Group Couples' Intervention to Improve Sexual Health Among Married Women in a Low‐Income Community in Mumbai,India

This article describes the design and implementation of a group couples' intervention focused on improving women's sexual health as a component of a multilevel community, clinical, and counseling intervention project conducted in association with a gynecological service in a municipal urban health center in a low‐income community in Mumbai, India. The group couples' intervention involved four single‐gender and two mixed‐gender sessions designed to address the dynamics of the marital relationship and establish a more equitable spousal relationship as a means to improve women's sexual and marital health. Involvement of men presented a major challenge to couple's participation. For those couples that did participate, qualitative findings revealed significant changes in couple and family relations, sexual health knowledge, and emotional well‐being.     

Pressure to Attend Therapy,Dyadic Adjustment,and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy

In this study we examine the role that pressure to attend therapy, dyadic adjustment, and adverse childhood experiences (ACEs) play in developing the therapeutic alliance. A total of 351 couples received treatment as usual at three family therapy training clinics. Participants rated predictor variables at intake and alliance at the fourth session. Results of a path analysis indicate that each partner's dyadic adjustment is directly associated with the quality of her or his own alliance. In addition, when male partners report more ACEs and pressure to attend treatment, their own alliance scores decrease. Additionally, when one partner reports feeling pressure to attend therapy, the other partner's alliance decreases. Finally, for males, there is an indirect effect of dyadic adjustment on alliance through pressure to attend therapy. These results suggest that clinicians should routinely assess relationship adjustment, how pressured each partner is feeling to attend treatment, and ACEs; as these may impact alliance quality.     

Way of being and the therapeutic pyramid: Expanding the application of a common factors meta‐model

Common factors proponents have suggested the need for principle‐based meta‐models to explain how various factors interact with each other to produce change. The therapeutic pyramid is a common factors meta‐model that outlines how therapeutic skills and techniques, the therapeutic alliance, and a therapist's way of being interactive to produce therapeutic change. Skills and techniques occupy the smallest top portion of the pyramid, with the therapeutic alliance in the middle and a therapist's way of being forming the foundation of the pyramid. The success of any layer rests on the quality of the immediately underlying layer. This study illustrates the broad applicability of common factors meta‐models by applying the therapeutic pyramid to couples therapy, family therapy, training and supervision, and professional ethics.     

Engaging Fathers in Family Therapy with Violent Adolescents

Violent behavior in adolescents can often signal profound distress or pain arising from family conflicts, hostile marital separations, sudden losses and other family turmoil. By circumventing blame the therapist engages the family in a constructive process that allows adolescents to change and grow and parents to share pain and sorrow about their own issues and responsibilities for their children. This re‐establishes healthy generational boundaries, produces a clearer co‐parenting alliance (e.g. after divorce) and creates sibling support. This paper describes an experiential approach, for working with violent adolescents in family therapy influenced by the pioneer work of Satir and Whitaker. It integrates systemic and developmental theories linking the presenting problem to relevant family events. The therapist: (1) explores adolescent development in the family and social context; (2) establishes a therapeutic alliance through understanding the interpersonal context for violent behavior, and (3) re‐directs negative actions into positive connections with family members. Segments of family therapy sessions with two adolescent boys and their families from different cultural backgrounds illustrate the impact of paternal absence for adolescent well‐being and the need to actively engage fathers in family therapy. Mario, the father's ‘tumor’, and Juan with his despairing violence are two problematic adolescents brought to therapy because of their aggressive behavior at home and/or in the school. The paper describes how to give them a different voice and build a therapeutic alliance with the family.     

THE INTEGRATIVE PSYCHOTHERAPY ALLIANCE: FAMILY,COUPLE AND INDIVIDUAL THERAPY SCALES*

The therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative-alliance concept for family, couple and individual therapy research are examined. Three new system-ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.     

The Family‐Friendly Community and Its Life Course Fit for Dual‐Earner Couples

Much is known about family‐friendly workplaces. This article examines the less understood family‐friendliness of the communities in which dual‐earner couples reside. Using data from a representative sample of dual‐earner couples (N = 727) in upstate New York, we examine how individual, couple, and neighborhood characteristics are associated with perceptions of community family‐friendliness. Using a life course perspective, we find that couples with young children rate their communities more favorably than do other couples. Findings also indicate that for couples with children of their own, living in a neighborhood with many other families with children is associated with higher ratings of family‐friendliness. We term this match, between a couple's life stage and their neighborhood's demographic structure, life stage‐neighborhood fit.     

Therapeutic Alliance; A View Constructed by a Family Therapy Team

Therapeutic Alliance is a construct which may have value for a family therapy team and influence its day to day practice. This paper discusses whether family therapeutic alliance can be observed, described and measured, and gives an account of the development of the Family Therapeutic Alliance Scale (FTAS) by a brief strategic family therapy team. Our focus is on the use of statistical technique as a means of clarifying the team's construct of therapeutic alliance, informing the team process without being the final arbiter in development of the scale. The second stage outlines the investigation of the usefulness of the construct with a wider group of family therapists. In individual psychotherapies measures of therapeutic alliance have been shown to predict outcome. Our early work suggests this is also true for family therapies and the FTAS may be a predictor for outcome in family work.     

When Baby Brings the Blues: Family Therapy and Postnatal Depression

Postnatal depression impacts on a significant number of women and their families. As a topic it is attracting much interest from researchers as we become clearer about its impact on the long‐term mental health of both women and their partners, as well as on the couple's relationship and their children's mental health. This article will provide a brief overview of postnatal depression and the current research associated with it, and consider the usefulness of systemic family therapy interventions. Examples of these are included along with a clinical vignette.     

Incorporating Internet‐based Interventions into Couple Therapy: Available Resources and Recommended Uses

Although there are a number of highly efficacious in‐person treatments designed to ameliorate relationship distress, only a small proportion of distressed couples seek out in‐person treatment. Recently developed internet‐based interventions based on these in‐person treatments are a promising way to circumvent common barriers to in‐person treatment and give more distressed couples access to these efficacious interventions. The overarching aims of this review are to provide couple and family therapists with a broad overview of the available internet‐based interventions and provide suggestions about how these interventions might be utilized before, during, or after in‐person treatment. The majority of the review centres on internet‐based interventions for distressed couples and covers four distinct types of resources: relationship advice websites; assessment/feedback interventions; enrichment interventions for satisfied couples; and interventions targeting at‐risk or distressed couples. Included is a case study of one couple's journey through a newly developed intervention targeting at‐risk couples, OurRelationship.com . Internet‐based interventions targeting individual psychopathology (e.g. anxiety and depression) are also reviewed. These interventions would be particularly useful as an adjunctive resource for in‐person couple or family therapy when referrals for a concurrent in‐person individual therapist are not feasible (because of time, financial, or geographic constraints). We close with three appendices: two appendices with information on currently available internet‐based interventions; and one appendix with recommendations on how to incorporate these resources into in‐person therapy.     

The Impact of Blamer‐softening on Romantic Attachment in Emotionally Focused Couples Therapy

Emotionally Focused Couples Therapy (EFT; Johnson, 2004 ) treats relationship distress by targeting couples' relationship‐specific attachment insecurity. In this study, we used hierarchical linear modeling (Singer & Willett, 2003 ) to examine intercept and slope discontinuities in softened couples' trajectories of change in relationship satisfaction and relationship‐specific attachment over the course of therapy from a total sample of 32 couples. Softened couples (n = 16) reported a significant increase in relationship satisfaction and a significant decrease in attachment avoidance at the softening session. Although softened couples displayed an initial increase in relationship‐specific attachment anxiety at the softening session, their scores significantly decreased across post‐softening sessions. Results demonstrated the importance of the blamer‐softening change event in facilitating change in EFT.     

Time for Each Other: Work and Family Constraints Among Couples

Little is known about couples' shared time and how actual time spent together is associated with well‐being. In this study, the authors investigated how work and family demands are related to couples' shared time (total and exclusive) and individual well‐being (happiness, meaningfulness, and stress) when with one's spouse. They used individual‐level data from the 2003–2010 American Time Use Survey (N = 46,883), including the 2010 Well‐Being Module. The results indicated that individuals in full‐time working dual‐earner couples spend similar amounts of time together as individuals in traditional breadwinner–homemaker arrangements on weekdays after accounting for daily work demands. The findings also show that parents share significantly less total and exclusive spousal time together than nonparents, though there is considerable variation among parents by age of the youngest child. Of significance is that individuals experience greater happiness and meaning and less stress during time spent with a spouse opposed to time spent apart.     

Direct and Indirect Effects of Newlywed Couples' Neuroticism and Stressful Events on Marital Satisfaction Through Mutual Problem Solving

This investigation examined the role of neuroticism, stressful experiences, and mutual problem solving in newlywed couples' marital satisfaction. The vulnerability-stress-adaptation model of marital development was used as the basis of the proposed hypotheses. Dyadic analyses and tests of indirect effects were performed on data from 186 couples in the first 5 years of their marriage. Results indicate that husbands' and wives' work, job–home interference, and family stress were significantly associated with their own lower marital satisfaction. Significant partner effects further indicated that husbands' and wives' family stress was negatively associated with the marital satisfaction of their partner. Additionally, the relationships between (1) neuroticism and marital satisfaction and (2) stressful events and marital satisfaction can be partially explained by mutual problem solving for both husbands and wives. This study emphasizes the important role of problem-solving communication in newlywed couples' experiences of stressful events and marital satisfaction.     

Couples relationship standards and satisfaction in Pakistani couples

Relationship standards are beliefs about what is important in a satisfying couple relationship, which vary considerably between cultures, and might mean that what couples seek from couple therapy differs across cultures. We assessed the standards of n = 49 Pakistani couples and whether those standards predicted couple satisfaction. To provide referents for the Pakistani standards, we also assessed selfreported relationship standards in n = 33 Western couples and n = 30 Chinese couples. Pakistani couples endorsed couple bond standards (e.g., expressions of love) as similarly important, and family responsibility (e.g., extended family relations) standards as more important, than Western or Chinese couples. In Pakistani couples, Couple Bond predicted couples' relationship satisfaction, but family responsibility and Religion predicted only wives' satisfaction. Modest sample sizes necessitate caution in interpreting results but suggest existing couple therapies might need modification to address the distinctive relationship standards of Pakistani couples.     

How Dual Are Dual‐Income Couples? Documenting Change From 1970 to 2001

Using Current Population Survey data for 1970, 1980, 1990, and 2001 (N =73,001), we document change in the prevalence of couples where (a) the wife contributes less than 40% of the family income, (b) income contributions are relatively equal, and (c) the wife's income contribution surpasses her husband's contribution. In 1970, close to 90% of couples had conventional earning arrangements: The husband was the sole provider in 56% of couples and contributed 60% or more of the income in an additional 31% of couples. By 2001, husbands were still the sole (25%) or major provider (39%) in a majority (64%) of couples but wives shared equally in providing income in 24% of couples, more than double the 9% in 1970. Additionally, wives as primary (or sole) earners increased from 4% to 12%. We investigate the associations between income provisioning within dual‐income families and ongoing cohort replacement by younger couples, women's increased human capital, life course processes, couple's labor supply, and race. Our findings suggest that wives’ increased human capital and couple's labor supply were strongly associated with increased female breadwinning patterns, but age cohort replacement processes and life stage factors also played a role in explaining change over time.     

Stress From Daily Hassles in Couples: Its Effects on Intradyadic Stress,Relationship Satisfaction,and Physical and Psychological Well‐Being

According to the systemic‐transactional stress model (STM; G. Bodenmann, European Review of Applied Psychology, 1997; 47: 137), extradyadic stress from daily hassles can have a negative impact on the individual psychological and physical health and the couple's relationship. This study is the first one to test the STM propositions in a model that includes both partners’ individual and relational outcomes simultaneously. The model also includes actor and partner effects as well as the interdependence between partners’ processes. Cross‐sectional, self‐report data were collected from 110 community couples in Switzerland. Consistent with STM predictions, results from the path model analysis indicate that for actor effects extradyadic stress from daily hassles relates directly to lower psychological (increase in anxiety symptoms) and physical well‐being and only indirectly to lower relationship satisfaction through increased intradyadic stress from relationship problems and also through more depressive symptomatology in men. The female extradyadic stress and intradyadic stress had partner effects on the male intradyadic stress and the male relationship satisfaction, respectively. Limitations as well as research and clinical implications for marriage and family therapists are discussed.     

Sex,Drugs, Rock ‘n’ Roll…and Children

Abstract

In this article we identify some of the challenges for gay men who desire to create more intimate relationships and more stable families in the evolving and potentially more conducive socio-political environment of the 21st century in the United States. Secondly, we delineate a multi-systemic structural model of working with male couples and families that addresses the interplay of the couple's interactional system with larger religious, civil and social systems. Finally, we demonstrate systemic interventions with a case example of a male couple and their family coping with 21st century challenges.     

The Differences in Role Division Between Partners in Long-term Marriages and Their Well-being

The study aims were to examine the relationships of 128 elderly couples married longer than 45 years and the role division between the partners, including a comparison of their perceptions of their first 3 years of their marriage with today. The research hypotheses were (a) there will be a change in the couple's perceptions about the traditional roles at the time of their marriage as opposed to today, and (b) men and women who recognize a change in traditional role division will experience better mental well-being than those who do not. The results showed a change in the couple's perceptions about traditional role division during the years of marriage. It was also found that these changes showed a positive correlation to the couple's mental well-being in those couples who recognized the changes.     

The Discursive Performance of the Alliance in Family Therapy: A Conversation Analytic Perspective

Following the ‘discursive’ turn in family therapy, the attention of practitioners shifted towards understanding how culture and language shape meaning‐making in therapy. In this article, we demonstrate how conversation analysis (CA) can be used to examine the processes and outcomes of systemic/constructionist practice. We used CA to study collaborative interactions of a renowned constructionist therapist Karl Tomm and one client‐family. Viewing collaboration as a pivotal aspect of the therapeutic alliance, we demonstrate how the ‘split’ within‐system alliances were developed and sustained in the course of therapy and how they were discursively transformed into ‘intact’ alliances. The therapist's efforts to align with perspectives of family members (and subsystems) seemed pivotal in this process.     

The Multisystemic and Multilevel Investigation of the Expanded Therapeutic Alliance‐Psychological Functioning Relationship in Individual Therapy

The expanded therapeutic alliance, consisting of multiple interpersonal alliance relationships, is a common factor inherent to the practice of all systemic therapies. The following study has three specific aims: (a) Bring an expanded, multisystemic emphasis to the study of the therapeutic alliance in individual therapy; (b) Understand better the session‐by‐session relationship between alliance and psychological functioning, including distinguishing within‐person from between‐person variability by using multilevel modeling techniques; and (c) Explore the role of early attachment relationships and family‐of‐origin experiences in moderating the alliance‐psychological functioning relationship. Instead of taking only one or two alliance measurements throughout treatment like in the majority of previous research, we measured both alliance and psychological functioning continuously at each session for 296 subjects.     

Promoting Fathers' Engagement With Children: Preventive Interventions for Low‐Income Families

Few programs to enhance fathers' engagement with children have been systematically evaluated, especially for low‐income minority populations. In this study, 289 couples from primarily low‐income Mexican American and European American families were randomly assigned to one of three conditions and followed for 18 months: 16‐week groups for fathers, 16‐week groups for couples, or a 1‐time informational meeting. Compared with families in the low‐dose comparison condition, intervention families showed positive effects on fathers' engagement with their children, couple relationship quality, and children's problem behaviors. Participants in couples' groups showed more consistent, longer term positive effects than those in fathers‐only groups. Intervention effects were similar across family structures, income levels, and ethnicities. Implications of the results for current family policy debates are discussed.