Varying Levels and Types of Engagement in an Online Relationship Enhancement Program for Couples Following Breast Cancer

Engagement in online interventions, defined as the extent to which participants are involved in and attentive to the contents of the intervention, has been shown to predict treatment outcome. However, participant engagement and program completion are often quite low. Aiming to provide insights that could help improve engagement, this study explores engagement in an online intervention for young couples with breast cancer, Couplelinks, by describing the development of a method to assess engagement, presenting a framework for understanding varying engagement levels, and discussing strategies used by Couplelinks facilitators to work with participants of differing engagement levels. The measure of engagement developed for this study was a composite consisting of indices of average completion time, accountability, and attitude. Utilizing this composite measure, the following distinct “couple types,” with varying levels of engagement, were discerned: (a) “keen” couples, (b) “compliant” couples, (c) “apologetic” couples, and (d) “straggling” couples. Facilitators’ approaches to working with each type of couple and suggestions for potential therapeutic applications are discussed. The finding that couples vary in terms of engagement level, and not solely based on facilitator skill and/or involvement, supports the need to better understand the concept of engagement in order to make online interventions more effective.     

Reshaping Couple Configurations that Get in the Way of Relationship Repair and Healing

In the context of relationship trauma, partners' reactive patterns of engagement can disrupt and derail attempts at relationship correction and healing. A circumplex typology of couple patterns of engagement in relational trauma context is defined in terms of partners' underlying views of self in relation to other (VSIRO). VSIRO is conceptualized along a continuum anchored at opposite poles by inflated (self-aggrandizing) versus collapsed (self-abnegating) VSIRO, with a balanced (egalitarian) VSIRO, characterized by accountability and forbearance, as the target position. The circumplex model delineates four problematic couple configurations—a dejected couple, a taker–enabler couple, an ultimate fighting couple, and a debtor–collector couple. Where problematic engagement occurs, therapists need to reshape couple engagement toward the balanced, egalitarian position prior to relational trauma work. Clinical vignettes depict these couples and springboard an analysis of unique needs and interventions associated with each couple configuration. Reshaping couple patterns of engagement using a circumplex model of couple configurations is an essential prerequisite to effective and ethical relational trauma work.     

Crossover of Weekly Work Engagement Among Dual-Working Couples

Purpose

Based on crossover theory and the actor-partner interdependence model, the purpose of this study was to investigate the crossover process of work engagement among Chinese dual-working couples.

Design/Methodology/Approach

Fifty-one dual-working couples first completed a general questionnaire to collect basic demographic information and then completed a weekly diary over five consecutive work weeks.

Findings

The results of multilevel analyses showed that (1) actor’s work engagement had a significant impact on his or her own work performance, (2) communication quality between the dual-working couples moderated the crossover of work engagement, but this effect was only found from husbands to wives and when women scored high on communication quality, (3) when men were treated as actors, the actor’s work engagement interacted with communication quality to relate to the partner’s work performance, through the mediating mechanism of the partner’s work engagement.

Implications

Dual-working couples should communicate with each other frequently through sharing positive experiences, and each member of the couple should support the partner through concrete actions. Organizations should adequately facilitate employees’ engagement, as engaged employees can not only positively influence their colleagues but also their partners at home.

Originality/Value

Previous research on work engagement has focused mainly on static and cross-sectional studies, and most studies on crossover have been conducted primarily in the context of western cultures, whereas systematic and empirical study of oriental cultures, especially Chinese cultures, is relatively scarce. The current study explored the crossover process of work engagement among Chinese dual-working couples using a diary study methodology.

     

Vulvar pain: a phenomenological study of couples in search of effective diagnosis and treatment

Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of ... the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships.     

Clinician experiences of homework in couples and family therapy: A survey of perceived impact on the working alliance

The process of engaging clients in homework assignments has been studied extensively in research settings, but rarely have the challenges in the implementation of the science been considered in couples and family therapy. A survey was conducted of 226 clinicians regarding (1) their experience of homework adherence (quantity and quality) with couple and family clients, and (2) their experience of the impact of homework non-completion (IHN) on the working alliance. Clinicians working with families reported less overall homework quantity and quality. However, across both couples and family clients, more negative IHN was reported among clinicians experiencing less homework quantity, both in terms of IHN bond (couple ρ = 0.71, p < 0.001; family ρ = 0.78, p < 0.001) and IHN agreement (couples ρ = 0.25, p < 0.001; ρ = 0.19, p = 0.006), and among clinicians with fewer years of clinical experience (r = 0.19, n = 136, p < 0.05). The present findings suggest that, in the context of couples and family therapy, there is a risk of perceived negative IHN on the working alliance. There would be merit to future investigations examining the processes of facilitating homework engagement within the context of a strong working alliance.     

双职工家庭父母工作投入对初中生学业投入的影响

基于资源保存理论,采用工作投入问卷、关系网络问卷、学业自我效能感问卷、学业投入问卷对326个双职工家庭的父母及其初中生子女进行调查,探讨父母工作投入对初中生学业投入的影响。结果表明：（1）父母工作投入、父母社会支持、子女学业自我效能感、子女学业投入两两之间呈显著正相关;（2）父母社会支持和子女学业自我效能感在父母工作投入影响子女学业投入中起中介作用;（3）父母社会支持和子女学业自我效能感的中介效应不存在显著的性别角色差异。从资源保存理论来看,父母工作投入对子女学业投入的影响,在一定程度上反映了资源在家庭系统内的投资和增益过程。     

双职工家庭父母工作投入对初中生学业投入的影响

基于资源保存理论,采用工作投入问卷、关系网络问卷、学业自我效能感问卷、学业投入问卷对326个双职工家庭的父母及其初中生子女进行调查,探讨父母工作投入对初中生学业投入的影响。结果表明：（1）父母工作投入、父母社会支持、子女学业自我效能感、子女学业投入两两之间呈显著正相关;（2）父母社会支持和子女学业自我效能感在父母工作投入影响子女学业投入中起中介作用;（3）父母社会支持和子女学业自我效能感的中介效应不存在显著的性别角色差异。从资源保存理论来看,父母工作投入对子女学业投入的影响,在一定程度上反映了资源在家庭系统内的投资和增益过程。     

Low-level relationship aggression and couple therapy outcomes.

Increasing evidence supports the efficacy of conjoint therapies that focus on intimate partner violence for couples who engage in mild to moderate physical aggression but want to preserve the relationship and end the aggression. However, there has been no examination of how this population responds to couple therapy that does not have a specific focus on aggression. This lacuna in the research literature is of concern because couples with a history of low-level aggression often seek couple therapy, but couple therapy without a focus on violence is thought to potentially exacerbate aggression. In the current study, the authors examined the efficacy of non-aggression-focused behavioral couple therapy for couples with and without a history of mild physical aggression. One hundred thirty-four couples, 45% of whom had experienced low-level aggression in the year prior to therapy, completed up to 26 sessions of couple therapy and 2 years of follow-up assessments. Results demonstrated no significant differences in relationship and individual outcomes by history of aggression. In addition, couples maintained very low levels of physical aggression during and after treatment and showed reductions in psychological aggression when relationship and individual functioning improved.     

Integrating couples and family therapy into a community alcohol service: a pantheoretical approach

This paper discusses the contribution of family systems theory and therapy to mainstream alcohol treatment programmes. Systemic psychotherapy is integrated with group analytic psychotherapy in a couples and family therapy service within a community alcohol service (CAS) which uses the Prochaska and Diclemente model of stages of change. Problems and solutions in putting these complex ideas into practice are discussed, with specific reference to issues of engagement. An example of our work with a couple is offered to illustrate our weave of theory and practice.     

Development and Initial Validation of the Perceived Power Imbalance Scale

Relationship power, which refers to the ability to influence one’s romantic partner, is an important organizing principle in the assessment and treatment of couples. Power imbalance is predictive of various dimensions of marital quality, which explains why it is often a central focus of couple therapy. Despite the importance of relationship power in couple therapy, assessing power in clinical settings has been hindered by the lack of a validated measure of power that has high clinical utility. Data from 640 married couples associated with the Flourishing Families Project were used to develop the Perceived Power Imbalance Scale by conducting exploratory factor analysis, confirmatory factor analysis, dyadic predictive validity analysis, and measurement equivalence analysis. Although power has been conceptualized as consisting of both outcome power and process power, results indicated that the final scale consisted of four items that only tapped aspects of process power. The scale demonstrated good reliability and was a significant predictor of marital quality, marital instability, and depression.

     

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.     

Engaged at Work and Happy at Home: A Spillover–Crossover Model

The current diary study among 50 Spanish dual-earner couples examines whether engagement at work has an impact on own and partners’ well-being. Based on the Spillover–Crossover model, we hypothesized that individuals’ work engagement would spill over to the home domain, increasing their happiness level at the end of the day. Moreover, we predicted a crossover of happiness between the members of the couple. Participants filled in a diary booklet during five consecutive working days (N = 100 participants and N = 500 occasions). The results of multilevel analyses showed that daily work engagement has a direct effect on daily happiness. We also found that employees’ daily work engagement influenced partner’s daily happiness through employees’ daily happiness. Finally, results showed a clear bidirectional crossover of daily happiness between both members of the couple. These findings indicate that the positive effects of work engagement go beyond the work setting and beyond the employee.     

Description and First Steps Toward the Empirical Validation of the Plan Formulation Method for Couples

The aim of this paper is to empirically assess the reliability of the plan formulation method for couples, a procedure for formulating the case, planning, and monitoring the couple therapies according to control-mastery theory. We hypothesized that when couples are looking for couple therapy, they have an unconscious couple’s plan for the therapy, which includes the couple’s goals; the pathogenic beliefs that the partners want to disprove; the traumas from which these beliefs originated and that the partners want to master; the vicious relational circles that make the couple suffer and that the couple wants to break; the virtuous relational circles that are expressions of the couple’s resources and that the couple wants to fuel; and the relational insights that may help the couple get better. Our study involved 15 couples treated by four experienced therapists. Four raters independently formulated each couple’s plan based on the first three sessions following a standard procedure, and we calculated the intraclass correlation for pooled judges’ ratings. For a subsample of three couples—who before and after treatment had completed the dyadic adjustment scale (DAS) and the outcome questionnaire-45.2 (OQ-45.2)—the compatibility of the therapists’ interventions with the couples’ and partners’ plans was assessed. The relationship between the ratings of compatibility, DAS and OQ-45.2, was assessed. The results showed excellent interjudge reliability for each couple’s plan formulation (average ICC?=?0.82), attesting to the validity of the procedure; and preliminary data on the therapeutic process suggested that therapists’ interventions compatible with couple’s plans could help partners achieve good outcomes.

     

Couple Therapy in the Presence of Mental Disorders

Abstract

Mental disorders and relationship discord commonly occur together and couples where one or both parties suffer from a mental disorder are commonly seen in couple therapy. Symptoms of mental disorders can usefully be conceptualized cybernetically and viewed as part of negative feedback loops that couples become trapped in without denying the potential contribution of biological or other types of knowledge. Most of the existing research focuses on couples and depression and couple therapy has been found to have efficaciousness as a treatment of depression especially when depression occurs along with relationship discord. There is less research on couple therapy and other mental disorders but general guidelines are offered that couple therapists can use with any of the mental disorders.     

Clinical Application of the Couple Adaptation to Traumatic Stress (CATS) Model: A Pragmatic Framework for Working With Traumatized Couples

ABSTRACT

The authors attempt to apply knowledge of traumatization to clinical practice with couple dyads. Elaborating on the Couple Adaptation to Traumatic Stress (CATS) Model (Nelson Goff & Smith, 2005), the authors have worked to bridge the gap between a general understanding of trauma's impact on the couple relationship and couples' treatment. This article facilitates the application of the CATS Model to clinical work with couples impacted by trauma. Incorporating Herman's (1997) traumatic process with the original CATS Model, the authors created a more specific, clinically useful framework for clinicians. The goal of the current article is to provide clinicians with a pragmatic illustration articulating a clinical framework for understanding and treating posttraumaumitc symptoms and processes within the couple relationship. The main implication is that clinicians will be able to conduct effectively guided systemic therapy with distressed couples necessary to generate progress in the treatment of symptomatology and couple functioning of trauma survivors and their partners.     

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.     

Nonverbal Behavioral Indicators of Negative Affect in Couple Interaction

Affect has been identified across numerous research studies to be a vital element in understanding couple relationship processes. Affect has been shown to distinguish between satisfied and dissatisfied couples and to be important in understanding processes leading to relationship dissolution. However, research has not yet uncovered nonverbal indicators that a couple is experiencing negative affect compared to other affective states. In this study we sought to identify specific nonverbal behaviors associated with different affective states. Results suggested that differences in looking-behavior and smiling can be used to identify affect states during couple communication. We outline how the results can aid couples therapy interventions.     

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.     

Heterosexual, lesbian, and gay male relationships: a comparison of couples in 1975 and 2000

This study examined the differences among lesbians, gay men, and heterosexuals at two points in time (1975 and 2000) using responses of 6,864 participants from two archival data sets. Groups were compared on variables representing equality of behaviors between partners in seven realms: traditionally "feminine" housework, traditionally "masculine" housework, finances, support, communication, requesting/refusing sex, and decision-making. In addition, the current study compared monogamy agreements and monogamy behaviors reported by the two cohorts of couple types. Overall, the results indicate that on the equality variables, there have been many statistically significant behavioral shifts among the different sexual orientations across 25 years. In addition, all couple types reported substantially greater rates of monogamy in the year 2000 than in 1975. The present study has important clinical implications for therapists working with couples because it provides new baseline evidence regarding how couples now interact with one another (especially about monogamy) and how this has shifted over time. In addition, it elucidates the differences that still exist between different couple types, which could serve to inform couple therapists as they strive to become more culturally competent working with same-sex couples.     

A Research Program Testing the Effectiveness of a Preventive Intervention for Couples with a Newborn

Noxious family environments are associated with a wide range of adverse child outcomes. In order to prevent couple and parent–child relationship problems, a number of programs have been developed for couples with newborns. The current paper describes a program of research evaluating the American version of couple CARE for parents of newborns. This version of CCP was administered to low‐income, unmarried couples with a new baby in an uncontrolled demonstration project (Study 1), compared with a waitlist control condition in a randomized controlled trial (Study 2), and evaluated with low‐income parents recruited from urban hospitals in two major metropolitan areas of the United States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventive effects of the program were limited and there was one potential iatrogenic effect. Results were likely impacted by major challenges with recruiting participants and maintaining their engagement in CCP for the duration of the program. We discuss methodological differences between this series of studies and previous trials of prevention programs and make recommendations for improving service delivery to at‐risk new parents. These results have implications for public policies that aim to benefit children and families.