons.     

Public transportation training: in vivo versus classroom instruction

This study evaluated a classroom program to teach public transportation usage (bus-riding skills) to retarded persons. Based on a task analysis of specific skills, five retarded male students were taught each of the components of locating, signalling, boarding and riding, and exiting a bus. These skills were taught sequentially, using training procedures consisting of role playing, manipulating the actions of a doll on a simulated model, and responding to questions about slide sequences. Before, during, and after training, subjects were tested on generalization probes in the classroom and in the natural environment. Results of a multiple-baseline design across subjects indicated that up to 12 months after termination of training, each subject exhibited appropriate bus-riding skills on actual city buses. Two other subjects were trained on each skill component in vivo, on city buses, in order to compare the relative effectiveness and efficiency of classroom versus in vivo training. Both of these subjects acquired appropriate bus-riding skills; however, the in vivo training procedure was both more time consuming and expensive than classroom training. These findings further demonstrate the effectiveness and practicality of properly designed classroom training procedures for teaching community survival skills to retarded persons.     

Outcomes of an Intensive Couple Relationship Education Program with Fragile Families

Couple relationship education (CRE) has been proposed as one means to help fragile families stabilize their relationships. The current research is one of the first studies to look at the outcomes of a CRE program with fragile families in the areas of couple stability and marriage formation. Data were from the Family Formation Project, a federal and state funded program working with fragile family couples (n = 96) in a metropolitan area. A historical cohort control group quasi‐experimental research design was used with a matched control group from the Fragile Family and Child Well‐being Study. The intervention consisted of in‐home education and support, group educational events, and social service referrals. Findings showed that couples had the same rate of couple stability as the control group but an increased rate of marriage. These findings suggest that CRE can help fragile families achieve marriage when that is their goal, but that some fragile families may need more than CRE to help them stabilize their relationship, or they may be better off separating.     

Dissemination and evaluation of marriage education in the Army

The effectiveness of marriage education was evaluated in two separate samples of primarily married couples in which at least one member of the couple was on active duty in the U.S. Army. The intervention was delivered by Army chaplains. Effects replicated well in the two samples, and demonstrated that marriage education was well received by this population and resulted in improvements in relationship functioning. Changes in relationship quality were examined separately for males and females, and also for couples in which both members of the couple were Caucasian as compared with all other couples. There were no significant differences in changes over time (i.e., from pre- to postmarriage education) among males and females or among couples with different ethnic makeup. These results have important implications for the generalizability of marriage education to diverse samples in nontraditional contexts.     

The Phenomenon of Comparative Development Between Female Survivors and Their Partners: Implications for Couples Therapy

The aim of this phenomenological study was to better understand the influences of families of origin on couple relationships when the female was a childhood sexual abuse survivor. Six couples participated in semi-structured individual interviews and each individual completed two-week diaries. The findings revealed that female survivors and their partners had comparable developmental histories. Implications for practice include the importance of recognizing that (1) male partners who had developmental experiences that were similar to those of their partners may contribute to the difficulties in the current couple relationship; and (2) both partners’ developmental experiences should be taken into consideration equally to facilitate the female survivors’ recovery process.     

The self in the couple relationship: part 1

This paper discusses the importance of the ‘good-enough’ development of the core self in the couple relationship. It argues that difficulties in the development of the self lie behind a significant number of troubled couple relationships. Part 1 focuses on individual psychotherapy and how changes to the core self are often attended by shifts in the marital relationship. It traces how this occurs through clinical material and analyses what kinds of changes to the self are needed for the couple relationship to function well. Psychodynamic theory is used to understand the core changes over time and how these are related to significant second-order change in the couple relationship. The construct of the ‘transitional space’ is used to theorize the couple relationship. Implications for the practice of individual psychotherapy are discussed. In Part 2, the significance of change in the experience of the self of one or both partners for a successful outcome of couples therapy is discussed, along with the place of work with individual partner(s) in the course of conjoint couples therapy.