Therapeutic alliance and progress in couple therapy: multiple perspectives

Therapeutic alliance research in couple therapy using multiple perspectives and longitudinal data has been sparse. This study used structural equation modelling to explore relationships between changes in alliance and in progress from clients' and therapists' perspective in a fairly large sample of couples (N=195) during the initial stage of therapy at an on‐campus training clinic. Self‐rated alliance was measured after sessions 2 through 4 with the Working Alliance Inventory. There was very little change in alliance over the early sessions of therapy, and changes in alliance did not always account for changes in relationship satisfaction. Husbands' perceptions of satisfaction and alliance seem to play an important role in the dynamics of the therapeutic process. Findings suggest a reciprocal relationship between perceptions of alliance and progress in therapy when combining perceptions of therapists and couple clients. Clinical implications and future research are discussed.     

Discovering forgiveness through empathy: implications for couple and family therapy

This article explores the concept of forgiveness in the context of couple and family therapy. Forgiveness is described as a complex psychological and relational process that is more a discovery via understanding and empathy than an act of will. Empathy is related to emotional intelligence, and the developmental and relational benefits of both are discussed. A rationale for viewing forgiveness in a contextual (family of origin), historical and relational attachment paradigm is offered. Relevant clinical cases illustrate the process of forgiveness as discovery in the context of an empathic relational environment where ambivalence is anticipated and respected.     

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.     

Congruence couple therapy for alcohol use and gambling disorders with comorbidities (part I): Outcomes from a randomized controlled trial

A nonblinded randomized trial was conducted at two Canadian provincial outpatient addiction clinics that tested the effectiveness of a systemic congruence couple therapy (CCT) versus individual-based treatment-as-usual (TAU) on nine clinical outcomes: (1) primary outcomes—alcohol use and gambling, psychiatric symptoms, and couple adjustment; (2) secondary outcomes—emotion regulation, substance use, depression, post-traumatic stress symptoms, and life stress. Data of primary clients and partners (N = 46) were analyzed longitudinally across baseline, posttreatment (5 months), and follow-up (8 months). Alcohol use disorder (95%) and gambling disorder (5%) were in the severe range at baseline, and co-addiction was 27%. Psychiatric comorbidity was 100%, and 18% of couples were jointly addicted. Between-group comparison favored CCT in primary outcomes with medium-to-large effect sizes (Cohen's h = 0.74–1.44). Secondary outcomes were also significantly stronger for CCT (Cohen's h = 0.27–1.53). Within-group, for all primary outcomes, a significant proportion of symptomatic CCT clients and partners improved, converging with ANOVA results of large effect sizes (0.14–0.29). All secondary outcomes improved significantly in CCT with large effect sizes (0.14–0.50). TAU showed significant within-group improvement in alcohol use, other substance use, and life stress with large effect sizes (0.16–0.40). Primary clients and partners made largely equivalent improvement within CCT and within TAU. Results were triangulated with clients' satisfaction ratings and counselors' reports. Overall, significant within-group effects were detected for CCT both clinically and statistically and between-group difference favored CCT. Future trials are required to validate these promising findings.     

Developing the couple perspective in parenting support: evaluation of a service initiative for vulnerable families

The importance of the relationship between parents is frequently underestimated by those designing and developing services to support parents in bringing up their children. Instead, the primary focus of recent family support initiatives in the United Kingdom has been on improving parenting skills. This article describes the outcomes of a project designed to maximize the effectiveness of parenting support to vulnerable families through sensitizing the workforce of a community‐based adult mental health agency to take account of the parental couple in providing postnatal support groups, parenting workshops and relationship counselling. Evaluating outcomes from these services suggests that a couple orientation adds significant value to the effectiveness of parenting support.     

A dialogue among various cultures and its manifestation in stuttering therapy

This paper presents a historical retrospective of the evolution of the clinical aspects of stuttering, and refers to social, cultural, political, and economic variables that might have exerted an influence on this evolution, particularly in relation to the authors’ experience in Israel. The retrospective commences in the early decades of the 20th century, when speech and language pathology did not exist as a profession, and presents the major approaches to therapy in children and adults employed by clinicians throughout the century. We focused on the impact of the change that occurred in religious society vis-à-vis stuttering on the various aspects of stuttering therapy and research. The Israeli Stuttering Organization - AMBI - is discussed in order to explore the possible influence of social, cultural, and political variables. In addition, we devoted special attention to the changes that occurred in the therapist-client relationship since they are indicative of the change in the nature of the treatment. We elaborated on the need for dialogue as a major component in the therapy and as an important contributor to a successful outcome. The dialogue is also discussed in terms of Eastern philosophy. Future developments in the understanding of stuttering and its implications for therapy are presented and discussed.Educational objectives: The reader will be able to: (1) summarize the history of the clinical development of stuttering and explore the possible influence of social, cultural, political, and economic variables particularly in relation to Israel; (2) provide a new definition of stuttering; and (3) contrast the model of a dialogue as opposed to a monologue and explain its use in the therapist-client relationship.     

Meditative dialogue: tuning in to the music of family therapy

Meditative dialogue is a mindfulness method through which families and their therapists are able to access the present moment and develop acceptance, non‐judgmental attitudes and attunement with one another and with the music that is always present in their lives. This process can be used to deepen empathic connections, tap into creative forces and loosen and encourage embodied and flexible interactions that alter patterns and cultivate openness to possibility and to change.     

When I think of you, I feel more confident about me: The relational self and self-confidence

Although much research has demonstrated the existence of relationship specific relational selves, the effects of those selves on feelings about the overall self-concept are unknown. The current research proposed that level of relational interdependent self-construal moderates the relationship between the activation of close relationship partners and self-confidence. The first study examined self-construal as a naturally occurring personality variable, whereas the second study manipulated self-construal. Both studies supported the hypothesis that those greater in relational interdependence experience greater self-confidence when close others are salient whereas those lower in relational interdependence experience lower self-confidence. The implications of the findings and linkages to past research are discussed.     

Clinician experiences of homework in couples and family therapy: A survey of perceived impact on the working alliance

The process of engaging clients in homework assignments has been studied extensively in research settings, but rarely have the challenges in the implementation of the science been considered in couples and family therapy. A survey was conducted of 226 clinicians regarding (1) their experience of homework adherence (quantity and quality) with couple and family clients, and (2) their experience of the impact of homework non-completion (IHN) on the working alliance. Clinicians working with families reported less overall homework quantity and quality. However, across both couples and family clients, more negative IHN was reported among clinicians experiencing less homework quantity, both in terms of IHN bond (couple ρ = 0.71, p < 0.001; family ρ = 0.78, p < 0.001) and IHN agreement (couples ρ = 0.25, p < 0.001; ρ = 0.19, p = 0.006), and among clinicians with fewer years of clinical experience (r = 0.19, n = 136, p < 0.05). The present findings suggest that, in the context of couples and family therapy, there is a risk of perceived negative IHN on the working alliance. There would be merit to future investigations examining the processes of facilitating homework engagement within the context of a strong working alliance.     

Integrative problem-centered metaframeworks therapy I: core concepts and hypothesizing

Over the last 20 years psychotherapy and family therapy have been inundated with a plethora of empirically validated treatments for particular disorders. That trend will increase. Psychotherapists will increasingly be exhorted and ultimately required to integrate empirical data and multicultural competence into their practice. Additionally, individual psychotherapy's default dominance of psychotherapeutic discourse needs to integrate and come to theoretical and clinical terms with the implications of the growing body of research demonstrating the validity and value of a multisystemic perspective. This article (and its companion article) presents a comprehensive, integrative, multisystemic, and empirically informed psychotherapeutic perspective to help therapists and psychotherapy trainers successfully address these challenges-Integrative Problem Centered Metaframeworks (IPCM) Therapy. This first article presents and illustrates IPCM's theoretical foundation, core concepts, and "case formulating" components. It delineates a Blueprint for the practice and teaching of 21st century psychotherapists who can meld science and art into best practice.     

Program for advanced studies in integrative psychotherapy: Family,couple, and individual therapy (an interdisciplinary program)

This article describes briefly an advanced program in integrative marital and family therapy and individual psychotherapy established at the Hebrew University of Jersusalem in 1993–94 and its first two years of successful operation.     

Creating Structure in a Time of Intense Stress: Treating Intimate Partner Violence

Violence is an increasingly visible problem in the United States, with the news and other forms of media bringing this into the forefront of the public’s awareness. Violence comes in many different forms, including intimate partner violence (IPV), which occurs for about 36% of women and about 29% of men across the United States. Given the high incidence in the United States, it is imperative to consider the best ways for mental health professionals to treat violence in relationships. Some professionals in the field have developed and utilized conjoint treatment models for working with couples who have a history of violence. This article presents the application of attachment theory to a conjoint treatment model for couples that have experienced violence. A case study is included to demonstrate the implementation of an emotionally focused therapy framework and provide a sample outcome of this treatment approach. The framework of this article provides clinicians with insight into how to approach working with violent couples in a safe and productive way. Mental health professionals are at the front lines of implementing evidence-based interventions and creating lasting change for the clients whom they work with.     

Joining with all members of a family system: The rhetoric of antilogic in family therapy dialogue

Family therapists face a significant rhetorical challenge in working with families that disagree about the problematic life-situation which brought them to therapy. Therapists must find a way to join with disagreeing family members and then find a way to engage in a therapeutically useful conversation with them. Thus, they must deal resourcefully with contradictions. This article explores the ways that the Sophistic rhetorical concept of antilogic may be employed in helping therapists join and then engage in a therapeutically useful conversation with families who hold contradictory views concerning the problem that brought them to therapy.The author wishes to thank Ronald Chenail, PhD, Douglas Flemons, PhD, and Shelly Green, PhD, for their assistance in the development of this project.     

Picturing ourselves in the world: Drawings,interpretative phenomenological analysis and the relational mapping interview

ABSTRACT

Some aspects of experience can be challenging for research participants to verbalise. Interpretative phenomenological analysis (IPA) researchers need to get experience-near to meet their phenomenological commitments, capturing the “texture” and quality of existence, and placing participants in relation to events, objects, others, and the world. Incorporating drawing into IPA designs provides a vehicle through which participants can better explore and communicate their lifeworlds. IPA researchers also require rich accounts to fulfil their interpretative commitments. Drawing taps into multiple sensory registers simultaneously, providing polysemous data, which in turn lends itself to hermeneutic analysis. This article outlines a multimodal method, the relational mapping interview, which was developed to understand the relational context of various forms of distress and disruption. We illustrate how the approach results in richly nuanced visual and verbal accounts of relational experience. Drawing on an “expanded hermeneutic phenomenology,” we suggest how visual data can be analysed within an IPA framework to offer significant experiential insights.     

Pre-trial therapy for child witnesses in cases of sexual abuse: A scoping literature review

Globally, child complainants of sexual abuse are expected to testify in criminal proceedings and in some countries therapy is delayed until after the child testifies as not to contaminate the child’s version of events. We carried out a scoping review of the literature on the provision of pre-trial therapy to child witnesses in cases of sexual abuse, to identity pertinent practice issues. We searched the following data bases: Academic FileOne, CINAHL, Cochrane Library, eBook (EBSCOHost); HeinOnline, OAPEN Library, PscyhARTICLS, PscyhINFO; SocINDEX, ScienceDirect, Google Scholar, and Scopus. We identified white and grey literature for the period spanning 1980 to 2016. Inclusion criteria included studies published in English, experimental studies, literature reviews, and policy documents relating to the provision of pre-trial therapy for child witnesses in criminal cases of sexual abuse. We discovered that an internationally accepted clear definition of pre-trial therapy is needed to ensure a common understanding thereof amongst all role players. A dearth of empirical studies exists and consequently the possible impact of different forms of therapeutic approaches on the child witness’ testimony is yet to be conclusively determined. In the interim, therapists and other role players should be acutely aware of the impact of different forms of therapy on the child witness’s testimony.     

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.”     

Media depictions of physical and relational aggression: connections with aggression in young adults' romantic relationships

Various studies have found that viewing physical or relational aggression in the media can impact subsequent engagement in aggressive behavior. However, this has rarely been examined in the context of relationships. Accordingly, the aim of this study was to examine the connection between viewing various types of aggression in the media and perpetration of aggression against a romantic partner. A total of 369 young adults completed a variety of questionnaires asking for their perpetration of various forms of relationship aggression. Participants' exposure to both physical and relational aggression in the media was also assessed. As a whole, we found a relationship between viewing aggression in the media and perpetration of aggression; however, this depended on the sex of the participant and the type of aggression measured. Specifically, exposure to physical violence in the media was related to engagement in physical aggression against their partner only for men. However, exposure to relational aggression in the media was related to romantic relational aggression for both men and women.     

Developing an indicator of family function and a practicable outcome measure for systemic family and couple therapy: the SCORE

There is a need for a measure of outcome in systemic family and couples therapy (SFCT) that reflects current theory and practice. To meet the needs of SFCT practice the measure needs to use self‐report by family members, take a short time to complete and be easy to understand. The development of such a measure, called the SCORE, is reported in this article. Substantial piloting, consultation and review in terms of clinical judgement led to the construction of the SCORE 40 which has forty items about how the family functions, rated by family members over 11 years of age on a Likert scale, in addition to independent ratings of the family and its difficulties. The SCORE 40 is shown to be a viable instrument but is too substantial for everyday clinical use. In a research project to reduce and refine the measure and determine its psychometric properties the SCORE 40 was administered to 510 members of 228 families at the start of their first appointment for family therapy at clinics throughout the UK. The scale has good psychometric properties and could operate with either three or four dimensions. The analyses of these data, combined with data from a convenience sample of 126 non‐clinical families, allowed a reduction to fifteen items while retaining most of the information provided by the SCORE 40. This version is offered with three dimensions of: (1) Strengths and adaptability; (2) Overwhelmed by difficulties; and (3) Disrupted communication. It is hoped that the ready availability of the SCORE 15 will encourage routine evaluation of outcomes in clinics as well as the SCORE being used flexibly for both therapy and research.