Research on the treatment of couple distress

This article reviews the research on couple therapy over the last decade. The research shows that couple therapy positively impacts 70% of couples receiving treatment. The effectiveness rates of couple therapy are comparable to the effectiveness rates of individual therapies and vastly superior to control groups not receiving treatment. The relationship between couple distress and individual disorders such as depression and anxiety has become well established over the past decade. Research also indicates that couple therapy clearly has an important role in the treatment of many disorders. Findings over the decade have been especially promising for integrative behavioral couples therapy and emotion-focused therapy, which are two evidence-based treatments for couples. Research has also begun to identify moderators and mediators of change in couple therapy. Finally, a new and exciting line of research has focused on delineating the principles of change in couple therapy that transcends approach.     

Change Processes in Couple Therapy: An Intensive Case Analysis of One Couple Using a Common Factors Lens

The article describes a research study that explored the process of how change occurred for one distressed couple and a specific therapist in a naturalistic setting. Quantitative and qualitative data were collected on the couple at multiple points in the therapy. A research team comprised of five members met regularly to analyze the data and collectively they arrived at a theory of change for the couple posttherapy. Conclusions are made related to how change occurred for the couple with an emphasis on the role of extratherapeutic events, client motivational factors, the therapeutic alliance, hope and expectancy factors, therapist factors, specific techniques and interventions, and other surprise factors that contributed to change.     

An Attachment Primer for Couple Therapists: Research and Clinical Implications

According to attachment theory, humans are relational beings and even a child's earliest experiences with caregivers have a profound effect on emotional development and an overall approach to relationships. With increasing regularity, couple therapy has utilized attachment language as a conceptual tool, but more work is needed to understand the full clinical implications of attachment theory. These include understanding the intergenerational nature of attachment and adapting the delivery, timing, and pace of interventions to client attachment strategies. In this article, we summarize the origins of attachment theory, its measurement, the role of attachment in couple relationships, attachment stability and change, and ways that attachment informs therapy process and intervention. We hope that this article will provide an impetus for couple therapists to expand their conceptualization and use of attachment in their clinical work and for couple researchers to conduct more clinically relevant, attachment‐oriented process research.     

Therapy with Infertile Heterosexual Couples: It’s Not About Gender—Or is it?

In spite of medical data that show males are equal to their female partners as a source of a heterosexual couple’s infertility, therapists face many unanswered questions about the extent to which gender influences each partner’s infertility experience in American culture. How is “hers” different from “his?” To what extent should the therapist strive to help the couple define the infertility issue as “ours”? This article explores how the therapist can elicit and be sensitive to gender issues while fostering resilience in the infertile couple.     

Self-disclosure and relationship quality

This article tests three competing theories that attempt to explain the reasons for and shape and direction of the relationship between self-disclosure and relationship quality among nonmarital cohabiting couples. The data strongly support the linear model which suggests that the greater the degree of self-disclosure, the greater the degree of relationship quality the couple will achieve. The article concludes that relationship depth emerges only after the couple are able to deal openly and creatively with conflict. One of the key prerequisites for achieving the ability to creatively handle conflict seems to be that the couple must have a high level of commitment to working on the relationship and possess the necessary communication and problem-solving skills that permit the couple to change and grow.     

The Marital Attitudes Scale: Assessing and Treating Ambivalent Clients

This article explores the complexities of the couple relationship commonly observed in the clinical settings of couple therapists. Whether described as the “push–pull” of the couple dyad, the mixed agenda couple, the couple that is leaning out versus leaning in, or the ambivalent couple, the literature suggests that this dynamic is to be assessed and explored before fully engaging in relational therapy or pursuing separation or divorce. The Marital Attitudes Scale is a 48-item self-report inventory that was normed with a clinical and nonclinical population at 2 clinical training sites. The inventory adheres to a cognitive-behavioral theoretical orientation with 4 subscales and a total score that measure cognitions, emotions, behaviors, schemas, and total scores relative to the ambivalence or the absence of commitment in the couple relationship. The instrument uses the frame of preambivalent, or committed to the relationship; ambivalent, ambivalently committed to the relationship; or postambivalent, no longer committed to the couple relationship. The inventory has evidenced good validity and reliability and is considered to be a useful inventory for assessing the degree of commitment to the relationship when a couple engages in therapy. This article explores the development of the inventory, its cognitive-behavioral theoretical orientation, the literature around the theme of marital dissolution, the concept of relational ambivalence, and the interface between assessment and therapeutic engagement.     

Therapist effects on dropout in couple therapy

Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university‐based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.     

Couples treatment issues for recovering male compulsive gamblers and their partners

Until recently, the couple relationship has been relatively neglected in both clinical reports and systematic research in the compulsive gambling literature. This article suggests the need for family and intergenerational assessment as well as early interventions within the couple system. The following treatment issues are discussed: multiple addictions; finances; control and power; anger; sexuality; and emotional intimacy. Overcoming deficits in intimacy is viewed as central to couples recovery.     

Statistics In Sociology, 1950–2000: A Selective Review

Statistical methods have had a successful half-century in sociology, contributing to a greatly improved standard of scientific rigor in the discipline. I identify three overlapping postwar generations of statistical methods in sociology, based on the kinds of data they address. The first generation, which started in the late 1940s, deals with cross-tabulations and focuses on measures of association and log-linear models, perhaps the area of statistics to which sociology has contributed the most. The second generation, which began in the 1960s, deals with unit-level survey data and focuses on LISREL-type causal models and event-history analysis. The third generation, starting to emerge in the late 1980s, deals with data that do not fall easily into either of these categories, either because they have a different form, such as texts or narratives, or because dependence is a crucial aspect, as with spatial or social network data. There are many new challenges, and the area is ripe for statistical research; several major institutions have recently launched new initiatives in statistics and the social sciences.     

The feminist/emotionally focused therapy practice model: an integrated approach for couple therapy

Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.     

Integrating Couple Teamwork Conversations Into Child Welfare Practice

This article summarizes the importance of and challenges to addressing couple teamwork issues in the child welfare population. Although there is substantial evidence to support the importance of healthy adult relationships for child well-being and the prevention of child maltreatment, there are a number of barriers to addressing these couple relationships in child welfare. These barriers include diverse family configurations and uncertain relationship commitments, the individual presentation of maltreatment, and worker discomfort with these issues. Additionally, there are few relationship programs designed specifically for low income individuals, and a number of policy and environmental constraints affect couple relationships in this population. However, building upon a comprehensive practice model for child welfare known as Solution Based Casework, this article describes casework skills to initiate and maintain couple teamwork conversations. These initiation skills include assessing patterns in everyday life, building partnerships with families, normalizing and externalizing problems, and tracking interactional sequences related to parent teamwork. The maintenance skills described include maintaining a common language, utilizing family team meetings, recognizing small steps of change, keeping treatment providers on track, and making the most of setbacks. These practical guidelines will assist child welfare professionals with building couple teamwork for child protection.     

Remediating Affect: “Luclyn” and Lesbian Intimacy on YouTube

This article focuses on Kaelyn and Lucy, a long distance (US–UK) lesbian couple who document their relationship on YouTube. Their channel has attracted a following of hundreds of thousands of individuals who profess to feeling an intimate attachment to the couple. This article considers how Kaelyn and Lucy's performance of lesbian intimacy online has amassed such a following. In exploring the multiple feelings that Kaelyn and Lucy's YouTube channel contains, it builds on and contributes to theorizing online emotion, and in particular, frames their channel as a “digital archive of feelings” (Kuntsman, 2012). Picking up on the way in which followers profess to having unmediated access to their relationship, I build on Bolter and Grusin's concept of “remediation” to argue that Kaelyn and Lucy produce a sense of immediacy for their followers through the remediation of other romantic genres. Secondly, I draw out the importance of time to the creation of a sense of shared intimacy, arguing that Kaelyn and Lucy's use of YouTube invites followers to feel as though they are sharing in the timing of the couple's relationship. This article thus uses this case study to reflect on the process by which a contemporary representation of lesbian intimacy has become a scene of attachment, whereby a larger “intimate public” (Berlant, 2008) has formed.     

From Scared to Repaired: Using an Attachment‐Based Perspective to Understand Situational Couple Violence

Situational couple violence (SCV) is a common problem in couples presenting for therapy. SCV, as seen through the lens of attachment, can be viewed as a result of an insecure attachment system within the couple. Although several authors have discussed individual attachment styles as predictors of both the receipt and perpetration of violence, in this article we seek to portray the attachment system as a relational and changing construct. As such, we argue for conjoint treatment for SCV as a way to restructure a more secure attachment system within the couple. Cautions for the appropriateness of couples counseling with ongoing violence are included. Finally, we discuss the use of an attachment‐based safety plan and time‐out strategy to use with couples experiencing SCV.     

Intervention research in couple and family therapy: a methodological and substantive review and an introduction to the special issue

This article serves as an introduction to this third version of research reviews of couple and family therapy (CFT) that have appeared in this journal beginning in 1995. It also presents a methodological and substantive overview of research in couple and family therapy from about 2001/2002 to 2010/2011 (the period covered in this issue), while also making connections with previous research. The article introduces quantitative research reviews of family-based intervention research that appear in this issue on 10 substantive areas including conduct disorder/delinquency, drug abuse, childhood and adolescent disorders (not including the aforementioned), family psycho-education for major mental illness, alcoholism, couple distress, relationship education, affective disorders, interpersonal violence, and chronic illness. The paper also introduces the first qualitative research paper in this series, as well as a paper that highlights current methodologies in meta-analysis. The first part of this article rates the 10 content areas on 12 dimensions of methodological strength for quantitative research and makes generalizations about the state of quantitative methodology in CFT. The latter part of the papers summarizes and makes comments on the substantive findings in the 12 papers in this issue, as well as on the field as a whole.     

Adapted Couple Therapy (ACT) for Pathological Gamblers: A Promising Avenue

The study of the effectiveness of treatment for pathological gambling constitutes a field that is still largely unexplored. To date, the models assessed primarily target the individual and include little or no involvement of the family circle. Yet, the deleterious effects of gambling on loved ones and especially spouses are well recognized. Further, the addition of a couple modality to individual treatment has been shown to be effective on many levels in the treatment of substances use disorders. This article therefore proposes a critical review of (1) the literature providing a better understanding of the complex interactions between the couple relationship and pathological gambling, (2) studies on the effects of couple therapies on gamblers and their partners. We then present the therapeutic model developed by our team of clinician-researchers in collaboration with actors from Québec clinical settings: Adapted Couple Therapy (ACT) for pathological gamblers. In the Québec context, this model will serve as a complement to an individual cognitive-behavioral treatment model that has been proven effective and is employed throughout the Canadian province. The assessment of couple therapies could reveal avenues of solutions to better assist pathological gamblers who tend to drop-out of treatment and relapse.     

Growing Up in a “WE” Family

SUMMARY

When couples choose to parent as a unit (the couple as WE) rather than as autonomous individuals, they and their children both benefit. The current article details some ways that parents can further expand their “couple as WE” into a “family as WE” with active parents and socially perceptive children. The article also discusses ways that family members can start and maintain a family dialogue.     

Children and the Stability of Cohabiting Couples

Theory and empirical evidence generally credit children with creating stability in their parents’ marriages, but whether children have a similar effect on cohabiting unions has not been previously investigated in the United States. This article uses the National Survey of Family Growth (N = 2,716) to evaluate the effects of children on the stability of couples who cohabit. The article distinguishes between conceptions and births because the two have different implications for union stability. The results indicate that children conceived during cohabitation are associated with greater stability of their parents’ relationship, particularly for Whites and Latinos, whereas children conceived and born during cohabitation are not. In addition, the effect of children on couple stability depends on whether the couple is cohabiting or has transitioned into marriage.     

Promoting reconciliation through psychoeducational and therapeutic interventions

This article presents a conceptualization of reconcliation as an interpersonal process that can mend relationships in which trust has been violated. We define reconciliation an describe a six-step program for promoting explicit reconciliation in couples. Psychoeducational groups of couples and couple therapy are often the contexts for promoting reconciliation. We discuss some theoretical support for each step, techniques used to promote progress through the step, and differential considerations in psychoeducation and therapy.     

The Brief Accessibility,Responsiveness, and Engagement Scale: A Tool for Measuring Attachment Behaviors in Clinical Couples

Measuring attachment behaviors is relevant to creating secure couple relationships. This article seeks to test and examine the reliability and validity of the Brief Accessibility, Responsiveness, and Engagement (BARE) Scale—a practical measure of couple attachment–in a clinical sample. Couples took the BARE and other assessments measuring relationship functioning (self and partner reports of relationship satisfaction, relationship stability, positive and negative communication, and attachment styles). Results suggest that the BARE appears to be a reliable and valid tool for assessing couple attachment and can accurately predict and classify whether the couples belong in the clinical or nonclinical group, as well as their level of relationship satisfaction. Results also indicate attachment behaviors are related to relationship outcomes.     

Serodiscordant Male Couples

IN studying male couples facing AIDS, the authors became aware of the existence of serodiscordant male couples. A couple is described as serodiscordant when one partner is antibody positive for the Human Immodeficiency Virus (HIV) and the other partner is antibody negative for HIV. This article is based on a research project, which included video taped interviews with 27 male couples facing AIDS and 14 survivors whose partners died of AIDS. Using the research participantsÆ interviews, the authors identified eight issues that serodiscordant couples encounter in the process of adjusting to their condition. The article has clinical focus, using adjusting to their condition. The article has a clinical focus, using vignettes fro the interviews to illustrate points and to offer methods for therapeutic intervention.