Current Issues in the Practice of Integrative Couple and Family Therapy

This paper provides an overview of current issues in integration in couple and family therapy. It summarizes the evolution of integration in couple and family therapy, the various traditions in integration, the strengths of integrative approach, and the possible pitfalls involved. It highlights the extent to which most couple and family therapy is now integrative practice. It concludes with a consideration of an emerging trend toward methods of practice centered on modules of intervention that have been identified as effective with certain presenting phenomena. The example of therapy for high conflict divorce is utilized to illustrate how various components can be brought together to create a maximally effective intervention.     

The Association between Symptom Accommodation and Emotional Coregulation in Couples with Binge Eating Disorder

Intense negative emotions and maladaptive behavioral strategies to reduce emotional distress occur not only in patients with various forms of psychopathology but also in their committed partners. One common strategy to reduce distress is for partners to accommodate to the symptoms of the disorder, which reduces distress short term but maintains symptoms long term. Accommodation is believed to be motivated by the partner reacting behaviorally to the patient's emotions, but the emotions of the partner in this context have yet to be examined. This pilot study examined how partner accommodation related to specific patterns of emotional coregulation between patients with binge eating disorder (BED) and their partners, before and after a couple‐based intervention for BED. Vocally encoded emotional arousal was measured during couples’ (n = 11) conversations about BED. As predicted, partners’ emotional reactivity to patients’ emotional arousal was associated with high accommodation before treatment. Thus, partners may use accommodation as a strategy to reduce both the patients’ and their own distress. After treatment, partners’ arousal was no longer associated with the patients’ emotional arousal; instead, partners showed greater emotional stability over time, specifically when accommodation was low. Additionally, patients were less emotionally aroused after treatment. Therefore, treatment may have decreased overall emotionality of patients and altered the association between accommodation and partners’ emotional reactivity. If replicated, this understanding of the emotional context associated with accommodation in BED can inform couple‐based treatment by targeting specific emotional precipitants of behaviors that maintain symptoms.     

Relationship Distress as a Mediator of Adverse Childhood Experiences and Health: Implications for Clinical Practice with Economically Vulnerable Racial and Ethnic Minorities

Adverse childhood experiences (ACE) are interpersonal sources of distress negatively correlated with physical and mental health, as well as maladaptive intimate partner conflict strategies in adulthood. Economically vulnerable racial and ethnic minorities report the greatest disparities in exposure to ACE, as well as relationship distress and health. Yet, little is known about the connections between ACE, relationship distress, and health. We therefore tested a theoretical model for the mediating role of relationship distress to explain the ACE‐health connection with a sample (N = 96) predominantly racial/ethnic minorities (87%) with low income. We applied partial least squares structural equation modeling with bootstrapping (N = 500). Relationship distress strengthened the predictive relationship between ACE and health, and accounted for 42% of the variance in health. The results provide preliminary support for relationship distress as a social determinant of health disparities with implications for interdisciplinary health intervention.     

Differentiation of Self and Dyadic Adjustment in Couple Relationships: A Dyadic Analysis Using the Actor‐Partner Interdependence Model

Bowen's multigenerational theory provides an account of how the internalization of experiences within the family of origin promotes development of the ability to maintain a distinct self whilst also making intimate connections with others. Differentiated people can maintain their I‐position in intimate relationships. They can remain calm in conflictual relationships, resolve relational problems effectively, and reach compromises. Fusion with others, emotional cut‐off, and emotional reactivity instead are common reactions to relational stress in undifferentiated people. Emotional reactivity is the tendency to react to stressors with irrational and intense emotional arousal. Fusion with others is an excessive emotional involvement in significant relationships, whilst emotional cut‐off is the tendency to manage relationship anxiety through physical and emotional distance. This study is based on Bowen's theory, starting from the assumption that dyadic adjustment can be affected both by a member's differentiation of self (actor effect) and by his or her partner's differentiation of self (partner effect). We used the Actor‐Partner Interdependence Model to study the relationship between differentiation of self and dyadic adjustment in a convenience sample of 137 heterosexual Italian couples (nonindependent, dyadic data). The couples completed the Differentiation of Self Inventory and the Dyadic Adjustment Scale. Men's dyadic adjustment depended only on their personal I‐position, whereas women's dyadic adjustment was affected by their personal I‐position and emotional cut‐off as well as by their partner's I‐position and emotional cut‐off. The empirical and clinical implications of the results are discussed.     

The Role of Parents in Emerging Adults’ Psychological Well‐Being: A Person‐Oriented Approach

The purpose of this study was to gain an overview of Spanish emerging adults’ family relationships and their link with psychological well‐being and psychological distress. The sample comprised 1502 undergraduate students (903 women and 599 men) aged between 18 and 29 (M = 20.32 and SD = 2.13), recruited from two universities in Spain. A cluster analysis identified three groups of families based on the centrality of five family variables: parental involvement, parental support for autonomy, parental warmth, behavioral control, and psychological control. The three groups or clusters were labeled high‐quality family relationships (HQ), intermediate‐quality family relationships (IQ), and low‐quality family relationships (LQ). Women were overrepresented in the HQ cluster, whereas men were overrepresented in the IQ cluster. Moreover, emerging adults who perceived better family relationships (high levels of parental involvement, parental support for autonomy and parental warmth, and low levels of behavioral and psychological control) were found to have a higher level of psychological adjustment. Thus, our results indicate that family plays a key role in the psychological well‐being of emerging adults. The discussion focuses on the implications of this finding for the parent‐child relationship, and explores how it extends our knowledge about family relationships during emerging adulthood.     

Theoretical foundations of analytical psychology: recent developments and controversies

This article gives an introductory overview of the papers in this volume originally given at the Joint Conference of the IAAP and the University of Basel, Basel, October 18‐20, 2018. The aim of the conference was to bring core concepts of analytical psychology together with theorizing and research from academic sciences, at the very place where Jung started his academic career, the University of Basel. The conference focussed on three fields: the relationship of consciousness and the unconscious and the theory of complexes; the theory of archetypes; and the status of analytical psychotherapy in contemporary psychotherapy research. The aim of the conference was to further the development of theory in analytical psychology in relation to results and insights in contiguous areas of knowledge. In the first area, contributors pointed to the solid evidence especially from the neurosciences for the psychodynamic conceptualizations of the unconscious, and also for the concept of complexes. In contrast to this, the concept of archetypes is controversial, with a majority of contributors questioning Jung’s biological conceptualizations of archetypes, and speaking instead for reformulations from the perspective of cultural theory, dynamic systems theory and other approaches. In the field of psychotherapy research, contributors pointed to the profound need for conducting more empirical studies on the outcome of Jungian psychotherapy, but also for a thorough reconsideration of standard research designs in the field.     

The analyst as a citizen in the world

Beginning with a ‘big dream’ from almost fifty years ago, this paper tracks movement back and forth from an inner/individual adaptation to life to outer/collective adaptations through various stages of a life's journey. The rhythm between more inner orientation at one stage gives way to more outer adaptation at another stage and vice versa. This same movement can be paralleled by an exclusive emphasis on analysis at one stage and more of a mixture of analysis and activism at another stage. At the heart of this narrative is the realization that an inner big dream of decades before, symbolised both an inner path of developing a relationship with life‐promoting energies and an outer path represented by facilitating others’ discovery and participation in those energies. The dream therefore anticipated a more activist future of connecting inner and outer, individual and collective in various professional projects. This has resulted in occasional glimpses of the fact that the ‘spirit of the depths’ and ‘the spirit of the times’ can have a common meeting ground.     

Trauma,resilience and healthy and unhealthy forms of dissociation

This paper outlines the difference between healthy and unhealthy forms of dissociation following, and in response to, traumatic experience, in particular the experience of refugees, calling on 30 years’ experience in working with refugees in voluntary and public sectors, including 20 years at the Refugee Therapy Centre, London. It differentiates dissociation from repression, and looks at some of the specific traumatic experiences associated with refugees’ displacement and situation, particularly relating to loss. Four key characteristics of resilience are described: ‘psychic space’, ‘sense of self’, and the use of a ‘listening other’ and ‘healthy dissociation/resiliency’. Two vignettes are given to illustrate the difference between healthy and unhealthy dissociation.     

A Research Program Testing the Effectiveness of a Preventive Intervention for Couples with a Newborn

Noxious family environments are associated with a wide range of adverse child outcomes. In order to prevent couple and parent–child relationship problems, a number of programs have been developed for couples with newborns. The current paper describes a program of research evaluating the American version of couple CARE for parents of newborns. This version of CCP was administered to low‐income, unmarried couples with a new baby in an uncontrolled demonstration project (Study 1), compared with a waitlist control condition in a randomized controlled trial (Study 2), and evaluated with low‐income parents recruited from urban hospitals in two major metropolitan areas of the United States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventive effects of the program were limited and there was one potential iatrogenic effect. Results were likely impacted by major challenges with recruiting participants and maintaining their engagement in CCP for the duration of the program. We discuss methodological differences between this series of studies and previous trials of prevention programs and make recommendations for improving service delivery to at‐risk new parents. These results have implications for public policies that aim to benefit children and families.     

Le TASC200, une épreuve d’attention et de saillance visuelle : fidélité, validité et normes préliminaires

In the clinical setting, attention is classically assessed by tasks that do not take into account theoretically important aspects, such as the salience-based guidance of visual search. The aim of this study was to develop a paced paper-and-pencil task for clinical use based on strong theoretical accounts that would assess salience-based visual search and that would meet the psychometric requirements for the assessment of attention. Participants were required to search and cancel targets of varying visual saliences as quickly and as accurately as possible during a predefined short period of time. The targets were intermixed with distractors. In agreement with theories of salience-based visual search, the results showed that the most salient targets were detected more easily than less salient targets. The task exhibited a quite acceptable test-retest reliability, and two construct validity studies showed that different scores involve different processes. This new task fully complies with the major theories of salience-based guidance of attention during visual search. It also meets the requirements of a plausible clinical task since its psychometric qualities are quite good. Preliminary normative data (n = 863) are presented for clinical use.