Teaching mindfulness to psychotherapists in clinical practice: The Mindful Therapy Programme

Introduction: Initially proposed as a treatment modality for psychological disorders, mindfulness is now being promoted as a means of enhancing both therapist self care and therapeutic efficacy. The degree to which mindfulness can be learned by therapists to manage their own and clients' processes in therapy is as yet unknown. This study examines training outcomes of a standardised introductory mindfulness programme for mental health professionals. Methods: Forty-seven mental health professionals completed an eight-week mindful therapy (MT) training programme and associated measures. Results: Compared with baseline scores, participants demonstrated knowledge acquisition on all measures, including increased mindfulness in clinical work, increased capacity to intentionally invoke mindful states of consciousness, and higher participant ratings of well-being over the course of training sessions. Discussion: This research provides preliminary evidence that a brief, standardised mindfulness training programme can achieve acceptable knowledge and skills outcomes for therapists that can aid their therapeutic practice. Of note, increased ‘therapeutic mindfulness’ in this study resulted from changed mindfulness ‘attitudes’ (i.e. a more accepting and equanimous orientation within therapeutic work) as opposed to a clear demonstration of increased attention-regulation skills. The implications of these and other results for programme development and wider research are discussed.     

The relationship between acceptance,fatigue, and subjective cognitive impairment in hematologic cancer survivors

Background/Objective: Cancer and its treatment can have a detrimental impact on psychological well-being. Acceptance as the basis of acceptance and commitment therapy (ACT) has shown beneficial effects on depression and anxiety. However, its relationship to fatigue and cognitive impairment has not been investigated. A protective effect of acceptance may open up a new target for psychological intervention.Method: A cross-sectional postal survey was undertaken. 922 hematological cancer survivors (≥ 2.5 years post diagnosis) were recruited through two regional cancer registries in Germany. Acceptance (AAQ-II), fatigue (BFI) and subjective cognitive impairment (AFI) were assessed.Results: Higher levels of acceptance were negatively associated with fatigue and subjective cognitive impairment (R²= .34 and R²= .26, respectively). The relationship between fatigue and fatigue-related impairment of daily life was weaker for survivors with high acceptance.Conclusions: Acceptance is strongly associated with fatigue and subjective cognitive impairment. ACT may be useful to reduce symptoms of fatigue and subjective cognitive impairment in cancer survivors.     

Unequally into “Us”: Characteristics of Individuals in Asymmetrically Committed Relationships

This study examined characteristics of individuals that are associated with being in asymmetrically committed relationships (ACRs), defined as romantic relationships in which there was a substantial difference in the commitment levels of the partners. These ACRs were studied in a national sample of unmarried, opposite‐sex romantic relationships (N = 315 couples). Perceiving oneself as having more potential alternative partners was associated with increased odds of being the less committed partner in an ACR compared to not being in an ACR, as was being more attachment avoidant, having more prior relationship partners, and having a history of extradyadic sex during the present relationship. Additionally, having parents who never married was associated with being the less committed partner in an ACR but parental divorce was not. Although fewer characteristics were associated with being the more committed partner within an ACR, more attachment anxiety was associated with increased odds of being in such a position compared to not being in an ACR. We also address how some findings change when controlling for commitment levels. Overall, the findings advance understanding of commitment in romantic relationships, particularly when there are substantial asymmetries involved. Implications for both research on asymmetrical commitment as well as practice (e.g., therapy or relationship education) are discussed.     

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis

As evidence‐based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural‐strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off‐model, nonsystemic formulations/interventions). Of these, “failure to think in threes” appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.     

Neuroticism and Marital Satisfaction During the Early Years of Chinese Marriage: The Mediating Roles of Marital Attribution and Aggression

On the basis of three annual waves of data obtained from 268 Chinese couples, we tested an actor–partner interdependence mediation model in which spouses’ neuroticism was linked to their own and partners’ marital satisfaction through both intrapersonal processes (i.e., marital attribution) and interpersonal processes (i.e., marital aggression). Considering intra‐ and interpersonal processes simultaneously, four indirect, mediating pathways were identified: Time 1 Wives’ Neuroticism → Time 2 Wives’ Attribution or Aggression, while controlling for Time 1 Wives’ Attribution or Aggression → Time 3 Wives’ or Husbands’ Marital Satisfaction, while controlling for Time 1 Wives’ or Husbands’ Marital Satisfaction. This study not only adds to a limited body of research examining why neuroticism is associated with conjugal well‐being, but also extends prior research by focusing on Chinese couples and utilizing a longitudinal, dyadic mediation model. Such findings have important practical implications. Couples involving neurotic partners may benefit from interventions based on cognitive‐behavioral approaches. When working with couples challenged by neuroticism, practitioners need to help them address dysfunctional interactive patterns as well as distorted cognitive styles.     

Treatment‐as‐Usual for Couples: Trajectories Before and After Beginning Couple Therapy

Couple therapy has been shown to be a meaningful way to improve couples’ relationships. However, less information is known about couples’ functioning prior to entering treatment in community settings, as well as how their relationship functioning changes from initiating therapy onward. This study examined 87 couples who began community‐based couple therapy during a longitudinal study of couples in the military. The couples were assessed six times over the course of 3 years, including time points before and after starting couple therapy. Using an interrupted‐time series design, we examined trajectories across the start of couple therapy in relationship satisfaction, divorce proneness, and negative communication. The results demonstrated that couples’ relationship satisfaction was declining and both divorce proneness and negative communication were increasing prior to entering couple therapy. After starting couple therapy, couples’ functioning on all three variables leveled off but did not show further change, but previous experience in relationship education moderated these effects. Specifically, those who were assigned to the relationship education program (vs. control) demonstrated greater reductions in divorce proneness and greater increases marital satisfaction after starting therapy; however, they also started more distressed.     

The Quarter-life Time Period: An Age of Indulgence,Crisis or Both?

A new developmental stage called the quarter-life is proposed, extending from approximately 18–29 years of age and sometimes later. The emergence of this period is believed to be the result of several social, historic and economic factors that occurred post WWII. This article explores these changes in terms of the experiences of affluent young people in today’s Western society. A typology of adaptational responses are presented and explored as the quarter-lifers attempt to navigate their way to adulthood within the context of this ‘new’ affluent society. Implications for family therapists are considered.     

Pathways of Influence: Marital Relationships and Their Association with Parenting Styles and Sibling Relationship Quality

We investigated the associations among marital relationship quality, mothers’ parenting styles, and young children’s sibling relationship quality drawing on the principles of family systems theory. Survey data were collected from 130 mothers who had a target child (mean age = 4.6 years) with a sibling close in age. The sample consisted of participants who self-identified as Mexican-American (49%), European-American (20%), and Taiwanese in Taiwan (24%). Structural equation modeling was used to test the direct and indirect effects of marital relationships on children’s sibling relationship quality through parenting styles and the reciprocal association between sibling relationship quality and parenting styles. The findings revealed evidence of a direct effect of marital relationships on sibling relationship quality and bidirectional relations between sibling relationships and parenting styles. The importance of research on bidirectional associations between sibling relations and parenting styles is discussed.     

Marital Conflict as a Mediator of the Longitudinal Connections between Maternal Emotional Distress and Early Adolescent Maladjustment

In this study, we examined the longitudinal relations among maternal emotional distress, marital conflict, and early adolescent externalizing behaviors and internalizing symptoms during the transition to adolescence. 3 years of self-report data were collected from 136 married mothers and their children, beginning when the children were in 5th grade. Structural equations modeling with latent variables were conducted to examine the nature and directionality of paths between constructs. For mothers, results indicated that marital conflict mediated the relation between prior maternal emotional distress and subsequent early adolescent externalizing behaviors and internalizing symptoms. For early adolescents, a mediating pattern was seen only for externalizing behaviors. In testing the reverse pattern of effects for mothers, marital conflict mediated the relation between prior early adolescent externalizing behaviors and subsequent maternal emotional distress whereas only an indirect pattern of effects existed for internalizing symptoms. Thus, we identified dynamic patterns of familial relations that accounted for the diminished well-being of both early adolescents and their mothers, suggesting that prevention and intervention work during the transition to adolescence should focus on multiple components of family functioning.     

Perfectionism and Acceptance

The present paper argues that there is both a positive and a negative form of perfectionism, and that they can be differentiated in terms of acceptance. The basic argument is that there is nothing unhealthy or dysfunctional about the striving for perfection as such—perfectionism, however, becomes dysfunctional when this striving for perfection turns into a demand for perfection, defined as an inability to accept being less than perfect. Positive perfectionism, in other words, is viewed as a dialectic combination of (a) a striving for perfection, and (b) the acceptance of non-perfection. Some therapeutic implications are discussed, and some directions for further research are pointed out.