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.     

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.     

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.     

Bisexual Issues in Same-Sex Couple Therapy

SUMMARY

The bisexual identity of a partner in a same-sex couple may not be an issue in the relationship, or it may introduce fear, mistrust, and divisiveness. Mixed-orientation couples face problems stemming from the dichotomizing of sexuality, negative myths and stereotypes, and lack of awareness of models and resources. It can be particularly problematic when a partner's bisexuality is first addressed within a committed relationship. Case examples illuminate some of the issues. Therapeutic tasks include addressing the context of oppression, assessing developmental stages of sexual identity and the relationship, clarifying personal meanings of bisexuality, providing education and resources, and, possibly, facilitating negotiations regarding safer sex and polyamory. Optimal couple therapy provides affirmation of bisexuality, validation of same-sex relationships, and reflection of the partner's and relationship's strengths.     

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.     

Differences in Dropout Rates Among Individual, Couple, and Family Therapy Clients

The premature dropout of clients from therapy is an inefficient expenditure of mental health resources. This study examined differences in dropout rates among individual, couple, and family therapy clients. Data came from archived records at a marriage and family therapy clinic at a university in the United States. Results indicated that there were no significant differences in dropout rates, despite the use of multiple measures of dropout. Thus, from a mental health services perspective, administrators and clinicians can expect that dropout rates will remain fairly consistent across treatment modalities.     

An Attachment Perspective on Reunions in Couple Psychoanalytic Psychotherapy

Psychoanalysis has been slow to acknowledge attachment theory as one of its own. Yet traditions of observational and representational research associated with it have much to offer in shedding light on intrapsychic as well as interpersonal phenomena. This paper explores these traditions and their potential clinical utility for couple psychoanalytic psychotherapy. In particular, attention is drawn to behaviour and representations associated with the experience of reunion in therapy sessions.     

Mechanisms of Change in Brief Couple Therapy for Depression

The goal of the present study was to investigate potential mechanisms of previously documented treatment effects for a brief, 5-session, problem-focused couple therapy for depression in a sample of 35 depressed women and their nondepressed husbands. The primary treatment effects were reducing women’s depressive symptoms and their husbands’ psychological distress and depression-specific burden. Secondarily, treatment resulted in increased relationship satisfaction for both partners. Given these significant treatment changes observed in 5 sessions, we sought to examine the mechanisms of change by testing the following three factors as potential mediators: (a) negative behaviors and attitudes toward depression, (b) support provision, and (c) empathic communication towards the depressed female partners. Women’s depression and husbands’ depression-specific burden were alleviated by positive changes in their illness-related attitudes and behaviors. Improvements in women’s marital satisfaction were also mediated by positive change in their illness-related attitudes and behaviors, along with perceptions of increased positivity and support from their husbands. Findings highlight the importance of targeting specific treatment agents in a brief couple therapy for depression such as psychoeducation about depression and support-building to increase partners’ understanding and acceptance of the illness, and teaching communication skills to reduce negative behaviors and criticism that are replaced by more empathic communication towards the depressed individual.     

The Role of Theory and Research in the Practice of Cognitive-Behavioral Couple Therapy: If You Build It,They Will Come

Cognitive-behavioral couple therapy (CBCT), while empirically validated and highly efficacious, does not always have positive results for couples. One factor that may limit the efficacy of this intervention is the way in which therapists are trained to provide this type of therapy. More specifically, there is a need for therapists to gain a solid foundation in CBCT theory in order to maximize treatment results. This paper presents an argument for why an understanding of theory is necessary for therapists in treating couples. Then, this paper presents our training model and how we integrate theory into our training of both graduate student therapists and more experienced clinicians. We take the stance that “if you build it, they will come.”     

Predictors and Moderators of Provoked Vestibulodynia Treatment Outcome Following a Randomized Trial Comparing Cognitive-Behavioral Couple Therapy to Overnight Lidocaine

Provoked vestibulodynia is a vulvar pain condition causing sexual dysfunction, affecting 8% to 10% of women. Our recently published randomized clinical trial (N = 108 couples) found that cognitive behavioral couple therapy (CBCT) and topical lidocaine reduced women’s pain and associated sexual symptoms, with CBCT showing more benefits. Little is known about pretreatment predictors of treatment outcomes in couples sex therapy. In the current study, we examined women and their partners’ pretreatment demographic (age, relationship length), clinical (pain duration, anxiety) and interpersonal (partner responses to pain, sexual goals) predictors/moderators of women’s pain intensity, pain unpleasantness, and sexual function at posttreatment and 6-month follow-up. Longer relationship duration, lower anxiety in women, partner higher solicitousness and partner higher approach sexual goals predicted better pain outcomes for women with PVD irrespective of treatment condition. CBCT was more effective than lidocaine for improving women’s sexual function at posttreatment when, at pretreatment, women had partners with higher anxiety and women reported lower approach sexual goals, whereas lidocaine was more effective for improving women’s sexual function at follow-up when partners had higher approach sexual goals. Findings can assist clinicians in determining what treatment will be most beneficial for whom.     

Playing with Dreams: The Introduction of a Third Party into the Transference Dynamic of the Couple

Dreams in couple therapy are expressions of the multiple discontinuous selves of partners and of interpersonal defenses. Two dreams offered during analytic couple therapy illustrate the use of transference and countertransference to observe disturbances in self-cohesion, communication of self-states, and attempts to affectively influence the partner. Dreams transferentially communicate the state of the realtionship, activate a third formation expressing shared pathology, and facilitate the growth of new aspects of the self seeking a more loving bond.     

Work and Family Conflict: An Often Overlooked Issue in Couple and Family Therapy

Despite the systemic interaction, family-based journals, as well as intake and assessment forms most frequently used by couple and family therapists (CFTs), have given a limited amount of attention to the issue of work and family conflict. Moreover, a review of the literature indicated that many CFTs perceive themselves as inadequately prepared to assist couples and families with work and family conflict. Addressing this apparent limitation, the present study identified various work stressors that contributed to family conflict (WFC), and the family stressors that contributed to work conflict (FWC). Results revealed significant predictors of WFC and FWC. Implications for CFTs and recommendations for changes in academic training and supervision are provided. The authors would like to thank Dr. Gary Bischof, Associate Professor of Counselor Education and Marriage and Family Therapy program Director at Western Michigan University, for editorial comments made on a previous version of this paper.     

Same-Gender Couple Therapy: Creating New Objects in Intimacy and Parenehood Transition

The formation of same-gender couple and parental relationships is described and analyzed from a combined relational and couple therapy. The parenthood transition of a homosexual couple into a family structure, that includes two biological parents and a stepfather, creates tremendous turbulence and crises. The couple link is transformed throughout critical and major changes from a two-ness unit into a four- one, which develops unique relationships with the mother and the baby. This paper presents how therapists can treat and intervene in both intra-psychic gender crises as well as inter-psychic breakdowns of the couple shared reality. The therapeutic processes highlight the transformative changes that the homosexual couple has to experience in order to accept the loss of previous accomplishments in gender identity and love relationships. In addition, therapy helps to disentangle co-joint couple objects while creating new shared spaces.Aviva Mazor, PhD, is at the Bob Shapell School of Social Work, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 69978, Israel (A-mazor@netvision.net.il). She received a PhD from University of Wisconsin-Madison. Her current research is in combined relational and family therapy with alternative families, separation processes from multigenerational perspective, and the post-traumatic effects of holocaust child-survivors.     

Differentiation,perceived stress and therapeutic alliance as key factors in the early stage of couple therapy

A sample of 168 couples were assessed at intake and over the first six sessions of treatment providing the opportunity to investigate not only the impact of client and common factors on initial levels of satisfaction, but also trajectories of change in satisfaction over time. The study used multi‐level modelling to examine changes in relationship satisfaction for both partners, thus enabling the couple to be maintained as the unit of analysis. We first examined changes in satisfaction and, having discovered differences there, we then investigated the impact of client factors of differentiation and stress in explaining these differences in relationship satisfaction. Finally we explored the additional influence of the common factor, therapeutic alliance, while controlling for the client factors, on relationship satisfaction.     

Vulnerability schemas of individuals in couples relationships: a cognitive perspective

The professional literature has recently given attention to addressing individual schemas in couples relationships, with particular emphasis on the fact that individual vulnerability has a significant impact on couples relationships. This article addresses how this vulnerability can be restructured during the course of couples therapy. Case vignettes are used to illustrate how the model can be applied. Some of the implications of this model are considered in the discussion section.Authors note: Portions of this article were published in Norwegian by the first author and appear in Nordby, T.T. (2002): Kognitiv parterapi. En tilnærming som ivaretar betydningen av den individuelle sårbarheten i samspillet. Reprinted by permission of Fokus på familien 30, 46–60.     

Attachment as an Integrating Concept in Couple and Family Therapy: Some Considerations with Special Reference to South Africa

Couples, marital, and family therapy in South Africa and throughout the world have undergone radical changes in theory and practice in the last three to four decades. These developments are seen in the emergence of different approaches which may be regarded as modern or post-modern, intrapsychic or systemic. While these different approaches are often seen as theoretically and clinically incompatible, it is the aim in this paper to suggest that the time has come to seek points of integration of these different approaches, and the construct of attachment is proposed as an ideal integrating concept. Two case illustrations are used to demonstrate attachment as an integrating concept. It is suggested that the concept of attachment may also be applied to family therapists and associations, including and especially in South Africa.     

Interviewing a Therapist in the Presence of a Couple: A Description of the Therapeutic Process

A therapy research team interviewed a therapist in the presence of a couple. Following each of six consecutive sessions with a couple, an interviewer posed questions to the therapist and couple. While one question was standard to each interview, other questions were generated by team members who tracked the entire process via live observation. These questions were directed first at the therapist, then at the couple, and then focused on therapeutic process and outcome. Findings of this process for the therapy system included decreasing the hierarchy within the client/therapist relationship; increasing the client ownership and energy in the therapy process; discovering the presence of parallel processes between the systems; and informing the direction of future therapy sessions. Practical, clinical implications are discussed for a variety of therapy settings.     

Attachment Change in Emotionally Focused Couple Therapy and Sexual Satisfaction Outcomes in a Two-year Follow-up Study

Emotionally focused couple therapy (EFT) is an empirically validated attachment based approach to couple therapy. From an EFT perspective, sexual functioning is viewed within the context of an attachment bond, but sexual satisfaction in EFT has not been empirically tested. We examined self-reported sexual satisfaction across 24?months in a sample of 32 couples who received an average of 21 EFT sessions. We found that sexual satisfaction increased across six time points from pre to post therapy and across follow-up (6, 12, 18, and 24?months), and that decreases in attachment avoidance from pre to post therapy predicted increases in sexual satisfaction across time. These findings provide evidence that EFT may help couples improve their sexual satisfaction by reducing attachment avoidance in therapy.