Multi-Level Couple Therapy: Applying a Metacommunicational Framework of Couple Interactions

Excerpts from a couple therapy case are cited to illustrate the practical significance of a multi-level framework in understanding couple interactions. The clinical implications of the metacommunicational framework, as a metaphor for examining and understanding relational processes, are discussed. Also, the pragmatics of following “process” at a variety of levels when working with punctuational differences, developing therapy strategies and goals, and measuring the progress of couple therapy are discussed.     

The Dual Career Couple: Concerns,Benefits, and Counseling Implications

A comprehensive conceptualization of concerns and benefits experienced by dual career couples is presented. Counseling implications are provided to address the concerns. Counselors are asked to expand their roles to help couples challenge unquestioned societal values and practices and uniquely define their own standards for success in career and family roles.     

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 Psychoanalysis in the United Kingdom: Past,Present, and Future

ABSTRACT

The evolution of couple psychoanalysis in the United Kingdom is historically rooted in, and currently supported by, what might be called the Tavistock tradition, which principally derives from the work of Tavistock Relationships, a London-based organization combining clinical practice, training, and research. Practitioners working within this tradition draw on a range of psychoanalytic theories and differ in the ways they are applied in clinical practice and with different client groups, but they are united by their focus on relationship dynamics and how these can be affected by unconscious processes. This article charts how the main ideas and practices associated with the Tavistock tradition of couple psychoanalysis came into being, describes the conceptual building blocks that provide the platform for current training and practice, and identifies nodal points that might indicate directions of growth in the future.     

Beyond the Binary: Trans‐Negotiations in Couple and Family Therapy

Dualistic notions about gender and sexuality have permeated the field of couple and family therapy. These binary constructions have been limiting for everyone, especially those who fall outside the male/female dichotomy. This article examines the impact of these binary notions, especially on transgender and gender‐creative individuals, couples, and families. Current theory and research in the field as they relate to gender identity, sexuality, and gender minority stress in couples and families are presented. Case examples are used to illustrate affirmative approaches to treatment issues such as coming out, safety, grief and loss, redefining relationships, and social/medical transitions that may arise for transgender or gender nonconforming (TGNC) individuals, couples, and families.     

Couple therapy in a therapeutic community setting†

An account is given of couple therapy offered as part of a comprehensive treatment programme in a unit run as a therapeutic community. The additional therapeutic force provided by couple or family therapy is important in dealing with adult patients who may not be highly motivated for change or who may not initially present their difficulties as springing from marital or family relationships. A combined approach with these kinds of patients may succeed where either group therapy or couple therapy alone is likely to fail.     

From Couple Therapy 1.0 to a Comprehensive Model: A Roadmap for Sequencing and Integrating Systemic,Psychodynamic, and Behavioral Approaches in Couple Therapy

Couple therapy is a complex undertaking that proceeds best by integrating various schools of thought. Grounded in an in‐depth review of the clinical and research literature, and drawing on the author's 40‐plus years of experience, this paper presents a comprehensive, flexible, and user‐friendly roadmap for conducting couple therapy. It begins by describing “Couple Therapy 1.0,” the basic conjoint couple therapy format in which partners talk to each other with the help of the therapist. After noting the limitations of this model, the paper introduces upgrades derived from systemic, psychodynamic, and behavioral/educational approaches, and shows how to combine and sequence them. The most important upgrade is the early focus on the couple's negative interaction cycle, which causes them pain and impedes their ability to address it. Using a clinical case example, the paper shows how all three approaches can improve couple process as a prerequisite for better problem solving. Additional modules and sequencing choice points are also discussed, including discernment counseling and encouraging positive couple experiences.     

Couple therapy,family therapy and systemic interventions for adult‐focused problems: the current evidence base

This paper updates previous similar reviews published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of couple therapy, family therapy, and systemic interventions for adults with a range or relationship and mental health problems. The evidence supports the effectiveness of systemic interventions, either alone or as part of multimodal programmes, for relationship distress, psychosexual problems, intimate partner violence, anxiety disorders, mood disorders, alcohol problems, psychosis and adjustment to chronic physical illness.     

The Infertility Resilience Model: Assessing Individual,Couple, and External Predictive Factors

Resilience in couples experiencing infertility is critical to decrease the impact of infertility-related stress and sustain positive interactions and collective perceptions in couples. The Infertility Resilience Model (IRM) presented in this article provides a framework within which various individual, couple, and external factors that influence resilience can be understood. Although numerous approaches have been applied to infertility, few of them have examined resilience and the interconnections between individual, couple, and external influences. The concepts and connections within the model can be used by clinicians for assessment and interventions when working with couples facing infertility.     

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.     

Couple Enrichment Approaches

Abstract

Contemporary couple enrichment approaches are classified and select programs described. The research on their effectiveness is summarized and their usefulness as primary interventions or as adjunct interventions for couples in therapy is highlighted. Directions for future research and practice are suggested.     

The Embodied Couple

SUMMARY

Herein is described the use of a specific physical posture for couples to assume for the purpose of assessing the dynamics of their relationship. Its careful and artful use creates a microcosm of the couple's interactive style, revealing significant behaviors and feelings in the therapist's presence.