Benchmarking Community-Based Couple Therapy: Considering Measurement Reactivity

Couple therapy has been shown to be effective in randomized clinical trials; however, results from naturalistic couple therapy have been less consistent. This study utilized a benchmarking approach to compare the effectiveness of couple therapy in a community-based setting with findings from efficacy treatments, such as treatment within randomized clinical trials. The current study is the largest couple therapy sample published to date (N = 3,347 couples). Clients in couple therapy were asked to provide initial and weekly ratings of symptomology on the Outcome Questionnaire (OQ-45.2). We found that treatment effect sizes found at community clinics were smaller than efficacy studies (i.e., the benchmark). However, when taking into account measurement reactivity, the effect sizes were comparable. This is the first benchmarking study for community-based couple therapy, allowing for meaningful comparisons and understanding of outcomes in real-world couple therapy. Implications for the field are offered in terms of evaluating community-based psychotherapy studies with benchmarking for couple therapy. Results of this study provide clinicians and researchers a way to meaningfully compare couple therapy outcomes, accounting for differences in community-based practices and randomized clinical trials. This benchmark also underscores the impact of measurement sensitivity, an issue commonly overlooked in psychotherapy research and practice.     

Response to MacIntosh’s Systematic Review of Psychoanalytic Couple Therapy: A Brief Note from the Classical Perspective

ABSTRACT

Working with couples from a classical perspective can be thought of as an oxymoron, unlike working from object relations and relational viewpoints, often seen to be the more natural fits. This article offers a fresh look at those parts of the classical perspective that relate very clearly to working with two partners in a couple. Freud’s theories in Three Essays on the Theory of Sexuality (1905) and On Narcissism (1914a) provide theoretical background for the work. Concepts such as transference (between partners, between the partner[s] and the therapist) and countertransference are shown to be manifested in complex ways with couples. Being mindful of unresolved developmental issues—for example, Oedipal and separation-individuation issues—which may have played a part in partner choice and in the resulting problems, allows the therapist to offer deep interpretations of within- and between-partner conflicts. Interestingly, unresolved Oedipal issues, particularly, may form an important part of the countertransference.     

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.     

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.     

Discrepant Alcohol Use,Conflict, and Couples Satisfaction in a Community Sample

Abstract

Discrepant alcohol use between partners has been shown to impact couples’ relationship functioning, emphasizing couples therapists’ need for careful assessment and informed treatment. This study recruited 514 participants from online crowdsourcing platforms to participate in an online survey. Participants were predominantly male (62.4%), heterosexual (76.1%), and Caucasian (47.6%). Ages ranged from 18 to 65 years and mean age was 33. Results indicated a negative association between couple satisfaction and both alcohol-related conflict and discrepant alcohol consumption. Being female combined with higher levels of alcohol discrepancies and couple satisfaction predicted increased alcohol-related conflict.     

Actor–partner interdependence of humility and relationship quality among couples transitioning to parenthood

The transition to parenthood is a challenging experience that often strains relationships, but perceiving one’s partner as humble (actor relational humility) and being perceived by one’s partner as humble (partner relational humility) were hypothesized to benefit couples during this transition. Married couples (N = 69) were tracked from the third trimester of pregnancy through 21 months postpartum. Husbands and wives provided ratings of relational humility and dyadic adjustment. Actor–partner interdependence models tested actor and partner effects of relational humility on dyadic adjustment across the transition. Although couples declined in dyadic adjustment over the transition at the same rate regardless of relational humility (counter to Hypothesis 2), those higher in relational humility reported greater dyadic adjustment at each time point during the transition (consistent with Hypothesis 1). These findings support the benefits of relational humility to relationship quality, and we call for further research into humility’s benefits during times of relationship transition.     

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.     

Assessing the health of a dyadic relationship in heterosexual and same‐sex partners

The purpose of this study was to assess characteristics of a measure of monitoring the health of a dyadic relationship based on data from self‐report surveys completed by both partners from dating heterosexual, married heterosexual, cohabiting gay male, and cohabiting lesbian couples from the United States (Ns = 127, 46, 81, and 224, respectively). Covariation among the measure’s 7 items conformed to 1 latent factor. Intraclass correlations between partners from the same couple were positive. Gender effects occurred only for married couples, with wives having higher scores than husbands. One’s own and one’s partner’s monitoring accounted for unique variance in one’s own commitment, even with controls for other variables. Monitoring buffered the negative effects of neuroticism on commitment.     

Effectiveness of an Educational and Support Program for Family Members of a Substance Abuser

Abstract

This paper investigates the relationship between marital adjustment and congruency of couple preference regarding wife employment. Implications for marriage and family therapists are emphasized. Husband, wife, and couple scores were obtained on the Marital Status Inventory and Dyadic Adjustment Scale for eight work pattern categories. The first four (Dual-Career, Dual-Work, Pre-Dual-Career, Traditional Single-Career) were current couple work patterns perceived as desirable by both spouses. The last four categories (Incongruent Dual-Career, Incongruent Dual-Work, Incongruent Pre-Dual-Career, Incongruent Traditional Single-Career) were current couple work patterns that one spouse, in conflict with the other spouse, perceived as undesirable. In addition, number and ages of children and number of wife work hours were analyzed for their effects on marital adjustment in these couples. The results of this study indicate that marital adjustment is negatively influenced only when the wife wants to work in her career, is not employed, and her husband does not want her to be employed now or in the future. Possible reasons for these findings and suggestions for further research are included.     

Evaluating the Effects of Creative Journal Arts Therapy for Survivors of Domestic Violence

The authors implemented a small series (N = 3) single-case research design to assess the effectiveness of a 9-session creative arts therapy treatment program for adult survivors of domestic violence. Analysis of participants’ scores on the Outcome Questionnaire (OQ-45.2) and Brief Resilience Scale using the percentage of nonoverlapping data procedure yielded treatment effects indicating that a creative arts therapy treatment program may be effective for reducing mental health symptoms and improving resiliency. It is recommended that this body of research continue for other educational, work, and health settings.     

Intimacies: An Integrative Multicultural Framework for Couple Therapy

Implicitly or explicitly, our ideas about intimacy are the most fundamental notions giving direction to the process of couple therapy. Yet, as a field, we have spent little time conceptualizing intimacy and even less time considering the diversity of priorities and meanings couples bring to our offices. In Part One, Varieties of Intimacy, I describe a kaleidoscope of contexts—socio‐historical, cultural, gender, life cycle, and developmental—that inform our ideas and expectations for intimacy in couples’ relationships. I highlight different spheres in which intimacy may take place such as the emotional, sexual, intellectual, or familial. I propose a starting point in which the therapist, in a collaborative manner, helps the partners articulate their yearnings and priorities in order to negotiate a shared vision. In Part Two, Conceptualizing Intimacy, I suggest an experiential definition that gives room for each partner's subjective meanings, yet consider diverse relational processes that may need to be addressed for a resilient ebb and flow of intimate experiences. In Part Three , Sexual Intimacy, I outline conditions in which sex is more likely to be experienced as intimate rather than nonintimate. Finally, in Part Four, I describe Therapeutic Principles to guide the therapist in taking couples from reactivity to dialogue to negotiations of intimacy. The integrative framework proposed here discourages monolithic a priori notions of intimacy and highlights instead: nuanced meanings, relational processes to be considered differentially, present and past emotional blocks, and a flexible clinical approach to foster conditions for the creation and resilience of intimate experiences.     

A Couple-Based Psychological Treatment for Chronic Pain and Relationship Distress

Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, “Mindful Living and Relating,” aimed at alleviating pain and suffering by promoting couples’ psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners’ health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one’s partner, fully attending to the present moment, and responding empathically in a way that serves one’s own and one’s partner’s values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.     

Hurt feelings in couple relationships: Exploring the role of attachment and perceptions of personal injury

This research program focused on perceptions of the appraisals and emotions involved in hurtful events in couple relationships. Study 1 tested the broad proposition that hurt feelings are elicited by relational transgressions that generally imply relational devaluation and that evoke a sense of personal injury by threatening positive mental models of self and/or others. Participants (N= 224) provided retrospective accounts of an experience of being hurt by a romantic partner. These accounts, together with expert judges’ ratings, showed that most hurtful events involved relational transgressions that signal both relational devaluation and threat to positive mental models; however, relational devaluation was relatively unimportant in explaining the hurt associated with partners’ distrust. A sense of injury emerged as the dominant theme in open‐ended accounts of emotional reactions; however, other negative emotions also featured and were related to the type of event reported. The emotion terms generated in Study 1 were used as stimuli in a word‐sorting task (Study 2). This study confirmed that many of the terms were perceived specifically as injury related, and shed further light on the link between appraisals and emotions. Theoretical and practical implications of the findings are discussed.     

Embodying the Couple Relationship: Kinesthetic Empathy and Somatic Mirroring in Couples Therapy

Kinesthetic sensitivity plays a central role in the development of empathy and in understanding others’ intentions, skills that greatly affect spousal satisfaction. The present study examines how, in the couple relationship, somatic mirroring of the other’s physical expressions creates an emotional experience in the relationship, and in couples therapy, sets processes in motion. Such understanding is critical in couples therapy to harness the embodied knowledge needed to address issues in areas where verbal discussion is insufficient. Nine couples (n?=?18) participated in 12 couples therapy sessions that incorporated somatic mirroring. The sessions were documented on video and through the personal diaries kept by the therapists and patients. The participants related to four main themes: Somatic mirroring (a) creates comfort and emotional availability, (b) contributes to identifying and labeling feeling, (c) contributes to arousing intimacy and desire, and (d) avoiding somatic mirroring is characteristic of moments of conflict in the relationship. To create a bridge between the research and the clinic, in the Discussion section methods for connecting with embodied knowledge in couples therapy are examined, with the implications of having familiarity with such knowledge on the intimate relationship and the couple’s communication.     

When Romantic Partners’ Goals Conflict: Effects on Relationship Quality and Subjective Well-Being

Most studies have explored goal pursuit from an intraindividual perspective; however, it is becoming increasingly clear that people’s relationships influence many aspects of goal pursuit (Fitzsimons and Finkel in Curr Direct Psychol Sci 19(2):101–105, 2010). The current study examined the influence of goal conflict between romantic partners on relationship quality and the subjective well-being of the partners. In a sample of 105 dating couples (N = 210) both partners provided ratings of their subjective well-being, relationship quality, and the degree of conflict they experience when trying to pursue their goals. Structural equation modeling was used to conduct dyadic analyses on the variables. Results showed that both partners’ reports of higher goal conflict were directly associated with lower relationship quality and lower subjective well-being. Lower relationship quality was, in turn, also associated with lower subjective well-being. Furthermore, one partner’s report of goal conflict was indirectly related to the other partner’s subjective well-being through relationship quality. These findings indicate that relational influences on goal pursuit have implications not only for goal pursuit but also for well-being and relationship quality.     

Couple Therapy for Depression Within a Naturalistic Setting in Finland: Factors Related to Change of the Patient and the Spouse

The study examined factors related to change in treatments for depression in couple therapy (CT; N = 29) and treatment-as-usual (TAU; N = 22). Treatments were adapted in accordance with the patient’s need. The patients’ depressive symptoms, general mental health and marital satisfaction were assessed at baseline and at 6 months post-baseline. The Hamilton Depression Rating Scale, the Beck Depression Inventory (BDI), the Symptom Check List-90, and the Dyadic Adjustment Scale (DAS) were used for the patients. The BDI and the DAS were used for the spouses. The couples in CT group assessed their subjective distress (SD) at every session by using the Outcome Rating Scale. The results showed that the spouses’ gender, the spouses’ depressive symptoms at baseline, and the number of therapy sessions were related to differing changes in the CT and TAU groups at the 6-month post-baseline assessment. The spouses in the CT group demonstrated a higher treatment response than those in the TAU group. In the CT group, the spouse’s benefit from the treatment was related to SD at the outset on the part of either the patient or the spouse or both. The change in the patient’s SD predicted the patient’s change in depressive symptoms, general mental health, and was associated with the patient’s change in marital satisfaction. The study emphasizes the importance of the spouse’s involvement in the treatment of depression, the provision of feedback on SD, and discussion of individual well-being and relational issues, in addition to the focus on depression.     

An entire life in one glance: a psychoanalytic reading of Revolutionary Road

This article, starting from an analysis of the film Revolutionary Road (2009; director, Sam Mendes), addresses the topic of conflictuality in relationships between couples, especially in those characterized by intense violence and a relational configuration of the sadomasochistic type. In particular, the film – in highlighting sequential moments in the couple’s life, from its formation through to its tragic conclusion – seems to strengthen the hypothesis that the specific quality of falling in love is a contributing factor in determining the dramatic unfolding of a couple’s relationship. The relationship is characterized by an experience of intense, erotic sensoriality, and by the nature of the unconscious fantasy underlying the bond between the couple that began with the moment of falling in love, a bond in which deep needs for fusion predominate. The presence of this neediness impedes a more adequate working through of the conflicts and the transition to more satisfying ways of relating.     

The Association between Symptom Accommodation and Emotional Coregulation in Couples with Binge Eating Disorder

Intense negative emotions and maladaptive behavioral strategies to reduce emotional distress occur not only in patients with various forms of psychopathology but also in their committed partners. One common strategy to reduce distress is for partners to accommodate to the symptoms of the disorder, which reduces distress short term but maintains symptoms long term. Accommodation is believed to be motivated by the partner reacting behaviorally to the patient's emotions, but the emotions of the partner in this context have yet to be examined. This pilot study examined how partner accommodation related to specific patterns of emotional coregulation between patients with binge eating disorder (BED) and their partners, before and after a couple‐based intervention for BED. Vocally encoded emotional arousal was measured during couples’ (n = 11) conversations about BED. As predicted, partners’ emotional reactivity to patients’ emotional arousal was associated with high accommodation before treatment. Thus, partners may use accommodation as a strategy to reduce both the patients’ and their own distress. After treatment, partners’ arousal was no longer associated with the patients’ emotional arousal; instead, partners showed greater emotional stability over time, specifically when accommodation was low. Additionally, patients were less emotionally aroused after treatment. Therefore, treatment may have decreased overall emotionality of patients and altered the association between accommodation and partners’ emotional reactivity. If replicated, this understanding of the emotional context associated with accommodation in BED can inform couple‐based treatment by targeting specific emotional precipitants of behaviors that maintain symptoms.     

Orgasm Frequency Predicts Desire and Expectation for Orgasm: Assessing the Orgasm Gap within Mixed-Sex Couples

While previous research has established the existence of an orgasm gap between men and women, research exploring this phenomenon within dyadic samples of mixed-sex couples has been limited. The current study aims to investigate the impact of this orgasm disparity on novel sexual outcomes for couples, including desire and expectation for orgasm. We conducted secondary data analyses on a sample of 104 sexually active mixed-sex couples using an online Qualtrics panel (M_age?=?43.9 years; 94.2% heterosexual; 79.3% White). Cisgender men and women within the couple reported on their sexual satisfaction, orgasm frequency, desired orgasm frequency, expectation for how often people should orgasm (“orgasm expectation”), and perceptions of their partner’s orgasm frequency. An orgasm gap emerged, and men significantly underreported the size of the orgasm gap in their relationships. In a dyadic path model, men’s and women’s own orgasm frequency positively predicted their desire and expectation for orgasm. Additionally, women’s orgasm frequency predicted men’s orgasm expectation. This relationship between orgasm frequencies and expectancies may partially explain women’s lower orgasm importance compared to men. A cycle of orgasm inequality within relationships may be perpetuated when women who experience less frequent orgasms lower their desire and expectation for orgasm. Sex educators, activists, and therapists should work to improve entitlement to sexual pleasure and orgasm, particularly for women who wish to increase their orgasm frequency.