Couple‐based Intervention for Depression: An Effectiveness Study in the National Health Service in England

This study represents an effectiveness study and service evaluation of a cognitive behavioral, couple‐based treatment for depression (BCT‐D) provided in London services that are part of the “Improving Access to Psychological Therapies” (IAPT) program in England. Twenty‐three therapists in community clinics were trained in BCT‐D during a 5‐day workshop, followed by monthly group supervision for 1 year. The BCT‐D treatment outcome findings are based on 63 couples in which at least one partner was depressed and elected to receive BCT‐D. Eighty‐five percent of couples also demonstrated relationship distress, and 49% of the nonclient partners also met caseness for depression or anxiety. Findings demonstrated a recovery rate of 57% with BCT‐D, compared to 41% for all IAPT treatments for depression in London. Nonclient partners who met caseness demonstrated a 48% recovery rate with BCT‐D, although they were not the focus of treatment. BCT‐D was equally effective for clients regardless of the clinical status of the nonclient partner, suggesting its effectiveness in assisting both members of the couple simultaneously. Likewise, treatment was equally effective whether or not both partners reported relationship distress. The findings are promising regarding the successful application of BCT‐D in routine clinical settings.     

Parent–Child Attunement Moderates the Prospective Link between Parental Overcontrol and Adolescent Adjustment

Parental overcontrol (OC), behavior that intrusively or dominantly restricts child autonomy, has been identified as a transdiagnostic risk factor for youth. However, it is as yet unknown whether the association between parental OC and child maladjustment remains even when OC is exerted infrequently or by attuned parents. Rather, the selective use of OC might steer children away from danger. Taking a developmental psychopathology approach, this study focuses on the larger parent–child relationship context, testing whether either the dose at which parents demonstrate OC or the degree to which children perceive their parents as attuned determines whether OC is risky or protective for adolescents’ adjustment. Among a community sample of 114 families of children followed from the ages of 12–18, we examine whether OC, behaviorally coded from triadic mother–father–child discussions in middle childhood, is associated with later risky behavior and anxiety symptoms in adolescence. Overcontrol exerted by either mothers or fathers had a curvilinear effect on adolescent risky behaviors, and this effect was moderated by children's perceived attunement. Although OC generally was associated with increased risky behaviors, low doses of OC or OC exerted by highly attuned parents protected against engagement in risky behaviors. No main effect of OC was observed on adolescent anxiety; however, mothers’ OC interacted with perceived parental attunement, such that OC exerted by less attuned parents predicted greater anxiety. Results underscore that the effect of parenting behaviors depends on the larger parent–child relationship context.     

The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Partners for Change Outcome Management System (PCOMS), along a normative (standardized measurement) to communicative (conversational) continuum, highlighting PCOMS’ origins in everyday clinical practice. The authors contend that PCOMS represents “both/and,” providing a valid signal of client progress while facilitating communicative process particularly prized by family therapists steeped in relational traditions. The article discusses application of PCOMS in systemic practice and describes how it actualizes time‐honored family therapy approaches. The importance of giving voice to individualized client experience is emphasized.     

Attachment Versus Differentiation: The Contemporary Couple Therapy Debate

This paper reviews the current debate between differentiation and attachment in treating couples through exploring the tenets of crucible therapy (Schnarch, 1991) and emotionally focused couple therapy (Johnson, 2004). We provide a review of the two theories—as well as the two “pure form” example models—and explore the debate in light of the integrative movement in couple and family therapy (Lebow, 2014). We also examine points of convergence of the two theories and models, and provide clinicians and researchers with an enhanced understanding of their divergent positions. Both differentiation and attachment are developmental theories that highlight the human experience of balancing individuality and connection in adulthood. The two models converge in terms of metaconcepts that pervade their respective theories and approach. Both models capitalize on the depth and importance of the therapeutic relationship, and provide rich case conceptualization and processes of therapy. However, they substantially differ in terms of how they view the fundamental aspects of adult development, have vastly divergent approaches to how a therapist intervenes in the room, and different ideas of how a healthy couple should function. In light of the deep polarization of the two models, points of integration—particularly between the broader theories of attachment and differentiation—are offered for therapists to consider.     

Attachment Style Differences and Depression in African American and European American College Women: Normative Adaptations?

This study examined ethnic differences in attachment styles and depression among African American and European American college women. African American women reported less favorable views of others, which suggests that attachment styles emphasizing caution in relationships may be normative and adaptive for these women. There were no differences between groups in views of self or reports of depressive symptoms. Implications for long‐term relationships and counseling are discussed. Este estudio examinó las diferencias étnicas en estilos de apego y depresión entre estudiantes universitarias Afroamericanas y Euroamericanas. Las mujeres Afroamericanas expresaron una visión menos favorable sobre los demás, lo que sugiere que los estilos de apego que enfatizan la precaución en las relaciones pueden ser normativos para estas mujeres, y el resultado de su adaptación. No hubo diferencias entre los grupos en cuanto a la visión de sí mismas o expresión de síntomas depresivos. Se discuten las implicaciones para las relaciones a largo plazo y la consejería.     

Somali Women's Reflections on the Adjustment of Their Children in the United States

Somali women were interviewed regarding their children's adjustment. Qualitative analysis revealed 5 themes: cultural comparisons, concerns about children, parents' loss of disciplinary authority, available support, and the future. The women discussed changes in their children, such as loss of respect and threats to use law enforcement against parents. They also discussed their loss of parental authority and the lack of support from U.S. institutions. Implications for schools and mental health professionals are presented. Se entrevistó a mujeres Somalíes con respecto a la adaptación de sus hijos. Los análisis cualitativos revelaron 5 temas: comparaciones culturales, preocupaciones sobre los niños, la pérdida de autoridad disciplinaria de los padres, apoyo disponible y el futuro. Las mujeres hablaron sobre los cambios en sus hijos, como la pérdida de respeto y las amenazas de usar las fuerzas del orden contra sus padres. También hablaron de la pérdida de su autoridad paterna y la falta de apoyo por parte de las instituciones de los Estados Unidos. Se presentan las implicaciones para escuelas y profesionales de la salud mental.     

The Shift from Monologue to Dialogue in a Couple Therapy Session: Dialogical Investigation of Change from the Therapists’ Point of View

As part of a larger research project on couple therapy for depression, this qualitative case study examines the nature of dialogue. Drawing on Bakhtinian concepts, the investigation shows how the conversation shifts from a monologue to dialogue. Among the findings are: first, the process of listening is integral to the transforming experience. That is, the careful listening of the therapist can evoke new voices, just as the experience of one of the partners’ “listening in” to the conversation between the other partner and the therapist can create movement and new trajectories. The latter is a qualitative difference between dialogic therapy with a couple and that with an individual. Second, the therapist not only acts as creative listener, but as the dialogue unfolds, actively contributes to meaning‐making. Third, the study upholds having a team of researchers as a polyphonic forum and the usefulness of Bakhtinian concepts in clinical research on dialogue in multi‐actor sessions.     

Those Easily Forgotten: The Impact of Emigration on Those Left Behind

Much has been written about the experiences and stresses of those who emigrate. By contrast, little attention has been paid to the experiences of those who stay behind—family members and friends who for various reasons do not to join their loved ones in the destination country. In this article, I describe the experiences of some South Africans whose families and friends have emigrated. This study forms part of a larger research project focusing on the impact of emigration on South African family life. Twenty‐one participants were interviewed by means of a semistructured interview at least 6 months after one or more family member(s) and/or friend(s) left South Africa, to explore participants’ experiences around their loved ones’ emigration. A thematic analysis of the data reveals that those left behind experience various emotions, ranging from emotional ambivalence to anger and distress. Emigration is mostly experienced as a vast loss, almost akin to a “death,” bringing about significant changes in social networks and relationships. The therapeutic significance of the findings for those working with emigrant families is also explored.     

Some reflections on the unique time of Nachträglichkeit in theory and clinical practice

Of the various forms that the matter of time assumes in analysis, Nachträglichkeit represents Freud’s first intuition on the subject. The focus of this article is directed toward the specific temporal dimension that the concept of Nachträglichkeit expresses, and how that dimension, which overturns linear time, is expressed in clinical work. The concept of Nachträglichkeit is approached from a theoretical point of view, tracing back the role and development that this notion has had in psychoanalytic Freudian and post‐Freudian thinking. The goal of this article is to demonstrate how Nachträglichkeit represents the unique temporal movement of the analytic session and the characteristic positioning of the mind of the analyst at work. Three clinical examples are presented. The analytic scene is formulated as occurring in two times, and through the working through that takes place, patients can recover the enigmatic ‘remainder’, which is consequently traumatic and which has compulsively accompanied them through the various times of their existence. Nachträglichkeit, as a non‐linear temporality, introduces a unique dimension into the clinical work that influences listening to and interpretation of the material. The recognition of that (trauma, infantile sexuality, non‐linear temporality) has consequences for the analyst’s way of working in session and on the interpretation of clinical material, as I will try to show through my theoretical exposition and clinical examples.     

Sources of Cognitive Exploration: Genetic Variation in the Prefrontal Dopamine System Predicts Openness/Intellect

The personality trait Openness/Intellect reflects the tendency to be imaginative, curious, perceptive, artistic, and intellectual - all characteristics that involve cognitive exploration. Little is known about the biological basis of Openness/Intellect, but the trait has been linked to cognitive functions of prefrontal cortex, and the neurotransmitter dopamine plays a key role in motivation to explore. The hypothesis that dopamine is involved in Openness/Intellect was supported by examining its association with two genes that are central components of the prefrontal dopaminergic system. In two demographically different samples (children: N = 608; adults: N = 214), variation in the dopamine D4 receptor gene (DRD4) and the catechol-O-methyltransferase gene (COMT) predicted Openness/Intellect, as main effects in the child sample and as a gene-gene interaction in adults.