Deterioration in Marital and Family Therapy: Empirical,Clinical, and Conceptual Issues

Recent empirical evidence of deterioration during both nonbehavioral and behavioral marital and family therapy is presented. While the frequency of patient worsening in marital-family therapy does not appear to exceed that previously found for individual psychotherapy, the acceptability of the evidence for negative effects in the treatment of systems may be greater than that which exists for individual treatment. After examining the empirical evidence of negative effects in family therapy and some of the factors that influence their occurrence, the authors discuss some conceptual issues relevant to a definition of worsening in marital and family therapy and present some methodological guidelines for the assessment of deterioration in therapy with family systems. It is concluded that the study of deterioration processes in family therapy may aid the understanding of family change processes more generally.     

The limits of systems therapy: The problem of intimacy

By placing so much emphasis on systemic thinking, marriage and family therapists have lost sight of the individual within the system. One of the limits of a systemic therapy is its capacity to deal with problems in intimacy, a central problem in marital therapy. A knowledge of individual development is crucial for family therapists. The two themes dealt with in this paper are 1) some concepts of self psychology which can be useful in understanding the fear of intimacy, and 2) at what point, in couples' therapy, it is advisable to shift to individual therapy for one or both partners.     

Individual Marital Therapy — Have Reports of your Death been Somewhat Exaggerated?

In this reply to Wells and Giannetti's critique of our earlier reviews of research in family therapy, we demonstrate that the sense of absolute certainty with which they reappraise and dismiss as useless the studies we reviewed on individual marital therapy is unjustified. We also consider the implications of their critique and the conclusions they derive from it for public policy and clinical practice. Though we acknowledge the appropriateness of certain aspects of their critique, we continue to hold to our original position that, for now, there is ample empirical warrant for considering conjoint therapy to be the treatment of choice for marital problems.     

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.     

Developmental perspectives and family therapy: The marital life cycle

Developmental perspectives have been part of family therapy for more than two decades with a primary focus on the family life cycle and individual development. Most efforts at recognizing a marital life cycle have subsumed marital tasks under rubrics based primarily on parental roles. This paper offers a marital life cycle based on marital development with specific tasks for each of four stages-the marital breakup and remarriage phases are not included here-and provides implications for therapy.     

The Relationship of the Self of the Therapist to Therapy Process and Outcome: are Some Questions Better Left Unanswered?

Gurman (1987) has challenged the field of marital and family therapy to answer questions concerning the relationship of the therapist to outcome. An examination of conceptual and empirical literature regarding the relationship of the self of the therapist to process and outcome in marital and family therapy discloses that empirical evidence for such relationship is not persuasive. The author constructs a crucible for the field of marital and family therapy.     

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.     

Ecosystemic Structural Family Therapy: Theoretical and Clinical Foundations

Ecosystemic structural family therapy (ESFT) is a systemic, strength-based, and trauma-informed family therapy model that has evolved from structural family therapy (SFT; Minuchin in Families and family therapy, Harvard University Press, Cambridge, 1974). ESFT is an evidenced-based family therapy approach designed to intervene with families of children who are experiencing behavioral health problems and are at the risk of out-of-home placement. In this article we review the theoretical, applied, and empirical evolution of ESFT relative to extant SFT models. ESFT is based on the fundamental assumption that child, parental, and marital functioning are inextricably linked to their relational environment. Five interrelated constructs guide ESFT therapists in their understanding of clinical problems: family structure; family and individual emotional regulation; individual differences (e.g., historical, biological, cultural, developmental); affective proximity; and family development (Gehart 2010). ESFT has an extensive evaluation history dating back to the 1980s involving over 4,000 families in 39 different sites. While ESFT is considered evidence-based, it might be more consistent with “Practice-Based Evidence” given its long, extensive, and successful, history in the child mental health system in Pennsylvania.     

An evaluation of a partial training program in psychiatric residency on the later practice of marital and family therapy

Abstract

This paper reports on the results of a survey of psychiatrists and residents who received marital and family therapy training during their second year of residency. The data indicate that such training has an immediate positive effect on practice and is carried forward into later practice. Practicing psychiatrists trained in marital and family therapy during residency report spending 25% of their caseloads in marital and family therapy which was seen as producing positive change in patients. In line with previous training, practicing psychiatrists define the unit of treatment as more than an identified patient and treat marital and family therapy cases themselves or refer to others for such therapy. Variations in practice and techniques raise questions regarding the structure and content of marital and family therapy training in psychiatry residency programs and point out the importance of such training in the later practice of psychiatry.     

Family adjustment,parental attitudes,and social desirability

This study examines the role of social desirability response set on the report of marital adjustment, child adjustment, and parenting attitudes. Results from 69 married couples closely replicate previous self-report findings suggesting that the more positive the report of marital adjustment, the fewer the number of child problem behaviors endorsed by parents (r = -.19(69), p less than .05). When social desirability is controlled, however, the marital-child adjustment relationship is nonsignificant. Previous reports of a global relationship between marital and child adjustment may have been inflated by individual differences in willingness to endorse problems on self-report measures. Parenting attitudes are not associated with social desirability or marital adjustment. Warmth, but not authoritarianism, is negatively correlated with child behavior problems in the home (r = -.25(69), p less than .01). The authors propose that family interaction research use a multimethod strategy to focus on circumscribed variables that influence marital and parenting behavior.     

Reducing work/home conflicts in employed couples: A proposed program to balance job and family demands

Work/home conflict is a dominant stress for workers in industrialized countries, particularly in dual-employment families. Interindividual (husband/wife) and interrole (work/home) conflicts in such families are a unique source of stress and adversely affect family and marital relationships as well as performance at work. Neither family therapy nor the stress literature have reported any interventions directed specifically at reducing work/home conflicts in employed couples or parents, although many workplaces today offer stress prevention programs aimed at individual workers. This paper discusses the underlying theoretical rationale for a marital enhancement intervention currently being developed for prevention of distress associated with work/home conflicts. The program combines marital enrichment and training principles with stress management techniques and aims at reinforcing shared coping resources. It focuses on four main variables associated with interpersonal processes: unrealistic expectations based on irrational beliefs, social undermining, shared decision control, and social support.     

Screening for Physical Violence in Couple Therapy: Methodological,Practical, and Ethical Considerations

Over two-thirds of clients in family therapy clinics engage in some form of physical violence against their partners within the year prior to the initiation of therapy. However, family therapists are aware of only a small proportion of these cases. The purpose of this article is to enhance the ability of family therapists to detect marital violence. We examine client and therapist reasons for why physical violence is not detected. We then review various methods to screen for the presence of physical violence, especially the Conflict Tactics Scales. Finally, indicators of life-threatening violence are presented to help family therapists detect cases that require immediate intervention to protect the partner whose life may be in danger.     

Romantic relationships in early adulthood: Influences of family,personality, and relationship cognitions

Two hundred and sixty‐five participants and their romantic partners were involved in a prospective, longitudinal, and multimethod study during the transition from adolescence to adulthood. Guided by the development of the early adult romantic relationships (DEARR) model (Bryant & Conger, 2002), the research (a) investigated mid‐adolescent family experiences and individual differences in personality as predictors of qualities in the early adult romantic union and (b) evaluated the degree to which marital beliefs mediated these associations. Structural equation modeling partially supported the mediating effects of marital beliefs. The findings were generally consistent with the DEARR model, suggesting that it is informative to study early adult romantic relationship functioning within a developmental‐contextual framework, while simultaneously considering the unique effects of personality and relationship cognitions.     

Life experiences of people who stutter, and the perceived impact of stuttering on quality of life: personal accounts of South African individuals

The purpose of the study was to investigate the life experiences of a group of South African adults who stutter and the impact of stuttering on their quality of life. Participants were 16 adults with a mean age of 28.9 and ranging from 20 to 59 years. Methods involved individual interviews designed to explore the life domains of education; social life; employment; speech therapy; family and marital life; and identity, beliefs and emotional issues. Main findings of the study indicated that the majority of participants perceived their stuttering to have impacted on their academic performance at school, and relationships with teachers and classmates. Although their stuttering was not perceived to adversely influence their ability to establish friendships, people generally reacted negatively to their stuttering. Many felt that their stuttering did not have an adverse effect on their choice of occupation, ability to obtain work, and relationships with managers and co-workers, although it was perceived to influence their work performance and hamper their chances for promotion. Although the majority viewed their speech therapy experiences as being negative; more than half the sample believed that speech therapy had, nevertheless exerted a positive effect on their quality of life. Overall, stuttering did not appear to have influenced participants’ family and marital life. Most participants felt that stuttering had affected their self-esteem and self-image, and had evoked strong emotions within them. Findings are taken to suggest the need to incorporate subjective feelings about stuttering into the clinical practice of speech-language therapy; to provide information and coping strategies for teachers and employers; and for further research.

Educational objectives: After completing this activity, the reader will be able to: (1) describe and explain the perceived impact of stuttering on quality of life in terms of education; social life; employment; speech therapy; family and marital life; and identity, beliefs and emotional issues; (2) to interpret and utilize the subjective meanings that individuals attach to their stuttering to improve stuttering treatment, counseling and research.     

Religiosity, Marital Satisfaction and Child Rearing

The following research sought to examine the relationship between an individual’s performance of religious duties and its impact upon his or her level of marital satisfaction and children supervision. Findings in this connection can help strengthen families. Six hundred and sixty heterosexual couples from Tehran were studied using multistage cluster sampling. Information regarding religious duties and marital satisfaction was collected using the researcher’s prepared questionnaire, and ENRICH marital satisfaction scale. The results showed that heterosexual couples who observe religious beliefs and perform religious duties (like participation in religious rituals and ceremonies) have a higher rate of marital satisfaction, and have suitable children supervision. Thus, there is a significant correlation between performing religious duties and marital satisfaction. Considering the relation between performing religious duties and nine subscales of marital satisfaction and children supervision questionnaire, Communication Parenting and Religious Orientation account for the highest rate of performing religious duties, and Sexual Relationship accounts for the lowest rate of performing religious duties. Thus, with the increase in religiosity and performance of religious duties, marital satisfaction rate will increase, and vice versa. However, those who perform religious duties have suitable children supervision, so they have good relationship with their family. It can be concluded that religiosity develops the grounds for marital commitment and child-rearing.     

Circumplex Model of Marital and Family Systems: I. Cohesion and Adaptability Dimensions,Family Types,and Clinical Applications

The conceptual clustering of numerous concepts from family therapy and other social science fields reveals two significant dimensions of family behavior, cohesion and adaptability. These two dimensions are placed into a circumplex model that is used to identify 16 types of marital and family systems. The model proposes that a balanced level of both cohesion and adaptability is the most functional to marital and family development. It postulates the need for a balance on the cohesion dimension between too much closeness (which leads to enmeshed systems) and too little closeness (which leads to disengaged systems). There also needs to be a balance on the adaptability dimension between too much change (which leads to chaotic systems) and too little change (which leads to rigid systems). The model was developed as a tool for clinical diagnosis and for specifying treatment goals with couples and families.     

婚姻质量对父母协同养育的影响：基于共同命运模型的跨层中介分析

共同命运模型(common fate model, CFM)是在家庭或二元层面研究中值得信赖的模型, 其更好地解释了亲密关系内在的相互依赖性。本研究基于共同命运模型探讨了家庭整体婚姻质量对父母协同养育程度的影响, 以及教养能力感在两者间的跨层中介作用。采用问卷法分层整群抽取上海市幼儿园中孩子(平均年龄5.14岁, 年龄范围4~7岁)的父亲与母亲参与调研, 分两个时间段(T1, T2; 间隔1年)收集数据, 最终得到650个家庭的父亲、母亲的婚姻满意度问卷(T1), 教养能力感问卷(T2)和协同养育感知问卷(T2)数据进行分析。结果发现: (1)基于共同命运模型, 家庭层面的婚姻质量正向预测家庭层面的支持性协同养育, 并负向预测家庭层面的破坏性协同养育; (2)家庭层面的婚姻质量正向预测父母各自的教养能力感; (3)父母各自的教养能力感正向预测家庭层面的支持性协同养育, 并负向预测家庭层面的破坏性协同养育; (4)父母个人层面的教养能力感在家庭层面的婚姻质量与家庭层面的支持性协同养育和破坏性协同养育起中介作用。总之, 本研究基于追踪数据运用共同命运模型, 并结合家庭层面(婚姻质量和协同养育)和个人层面(教养能力感)探讨了教养能力感在婚姻质量与父母协同养育间的跨层中介效应, 为营造良好的家庭环境提供一定的理论支持与指导意见, 并进一步促进了共同命运模型发展。     

Using the Michigan State University Family Therapy Questionnaire for Training

The development of the Michigan State University Family Therapy Questionnaire (MSU/FTQ) is described and a case example given of its use as a training tool. The MSU/FTQ is a relatively exhaustive list of 74 generic, structural, strategic, brief, and trans-generational family therapy interventions culled from the literature and translated into layperson's language. The marital and family therapy client uses it to provide feedback about the effectiveness of therapy by assessing those things theorists consider important about behavior maintenance and systemic change, indicating whether or not specific interventions occurred and their importance.     

The efficacy of couples-based interventions for panic disorder with agoraphobia

From this systematic literature review it was concluded that panic disorder with agoraphobia (PDA) can sometimes occur in conjunction with marital problems. Couples-based treatments for PDA – partner-assisted exposure and marital therapy – can be an effective treatment for the condition. It is as effective as individually based cognitive behaviour therapy. Involving partners of people with PDA in therapy may be appropriate in some cases, particularly those in which there are marital difficulties. Couple-focused interventions may enhance the maintenance of treatment gains by facilitating interactions that positively reinforce and perpetuate attempts by people with PDA to enter feared situations and cope with these effectively. People with PDA who have good marital relationships show a better response to both individual and couples-based treatment programmes. In some instances effective couples-based treatment leads to improvement in marital adjustment as well as in PDA symptomatology.     

ABSTRACTS OF LITERATURE

A research study in a private outpatient clinic for children attempted to parcel out factors that influence choice of psychotherapy. Instruments used were a 197-item Q-sort based on statements of preference (not practice) for treatment modality from the clinic therapists (psychiatrists, psychologists, and social workers), 86 demographic variables, and the Douglas Thom Child Guidance List of presenting complaints. Results indicate that 127 of the 197 factors reached significance in terms of consensus. Indications and contraindications for individual therapy, family therapy, marital therapy, group therapy, and combinations thereof are listed.