Towards an Integration of Interpersonal Risk Models of Depression and Cognitive Behaviour Therapy: A Commentary on What Constitutes Interpersonal Therapy

The article by Dobson, Quigley, and Dozois on interpersonal model provides a very useful guide on how to extend cognitive behavioural models of depression to incorporate interpersonal vulnerabilities that influence how depressed people behave towards others. The point is made that interpersonal processes are very likely to influence the onset and course of depression. In this commentary, I extend this analysis further examining the evidence on how interactions within close relationships, particularly couple relationships, interact with individuals' depression. Evidence is also cited on the effectiveness of couple‐based therapy in treating depression.     

Placement of responsibility and moral reasoning in couple therapy

Within the past two decades there has been a growing awareness of the importance of moral and ethical judgements in family and couple therapy. In this article we provide a detailed analysis of placements of responsibility related to blame in one couple therapy session. We suggest that it is important to study therapeutic interaction in situ , when searching for an understanding of moral reasoning in couple therapy and an ethical evaluation of the practice. A detailed analysis of discursive tools used by clients and therapists makes it possible to look at moral reasoning in action as it unfolds within the flow of therapeutic conversation. The findings are discussed in relation to two discourses of moral justification: autonomy and relationality. The principle guiding the therapists' actions in the studied conversation could be called 'relational autonomy'.     

Couple Therapy and Spirituality and Religion

Abstract

The current state of the art of the integration of couple therapy with spirituality and religion is presented. Each of three waves of this integration identified in this article have seen an increase in the literature in this area, although only a limited amount in each wave has addressed couple therapy specifically. In the first wave, from 1990–1994, articles set forth arguments for why spirituality should be integrated in therapy. During the second wave, 1995–1999, publications focused on the ways that including spirituality in therapy can enhance as well as harm the therapeutic process. In the third wave, 2000-present, attention has shifted away from whether to include spirituality to how it should be included, and the literature of this period features many practical interventions and suggested guidelines for integrating spirituality and religion into therapy and training. The article concludes with recommendations for further developing the integration of spirituality and religion into couple therapy models, research, and training.     

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.     

Gendered Patterns of Interaction: A Foucauldian Discourse Analysis of Couple Therapy

In recent years, there has been a rapid increase in attention to gender and gender-based inequalities in family therapy. Despite this, there is a dearth of empirical work that examines how gendered inequalities intersecting with other axes of privilege/oppression are maintained within families, including in the therapeutic context. In this study, we used Foucauldian discourse analysis to examine how gendered power is produced and reproduced circularly or through recurrent patterns of interaction in couple therapy. We identified gendered discourses and assumptions informing partners’ constructions of their gendered selves and relationships. We highlight the complexity and intersectionality of gendered subjectivities and relations in contemporary Canadian couples involved in heterosexual relationships. Although women in this study contest their oppression and exhibit agency to negotiate who they are in general and in relation to men, they simultaneously continue to occupy subordinate positions in a gender order that is culturally and interactionally allocated to them. We discuss implications for family therapy practice.     

‘The experiencing of experience’: a Pragmatic reassessment of Rogerian Phenomenology

This paper draws on a study that asked twenty family users about their first session of family therapy. Analyses of the interviews indicated that families entered therapy with a pre-existent knowledge about therapy, which did not always chime with those of professionals and which positioned speakers in ways which governed their expectations and perceptions of therapy. This paper, therefore, is concerned with the acquisition and deployment of knowledge: specifically, the knowledge involved in being a user of family therapy. Three key discourses were identified through this analysis: medical, counselling and consumerist. We aim to illustrate how these discourses served as a resource for members of the family in constructing therapists, therapy and themselves in relation to their experience. The examination of the rhetorical, ideological and practical effects of the positions chosen and the objects constructed, in terms of how speakers wanted to present themselves, with what enhanced or diminished status as patients, shows users actively engaging with the power of therapeutic institutions. Users’ accounts suggest that while most speakers felt anxious about the prospect of therapy, there were clear differences in overall satisfaction/dissatisfaction with the experience according to the synchrony between speakers’ construction of the therapist, and themselves as client/patients. Those who seemed to take a traditional view of therapy within a medical discourse valued therapists who offered diagnosis and a cure; those who sought and experienced a counselling relationship with the therapist found their experience to be constructive in terms of enhanced self-knowledge. We believe that the research findings discussed in this paper have implications for family therapists in accommodating to parental and child positions to maximise the effectiveness of therapy and so minimise drop-out.     

Broken Bonds

SUMMARY

Infidelity comes in many forms. Different meanings may be assigned to the various forms. This article discusses not only the different forms infidelity may take, but also the larger issue in the field of couple and family therapy; the meaning frame for understanding the impact of different kinds of events, specific relationship problems, and how to deal with them. This is done through the use of emotion focused therapy and the context of adult attachment.     

‘I love you’. How to understand love in couple therapy? Exploring love in context

Acknowledging the place of love in couple therapy requires therapists to reflect upon what love means to them. We propose that love defines the couple relationship and in turn the relationship defines love. In this article we explore and focus on our conceptualization of love and its influence on couple therapy. Exploring love in the context of the phrase ‘I love you’ leads us to consider built‐in contradictions. These contradictions can be contextualized and understood in a relational dialectic framework. Implications for therapy are explored and briefly illustrated in a case vignette.     

Integrating Sex and Couples Therapy: A Multifaceted Case History

Traditionally, sexuality has not been a focus in couples therapy training, research, or practice, although it is an important, often complex issue for many couples. This article tells the story of a couple presenting for sex therapy due to their unconsummated marriage, and is told to exemplify how sex therapy and couples therapy can be integrated in order to best meet the needs of couples. As the story unfolds, the multilayered facets of the presenting issue are revealed. The therapy incorporates and weaves together family of origin history, intrapsychic and cognitive issues, relational dynamics, patterns of interaction, and physiological/medical concerns into a postmodern couples therapy with behavioral interventions. This combined approach recognizes the value of each method on its own and their greater usefulness when blended together.     

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.     

An Aesthetic Review of New Mothers as the Ultimate Weaver: Achieving a Harmonious Integration of Prevalent Discourses and Lived Experience

Experiences in new motherhood are influenced by popular sociological discourses and ideologies. The narratives promoted in these discourses may or may not fit with the subjective experience of the mother. Lacking experience in motherhood, the new mother may misguidedly accept these mainstream discourses and ideologies as standard. The process of adapting and blending sociological narratives to fit with lived experience is similar to the art of weaving. This article, an original argument grounded in relevant literature, explores how new mothers can develop a balanced weave of popular social discourse and her subjective experience by: accepting motherhood as a creative process, being aware of the powerful influence of social constructs on her perceptions, and recognizing the influence of her body/biology on her lived experience. The aesthetic narrative of the spider, the ultimate weaver, accompanies the research presented. Complementary art therapy interventions such as weaving, art boxes, and dolls are discussed.     

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single‐case study comprise couple therapy process videotapes recorded in a multi‐camera setting, and measurements of participants’ SNS activity. The voluntary participants were a marital couple in their late thirties and two middle‐aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.     

“Am iz kwiin” (I’m his queen): Combining interpretative phenomenological analysis with a feminist approach to work with gems in a resource-constrained setting

ABSTRACT

This article focuses on working with gems using a feminist approach to interpretative phenomenological analysis (IPA) in a resource-constrained setting. The research explores the experiences of maternal disclosure of HIV to children of HIV positive mothers in Kingston, Jamaica. A feminist approach helps recognise power imbalances within research relationships and the women’s lived experiences. We present three “gems” which illuminate women’s lived experiences and explore how popularised representations of women’s sexuality and mothering influence disclosure discourses. We use emotion work as a conceptual resource to structure the women’s narratives and challenge existing policy discourses, which arguably represent disclosure within a binary, rationalist, decision-making framework. This article adds to global literature on maternal HIV disclosure and problematises policy discourses by bringing into relief the emotion work women engage in when deciding if and how to communicate their HIV status to their children. It adds to the body of research using IPA, particularly in resource-constrained settings where IPA has thus far had little application.     

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.     

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.