Clinical Application of the Couple Adaptation to Traumatic Stress (CATS) Model: A Pragmatic Framework for Working With Traumatized Couples

ABSTRACT

The authors attempt to apply knowledge of traumatization to clinical practice with couple dyads. Elaborating on the Couple Adaptation to Traumatic Stress (CATS) Model (Nelson Goff & Smith, 2005), the authors have worked to bridge the gap between a general understanding of trauma's impact on the couple relationship and couples' treatment. This article facilitates the application of the CATS Model to clinical work with couples impacted by trauma. Incorporating Herman's (1997) traumatic process with the original CATS Model, the authors created a more specific, clinically useful framework for clinicians. The goal of the current article is to provide clinicians with a pragmatic illustration articulating a clinical framework for understanding and treating posttraumaumitc symptoms and processes within the couple relationship. The main implication is that clinicians will be able to conduct effectively guided systemic therapy with distressed couples necessary to generate progress in the treatment of symptomatology and couple functioning of trauma survivors and their partners.     

Divorce Therapy in Context

Abstract

Partners trying to decide whether to continue or end their marriage rely on the expertise of therapists to help them evaluate their alternatives. Research on what predicts divorce and what consequences divorce has for parents and children is reviewed so therapists are informed in the guidance they give clients. Attention is given to the environmental context of marriage as well as its interior quality. Implications for therapists doing divorce therapy in the context of a “pro-marriage” climate are also discussed.     

Couple Relationship Distress and Observed Expression of Intimacy During Reminiscence About Positive Relationship Events

Satisfied couples report that positive, intimate communication is central to their relationship. We developed the positive reminiscence task, in which couples discuss positive relationship moments to assess communication of positive intimacy. The behavior and heart rate of 28 satisfied and 25 distressed couples were assessed during positive reminiscence and problem solving. As predicted, satisfied couples demonstrated higher rates of positive affect and dyadic intimacy than distressed couples during positive reminiscence, and these positive behaviors occurred at much lower rates during problem solving than positive reminiscence. However, the differences between distressed and satisfied couples were more marked on most assessed behaviors during problem solving rather than positive reminiscence. Two notable exceptions were that dyadic intimacy and sadness differed more between distressed and satisfied couples during positive reminiscence than problem solving. The positive reminiscence task assesses intimate behaviors in a manner likely to be useful in research and practice.     

Increasing Marital Intimacy: Lessons from Marital Enrichment

Both marriage and family therapists and family life educators work to increase marital intimacy. In this study the effectiveness of two marriage enrichment programs was assessed with implications for practicing therapists. Participants were randomly assigned to an Adventure or ACME (Association for Couples in Marriage Enrichment) treatment group or to a control group. Marital intimacy was assessed before and after treatment. Findings demonstrated that both enrichment groups had a statistically significant increase in marital enrichment. Suggestions for adopting adventure-based interventions for traditional therapy are discussed.     

The Efficacy of Behavioral Couples Therapy and Emotionally Focused Therapy for Couple Distress

Twenty treatment outcome studies, 13 of which evaluated behavioral couples therapy (BCT) and seven of which evaluated emotionally focused therapy (EFT) were reviewed, leading to the following conclusions. BCT leads to short and long-term gains for moderate to severe couple distress. In the long term BCT probably leads to no better outcomes than its constituent components—behavioral exchange training and communication and problem solving skills training. Addition of a cognitive therapy component to BCT or the use of a variety of treatment formats does not improve the efficacy of BCT. Integrative couples therapy and insight-oriented marital therapy may be more effective than BCT, but studies supporting this conclusion require replication. EFT leads to short and long-term gains for mild to moderate couple distress. Addition of a cognitive therapy component to EFT does not enhance its efficacy. EFT may be more effective than problem solving therapy and less effective than integrated systemic therapy, but the two studies supporting this conclusion require replication.Michael Byrne, PhD, is a Clinical Psychologist, Midland Health Board, Ireland; Alan Carr, PhD, is Director of the Clinical Psychology Training Programme, Department of Psychology, Arts Building, University College Dublin, Belfield, Dublin 4, Ireland (alan.carr@ucd.ie). Marie Clark, PhD, is Lecturer, Department of Psychology, University of Surrey, United Kingdom.     

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.”     

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.     

An Attachment Perspective on Reunions in Couple Psychoanalytic Psychotherapy

Psychoanalysis has been slow to acknowledge attachment theory as one of its own. Yet traditions of observational and representational research associated with it have much to offer in shedding light on intrapsychic as well as interpersonal phenomena. This paper explores these traditions and their potential clinical utility for couple psychoanalytic psychotherapy. In particular, attention is drawn to behaviour and representations associated with the experience of reunion in therapy sessions.     

Same-Gender Couple Therapy: Creating New Objects in Intimacy and Parenehood Transition

The formation of same-gender couple and parental relationships is described and analyzed from a combined relational and couple therapy. The parenthood transition of a homosexual couple into a family structure, that includes two biological parents and a stepfather, creates tremendous turbulence and crises. The couple link is transformed throughout critical and major changes from a two-ness unit into a four- one, which develops unique relationships with the mother and the baby. This paper presents how therapists can treat and intervene in both intra-psychic gender crises as well as inter-psychic breakdowns of the couple shared reality. The therapeutic processes highlight the transformative changes that the homosexual couple has to experience in order to accept the loss of previous accomplishments in gender identity and love relationships. In addition, therapy helps to disentangle co-joint couple objects while creating new shared spaces.Aviva Mazor, PhD, is at the Bob Shapell School of Social Work, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, 69978, Israel (A-mazor@netvision.net.il). She received a PhD from University of Wisconsin-Madison. Her current research is in combined relational and family therapy with alternative families, separation processes from multigenerational perspective, and the post-traumatic effects of holocaust child-survivors.     

Does It Help or Hinder? Technology and Its Role in Healing Post Affair

For couples experiencing infidelity, technology can be either a source of comfort or a constant threat. Technology has created an atmosphere where individuals have access to more people, in more ways, and at more times than ever before. While this accessibility has increased partners' ability to connect with each other, it has also increased opportunities for infidelity and makes it easier to maintain an affair. From an attachment perspective, infidelity can lead to heightened sensitivities that alter how an individual experiences the availability, responsiveness, and engagement of their partner. Everyday interactions like text messages, phone calls, and computer use become potential threats that compromise the safety of the relationship. Using an extensive clinical vignette, this article highlights the systemic relationship between technology, attachment, and infidelity and provides clinicians with a framework to use when helping couples heal post affair.     

Relational Couple Therapy with Post-Traumatic Survivors: Links Between Post-Traumatic Self and Contemporary Intimate Relationships

The present article describes a clinical case study of relational couple therapy with post-traumatic spouses. Survivors, who were infants and toddlers during the Holocaust, disclose tremendous difficulties in their intimate relationships. The early loss of parental figures, and cumulative traumatic experiences throughout survivors' lives in the post war era hampered their capacity for intimate partnership despite its ultimate necessity. Relational couple therapy creates an unfamiliar experiential space with the couple's bond. This experiential space enables each partner to change destructive emotional patterns within one's inner psychic reality as well as the couple's emotional system. In addition, the therapeutic triangle creates partial transformational boundaries between past traumas and the couple traumatic bonds.     

EMDR and Emotionally Oriented Couples Therapy

When reviewing past and current research on the role of emotion in couples therapy, there appeared to be a lack of articulation concerning how emotional expressions and relational dynamics are affected by emotional trauma that has not been accessed. The authors demonstrate how emotionally and experientially oriented therapy with couples can be enhanced by accessing stored trauma through the use of Eye Movement Desensitization and Reprocessing (EMDR). This approach is called Eye Movement Relationship Enhancement (EMRE) therapy and includes key clinical areas such as accessing and tolerating previously disowned emotion, reprocessing emotional experiences, and amplifying couple intimacy. These key areas are discussed and illustrated with case examples.