Early Termination from Couple Therapy in a Naturalistic Setting: The Role of Therapeutic Mandates and Romantic Attachment

Drawing on a series of 141 couple therapy cases, the main goal of the present study was to determine whether romantic attachment, pre-treatment relationship distress and therapeutic mandates (i.e., reduction of couple distress or ambivalence resolution) are prognostic indicators of early termination. Couples completed the Dyadic Adjustment Scale (Spanier 1976) and the Experiences in Close Relationships Questionnaire (Brennan et al. 1998) at intake, whereas therapists filled in the Classification of Therapeutic Mandates (Poitras-Wright and St-Père 2004) after the 4th session. Results showed that an ambivalence resolution mandate, elevated couple distress and higher levels of attachment anxiety were associated with early termination. The implications of these findings to further understand early termination in couple therapy 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.     

Emotionally Focused Couple Therapy With Neurodegenerative Diseases: A Pilot Study

ABSTRACT

This research wants to verify the effectiveness of couple's treatment, when a neurodegenerative disease affects one of the two partners. The disease affects not only the ailing individual, but also the dynamics within the couple. Fourteen patients affected by neurodegenerative diseases participated in an emotionally focused couple therapy (EFT) with their spouses. We collected a measure of the quality of life (SF-36) and relationship satisfaction (DAS) at the beginning and at the end of the treatment for both partners. The results show an improvement in quality of life and couple contentment, underlining the usefulness of such a psychotherapeutic intervention on the couple.     

New Sexism in Couple Therapy: A Discursive Analysis

The persistence of gender inequality in postindustrial societies is puzzling in light of a plethora of changes that destabilize it, including shifts in economy, legislation, and the proliferation of feminist politics. In family relations, such persistence manifests as a disconnect between couples aspiring to be more egalitarian yet continuing to enact traditional gender roles and hierarchies. There is an emerging consensus that gender inequality persists because of people's continued reliance on sexist ideology or gendered assumptions that constitute women as innately distinct from and inferior to men. Sexist ideology changes its form to accommodate to changing socio‐economic conditions. Contemporary forms of sexism are old ways of legitimizing male power articulated in new and creative ways, often by incorporating feminist arguments. To effectively recognize and address “new sexism,” scholars and practitioners require new, innovative research frameworks. Our objective in writing this article is two‐fold. First, we seek to advance discursive (i.e., focused on language in use) approaches to the study of sexism. Second, we present the results of a discursive analysis of “new” sexist discourse in the context of couple therapy. The study provides preliminary evidence that, despite endorsing egalitarian norms, couples studied continue to rely on gender binaries and remain entrenched in old‐fashioned patterns of gender inequality. Implications of these results for the practice of couple therapy and for future research are discussed.     

Dyadic Coping in Couple Therapy Process: An Exploratory Study

This study aimed at moving beyond previous research on couple therapy efficacy by examining moment‐by‐moment proximal couple and therapist interactions as well as final treatment outcomes and their reciprocal association. Seven hundred four episodes of dyadic coping within 56 early therapy sessions, taken from 28 married couples in treatment, were intensively analyzed and processed using a mixed‐methods software (T‐LAB). Results showed that negative dyadic coping was self‐perpetuating, and therapists tended to passively observe the negative couple interaction; on the contrary, positive dyadic coping appeared to require a therapist's intervention to be maintained, and successful interventions mainly included information gathering as well as interpreting. Couples who dropped out of treatment were not actively engaged from the outset of therapy, and they used more negative dyadic coping, whereas couples who successfully completed treatment showed more positive dyadic coping very early in therapy. Results highlight the role of therapist action and control as critical to establishing rapport and credibility in couple therapy and suggest that dyadic coping patterns early in therapy may contribute to variable treatment response.     

A Systemic Approach to Couple Therapy

This article presents a model of couple therapy based on the reciprocal double bind. Two cases are presented to illustrate the model, and different modes of intervention are described. This paper stresses that therapy has more to do with the intersection of the maps of the world of members of a system than it has with a search for some individual or systemic truth.     

The Therapeutic Alliance in Couple Therapy for Depression: Predicting Therapy Progress and Outcome from Assessments of the Alliance by the Patient, the Spouse, and the Therapists

This study examined Couple Therapy (CT) for depression in a naturalistic setting. It looked at the associations between the therapeutic alliance and subjective distress, and between the alliance and depression outcome. Twenty-nine depressive patients and their spouses were treated via CT. Treatments were adapted in accordance with the patient’s need. The couples assessed the alliance and their subjective distress at every session. In addition, the therapists assessed the alliance at every session. The patient’s depression outcome was assessed at baseline and at 6, 12, 18, and 24 months post-baseline. The Outcome Rating Scale, The Session Rating Scale, and the Beck Depression Inventory were used. At any given session, the patients’ and spouses’ deviations from their average subjective distress ratings predicted their deviations from their average alliance ratings in the same session. At any given session, the patients’ and spouses’ deviations from their average alliance ratings predicted their deviations from their average subjective distress in the next session. The therapy-system alliance was significantly associated with the patients’ depression outcome, explaining 19.4 % of the variance in the patients’ depression change. The results indicate the importance of taking into account the association between the alliance and subjective distress during the treatment, and confirm the usefulness of routine evaluation of the therapeutic process as an indicator of the association between alliance and therapy outcome in everyday CT for depression.     

A Solution-Based Approach to Couple Therapy

Abstract

Couples often present for counseling as a last resort. As relationships in crisis may not last it is important that treatment be time-effective. Solution-based therapies have been described as brief and time-effective and applied effectively to working with couples. This article presents a case example demonstrating the application of a solution-based approach to therapy with a married African-American couple entering therapy to resolve their relationship difficulties that lead to the initiation of divorce proceedings. The processes of reducing blame and conflict, creating hope and solution building utilizing solution-based interventions are discussed, as well as the treatment outcomes.     

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.     

Feedback in Couple and Family Therapy: A Randomized Clinical Trial

Routine Outcome Monitoring (ROM) is recommended as a psychotherapy procedure to serve as clinical feedback in order to improve client treatment outcomes. ROM can work as a warning signal to the therapist if the client shows signs of no change or deterioration. This study has investigated whether any difference in outcome could be detected between those clients in couple and family therapy who used the Systemic Therapy Inventory of Change (STIC) feedback system (ROM condition) versus those who were offered treatment without the use of STIC (“treatment as usual” or TAU condition). A sample of 328 adults seeking couple and family therapy in Norway was randomly assigned to ROM versus TAU conditions. Outcome measures were The Outcome Questionnaire–45 and The Revised Dyadic Adjustment Scale. The results demonstrated no significant differences in outcomes between the ROM and TAU. Possible explanations of this result related to design and implementation issues are discussed.     

Relational Drawings in Couple Therapy

In couple therapy sessions, partners often get into long and drawn-out discussions, heavy with pain, resentment, and blame. It is vital for the therapist to avoid becoming entangled in these escalating interactions. In this article, as one way of avoiding these interactions, a protocol is proposed of using relational drawings in couple therapy for opening space for new stories. This approach is strongly rooted in extensive therapeutic experience, as well as in dialogical ideas. Not the content of the partners' imagery is central, but rather the dialogical exchange about the drawings. In particular, the focus of the therapist is on the partners' interactions, their hesitations and their surprises. Working in this way opens space for the partners to reflect on what they experience as crucial in their bond. The protocol is illustrated with two detailed case examples.     

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.     

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.     

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.     

Therapeutic Assessment With Children: A Pilot Study of Treatment Acceptability and Outcome

Therapeutic Assessment (TA) with children is a hybrid of psychological assessment and short-term intervention. It uses the ongoing process and results of psychological assessment to enhance parents' understanding of their child and to facilitate change. Clinical reports and single case studies suggest that TA with children is an acceptable and effective brief intervention. However, no aggregate data have been published to support this claim. This pilot study investigated the acceptability and preoutcome–postoutcome of TA with 14 clinically referred children with emotional and behavior problems and their parents. Results indicated high treatment acceptability as well as significantly decreased child symptomatology and enhanced family functioning as reported by children and mothers. In addition, mothers demonstrated a significant increase in positive emotion and a significant decrease in negative emotion pertaining to their children's challenges and future. The findings, although limited due to the design and small sample size, support assertions from published single case studies that TA is possibly an efficacious child and family intervention for children with emotional and behavioral problems and should be studied in a larger, comparison design.