“Almost There”...Why Clients Fail to Engage in Family Therapy: An Exploratory Study

A great deal of clinical research has sought to describe and suggest remedies for the client dropout phenomenon. However, few studies have addressed the equally pervasive, yet often ignored, non-engagement problem. An exploratory study was conducted to understand why many clients fail to engage in family therapy services after they have completed the initial intake. The results of the study suggest that therapist gender and experience level, clinic policies regarding videotaping sessions, family concerns, and changes in the presenting problem prior to the first session, had an impact on potential clients’ decision to engage in therapy. Implications and future research are discussed.Meng-ning Wang, MA, a doctoral student, and Jonathan Sandberg, PhD, a faculty member in the Marriage and Family Therapy Program at Syracuse University at Syracuse University are co-first authors. Amy Zavada, MA, Tziporah Rosenberg, MA, Aaron Jeffrey, MA, and Justin McPheters, MA, are doctoral students, and Mona Mittal, PhD, and Anne Gosling, PhD, are faculty in the same program.     

Family Functioning,Family Structure,and Differentiation of Self in Heterosexual Spanish Couples: An Actor–Partner Analysis

This study used an actor–partner interdependence model to assess the relationship between differentiation of self and family functioning in a sample of 118 heterosexual Spanish couples, with additional attention to family structural correlates, including age of the children, number of children in the household, and educational level. Results showed a significant actor effect, with greater differentiation of self levels predicting better family functioning within individuals. Implications for mental health professionals regarding differentiation are provided.     

Biological Correlates of Social Support and Pressure at Work in Managers

The aim was to explore the patterns of correlations between psychosocial stress indices and neuroendocrinological factors in managers. Fifty-eight male managers in three Swedish companies constituted the sample. They answered two questionnaires with 17 selected stress indices and also an organizational test. The indices have been analyzed by means of computations of age adjusted partial correlations with nine different variables analyzed in fasting blood samples. The serum concentrations of lipids were the variables most strongly correlated with psychosocial factors. Neither smoking nor physical activity changed the correlations significantly. Good social support at work and in private life was consistently associated with low adverse serum lipids and corresponding lipoproteins. On the other hand, some indices of social support were associated with indices of high arousal levels. This may indicate a possible psychophysiological "load effect" of some aspects of social support in managers. The analyses of corporate culture measured as "Rules of the Game" indicated that "bureaucracy" was significantly associated with high LDL-cholesterol and low HDL-cholesterol. Managers have special conditions and therefore the patterns of associations between psychosocial conditions and coping strategies on one hand and endocrine-biochemical state on the other hand may be different from those of other groups. To what extent such differences are due to individual characteristics or environmental factors needs to be further investigated. According to the results, however, good social support is in general health promoting also to managers, at least with regard to serum lipids. Bureaucracy, on the other hand, seems to be dangerous to the health of managers.     

Perceptions of Parents' Marriage Predicting Marital Satisfaction: The Moderating Role of Attachment Behaviors

This study sought to examine the relationship between perception of parents' marriage, marital satisfaction, and attachment behaviors. Participants included 521 married couples taken from the RELATE project. Gender differences were found between husbands and wives perception of parents' marriage and marital satisfaction. Results also indicated that attachment behaviors were positively and significantly related to increased martial satisfaction for both husbands and wives. Additionally, attachment behaviors moderated the relationship between perception of parents' marriage and marital satisfaction. When perception of parents' marriage was negative but attachment behaviors were high, marital satisfaction increased. These findings underscore the importance attachment behaviors play in married relationships. Clinical implications and future research are discussed.     

The question-behaviour effect: A theoretical and methodological review and meta-analysis

Research has demonstrated that asking people questions about a behaviour can lead to behaviour change. Despite many, varied studies in different domains, it is only recently that this phenomenon has been studied under the umbrella term of the question-behaviour effect (QBE) and moderators of the effect have been investigated. With a particular focus on our own contributions, this article: (1) provides an overview of QBE research; (2) reviews and offers new evidence concerning three theoretical accounts of the QBE (behavioural simulation and processing fluency; attitude accessibility; cognitive dissonance); (3) reports a new meta-analysis of QBE studies (k = 66, reporting 94 tests) focusing on methodological moderators. The findings of this meta-analysis support a small significant effect of the QBE (g = 0.14, 95% CI = 0.11, 0.18, p < .001) with smaller effect sizes observed in more carefully controlled studies that exhibit less risk of bias and (4) also considers directions for future research on the QBE, especially studies that use designs with low risk of bias and consider desirable and undesirable behaviour separately.     

Can Couple Level Attachment Mediate the Influence of Depressive Symptoms on Health?

This study examined whether couple attachment behaviors, as measured by the BARE (Brief Accessibility, Responsiveness, and Engagement Scale), can mediate the influence of depressive symptoms on health for men and women. Data were gathered from the Relate Institute (www.relateinstitute.com) from 797 couples who were in a romantic relationship. Results showed depressive symptoms negatively predict daily eating habits and activity level and positively predicted total health problems and healthcare utilization for both females and males. For partners, female depression negatively predicated both male physical activity and total health problems, and also positively predicted healthcare utilization for men. Results also suggest that attachment behaviors mediated the association between depressive symptoms and total health problems. Findings are discussed from both a clinical and systemic perspective. It may be that fostering secure attachment behaviors in romantic relationships would be a helpful tool for providers working to address the depressive symptoms patients face.     

Cognitive Enhancement: Methods, Ethics, Regulatory Challenges

Cognitive enhancement takes many and diverse forms. Various methods of cognitive enhancement have implications for the near future. At the same time, these technologies raise a range of ethical issues. For example, they interact with notions of authenticity, the good life, and the role of medicine in our lives. Present and anticipated methods for cognitive enhancement also create challenges for public policy and regulation.     

They May Disapprove,but I Still Love You: Attachment Behaviors Moderate the Effect of Social Disapproval on Marital Relationship Quality

The degree of approval for a relationship from one’s social network has been shown to predict relationship outcomes. Additional research has shown that attachment can buffer the negative effects of various factors (e.g., depression) on relationships. Using an actor–partner interdependence model in an SEM framework, we research the effects of disapproval from parents and friends for one’s relationship on marital relationship quality for self and partner in a sample of 858 married couples. We also examine whether each spouse’s attachment behaviors can moderate these effects. Results indicated that one’s own attachment behaviors moderate the effects of their own parents’ and friends’ disapproval on their self-reported relationship quality for both men and women. Partner’s attachment behaviors moderate own friend’s disapproval on self-reported relationship quality for men and women; additionally, the main effect of partner’s friends’ and parents’ disapproval became nonsignificant with that test. The findings provide evidence that attachment behaviors of both partners play a role in buffering the negative effects of the social network disapproval on relationship outcomes. Clinical implications are discussed.     

A Patient Who Does Not Look: A Collaborative Treatment with Video Feedback

We describe a collaborative treatment of a woman in face-to-face psychoanalytic psychotherapy (with Larry Sandberg), whose persistent gaze aversion was a symptom immune to interpretive efforts. After many years of treatment, the patient agreed to engage in video feedback sessions (with Beatrice Beebe), which have occurred for the past decade. The face of Dr. Beebe, but not the face of the patient, was videotaped during psychotherapy sessions. Dr. Beebe and the patient then reviewed segments of the videotaped session, collaboratively observing and thinking together, translating between the verbal dialogue and the therapist’s implicit action dialogue. We examine the impact of this intervention on the psychotherapy process.