Problems Confronting the Female Therapist Doing Couple Therapy*

This paper describes some of the special problems confronting the female therapist doing couple therapy. They are grouped into four main categories, identified by a specific characteristic of the couple: the passive male, the aggressive male, the submissive female, and the dominant, aggressive female. The dynamics of each problem are delineated and suggestions for dealing with them, in marital as well as sex therapy, are presented. Additional observations are made on the values of using appropriate role modeling, and of forming and shifting supportive alliances, as therapeutic techniques.     

Clients' Attributions of the Presenting Problem and the Therapeutic Alliance in Couple Therapy: Systemic Versus Intrapersonal Perspectives

The therapeutic alliance is central to couples' therapy success. The current study examined associations between couples' initial agreement and causal attributions of the presenting problem and changes in the therapeutic alliance. To test study hypotheses, 85 couples were recruited from a university training clinic focused on couple and family therapy. Couples completed an intake questionnaire concerning their attribution of the presenting problem, either as systemic or individual, and therapeutic alliance was assessed at the end of sessions 2–8. A dyadic multilevel model revealed that a disagreement in the couple's attributions of the problem (with one viewing it as systemic, the other as individual) was associated with a larger initial discrepancy in the couple's therapeutic alliance, as well as a decline in the discrepancy over time. Findings were discussed in the context of systemic family theory, with implications for improving assessment, treatment, and psychoeducation aimed toward couples in distress.     

Psychodynamic Couple Therapy: A Practical Synthesis

This essay reviews the most significant contributions of psychodynamic thought to the field of couple therapy. It distills the work of numerous clinicians and researchers who, though writing from diverse perspectives, share fundamental assumptions and concerns. Rather than emphasizing differences between schools of thought, this paper mines their best contributions in a discussion of five central therapeutic targets: underlying issues, divergent subjective experiences, transferences, projective identification, and acceptance. Two detailed cases illustrate the benefits and techniques for targeting these five therapeutic domains. Video Abstract is found in the online version of the article .     

Systemic Therapy and the World Cup: Systemic Couple Therapy and Depression

Reviewing Elsa Jones and Eia Asen's Systemic Couple Therapy and Depression, the author reports also on the discussion which followed systemic therapy's participation in the London Depression Intervention Trial.     

Colliding Intersubjectivites: Transparency in Analytic Couple Therapy

Using a research‐informed version of how analysts think and work, this paper renders more explicit and transparent how analytic concepts can inform working with couples. It describes how each partner's subjectively held belief systems interlock and escalate, which is referred to as ‘colliding subjectivities.’ The paper illustrates the potential for this situation of heightened tension to facilitate change.     

The Case for Insurance Reimbursement of Couple Therapy

A case is made for why it may now be in the best interest of insurance companies to reimburse for marital therapy to treat marital distress. Relevant literature is reviewed with a considerable focus on the reasons that insurance companies would benefit from reimbursing marital therapy – the high costs of marital distress, the growing link between marital distress and a host of related physical and mental health problems, as well as the availability of empirically supported treatments for marital distress. This is followed by a focus on the major reasons insurance companies cite for not reimbursing marital therapy, along with a discussion of advances in several growing bodies of research to address these concerns. Main arguments include the direct medical offset costs of couple and family therapy (including for high utilizers of health insurance), and the fact that insurance companies already find it cost effective to reimburse for prevention of other health and psychological problems. This is followed by implications for practitioners and researchers.     

Couple Therapy and Attachment: An Interview with Susan Johnson

Susan M. Johnson is an international expert in Emotionally Focused Couple Therapy (EFT). She is a Professor of Psychology and Psychiatry at the University of Ottawa and Director of the Marital and Family Therapy Clinic at Ottawa Civic Hospital. She is the author of The Practice of Emotionally Focused Marital Therapy – Creating Connection (Brunner/Mazel, 1996) and the co‐author of Emotionally Focused Therapy for Couples: The Heart of the Matter. EFT is now one of the most empirically validated couples therapies and is accepted as such by the American Psychological Association. On sabbatical in 1999, she went to New Zealand and then visited Australia in April, conducting workshops in Sydney and Perth.     

Discursive Methodologies for Couple and Family Therapy Research: Editorial to Special Section

In this article, we aim to introduce the special JMFT section on discursive research methodologies for couple and family therapy research. These are qualitative research methodologies which resonate with the systemic emphasis on the semantics and the pragmatics of therapy discourse. First, we provide a brief overview of such methodologies and their use in the family therapy field. We then introduce the context and the content of the special section, where four approaches, including conversation analysis, discursive psychology type of discourse analysis, poststructurally informed discourse analysis (subject positioning analysis), and semantic analysis, are introduced by means of analyzed extracts from a Tom Andersen consultation session with a couple in distress and their therapist. We conclude with implications for the field. For Tom and Michael     

Competencies for Addressing Gender and Power in Couple Therapy: A Socio Emotional Approach

Power imbalances between partners are intrinsic to relationship distress and intricately connected to emotional experience, couple communication processes, and socio cultural contexts such as gender. The ability to work with the power dynamics between partners is thus critical to the practice of couple therapy. However, few practical guidelines for dealing with this issue are available. The authors present seven clinical competencies regarding gender and power issues that they identified by examining their own work: (a) identify enactments of cultural discourse, (b) attune to underlying socio cultural emotion, (c) name underlying power processes, (d) facilitate relational safety, (e) foster mutual attunement, (f) create a model of equality, and (g) facilitate shared relationship responsibility. Each competency is illustrated through a case example. The competencies represent an over‐arching guide to practice that may be integrated with other clinical approaches and is particularly useful for training and supervision.     

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.     

Couple Therapy as a Method for Treating Male Exhibitionism: "Flashing"

The exhibiting of the genitals by males has previously been defined as symptomatic of narcissism and infantile sexuality. Viewed as a developmental anomaly of emotional life, treatment has been focused upon stimulating personal development by working out the problems which have inhibited maturation. Results have been discouraging. As an alternative, defining the problem as symptomatic of disturbances in basic relationships and treating the current central relationships as the focus offers a strong opportunity for inducing satisfactory changes.     

Clinical and Ethical Considerations for Delivering Couple and Family Therapy via Telehealth

Studies have generally supported telehealth as a feasible, effective, and safe alternative to in‐office visits. Telehealth may also be of particular benefit to couples/families interested in relational treatments, as it addresses some of the barriers that may be more prominent for families, such as childcare and scheduling difficulties. Therapists interested in expanding their practice to include telehealth should understand ethical and practical considerations of this modality. This article discusses areas unique to the delivery of telehealth to couples and families. Each broad domain is then elaborated upon with case examples from actual clinical practice and specific recommendations for addressing potential difficulties. Authors recommend further empirical research examining differences in modality outcome, as well as feasibility of the suggestions proposed here.     

Sympathetic Nervous System Synchrony in Couple Therapy

The aim of this study was to test whether there is statistically significant sympathetic nervous system (SNS) synchrony between participants in couple therapy. To our knowledge, this is the first study to measure psychophysiological synchrony during therapy in a multiactor setting. The study focuses on electrodermal activity (EDA) in the second couple therapy session from 10 different cases (20 clients, 10 therapists working in pairs). The EDA concordance index was used as a measure of SNS synchrony between dyads, and synchrony was found in 85% of all the dyads. Surprisingly, co‐therapists exhibited the highest levels of synchrony, whereas couples exhibited the lowest synchrony. The client–therapist synchrony was lower than that of the co‐therapists, but higher than that of the couples. A Video Abstract is available next to the online version of this article on the JMFT web site .     

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.     

Solving Social Problems: Southern Perspectives

Locating an appropriate starting point for this review is nosimple task. Part of the difficulty is that the book breaksimportant new territory for New Zealand and Australian studentsand, possibly, students and practitioners at the internationallevel because of the strong and explicit connection betweensocial problems and the work of community and social workersas social change agents. It also attempts to make direct connectionsbetween theory and practice and the unequivocal preference forcommunity-based responses, arguments and solutions. There isa good body of material that focuses on different dimensionsof social problems and a significant body of material on socialwork intervention and practice. The authors' purpose is clear. As they note on the back cover,the book is intended for students and practitioners ‘whowish to develop their reflexive practice’. The developmentof this practice is, the authors