PREDICTORS OF SUCCESS IN EMOTIONALLY FOCUSED MARITAL THERAPY

This study examined client variables expected to predict success in emotionally focused marital therapy (EFT), now the second most validated from of marital therapy after the behavioral approaches. The relationship of attachment quality, level of emotional self-disclosure, level of interpersonal trust, and traditionality to the therapy outcome variables, marital adjustment, intimacy, and therapist ratings of improvement, was examined. These variables were chosen for their relevance to the theory and practice of EFT and to intimate relationships in general. Overall, therapeutic alliance predicted successful outcome; the task dimension of the alliance in particular predicted couples' satisfaction. More specifically, one dimension of female partners' trust, their faith in their partner, predicted couples' satisfaction at follow-up. Females' faith also significantly predicted males' level of intimacy at follow-up. Males who were most likely to be nondistressed at termination indicated higher levels of proximity seeking on an attachment measure at intake, and older males and males whose partners had higher levels of faith in them were more likely to be nondistressed at follow-up. Traditionality was not found to be significantly related to outcome. Couples who made the most gains at follow-up also indicated lower initial marital satisfaction and included males who indicated lower levels of use of attachment figure on the attachment measure at intake. Males who made the largest gains at termination were older and were rated as less expressive by their partner on self-disclosure measures at intake. Age was the only variable significantly related to males' gains in satisfaction at follow-up, Implications for the practice of marital therapy and future research are delineated.     

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.     

Sexual satisfaction, perceived availability of alternative partners, and marital quality in newlywed African American couples

The goal for this project was to examine the manner in which husbands' and wives' sexual satisfaction was related to their perceptions of the availability of alternative partners and overall marital quality. Participants were 470 newlywed African American couples residing in the southern region of the United States. Path analysis was used to simultaneously examine actor (individuals' sexual satisfaction on their own outcomes) and partner (individuals' sexual satisfaction on their partners' outcomes) effects. Wives' and husbands' sexual satisfaction was strongly and positively associated with their own reports of marital quality, although it was not associated with their partners' reports of marital quality. For both wives and husbands, higher sexual satisfaction was associated with lowered perceptions that they would be able to find other acceptable partners should their current relationship end. Perceived availability of alternative partners was, in turn, negatively associated with reports of marital quality.     

Predicting Spouses’ Perceptions of Their Parenting Alliance

This study used marital‐ and individual‐level variables to predict spouses’ perceived parenting alliance. One hundred married couples completed measures of parenting alliance, marital consensus, marital power, and depression. Analyses revealed that marital consensus was a significant predictor of parenting alliance for both parents, and that depression also was a significant predictor for wives. Analyses using both spouses’ data indicated that wives’ perceptions of consensus and depression significantly predicted both spouses’ parenting alliance, suggesting that wives are the barometer of the marital relationship ( Floyd & Markman, 1983 ) and of the parenting relationship as well. Implications for research are discussed.     

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.     

Emotion-Focused Couples Therapy and the Facilitation of Forgiveness

The goal of this study was to evaluate the effectiveness of an emotion-focused couple therapy intervention for resolving emotional injuries. Twenty couples acting as their own waitlist controls were offered a 10–12-session treatment to help resolve unresolved anger and hurt from a betrayal, an abandonment, or an identity insult that they had been unable to resolve for at least 2 years. Treated couples fared significantly better on all outcome measures over the treatment period compared to the waitlist period. They showed a significant improvement in dyadic satisfaction, trust, and forgiveness as well as improvement on symptom and target complaint measures. Changes were maintained on all of the measures at 3-month follow-up except trust, on which the injured partners deteriorated. At the end of treatment, 11 couples were identified as having completely forgiven their partners and six had made progress toward forgiveness compared with only three having made progress toward forgiveness over the waitlist period. The results suggest that EFT is effective in alleviating marital distress and promoting forgiveness in a brief period of time but that additional sessions may be needed to enhance enduring change.     

Impact of marital and psychological distress on therapeutic alliance in couples undergoing couple therapy

In this study, we describe the psychometric properties of the Couple Therapy Alliance Scale--revised (CTAS-r) and investigates the impact of marital and psychiatric distress on alliance. Seventy-nine couples in therapy completed a French version of the Dyadic Adjustment Scale and of the Psychiatric Symptoms Index at session one, and a French version of the CTAS-r at session three. Results indicate that the French version of the CTAS-r has adequate psychometric properties, although the subscales of the instrument are highly intercorrelated. Furthermore, marital adjustment predicts alliance scores, whereas psychiatric symptoms do not. Finally, male marital adjustment and female psychiatric symptoms are lower in couples where spouses have divergent perceptions of the alliance. Future research directions are discussed.     

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.     

Emotionally focused interventions for couples with chronically ill children: a 2-year follow-up

Couples with chronically ill children are particularly at risk for experiencing marital distress. The study presented here is a 2-year follow-up of a randomized control trial that assessed the efficacy of Emotionally Focused Therapy (EFT) in decreasing marital distress in a sample of couples with a chronically ill child. Thirteen couples with chronically ill children who received treatment were assessed to determine if the significant improvement in relationship distress observed at posttreatment and 5-month follow-up would be maintained at 2-year follow-up. Results demonstrated that improvements in marital functioning were not only maintained but, in some cases, enhanced at the 2-year follow-up. This uncontrolled follow-up study provides initial evidence of the longer-term benefits of EFT.     

Marital distress,co-occurring depression,and marital therapy: a review

This article reviews several factors that contribute to marital distress and co-occurring depression and also reviews empirically supported therapies. Gender contributes to marital distress and depression but does not appear to be the cause of either. Marital distress and depression appear to have bidirectional influence on each other. The depressed spouse's depression has a marked impact on the marital adjustment of the nondepressed spouse. Both marital distress and depression appear to be chronic. It is recommended that treatment be designed to help couples be supportive of each another, to adapt, and to cope with the depressive symptoms within the framework of their ongoing marital relations.     

DYSPHORIA AND MARITAL DISCORD: ARE DYSPHORIC INDIVIDUALS AT RISK FOR MARITAL MALADJUSTMENT?

The effect of dysphoria on husbands' and wives' later marital adjustment was examined in a sample of 264 white couples about to marry who responded to advertisements. Relationship satisfaction and level of dysphoria were assessed in both spouses prior to marriage, 6 months after marriage, and 18 months after marriage. Premarital dysphoria was associated with later marital dissatisfaction. Husbands' premarital dysphoria, regardless of chronicity, was associated with greater deterioration in both their own and their partners' marital satisfaction. Wives' premarital dysphoria was associated with greater deterioration in marital satisfaction only if it was chronic. Results suggest that premarital dysphoria is associated with subsequent deterioration of marital relationships.     

Three perspectives on clients' experiences of the therapeutic alliance: a discovery-oriented investigation

To deepen our understanding of the therapeutic alliance in conjoint treatment, we interviewed clients in four families about their individual, private experience of the alliance after an early session. These qualitative data were triangulated with family members' scores on Pinsof's Family Therapy Alliance Scale-Revised and observational ratings of their behavior on the System for Observing Family Therapy Alliances. This discovery-oriented investigation focused on three interrelated aspects of the alliance: the family's shared sense of purpose about the needs, goals, and value of therapy (i.e., within-system alliance), split alliances with the therapist, and felt sense of safety within the therapeutic context. Results were highly consistent across the three perspectives and congruent with idiographic, therapist-rated outcomes.     

FACILITATING INTIMACY: INTERVENTIONS AND EFFECTS

The Present study investigated by effects of two sets of marital interventions taken from Emotionally Focused Therapy (EFT) and Cognitive Marital Therapy (CMT) on level of marital intimacy, dyadic trust, and dyadic adjustment. It was hypothesized that both EFT and CMT would have a positive effect on levels of intimacy, trust, and adjustment as compared to a wait-list control group and that there would be a differential effect in favor of EFT as compared to CMT. Thirty-six couples free of marital distress and seeking to enhance theor intimate relationship were randomaly assigned to EFT, CMT, or a wai-list control group. Therapists' interventions were monitored and found to be faithfully implemented. Groups were equivalent on demographic variables and the quality of the therapeutic alliance. Both EFT and CMT group posttest means were found to be significantly higher than controls on the self-report measures of intimacy, Observational measures of intimacy revealed differential effects in favor of EFT as comopared to CMT at posttest. At a 10-week follow-up, EFT group means were significantly higher than CMT on self-reported intimacy and adjustment.     

Predicting 2-year marital satisfaction from partners' discussion of their marriage checkup

This study tested whether the observed marital interactions of partners following a marriage checkup predicted marital satisfaction 2 years later. In addition, this study examined whether recommendations to pursue therapy predicted subsequent treatment seeking and whether changes in marital distress following the checkup remained stable over 2 years. Results suggest that the affective tone of a couple's interaction predicts later marital satisfaction. Further, receiving a treatment recommendation predicted subsequent treatment seeking for wives. Finally, support was found for the hypothesis that changes in marital distress are self-sustaining.     

THE THERAPEUTIC ALLIANCE IN HOME‐BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented.     

Individual and Crossover Effects of Work Schedule Fit: A Within‐Couple Analysis

A couple‐level analysis with a sample of 105 female reduced‐hours physicians and their full‐time–employed husbands found individual and spouse crossover effects: Each spouse's ratings of own schedule fit predict own job‐role quality; wives' ratings of partner/family schedule fit predict their marital‐role quality, with a similar trend for husbands; husbands' ratings of own schedule fit predict wives' marital‐role quality; and husbands' ratings of partner/family schedule fit and wives' ratings of own schedule fit predict husbands' psychological distress. These findings highlight the interdependence of couple members' experiences and illustrate potential costs of wives' trading off time at work for time at home.     

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.     

Marital Relationships Following the Korean Economic Crisis: Applying the Family Stress Model

In response to the recent economic crisis in Korea and its negative effects on families, the current study examined the interrelationships among economic pressure, emotional distress, marital conflict, and marital satisfaction for 236 Korean couples. The family stress model ( Conger & Elder, 1994 ; Conger, Rueter, & Conger, 2000 ; Conger, Rueter, & Elder, 1999 ) was tested using structural equation modeling. The results generally supported the theoretical model, showing that economic pressure negatively affects marital satisfaction via emotional distress and marital conflict. The results also implied cultural differences in the process of family stress. Korean husbands' emotional distress did not affect marital conflict or marital satisfaction, suggesting that Korean husbands may differ from their wives in their reaction to emotional distress from economic pressure.     

MARRIAGE, DEPRESSION, AND COGNITION: UNRAVELING THE GORDIAN KNOT-REPLY TO ETTINGER ET AL.

Heim and Snyder (1991) explicitly applied a multidimensional assessment and data-analytic strategy to predict husbands' and wives' depressive symptoms from measures of marital disaffection, overt marital conflict, appraisals of relationship prognosis, characterizations of the spouse, and causal attributions. For both genders, the best single predictor of depression was a measure of marital disaffection—accounting by itself for approximately one third of the variance in subjects' depressive symptoms. Additional attributional predictors of depression for married women indicated the need for therapists to support wives' assertive expression of relationship concerns and confrontation of husbands' behaviors contributing to their distress. We reiterate the complex and recursive relationships among marital difficulties, depression, congnitive processes, and their antecedents and consequences and encourage focused research on components of this intricate puzzle.     

Therapeutic alliance between youth and staff in residential group care: Psychometrics of the therapeutic alliance quality scale

Therapeutic alliance has been frequently studied in individual counseling sessions; however, research on therapeutic alliance in residential settings for youth with mental health diagnoses has been limited. This may be due, in part, to the presence of multiple service providers often in caregiving roles. The purpose of this study was to examine the psychometric quality of a widely utilized measure of therapeutic alliance used in psychotherapy with youth in residential care where the treatment is provided by a trained married couple. We also compared the relationship between youth ratings of their male and female service providers, as well as examined correlations in ratings between youth and staff on therapeutic alliance. Finally, we investigated the direction, magnitude, and trajectory of change in therapeutic alliance over a 12-month period following admission into residential care. The method was a longitudinal assessment of 135 youth and 124 staff regarding therapeutic alliance over the course of 12 months or discharge from services. Results indicated strong psychometric properties and high correlations for youth ratings of both their male and female service providers. However, the correlation was low between youth and service provider ratings of alliance. Longitudinal analyses indicated that rates of therapeutic alliance changed over time.