Narrating attachment: Some lessons learned from Charles Dickens' novel ‘Little Dorrit’

In this paper the author aims to explore the way in which contemporary society is informed by the values of technology, and how this ‘technological milieu’ influences the practice of counselling and therapy. The philosopher Albert Borgmann identifies some of the values of technology as efficiency, speed of results and ease of availability. While acknowledging technology's undoubted benefits, Borgmann warns that allowing these values to dictate ever more aspects of life threatens to impoverish us. In contrast with technological devices, the ‘focal’ experiences which give our lives meaning are rich and complex, as much to do with the journey as with reaching a goal. In this paper, the author argues that it is important to try and preserve counselling and psychotherapy as focal experiences, despite increasing pressure to conform to a more technological approach. In the light of this, the drive towards evidence-based treatments, the promotion of time-limited focused approaches to treatment and current trends such as the interest in neuropsychological approaches to attachment theory are examined.     

A Caring Framework for Enhancing Couples Therapy

As couples move away from role oriented patterns of relating they enter a transitional phase where marital expectations are less clearly defined. Frequently couples seeking therapy complain of a lack of caring in their relationships. They also express confusion about the appropriateness of their desire for more caring. In this article the authors present a caring framework based on their research with couples in "vital-total" marriages. They also suggest several ways this caring framework can be used in clinical work with couples.     

Development of the Couples Resource Map Scales

Abstract

This article describes the initial phases of development of the Couples Resource Map Scales (CRMS). These scales are designed to assess the degree of support couples receive from various personal, relationship, and contextual resources. The first phase involved the initial item development and an expert review of an extended list of potential items. The second phase involved a survey of university seniors (n = 397) involved in monogamous, intimate relationships to test the psychometric properties of the instrument. The third phase involved an analysis of variance in CRMS scores based on participants' self-reported level of satisfaction with their relationship. The results provide preliminary support for the reliability and validity of the CRMS.     

Dyadic Causal Sequencing of Depressive Symptoms and Relationship Satisfaction in Romantic Partners Across Four Years

Abstract

Causal sequencing between relationship satisfaction and depressive symptoms has important ramifications for couples therapy. Using dyadic data from the Pairfam study (N?=?1,876 German couples), an auto-regressive cross-lagged model was used to test the causal sequencing of these associations annually across four years. Although depressive symptoms had a significant bidirectional association with relationship satisfaction both within and between partners, depressive symptoms tended to serve as a stronger and more consistent predictor of relationship satisfaction than the reverse direction. Thus, clinically focusing on reducing depressive symptoms in couples’ therapy may serve to help prevent future deterioration in relationship quality.     

What Must You Know and Do to Get Good Outcomes With DBT?

Because little research has been conducted on which therapist-client interactions lead to intermediate and end-point improvements in Dialectical Behavior Therapy (DBT), we have a small evidence-base from which to specify what therapists must know and do in order to obtain good outcomes using DBT. As with other evidence-based practices, dissemination of DBT has defaulted to assumptions and methods from the “psychotherapy technology model,” which emphasizes transfer of the validated treatment package from the research clinic to routine settings with high fidelity (Morgenstern & McKay, 2007). However, serious limitations of the psychotherapy technology model require pursuit of alternative complementary models to guide dissemination. One complementary approach is to use well-designed practice-based training research. In this approach, therapists learn modular competencies linked to a highly structured yet flexible clinical decision-making framework. Modular training of therapist competencies emphasizes the continuity of the component therapist strategies across evidence-based protocols rather than emphasizing the packages or manuals as separate and distinct. Key hypotheses about the change processes responsible for client change and the associated treatment strategies used to influence these change processes should be specified and measured at the level of client, therapist, and service delivery setting. Adopting this approach may offer advantages that apply to the dissemination and implementation of DBT and other evidence-based practices (EBPs).     

Associations between type of treatment and illness-specific locus of control in type 1 diabetes patients

Abstract

This study examined differences in diabetes-specific locus of control beliefs of 82 insulin-treated Type I diabetes patients undergoing either conventional therapy (CT), intensified conventional therapy (ICT) or continuous subcutaneous insulin infusion (CSII). Compared to CT with its adherence to a strict regimen, ICT and CSII allow a much greater flexibility in timing of meals and daily activities. On the other hand, such flexibility requires a much more active role of the patient. The hypotheses of higher internality and lower powerful others locus of control beliefs in ICT and CSII patients than in CT patients could be supported for powerful others locus of control only. A one-year follow-up replicated this finding. Furthermore, high powerful others locus of control was associated with low diabetes-related knowledge and poor glycaemic control. The relevance of the patients' experience with the respective treatment is examined in view of the results and implications for studies on the feasibility of diabetes regimens are discussed.     

Adherence to Hormone Replacement Therapy: A Longitudinal Study Using the Theory of Planned Behaviour

The aim of this longitudinal study was to assess the stability and determinants of the intention to adopt HRT over a one-year period using the Theory of Planned Behaviour. At baseline, a total of 644 middle-aged premenopausal women who had never used HRT, were recruited. At follow-up, 417 women completed an interview to assess any change in their reproductive status and in their behavioural intention. Among women who stayed premenopausal (n = 172) and among those who became perimenopausal (n = 209), the intention to adopt HRT was quite stable over the one-year period. However, being perimenopausal had a significant effect on the intention to adopt HRT at follow-up, as did subjective norm, perceived behavioural control and moral norm measured at baseline. Attitude towards HRT did not have a significant effect on the intention to adopt HRT one year later. Therefore, interventions to support women's decision-making about HRT should be tailored to their menopausal status and take into account their perception of social pressure to perform, control over this behaviour and moral obligation.     

Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes

Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.     

Navigating Critical Theory and Postmodernism: Social Justice and Therapist Power in Family Therapy

The family therapy field encourages commitment to diversity and social justice, but offers varying ideas about how to attentively consider these issues. Critical informed models advocate activism, whereas postmodern informed models encourage multiple perspectives. It is often not clear how activism and an emphasis on multiple perspectives connect, engendering the sense that critical and postmodern practices may be disparate. To understand how therapists negotiate these perspectives in practice, this qualitative grounded theory analysis drew on interviews with 11 therapists, each known for their work from both critical and postmodern perspectives. We found that these therapists generally engage in a set of shared constructionist practices while also demonstrating two distinct forms of activism: activism through countering and activism through collaborating. Ultimately, decisions made about how to navigate critical and postmodern influences were connected to how therapists viewed ethics and the ways they were comfortable using their therapeutic power. The findings illustrate practice strategies through which therapists apply each approach.     

Couples Relationship Education and Couples Therapy: Healthy Marriage or Strange Bedfellows?

This paper focuses on issues sparked by the Couples Relationship Education (CRE) field moving toward a more clinical model to meet the needs of an increasing number of distressed couples coming to CRE programs. We review the concerns raised and recommendations made by Bradford, Hawkins, and Acker (2015), most of which push CRE toward a more clinical model. We address these recommendations and make suggestions for best practices that preserve the prevention/education model underlying research‐based CRE. The three main issues are couple screening, leader training, and service delivery models. Our suggested best practices include: conducting minimal screening including the assessment of dangerous levels of couple violence, training leaders with key skills to handle issues raised by distressed couples as well as other couples who may place additional burdens on leaders, providing referrals and choices of programs available to participants at intake and throughout the CRE program, and adding (rather than integrating) clinical services to CRE services for couples who desire additional intervention. Finally, throughout the paper, we review other key issues in the CRE field and make recommendations made for future research and practice.