Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout

Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence‐based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the “active” treatment stage after the 3–4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non‐Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non‐Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment.     

Daily Events for Clinical Couples: Examining Therapy Interventions,Positive Events,Arguments, and Exercise in the Beginning Stage of Therapy

This study examined the daily association of several events within the beginning phase of couple therapy. Events examined were as follows: trying something from therapy, an argument, a positive event, and physical exercise. Participants were 33 couples in a treatment‐as‐usual setting who completed the Daily Diary of Events in Couple Therapy (DDECT). A dyadic multilevel model was used to explore the daily associations between predictor and outcome variables. Results showed when male partners tried something from therapy at rates greater than the average their female partners reported a more positive relationship while when female partners tried something from therapy at rates greater than the average it contributed to a more negative relationship. In addition, results showed that clients in couple therapy rarely try things from therapy on a daily basis. Finally, relative to other predictors trying something from therapy had a smaller, but significant relationship with outcomes.     

Physical and Mental Health and Functioning Among Traumatic Brain Injury Close Relatives: The Role of Posttraumatic Stress Symptoms

Severe Traumatic brain injury (sTBI) often instigates widespread long-lasting disability and is accompanied by extensive rehabilitation. Unsurprisingly, sTBI also holds malignant consequences for patients’ close relatives. The burden caused by the injury and its severity explains some of the ramifications for the relatives. Additionally, some findings demonstrate that patients with sTBI and their relatives develop posttraumatic stress (PTS) symptoms. However, although the link between PTS symptoms and physical and mental health is well-documented in literature, the effect of PTS symptoms on relatives of patients with sTBI has barely been examined. This study examines the influence of PTS symptoms of patients with sTBI and their relatives on the physical and mental health and functioning of the relatives. Patients who sustained a severe sTBI (Abbreviated Injury Scale of the head region > 3) and close relatives were included in a multi-center, prospective cohort study (TRAST-MI). One-hundred patients and their relatives were assessed at 2, 6, and 12 months post injury. Outcome variables included health-related quality of life (SF-12) as well as emotional, cognitive, interpersonal, and total functioning (PCRS). Relatives’ physical health was predicted by relatives’ PTS symptoms (Slope=−1.76; p = .043), and mental health was predicted by both patients’ (Slope=−2.77; p = .034) and relatives’ (Slope=−6.59; p < .001) PTS symptoms. Functioning level was only predicted by patients’ PTS symptoms (Slope=−.25; p_<.001). The findings emphasize that TBI should be considered a comprehensive traumatic experience reaching further than mere physical damage to the brain and its direct consequences, affecting the injured individual and close relatives.     

Scene-Based Psychodramatic Family Therapy With Troubled Adolescents and Parents: A Pilot Study

Scene-Based Psychodramatic Family Therapy (SB-PFT) is an innovative treatment used with troubled adolescents and their parents to improve family relationships and reduce adolescents’ problematic behavior. It integrates the principles of family therapy, psychodrama, and multiple-family group methodology. This research is a pilot study to obtain empirical evidence on the SB-PFT therapeutic process by gauging the perception of change of troubled adolescents and their parents, and assess the perceived helpfulness of its methodology and techniques. Ten multiple-family intervention groups were drawn up, with 110 participants (63 adolescents and 47 parents), and we adopted a qualitative methodology with focus groups, using an inductive analysis of 290 active constructions of participant narratives. Concerning perception of change, the adolescents reported mainly gaining in social support, prosocial attitudes, keys to problem solving, and expression of emotions due to the treatment. The parents perceived improvement in social support, keys for educational practices, emotional well-being, and expression of emotions due to the treatment. Regarding the perceived helpfulness of methodology and techniques, both adolescents and parents highlighted the usefulness of the group methodology for gaining social support, relativizing the problem, and expressing emotions. Additionally, participants referred to role-playing and mirror techniques as the most useful techniques. In conclusion, this first study on SB-PFT presents and describes its treatment for troubled adolescents and their parents. The participants’ positive perception of their personal and relational change after treatment should serve to promote further studies with quantitative methodology in order to verify the effectiveness of SB-PFT treatment.     

A Task Analysis of Client Re-engagement: Therapeutic De-escalation of High-Conflict Coparents

Parents who are engaged in protracted conflict following a divorce are often referred to coparenting therapy. Episodes of intense conflict are common during these therapy sessions and often result in coparents disengaging from the therapist while they engage in escalating conflict with each other, potentially disrupting their progress in therapy. The purpose of this study was to identify how therapists successfully re-engage clients in the session. To understand this process, 24 disengagement events (12 successful and 12 unsuccessful) from 13 cases were analyzed using a task analytic approach. The sample included coparent dyads referred by the judicial system to a high-conflict coparenting therapy program. Task analysis was used to create a model of how re-engagement unfolds in treatment. The empirical model that resulted has five phases: (1) disengagement from the therapeutic process, (2) disruption of the conflict, (3) de-escalating the most escalated coparent, (4) de-escalating the other coparent, and (5) therapist buffered re-engagement. Successful episodes of re-engagement tended to have therapists who remained active throughout the conflict episode, used structuring interventions aimed at disrupting and then regulating the most escalated partner, blocked attempts to re-engage in conflict, and then repeated this process with the less escalated partner. Additional interventions that promote therapeutic re-engagement are described for each phase, and implications for clinicians and researchers are discussed.     

Exploring Exceptions and Discovering Solutions: A Case Presentation of Autism and the Family

As the prevalence of autism spectrum disorder (ASD) continues to rise, there is a rapidly increasing need for treatment services among individuals diagnosed with ASD and families. Currently, the majority of the evidence-based treatments, such as Applied Behavior Analysis, overlook the notable systemic effects of ASD and maintain a problem-focused lens. There is a growing body of research calling for strength-based, relational interventions that build on existing resources to enhance coping, efficacy, and well-being among families affected by ASD. Solution-Focused Brief Therapy (SFBT) is a widely practiced clinical approach that is increasingly being used among clinicians to address the systemic effects of developmental disabilities in the family. However, particular modifications to specific interventions may better accommodate autism-associated deficits in executive functioning (e.g., goal development and impulsivity), perspective taking, or restricted interests when using an SFBT approach. This article offers recommendations for adapting a solution-focused approach by modifying commonly used SFBT interventions to address family-driven treatment goals using a collaborative stance with families of children with ASD. A case presentation is included to demonstrate SFBT as informed by the unique challenges and inherent resources of families affected by ASD that have been identified in the extant literature.     

Digging Deeper: An Object Relations Couple Therapy Update

Over the past two decades, neurobiology research has added clarity to the process of emotional and behavioral change. In turn, this has led to endorsement of interventions that appear to be most helpful in individual and couple therapy. In addition to research on emotional dysregulation, contemporary studies have focused on the construction of meaning and its relevance to interpersonal relationships. According to Lisa Barrett, Richard Lane, and others, the brain references concepts to rapidly arrive at the most probable conclusions. Encoded experience and memory fragments guide this process and are vital in understanding partners' emotional responses. These findings support an object relations perspective that emphasizes the importance of past relational experiences that inform the present. This is particularly relevant in work with couples, as each individual's beliefs, expectations, and capacity for intimacy are invariably tied to earlier relationships. Research findings on memory reconstruction provide a basis for interventions that can add to the existing treatment approach, as it is suggested that working in a specific way with emotionally based memories has the potential to modify and reduce their predictive power and ability to unleash beliefs and behaviors that work against intimacy. The therapist who is informed by emerging neuroscience research can better uncover and actively work with memories that may be compromising a couple's relationship.     

Self,other and individuation: resolving narcissism through the lunar and solar paths of the Rosarium

This paper describes narcissism as our natural, infant-like behaviour, and specifies three characteristics relating to the evacuation and avoidance of distress, to control, and to distancing from relationship. It suggests that the processes of incarnation and individuation represent the development of the early ego and the ‘resolution’ of these narcissistic ways of being, including escape from the ‘mirror trap’. The development of the early, controlling ‘homunculus-ego’ entails the loosening and broadening of ego-identifications and the ego becoming subject to the Self. This is an embodied-relational-social-spiritual process outlined in detail by the full 20 woodcuts of the Rosarium Philosophorum, and specifically the lunar (relational) and solar (self-expressive) paths, which are explored herein. These processes are illustrated with respect to the interaction between infant and caregiver, clinical vignettes and examples from the political sphere.