A REVIEW AND EVALUATION OF MARITAL AND FAMILY THERAPIES FOR AFFECTIVE DISORDERS

Although the efficacy of individual treatments of affective disorders has been well-documented, there are also significant limitations to existing treatments. In the last decade attention has focused increasingley on the interpersonal context of affective illness, and on marital and family relationships in particular. As a result, a number of approaches have been developed which directly involve family members in treatment. In this article we evaluate the current status of marital and family therapies for affective illness. We begin with a discussion of several lines of research bearing on the relationships between family processes and affective illness. The available treatment outcome data evaluating the efficacy of marital and family interventions are then reviewed, with particular attention paid to predictors of treatment success and cost efficacy issues. Finally, we suggest several priorities for future research.     

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.     

Affective disorders

Unipolar depressive disorders are especially common among persons presenting with marital and family problems, rendering their impact on the treatment of marital and family problems of interest to every marriage and family therapist. The current paper describes empirically based decision making rules for determining who may benefit most from marital and family therapy interventions. Using well-controlled outcome research, it is concluded that both marital therapy and parenting interventions can play an important role in the treatment of many but not all depressed persons. Predictors of treatment response are discussed and recent epidemiological research is used to examine the size of the population that may respond especially well to marital therapy. Future directions for research are suggested and public policy implications are discussed.     

Anxiety Disorders and Family Therapy

The role of family therapy in anxiety disorders is controversial. Empirical data exist only in relation to agoraphobia and obsessive compulsive disorders. Experienced clinicians, generally working with complex cases, regard marital and family conflict as central to many cases, which require a family approach for optimal therapy. In contrast, research workers generally regard marital and family factors as irrelevant to treatment. This is because complex cases are usually excluded from empirical research. This leaves mainly uncomplicated cases without significant family conflicts, for which a family approach is rarely necessary. Techniques for treating anxiety disorders in a marital/family setting are outlined.     

Marital Therapy,EMDR, Herman's Model of Recovery from Trauma The Journey of One Woman and Her Family

Judith Herman (1992, page 183) delineates a three stage model of recovery from trauma: 1) Safety, 2) Remembrance and Mourning, 3) Reconnection. She criticises current treatment methods for their failure to make a difference in the “constrictive symptoms of numbing and social withdrawal … and marital, social and work problems do not necessarily improve”. Family therapy has been criticised often for insufficient focus on emotion and general sensations. This case analysis will illustrate how these shortcomings can be successfully addressed with the use of marital counselling and EMDR. The use of multiple treatment approaches contributed to one client's resolution of recent trauma due to a car accident, of past crises due to marital infidelity and early childhood abuse, with significant changes for her in her current family as well as in her family of origin. Theoretical implications for “family therapy” are raised.     

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 Clinical Uses of Video Therapy in the Treatment of Childhood Sexual Trauma Survivors

The power of visual images, combined with the increased availability of video taping equipment, has dramatically expanded the use of recorded images in psychotherapy over the past three decades. However, it appears that earlier video feedback techniques may not have fully capitalized on this modality's potential for catalyzing therapeutic change. Further, we have found scant literature on the use of video therapy in the treatment of adult survivors of sexual trauma. Drawing conceptually from a trauma model, as well as from cognitive behavioral and systemic/cybernetic frameworks, this article describes the therapeutic use of video therapy in the treatment of childhood sexual abuse. In video therapy, the patient is directed to independently view video recordings of therapy sessions to help correct cognitive and affective distortions resulting from trauma. How these distortions develop within the context of an incest "family trance" and how they are connected with processes of conditioning and programming are discussed. Further, the use of video therapy for marital therapy, perpetrator confrontations, and addressing suicidal impulses is described. The need for further empirical research is highlighted.     

Just the Two of Us? How Parents Influence Adult Children's Marital Quality

We work from a life-course perspective to explore how relationships with parents affect adult children's marital quality. We further ask whether the effects of parents on adult children's marital quality depend on the adult child's gender, age, marital duration, and childhood family experiences. Growth-curve analysis of national, longitudinal data (Americans' Changing Lives) indicated that relationships with fathers (n = 336) and mothers (n = 520) differentially affected the marital quality of adult children over time. Findings suggest that the effects of the parent - adult child relationship on adult children's marriages depend on age, marital duration, and levels of family stress experienced in childhood.     

Abstracts

Beal, E. W. Current trends in the training of family therapists.
Bryson, R. B., Bryson, J. B., Licht, M. H., & Licht, B. G. The professional pair.
Cromwell, R. E., Olson, D. H. L., & Founier, D. G. Tools and techniques for diagnosis and evaluation in marital and family therapy.
Hartley, D., Roback, H. B., & Abramowitz, S. I. Deterioration effects in encounter groups.
Jones, W. P. Some implications of the sixteen personality factor questionnaire for marital guidance.
Kelly, G. F. The counselor and human sexuality.
Mace, D., & Mace, V. The selection, training, and certification of facilitators for marriage enrichment programs.
Masters, W. H. & Johnson, V. E. Principles of the new sex therapy.
McConnell, L. G. An examination of the counselor's skills when counseling with sexual problems.
Meyer, J. K. Training and accreditation for the treatment of sexual disorders.
Robertielle, R. C. The decline and fall of sex.
Rubin, Z., & Mitchell, C. Couples research as couples counseling.
Sager, C. J. The role of sex therapy in marital therapy.
Whittaker, J. K. Causes of childhood disorders: New findings.     

Modeling Trajectories of Adolescent‐Perceived Family Conflict: Effects of Marital Dissatisfaction and Parental Alcoholism

We evaluated the effects of marital dissatisfaction on adolescent‐perceived conflict in 435 families with and without a parental history of alcoholism. On average, family conflict decreased linearly as adolescents aged. Families with an alcoholic parent demonstrated higher adolescent‐reported family conflict and this effect was partially mediated by higher mother‐ and father‐reported marital dissatisfaction. Families with higher marital dissatisfaction had greater conflict when adolescents were young (based on fathers’ marital dissatisfaction) and as they aged (based on mother's marital dissatisfaction). Years in which mothers reported higher marital dissatisfaction than usual coincided with years in which adolescents reported greater family conflict. Results indicate that marital dissatisfaction has both within and between‐family effects on adolescent perceptions of conflict.     

Stress in Childhood and Adulthood: Effects on Marital Quality Over Time

We work from a stress and life course perspective to consider how stress affects trajectories of change in marital quality over time. Specifically, we ask whether stress is more likely to undermine the quality of marital experiences at different points in the life course. In addition, we ask whether the effects of adult stress on marital quality depend on childhood family stress experiences. Growth curve analysis of data from a national longitudinal survey (Americans' Changing Lives, N = 1,059 married individuals) reveals no evidence of age differences in the effects of adult stress on subsequent trajectories of change in marital experiences. Our results, however, suggest that the effects of adult stress on marital quality may depend on childhood stress exposure. Stress in adulthood appears to take a cumulative toll on marriage over time-but this toll is paid primarily by individuals who report a more stressful childhood. This toll does not depend on the timing of stress in the adult life course.     

FAMILY STRUCTURE, CLOSENESS TO RESIDENTIAL AND NONRESIDENTIAL PARENTS, AND PSYCHOLOGICAL DISTRESS IN EARLY AND MIDDLE ADOLESCENCE

American adolescents currently live in a variety of different family structures, with the vast majority of adolescents living in intact, blended, divorced, and never-married families. Previous research shows that family structure correlates both with the quality of parent–adolescent relationships and adolescent psychological distress. The quality of parent–adolescent relationships also correlates with adolescent distress. This research hypothesizes that the observed differences in adolescent distress across family structure might result from differences in the quality of parent–adolescent relationships across family structure. Analyses, using data on 1,443 youth in early and middle adolescence from the National Longitudinal Survey of Youth (NLSY), indicate that when the variations in both the quality of parent–adolescent relationships and background characteristics across family structure are controlled, the association between family structure and adolescent psychological distress is significantly reduced. Further analyses revealed that the quality of residential parent–adolescent relationships explained the most variation in adolescent psychological distress. The quality of relationships with nonresidential fathers only had a significant association with adolescent psychological distress for adolescents in blended families.     

The Intergenerational Transmission of Spouse Abuse: A Meta‐Analysis

This study uses meta‐analytic procedures to examine the relationship between growing up in a violent home and subsequently becoming part of a violent marital relationship. Our meta‐analysis examines published and unpublished research studies that investigate the relationship between witnessing or experiencing family violence in childhood and receiving or perpetrating violence in an adult heterosexual cohabiting or marital relationship. The findings of this meta‐analysis suggest there is a weak‐to‐moderate relationship between growing up in an abusive family and becoming involved in a violent marital relationship. Differential effects of gender and sample type are also discussed.     

Family of Origin,Race/Ethnicity,and Socioeconomic Attainment: Genotype and Intraindividual Processes

Previous research has mainly focused on the persistent direct influence of early life contexts on young adult socioeconomic attainment, and less is known about intraindividual processes that are responsible for this persistent influence. The present study, using genetically informed longitudinal, prospective data from a nationally representative sample (Add Health), attempted to fill this gap by adding three important findings to the literature: (a) Adolescents experiencing adverse family contexts during childhood and early adolescence showed lower socioeconomic attainment in early adulthood than adolescents from less adverse family contexts, (b) adolescent academic and cognitive competencies and psychological vulnerabilities partially mediated these persistent influences, and (c) individual cumulative genetic characteristics additively and interactively influenced adolescent competencies and vulnerabilities as well as young adult socioeconomic attainment. The results demonstrate that although substantial continuity exists in early adversities, individual genetic variability is a factor that influences individuals' response to early socioeconomic conditions.     

EFFICACY OF FAMILY THERAPY FOR DRUG ABUSE: PROMISING BUT NOT DEFINITIVE

Drug abuse is an enormous public health problem with consequences not only for individuals using drugs but also for families, communities, and society. Moreover, research evidence and clinical experience agree that drug abuse is one of the more difficult problems to treat. Despite considerable research on the connection between family factors and drug use, and the existence of family therapy models for drug abuse, comparatively few controlled efficacy studies have been conducted. This article presents a critical review of controlled treatment outcome research in the area of family therapy for drug abuse in both adults and adolescents. A number of studies from different clinical research groups demonstrate that different versions of family intevention can engage and retain drug users and their families in treatment, significantly reduce drug use and other related problem behaviors, and enhace particular domains of prosocial functioning. Moreover, a smaller number of comparative efficacy studies have shown family therapy to be more effective than nonfamily therapies. Family therapy of adolescent drug abuse is more developed at present than family therapy of adult drug abuse. Although the results of the reviewed studies are promising, a blanket confirmation of family therapy's efficacy for drug abuse cannot be made at this time because of the relatively small number of studies and the noted methodological limitations of the studies published to date. Nonetheless, substantial progress in this clinical research area has occurred, and if research and funding support continue or can expand, significant breakthroughs in the treamtment of drug abuse with family-based treatments are possible.     

DEPRESSION IN MATURE MARRIAGES: IMPACT AND IMPLICATIONS FOR MARITAL THERAPY

Recent reviews of MFT literature have shown a failure to address mental health issues of the aging. Chief among these issues is depression, one of the most common psychological disorders found in older people. Although the relationship between depression and aging is a well-researched topic, few studies approach this common problem from a systemic perspective. Using data from a national survey of preretirement- and retirement-aged couples, this paper discusses the association between depression and marital quality in mature marriages as well the possibility of mediating variables such as the personality construct hardiness. Implications for marital therapy with older couples experiencing depression and future research are discussed.     

Family formation: A positive outcome for vulnerable young women?

While marriage and childbirth are generally considered positive adult outcomes, it is not clear that this holds true among low income young women. Beyond adolescent parenting, little empirical data exists on various types of family formation in this population. The aims of this study were twofold: (1) to understand predictors of type of family formation (e.g., none, childrearing, marriage, or both) among 4385 young women with childhood histories of poverty and/or maltreatment; and (2) to explore whether family formation patterns were associated with negative adult behavioral and health outcomes. Results of the AIM 1 multinomial regression analysis of family formation indicated that the likelihood of childrearing with or without marriage increased with an increase in the number of adolescent risk behaviors after controlling for the maltreatment and/or poverty histories. Among women with maltreatment histories, early onset maltreatment was associated with childrearing or marriage compared to no family. Among previously maltreated women, predictors of family formation varied according to prior poverty history. AIM 2 Cox regression results indicated that having children with or without marriage was associated with a higher risk of negative outcomes after controlling for maltreatment and adolescent risk factors. Bivariate analyses suggested that most of the increased risk was associated with having at least two children. Findings underscore the importance of preventing adolescent risk behaviors among low income and maltreated girls as well as early and unplanned births among vulnerable young adult women.     

Trajectories of Conflict Over Raising Adolescent Children and Marital Satisfaction

The present study examined trajectories of marital satisfaction among couples with adolescent children and evaluated how changes in parents' conflict over raising adolescent children were associated with changes in marital satisfaction over 4 years. Using a prospective, longitudinal research design and controlling for family socioeconomic status, dyadic growth curve analysis from a sample of 431 couples with adolescent children indicated that marital satisfaction decreased over time for parents with adolescent children and that the trajectories for mothers and fathers were substantially linked. More importantly, the study demonstrated that increases or decreases in parents' marital conflict over raising adolescent children were associated with corresponding decreases or increases in marital satisfaction for both mothers and fathers.     

ADOLESCENT WORK AND BOYS' AND GIRLS' ORIENTATIONS TO THE FUTURE

This study compares adolescent boys' and girls' aspirations and plans concerning achievement, family, and other adult life spheres, and examines the effects of adolescent work experience on these future orientations. The data were obtained from 1001 students, chosen randomly from a list of enrolled ninth graders in a large Midwestern city. Girls were not found to have lower achievement orientations than boys. Examination of the interrelations of achievement and family plans suggests that boys see their future educational, work, and family roles as more closely integrated than do girls. Just as work and family roles are mutually supportive for adult men but in conflict for adult women, so too do employed adolescent boys appear to be developing traditional family orientations, while employed girls, especially those much exposed to formal work, expect less involvement in marriage and family life. The analyses indicate that paid work is traditionalizing for boys, promoting optimism about, and commitment to, numerous adult life domains; but for girls, formal work lessens interest in traditional female gender roles.     

Childhood mental health and adult family relationships: How ADHD shapes experiences with intimate unions and parenthood

Increasingly recognized as a chronic condition that can endure across the life course, childhood attention-deficit/hyperactivity disorder (ADHD) is associated with less stable family formation and more strain around intimate unions (dating, cohabitation and marriage) and parenthood. This article reviews and evaluates multidisciplinary research on childhood ADHD, intimate unions and parenthood, with the purpose of motivating future sociological research in this area. The paper is organized into three general sections. First, I provide an overview of information on ADHD including its diagnosis and treatment, cross-disciplinary etiologies, and sociodemographic correlates. Next, I blend sociological perspectives on labeling and stigma, social stress, and the life course to consider the role of ADHD-related stigma in shaping associations of childhood ADHD with family formation processes (intimate unions and parenthood) and family functioning (relationship quality and communication) in adulthood. Finally, I discuss opportunities for future sociological research on childhood ADHD and adult family relationships that have the potential to contribute both to empirical research on childhood ADHD and adult family relationships, as well as to sociological research at the intersection of family and health.