Couple Therapy and Spirituality and Religion

Abstract

The current state of the art of the integration of couple therapy with spirituality and religion is presented. Each of three waves of this integration identified in this article have seen an increase in the literature in this area, although only a limited amount in each wave has addressed couple therapy specifically. In the first wave, from 1990–1994, articles set forth arguments for why spirituality should be integrated in therapy. During the second wave, 1995–1999, publications focused on the ways that including spirituality in therapy can enhance as well as harm the therapeutic process. In the third wave, 2000-present, attention has shifted away from whether to include spirituality to how it should be included, and the literature of this period features many practical interventions and suggested guidelines for integrating spirituality and religion into therapy and training. The article concludes with recommendations for further developing the integration of spirituality and religion into couple therapy models, research, and training.     

Emotionally Focused Couple Therapy

Abstract

Working with couples who are both survivors of emotional abuse and are currently in an emotionally abusive relationship can be particularly challenging for the clinician. This article focuses on Emotionally Focused Couple Therapy as a recommended practice approach for clients who are caught in emotionally abusive patterns with one another. The article reviews relevant literature on this approach and illustrates the specific interventions applied lo an emotionally abusive couple.     

Dropping Out of Couple Therapy

Abstract

Current literature on dropouts in marriage and family therapy includes few studies that focus exclusively on couple therapy and only a limited number of qualitative studies. Clients' perceptions of premature termination are seldom considered. This qualitative case study describes, from both the clients' and the therapist's perspectives, one couple's experience of dropping out of couple therapy after three, sessions. Findings from this case study are compared with existing literature and a fourfold typology of dropouts is proposed. We offer recommendations for future research of dropouts in couple therapy.     

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.     

The Effectiveness of Couple Therapy

Abstract

Most theories and methods about couple dierapy are developed and tested in Anglo-Saxon countries. In this clinical study, we tested these theories and methods within a Swedish public health context. We assessed the outcomes of 131 couples (262 individuals) using the Dyadic Adjustment Scale (DAS) and the Family Climate (FC) survey. Initially, the couples displayed severe marital distress and a dysfunctional family climate. Both marital satisfaction and family climate improved considerably, which confirmed the effectiveness of these methods in a Swedish context.     

Couple Therapy and Addictions

Abstract

Therapies for alcoholism, substance abuse, and other addictions traditionally focus on characteristics of individuals such as behaviors, thoughts, and emotions. These kinds of programs tend to target problems inside the abusing person rather than a relational system. Treatments that are more recent locate the problems within systems of people. Regardless of the locus or cause of the abuse or addiction, seen as arising from disease processes, systemic dynamics, or other mechanisms that lead to unfortunate habits and behaviors, utilizing the individual's partner or family in therapy has become an important part of successful treatment. This article reviews models of couple treatment for alcoholics and substance abusers in terms of initiation into treatment, primary treatment, and relapse prevention.     

Individual and Couple Patterns of Self-views and their Implications for Working with Premarital Couple Relationship Dissatisfaction

A sample of 520 Australian heterosexual couples participating in the PREPARE premarital program completed the multidimensional PREPARE relationship assessment inventory (Olson D. H. Prepare-Enrich Counsellor’s Manual. Brisbane, Australia: Prepare-Enrich, 1996) providing measures of couple relationship satisfaction and individual levels of self-confidence, assertiveness, avoidance, and partner dominance. Multiple regression analyses indicated that, after controlling for idealistic distortion and couple relationship status, high individual male and female self-confidence and assertiveness, and low individual male and female avoidance and partner dominance, were all significant independent predictors of couple satisfaction. Couples in which both partners were high on self-confidence were significantly more satisfied than couples in which one or both of the partners were low on self-confidence. A similar result was evident for couple patterns involving mutually high assertiveness, low avoidance or low partner dominance, relative to couple patterns in which one or both partners were unassertive, highly avoidant or high in partner dominance. These aspects of self-view point to a salient evidence-based intrapersonal and interpersonal context in which to conduct couple therapy.     

Integrating Sex Therapy Interventions with Couple Therapy

This conceptual/clinical paper presents a couple, integrative, psychobiosocial model of assessment, treatment, and relapse prevention for common sexual dysfunctions. The goal is to encourage couple therapists to integrate sexual permission-giving, scientifically and clinically relevant sexual information and guidelines, and specific sexual suggestions/interventions into their couple work. The artificial barriers between couple and sex therapy is to the detriment of couples who need to address intimacy and sexuality problems.     

Couples Therapy for Drug Abusing Women in an Inpatient Setting: A Pilot Study

This article describes a pilot study to examine the usefulness of adding a couples therapy component to inpatient drug and alcohol treatment for women. The treatment model was modified from a 12-week integrative systems model that has been empirically supported in outpatient treatment settings. A team of student-therapists received intensive training and supervision in the modified version. This article discusses the ability of chemical dependency counselors to implement this model, includes pre and post treatment comparisons, and qualitative findings regarding the efficacy of the project. The treatment model promises to be usable, safe, and practical in inpatient settings, and merits a more thoroughgoing clinical trial.     

Integrating Social Information Processing and Attachment Style Research with Cognitive-behavioral Couple Therapy

The majority of the empirically validated interventions for relational distress focus primarily upon improving behavioral functioning, particularly couples’ communication patterns in conflict situations. However, although communication is highly predictive of relationship distress and later divorce, research on the effectiveness of premarital and marital interventions based on communication training has shown limited results. Therefore, although the skills-based approaches can be effective in treating relational discord and instability, they also often neglect another potentially powerful mechanism in the development of relational distress: the social cognitions and/or schemata regarding relationships that individuals carry into their marriages that stem from negative attachment experiences. Thus, this article describes how blending information gleaned from attachment style research with the body of literature addressing social information processing can enhance current methods for the treatment of relational discord. The existing research on adult romantic attachment styles is placed within a social-cognitive information processing framework and a case study demonstrating the utility of this approach with difficult couples is described.     

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.     

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.     

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.     

Crossing the Desert Alone:

No abstract available for this article.     

Couple Adjustment and Differentiation of Self in the United States,Italy, and Spain: A Cross-Cultural Study

This study comprises a first attempt to explore a cross-cultural application of Bowen family systems theory and examines the relationship between differentiation of self and couple adjustment using measurement invariance. A sample of 2,141 individuals (n = 915 from the United States; n = 635 from Italy; n = 591 from Spain) completed measures of differentiation of self (DSI-R; Skowron & Schmitt, J Marital Fam Ther, 29, 2003, 209) and couple adjustment (DAS; Spanier, J Marriage Fam, 38, 1976, 15). Results showed evidence of partial measurement equivalence for the DSI-R across the three samples. Additionally, results from latent regression showed that less emotional cutoff predicted greater couple adjustment in the United States, Spain, and Italy, whereas greater emotional reactivity predicted poorer couple adjustment only in the more collectivistic cultures, Spain and Italy. Our findings are consistent with prior empirical studies, which suggest that emotional cutoff is a strong predictor of relationship adjustment. The use of measurement invariance provides a foundation for future studies to continue employing rigorous statistical methods when examining constructs across different cultures. The findings highlight culture-specific similarities and differences in differentiation that may benefit practitioners by informing psychotherapy with individuals, couples, or families from diverse populations.     

Differences in Dropout Rates Among Individual, Couple, and Family Therapy Clients

The premature dropout of clients from therapy is an inefficient expenditure of mental health resources. This study examined differences in dropout rates among individual, couple, and family therapy clients. Data came from archived records at a marriage and family therapy clinic at a university in the United States. Results indicated that there were no significant differences in dropout rates, despite the use of multiple measures of dropout. Thus, from a mental health services perspective, administrators and clinicians can expect that dropout rates will remain fairly consistent across treatment modalities.     

Codependency: An Empirical Study from a Systemic Perspective

To empirically investigate the construct validity of codependency, differences between young adults on a measure of codependency on theoretically relevant variables were examined. Compared with individuals who scored low on codependency, those who obtained high scores reported significantly more family of origin difficulties and parental mental health problems, problematic intimate relationships including relationships with chemically dependent partners, and personal psychological problems including compulsivity. Contrary to prevailing theoretical predictions the high codependency group did not contain more individuals whose parents had alcohol or drug abuse problems, or a higher level of childhood physical or sexual abuse. These results suggest that co-dependency is one aspect of wider multigenerational family systems problems which are not unique to families where drug and alcohol abuse or physical and sexual abuse are major concerns.     

Test Anxiety: A Cross-Cultural Perspective

The present paper examines test anxiety from a cross-cultural perspective with specific reference to the Indian and American cultures. The construct of test anxiety has been examined in many cultures all over the world. In this review, the importance of understanding and incorporating contextual factors in cross-cultural research is emphasized. Moreover, some of the methodological issues related to investigating culture-behavior relationship are discussed. Specifically, the derived-etic approach for conducting cross-cultural research is espoused. Then, research findings from western, cross-cultural, and Indian studies on test anxiety are reviewed. Consistent with the individualistic orientation of the western society, much of the research in the western world has adopted a de-contextualized approach. Inasmuch as many of the cross-cultural and Indian studies on test anxiety have their roots in western research, they have ignored the cultural context as well. To address this void, contextual variables relevant to test anxiety in the Indian setting are examined and hypotheses regarding the nature of test anxiety in Indian children are proposed. Finally, a research agenda is presented to examine these hypotheses using a derived-etic approach.     

A Dance with Many Secrets: The Experience of Emotional Harm from the Perspective of Past Professional Female Ballet Dancers in Canada

Originating in the Italian and French courts, ballet is an age-old art that fuses aesthetics and athleticism (Wulff, 2008). Despite changing times, ballet masters and mistresses tenaciously hold on to a sense of deep traditionalism. However, some scholars suggest that unwavering devotion to the art may conceal troubled embodied relations and oppressive practices (Gvion, 2008). In this study, we drew on the phenomenological research tradition in an effort to further examine the power relations that play out on the body in the world of Canadian professional ballet (Papaefstathiou, Rhind, & Brakenridge, 2013). Twenty past professional female ballet dancers from across Canada participated in this study. Our dedicated dancers were relentless. They sacrificed body and mind in the pursuit of excellence in a broader cultural context that expected nothing less. The dancers normalized harmful emotional experiences, inappropriate sexual transgressions, and chronic injury (Gvion, 2008). They also described experiences of neglect—and feeling replaceable—after the onset of injury. We have attempted to theorize our findings within the context of embodiment literature and the work of gender theorists. Emboldened by our dancers’ voices, we have shed light—and broken secrets—regarding some of the harmful practices that still characterize professional ballet in Canada. We hope that our work might further continue efforts to democratize power imbalances in professional ballet and ultimately enhance holistic dancer development and health.