Emotion-Focused Therapy for Couples in the Treatment of Depression: A Pilot Study

Emotion-focused therapy (EFT) for couples was compared to pharmacotherapy in the treatment of major depressive disorder. Eighteen distressed couples in which the female partner met diagnostic criteria for major depressive disorder were randomly assigned to 16 weekly sessions of emotion-focused therapy or pharmacotherapy with desipramine, trimipramine, or trazadone. Twelve couples completed the study. Both interventions were equally effective in symptom reduction. There was some evidence that females receiving EFT made greater improvement after the conclusion of treatment than those receiving pharmacotherapy. The results suggest EFT might be useful in the treatment of comorbid major depressive disorder and relational distress.     

A Clinician's Guide to PTSD Treatments for Returning Veterans

What options are available to mental health providers helping clients with posttraumatic stress disorder (PTSD)? In this paper we review many of the current pharmacological and psychological interventions available to help prevent and treat PTSD with an emphasis on combat-related traumas and Veteran populations. There is strong evidence supporting the use of several therapies including prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and cognitive processing therapies (CPT), with PE possessing the most empirical evidence in favor of its efficacy. There have been relatively fewer studies of non-exposure based modalities (e.g., psychodynamic, interpersonal, and dialectical behavior therapy perspectives), but there is no evidence that these treatments are less effective. Pharmacotherapy is promising (especially paroxetine, sertraline, and venlafaxine), but more research comparing the relative merits of medication vs. psychotherapy and the efficacy of combined treatments is needed. Given the recent influx of combat-related traumas due to ongoing conflicts in Iraq and Afghanistan, there is clearly an urgent need to conduct more randomized clinical trials research and effectiveness studies in military and Department of Veterans Affairs PTSD samples. Finally, we provide references to a number of PTSD treatment manuals and propose several recommendations to help guide clinicians' treatment selections.     

Assessment-Driven Case Formulation and Treatment Planning in Dialectical Behavior Therapy: Using Principles to Guide Effective Treatment

Dialectical Behavior Therapy (DBT) is a complex cognitive-behavioral treatment designed for a population with multiple problematic and high-risk behaviors. As with any behavioral treatment, the role of assessment in DBT is critical. Although there is a significant body of research supporting the efficacy of DBT, there is a relative dearth of practical and principle-based information that help therapists formulate cases and treatment from a DBT perspective. In this article, we provide a step-by-step guide for creating an assessment-driven DBT case formulation and treatment plan. We focus on identifying stage of treatment, determining goals, developing the target hierarchy, assessing and treating the primary target behavior, and tracking outcomes. We highlight the few rules that inform DBT assesssment and practice, note and correct several common misconceptions, and demonstrate how the use of thorough assessment can result in a more nuanced case formulation and treatment plan.     

A Caring Framework for Enhancing Couples Therapy

As couples move away from role oriented patterns of relating they enter a transitional phase where marital expectations are less clearly defined. Frequently couples seeking therapy complain of a lack of caring in their relationships. They also express confusion about the appropriateness of their desire for more caring. In this article the authors present a caring framework based on their research with couples in "vital-total" marriages. They also suggest several ways this caring framework can be used in clinical work with couples.     

Commitment First,Communication Later: Dealing with Barriers to Effective Couples Therapy

Teaching communication techniques to couples is a common way for therapists to begin treatment. In many cases, couples then use these newly acquired skills to express negative or even hostile information to each other, sometimes doing more harm than good to the relationship. Based upon years of clinical experience with hundreds of couples in treatment, this article presents the idea that having the couple see themselves as an entity first, not as two individuals, may be necessary before clear communication can be maximally therapeutic. The article outlines the Couple Power model of treatment, suggesting that four basic tasks—commitment, cooperation, communication and community—need to be accomplished in that order, postponing the teaching of communication skills until later in therapy. Theory behind the tasks and suggestions for effective techniques to achieve the “Four C’s” of Couple Power are presented and discussed.     

Couples Therapy

The authors propose a more comprehensive definition of couples therapy since parenting and individual issues can impact so forcefully on spousal relationships. Couples therapy, is redefined as a therapy with both spouses concerning their individual, parenting, and marital functioning which is conducted in conjoint marital/family sessions and individual meetings with each spouse. A case example illustrates this approach which is called Comprehensive Family Therapy.     

Empowerment Themes for Couples Therapy

SUMMARY

Empowerment is defined as a process occurring in a relational context in which all participants in the relationship interact in a manner which establishes connection and strengthens each person's sense of self worth and personal power. The purpose of the article is to apply specific themes of empowerment for couples therapy. Six major themes are presented: (1) taking and being in charge of one's self; (2) acknowledging and valuing difference and diversity; (3) power in relationship; (4) choices and options; (5) necessity of skills in relating to the wider societal context; and (6) taking action. Techniques for working with couples from an empowerment perspective are also offered.     

A Report: Couples with Medical Conditions, Attachment Theoretical Perspectives and Evidence for Emotionally-Focused Couples Therapy

This brief report examines the contribution of Emotionally-focused Therapy for distressed couples, particularly in the context of medical illness. An attachment theoretical framework is provided to assist in understanding individual differences in the experience of both the ill and the care-giving partner.     

Dialectical Behavior Therapy Is Effective for the Treatment of Suicidal Behavior: A Meta-Analysis

Dialectical Behavior Therapy (DBT) prioritizes suicidal behavior and other self-directed violence as the primary treatment targets, and has been demonstrated to reduce self-directed violence in clinical trials. This paper synthesizes findings from controlled trials that assessed self-directed violence and suicidality, including suicide attempts, non-suicidal self-injury (NSSI), suicidal ideation, and accessing psychiatric crisis services. Eighteen controlled trials of DBT were identified. Random effects meta-analyses demonstrated that DBT reduced self-directed violence (d = -.324, 95% CI = -.471 to -.176), and reduced frequency of psychiatric crisis services (d = -.379, 95% CI = -.581 to -.176). There was not a significant pooled effect of DBT with regard to suicidal ideation (d = -.229, 95% CI = -.473 to .016). Our findings may reflect the prioritization of behavior over thoughts within DBT, and offer implications for clinical practice and future research concerning the implementation of DBT for acute suicidality.     

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.     

Using Acceptance and Commitment Therapy to Treat Distressed Couples: A Case Study With Two Couples

Although the field of couple therapy has made significant strides in recent years, there continues to be a need for theoretically sound and empirically supported treatments. The current case study examines whether Acceptance and Commitment Therapy (ACT), an experiential acceptance-based behavior therapy, can be effective in treating distressed couples. Although ACT has demonstrated effectiveness in treating a variety of disorders in individuals, it has not been systemically applied to the treatment of couple distress, and the current study is the first empirical examination of ACT for the treatment of couples. Two married couples participated in the study. A number of core ACT interventions were modified to treat couples in a conjoint format. Cognitive defusion exercises were used to help couples reduce their fusion with and the believability of negative thoughts and feelings related to the relationship. Mindfulness and acceptance techniques were used to help couples increase awareness of their reactions to negative relationship cycles. Finally, value-directed action was used to help partners act in ways consistent with relationship values even in the presence of unwanted thoughts and feelings. The results of this preliminary case study suggest that ACT may be effective in increasing marital adjustment and satisfaction, and in reducing interpersonal and psychological distress in couples. Future studies with larger samples and more controlled designs are needed to build on the results from this single-case study.     

No Fault Couples Therapy

A conceptual framework for treating couples who come into therapy desirous of changing the behavior of their partner. A case history is cited wherein sensitivity towards equality of input, power and responsibility for the couples' plight is continuously emphasized for each member of the pair. The histories of both partners are described in order to stress the no fault nature of the couples' conditions.     

Core Energetic Couples Therapy

SUMMARY

Core energetics is a method of psychotherapy that seeks the integration of all aspects of humanity: the emotional, physical, mental, and spiritual. Based on a deep understanding of the ways in which energy and consciousness work together, the therapy, developed by John C. Pierrakos, MD, invites couples to experience their inner truth and to identify their universal life goals and core feelings. Core energetics emphasizes wholeness and unification without loss of individuation for the couple. This article describes core energetics as it is used in couples work; the theory, therapeutic stance, methods of diagnosis, and energetic techniques are discussed, as well as the focus on sexuality and Spirituality.     

Virginia Satir's Triad Theory for Couples Therapy

SUMMARY

Virginia Satir's understanding of the fundamental building block of all human relationships, the triad, surpassed that of her colleagues. She went beyond their themes of conflict, opposition and pathology to emphasize the positive, constructive and nurturing potential of every human triadic interaction. Couples therapy is a triad and the author focuses on this specific context to illustrate some of the rich and varied uses of Satir s theory of triads.