Goal Direction and Effectiveness, Emotional Maturity, and Nuclear Family Functioning

Differentiation of self, a cornerstone concept in Bowen theory, has a profound influence over time on the functioning of the individual and his or her family unit. This 5-year longitudinal study tested this hypothesis with 50 developing nuclear families. The dimensions of differentiation of self that were examined were goal direction and effectiveness and emotional maturity. A qualitative analysis of participants' goals demonstrated that couples with higher functioning developing nuclear families, when compared with couples with lower functioning families, placed more emphasis on family goals, had more balance between family and personal goals, and pursued more goals over the 5 years. The quantitative analysis supported the hypothesis that goal effectiveness and emotional maturity influenced variation in nuclear family functioning. In addition, couple goal effectiveness and emotional maturity were associated with nuclear family functioning more strongly than individual goal effectiveness and emotional maturity were associated with individual functioning.     

Intervention with Families in Extreme Distress (FED)

The FED (Families in Extreme Distress) Project described in this article was developed as an intervention model for families in extreme distress. The concept of families in extreme distress includes not only those families which have been widely regarded as multi-problem families for decades, but also those which may appear to be like any other middle class family. The dis- organization in family functioning that is created by an interaction of many problems results in a durable distress which is repeated throughout successive generations. The intervention design of this project was structured and short- term, and each family in the group met once a week in their own home for ten sessions with a therapeutic team composed of three workers. The target of the intervention was the functioning of the entire family as a unit; and goals included clarifying boundaries, strengthening roles, and developing a communication system. Analysis of the therapeutic sessions revealed several techniques which are useful for intervention with the FED population. The intervention process with these families should be multilevel and case management should not only include providing family therapy, but also advocating and mediating with various institutions in the community, as well as making connections for financial assistance.While some major policy changes may be required to meet the finan- cial and manpower needs involved in such a model, this demonstra- tion project indicates that investing the right resources is worthwhile for effecting change within the FED population.     

Family therapy of a domestic violence service delivery system

In this paper the author recounts how one agency in a community of agencies sought to integrate services to multiproblem families. The paper describes how the integration was attempted, conceptualizing the community of agencies as a multiproblem family itself. The advantages and limitations of applying the family metaphor to a larger social system are also discussed.Partial funding was provided by the National Center on Child Abuse and Neglect, Grant 90-C-1757.     

Feminism and Family Social Work

The intent of this paper is to explore the applicability of a feminist model for clinical social work mactice with couples and families. A brief overview of the literature relating to feminism social work is presented in preparation for the examination of clinical issues. The feminist critique of traditional family systems theory is summarized and other areas of concern in clinical work with couples and families are explored including family theory and healthy family functioning. A brief overview of feminist family therapy practice literature is provided along with a summarization of training recommendations.     

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.     

Review of Chinese sex attitudes & applicability of sex therapy for Chinese couples with sexual dysfunction

Although sex therapy techniques have widely been used to help Western couples with sexual dysfunction, there has been little research on the applicability of these techniques among Chinese couples. This article discusses the Chinese views and concepts of sex and sexual dysfunction in the past and present, culturally bound sexual problems, and gender role stereotypes. We suggest that with careful integration of the therapeutic techniques with Chinese sex concepts, sex therapy can be applied to Chinese couples experiencing problems in sexual functioning.     

Relationship Education and Therapy for Same‐Sex Couples

The gay and lesbian community suffers higher rates of discrimination, mental health problems, and relationship break‐up than their heterosexual counterparts. In this paper we analyse the challenges confronting same‐sex couples, and the implications for couple education and therapy with same‐sex couples. We describe some similarities in the challenges confronting heterosexual and same‐sex couples (e.g., negotiation of shared realistic relationship expectations, effective communication). These similarities suggest existing evidence‐based approaches to couple therapy and relationship education are likely to assist same sex couple relationships. We also describe distinctive challenges for same‐sex couples (e.g., homophobic discrimination, internalised homophobia, and low support from many families for same sex relationships). These distinctive challenges suggest some adaptation of existing approaches to couple education and therapy could enhance their relevance and effectiveness to same sex couples.     

THE SYSTEMIC TREATMENT OF SHAME IN COUPLES

Shame remains largely a hidden phenomenon in the treatment of couples. It can manifest itself as a determining factor in events ranging from entrenched blaming to missed appointments. Although there is a growing body of literature on individual shame dynamics and, to a lesser extent, on couple and family shame dynamics, there is little written on how to incorporate these theories into treatment. This paper offers working definitions of shame, proposes a systemic definition of shame as seen in couples, reviews the literature on coule shame dynamics, and explores issues of therapeutic stance and treatment techniques in working with shame in couples therapy.     

Work–home conflict and facilitation across four different family structures in Norway

The purpose of this study was to examine how work–home conflict and facilitation vary among people living in different family structures in Norway, here conceptualized as: two-parent families; single parents; childless couples; and singles. The study used data from a Norwegian study on occupational health (N=2414). We hypothesized that respondents living in two-parent families experience more work–home conflict and facilitation than others due to more complex role expectations. Similarly, we hypothesized that the effect of workload and autonomy on work–home conflict and facilitation would be stronger among this group. The results indicate that conflict between work and home life are more profound among those living in two-parent families and among single parents than among childless couples and singles. Work-to-home facilitation did not vary by family structure, whereas the childless couples reported more home-to-work facilitation. Furthermore, with a few exceptions the effects of workload and autonomy on work–home conflict and facilitation did not differ by family structure.     

Review of outcome research on marital and family therapy in treatment for alcoholism

This review of controlled studies of marital and family therapy (MFT) in alcoholism treatment updates the earlier review by O'Farrell and Fals-Stewart (2003). We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, both Al-Anon facilitation and referral and spouse coping skills training (based on new findings) help family members cope better, and CRAFT promotes treatment entry and was successfully transported to a community clinic in a new study. Once the alcoholic enters treatment, MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. New BCT studies showed efficacy with women alcoholics and with gay and lesbian alcoholics, and BCT was successfully transported to a community clinic, a brief BCT version was tested, and BCT was adapted for family members other than spouses. Future studies should evaluate the following: MFT with couples where both members have a current alcohol problem and with minority patients, mechanisms of change, transportability of evidence-based MFT approaches to clinical practice settings, and replication of MFT outcomes of reduced partner violence and improved child functioning.     

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.     

A survey of homework use, experience of barriers to homework, and attitudes about the barriers to homework among couples and family therapists

Homework is a therapeutic process that has strong theoretical and empirical basis, but existing research has focused on "compliance" rather than considering the broader and more clinically meaningful construct of "engagement." Absent in the literature is empirical study of the barriers to engagement or study of homework use among couple and family therapists (CFTs). The current study investigates the frequency and type of homework, as well as the influence of homework compliance, quality of compliance, and experience of barriers to compliance on CFTs' attitudes and beliefs toward barriers to homework completion for couples and families. Results indicated CFTs (N=226 AAMFT Clinical members) use homework more often with couples than with families, and CFTs report greater homework compliance and quality of compliance for couples when compared to families. A path analysis examining compliance, quality of compliance, and barriers to compliance as predictors of attitudes/beliefs toward barriers revealed no significant findings. A discussion presents implications for future research and practice for homework in couple and family therapy.     

Couple and Familial Characteristics of Father-Child Incest Families

Couple and familial characteristics of father-child incest families are often described in the sexual abuse clinical and theoretical literature. However, few of these ideas have been tested empirically, and the limited research on the systemic functioning of incest families has resulted in contradictory findings. Results from a study describing couple and family system characteristics of 54 father-child incest families are reported. Both mothers and father perpetrators in the families were assessed. Findings from this study indicate that when compared to normative scores parents in incest families report greater than average social isolation, higher levels of family control and moral-religious emphasis, and lower emphasis on personal independence and individuation. Support was not found for an enmeshed level of family cohesion, as is often reported in the clinical literature. Nearly one-half of the couples reported clinically significant relationship distress and high levels of desired behavior change by their partner. Over one-half of the couples also reported substantial sexual discord in their relationships. The clinical and research implications of the findings are discussed.     

Family Therapy and the Black Middle Class: A Neglected Area of Study*

Little has been written and virtually no empirical research has been presented concerning family therapy with members of the Black middle class. In this article, a number of factors are discussed in the light of recent sociological inquiries. These findings are discussed in terms of family systems theory in order to provide the clinician with some insights into the dynamics of family functioning in the Black community. Suggestions for working with these families are then offered. The question of whether White therapists can work effectively with Black families is discussed and the pertinent empirical findings available from the field of individual therapy are considered.     

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.     

SIBLING THERAPY WITH MULTIPROBLEM FAMILIES*

Most family therapy deals with the parent-child system. However, with chaotic multiproblem families, this often is not possible. When parents refuse to, or cannot, participate in the therapy, working with just the siblings (Sibling Therapy) offers one way to provide help to troubled children. When parents offer inconsistent or inadequate nuturing, seeing the children together is a way of developing or strengthening the bonds among them and teaching them how to be available to each other. This article proposes setting treatment goals that are consistent with the cultural and family styles of these children, describes methods for developing caring and cohesion, and presents techniques for working with these children.     

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.     

Working with Military Families Through Deployment and Beyond

Military families experience considerable stress, periods of long separation, and changes to the family system due to family members planning to enter a war zone, actively living in a war zone, and reuniting after being in a war zone. Anticipation and understanding of the stages of deployment improves family, couple and individual functioning. The issues that the family and the couple are confronting at each stage of deployment: pre-deployment, deployment, and post-deployment are presented. Clinical interventions for the family and the couple are presented at each stage of deployment. Additionally, the impact of the service member’s war time experience on the family, couple, and her/himself is discussed.     

Exploring Social Class: Voices of Inter‐Class Couples

Social class is not often discussed or examined in‐depth in couple and family therapy research and literature even though social class shapes familial relationships and is considered an important variable in marital satisfaction. In this qualitative study, we explored the perceptions of eight couples who made lasting commitments across class lines by asking them about the impact of their social class backgrounds on their relationships. Three categories of themes emerged including: (a) differences and similarities in values and attitudes toward education, work, money, and class awareness/classism, (b) relationship issues involving families of origin, friends, and class‐based couple conflict, and (c) differences in economic resources, social capital and privileges/opportunities. Implications for assessment and treatment of couples are included.     

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.