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     

What Novice Family Therapists Experience During a Session… A Qualitative Study of Novice Therapists' Inner Conversations During the Session

“What do novice family therapists experience during a session with a couple or family?” This is the central question in this article. A videotape‐assisted recall procedure was used to study novice family therapists’ inner conversations. The therapists' reflections were analyzed using thematic analysis. This resulted in a coding system that distinguishes four main domains: (a) reflections concerning the self; (b) reflections about the therapy process; (c) reflections on emotions about the family members; and (d) managing the session as well as own emotions. The study furthermore revealed that during a session, novice family therapists experience strong emotions, such as self‐criticism and irritation. Both emotions may encompass dangers, as well as opportunities for the therapeutic alliance and the process.     

Exploring the influence of the attachment organizations of novice therapists on their delivery of emotionally focused therapy for couples

Clinicians' own internal resources for understanding relationships--that is, their attachment organizations--have been found to influence the process and outcome of treatment. The current study addressed whether the attachment organizations of novice couple and family therapists were associated with couples' experiences of their therapists, therapeutic alliance, session impact, and emotionally focused couple therapy (EFT) fidelity (i.e., especially as related to targeting and working with attachment needs and overt and underlying emotions). Novice couple and family therapists delivered EFT, an attachment-based approach, to couples in a simulated session and an embedded multicase study design guided a cross-case analysis. Findings indicated that secure therapists, when compared to their insecure peers, were more competent at working with attachment needs, as well as the overt and underlying emotions of their clients. Secure therapists perceived themselves as being more skilled in emotion regulation, which may have contributed to their abilities to remain attuned to their clients' attachment needs and emotional expression, even in the face of emotional arousal in session. Couples of insecure therapists also reported greater alliance splits. Future research is needed to further explore the dyadic influences of both therapists' and clients' attachment organizations, as well as the training and supervision practices these findings implicate.     

Family Support Groups for Family Members of Mentally Ill Offenders: Therapeutic Factors

This study investigates therapeutic factors of a Family Support Group (FSG) intervention for family members of mentally ill offenders. Seventeen family members completed the ‘Group Therapeutic Factors‐Client Questionnaire’ (GTF‐CQ‐28) during four sessions of two FSGs. Results indicate that family members experienced the following therapeutic factors over the course of treatment: the relational climate, interactional confirmation, expressing and experiencing mutual positive feelings, forgetting own problems, hope from seeing progress in others, guidance from therapists, and getting interpersonal feedback treatment. The therapeutic factors, including learning by observation, support from the group, and universality of problems, correlated with a decrease in self‐blame, improved emotional well‐being, and experiencing less loss of control over one's life, respectively. Further, family members were satisfied with what the FSG has provided for them personally and for the relation with their relative. Finally, clinical implications of the FSG are discussed. The study sheds light on valuable therapeutic factors within an FSG and the important role of therapists.     

‘Somebody Watching You’: Impact of Reflecting Teams on Hope in Couple Relationships

Reflecting teams (RTs) represent both an epistemological stance and a therapeutic technique. Most commonly associated with narrative and systemic approaches to therapy, RTs offer an outsider perspective that can bring hope and alternative narratives and perspectives for therapists and clients to explore. Relational hope is a little researched concept in the field of couple therapy research. This study explores the experience of RTs in couple relationships and the aspects of the experience that couples describe as connected to a sense of hope for their relationship. The study also considers whether difference in attachment style shows any relationship with hope in couple relationships before and after the clients’ session with a reflecting team. Couples completed questionnaires about their attachment style, demographics, and relational hope and were given the option to complete an interview about their experience with the reflecting team within 1 month of their therapy session. Our findings suggest that RTs contribute positively to hope in couple relationships particularly for clients who present with an anxious attachment style. This direction for research is important because there is very little research about hope in couple relationships despite its importance (Merolla, 2014; Snyder, 2002) and there is no research about what aspects of a reflecting team contribute to hope in couple relationships. Analysis of interviews indicates a number of features of the reflecting team feedback that were valued by clients.     

Changes in Relationship‐Specific Attachment in Emotionally Focused Couple Therapy

Emotionally focused couple therapy (EFT; Johnson, The practice of emotionally focused couple therapy (1st/2nd edition). Brunner‐Routledge, New York, 2004) is an effective treatment of relationship distress (Johnson et al., Clinical Psychology: Science and Practice, 1999; 6, 67). However, less is known about EFT's impact on couples' relationship‐specific attachment bond. Using hierarchical linear modeling with a sample of 32 couples, we examined session‐by‐session changes in couples' relationship‐specific attachment anxiety and avoidance and pre‐ to posttherapy changes in their relationship‐specific attachment behaviors. Couples significantly decreased in relationship‐specific attachment avoidance, and those who completed a blamer softening significantly decreased in relationship‐specific attachment anxiety. Couples' attachment behavior significantly increased toward security. Finally, session‐by‐session decreases in relationship‐specific attachment anxiety and avoidance were significant associated with increases in relationship satisfaction across sessions. These results provide empirical support for the attachment‐based assumptions of EFT. Video abstract accessible by clicking here     

Typology of Couples Entering Alcohol Behavioral Couple Therapy: An Empirical Approach and Test of Predictive Validity on Treatment Response

This study aimed to examine whether classification of couples in which one partner has an alcohol problem is similar to that reported in the general couples literature. Typologies of couples seeking alcohol behavioral couple therapy (ABCT) were developed via hierarchical cluster analysis using behavioral codes of couple interactions during their first ABCT session. Four couples types based on in‐session behavior were established reliably, labeled avoider, validator, hostile, and ambivalent‐detached. These couple types resembled couples types found in previous research. Couple type was associated with baseline relationship satisfaction, but not alcohol use. Results suggest heterogeneity in couples with alcohol problems presenting to treatment; further study is needed to investigate the function of alcohol within these different types.     

Predicting Change in Marital Satisfaction Throughout Emotionally Focused Couple Therapy

Emotionally focused couple therapy (EFT) is an empirically validated approach to couple therapy that uses attachment theory to understand the needs and emotions of romantic partners. EFT is recognized as one of the most effective approaches to couple therapy, but to guide therapists in their use of EFT, a theoretically based model to predict change is needed. This study tested such a model by recruiting 32 couples, and 14 therapists who provided approximately 21 sessions of EFT. Couples completed self‐report measures of marital satisfaction, attachment security, relationship trust, and emotional control at pre‐ and posttherapy and after each therapy session. Results of hierarchical linear modeling suggested that individuals higher on self‐report attachment anxiety and higher levels of emotional control had greater change in marital satisfaction across EFT sessions. Assessing attachment security at the start of therapy will inform therapists of the emotion regulating strategies used by couples and may help couples achieve positive outcomes from EFT.     

Issuing and Responding to Unusual Questions: A Conversation Analytic Account of Tom Andersen's Therapeutic Practice

Tom Andersen is considered one of the key contributors to the development of postmodern practice. Little is known, however, about the ways in which his ideas and practices are routinely carried out in situ. We used Conversation Analysis (CA) to investigate a session of couple therapy facilitated by Andersen. We show how Andersen and client participants oriented to and addressed problems of understanding that occurred between them. The source of this trouble was Andersen's use of unusual question formulations. We offer preliminary evidence that such unusual formulations served particular interactional and institutional (i.e., therapeutic) functions in their local contexts of use. We conclude by considering some implications of this analysis—and of conversation analytic inquiry more generally—for the practice of family therapy.     

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 .     

The Development and Implementation of a Multi‐Couple Therapy Model with Torture Survivors in the Democratic Republic of the Congo

In this article, we present development and feasibility of implementation of a multi‐couple group for use with torture‐surviving couples. The model was developed in the Democratic Republic of the Congo in a community that experienced widespread torture during the wars from 1998 to 2004. The Torture‐Surviving Couple Group model is a short‐term intervention designed to use few human resources to address relational difficulties resulting from exposure to traumatic stressors. The model was guided by critical and feminist epistemologies and employed an ecological lens to incorporate neurobiology and attachment processes along with narrative therapy techniques. An existing multi‐couple group model for addressing violence (Stith, Rosen, McCollum, & Thomsen, 2004 ), and a stage model for healing trauma (Herman, 1992 ) also informed the structural development of the Torture‐Surviving Couple Group model. Couple groups were conducted using a 10‐session program with 13 couples who met weekly. Session themes were incorporated into four phases emphasizing: (a) preparation; (b) safety and stabilization; (c) processing the relationship effects of trauma and grief; and (d) reintegration and rebuilding couple and family life. Couples reported and showed remarkable progress in their relationships after participating in the groups. Clinical and research implications and discussed along with the feasibility of developing and testing the model in a post‐conflict low income setting.     

Determinants and Long‐Term Effects of Attendance Levels in a Marital Enrichment Program for African American Couples

Although most efficacious marital enrichment programs are multisession, few studies have explored whether outcomes differ according to session attendance, particularly among minority groups with lower than average participation in prevention programs. This study therefore investigates attendance levels and long‐term improvements in couple functioning among 164 couples participating in the Promoting Strong African American Families program. Structural equation models indicated session attendance predicted 2‐year changes for men's reports of communication, commitment, and spousal support (marginally) but not for women's. Individual and couple characteristics that predicted attendance levels were also identified. Results highlight distinct gender differences in the effects of sustained attendance as well as characteristics that provide early identifiers for African American couples at increased risk of low program attendance.     

Which therapist perceptions best predict client outcomes? A naturalistic examination

Examining associations between therapists' perceptions of therapy sessions and client-reported outcomes in naturalistic settings (real-life therapy settings) can provide valuable guidance for the assessment, treatment, and monitoring of clients. This study included data of 1334 sessions from 127 clients (86 individual and 41 couple cases) and 15 therapists, collected at a therapy training center. Clients reported their personal functioning and individual symptoms before each session. Therapists rated clients' participation, receptivity, session progress, goal progress, and therapeutic alliance at the end of each therapy session. Multilevel Structural Equation Modeling analyses revealed that therapist-rated client participation and goal progress predicted better personal functioning, beyond clients' previous personal functioning scores. In contrast, none of therapist-rated session variables predicted clients' individual symptoms, beyond previous symptom scores. Power analyses suggested sufficient statistical power to detect small effect sizes. Findings of the current study have clinical implications for treatment planning and progress monitoring.     

Constructing Unfinalizability: A Subject Positioning Analysis of a Couple's Therapy Session Hosted by Tom Andersen

The notion of subject positions is a useful tool in thinking through therapeutic interactions. In this article, I discuss positioning as an everyday phenomenon, and highlight the relational and social power dynamics that shape the subject positions persons may inhabit. Analysis is presented of the positional dynamics that play out in the couple's therapy session facilitated by Tom Andersen. Analysis suggests that Andersen adopts a not‐knowing, uncertain, and curious position, while constructing the couple as competent, unfinalizable persons able to negotiate the choice‐points that arise in front of them. However, if subject positions are grounded in social power dynamics, the session leaves a particular question unanswered: How will these emergent positions take hold outside of the consulting room?     

Discursive Research and Clinical Realities,or the Eye of the Beholder

The comparison of four discursive and conversational analysis studies performed on the same couple consultation session, held by Tom Andersen, show a diversity of results. It can be argued the results are so varied that they constitute different realities, often incompatible with each other. This, far from being a shortcoming of these studies, can be seen as the true richness they can offer to the practicing therapist, who can use research to investigate the different perspectives we can adopt in viewing our clinical activity. The comparison of the four studies raises questions about the role of the therapist in such process. Clinical implications of this are also discussed.     

Discursive psychology as a method of analysis for the study of couple and family therapy

The field of couple and family therapy has benefitted from evidence generated from qualitative approaches. Evidence developed from approaches relying on language and social interaction using naturally occurring recordings of real‐world practice has the benefit of facilitating practice‐based recommendations and informing practice. The aim of this article is to provide an overview of one approach to discourse analysis, Discursive Psychology (DP), demonstrating how a social constructionist framework and focus on discourse can provide an important contribution to the field of therapy. To illustrate the methodological decision‐making process for researchers and/or practitioners who utilize DP, we draw upon a video‐recorded therapeutic session involving Tom Andersen. To conclude, we make recommendations for practitioners using DP to explore and examine therapeutic practice.     

Making Sense of Multi‐Actor Dialogues in Family Therapy and Network Meetings

In recent years, a number of family therapists have conceptualized psychotherapy as a dialogical activity. This view presents family therapy researchers with specific challenges, the most important of which is to find ways of dealing with the dialogical qualities of the multi‐actor dialogues that occur, for example, in family therapeutic conversations. In this article, we propose some preliminary ideas concerning qualitative investigations of multi‐actor dialogues. Our aim is to work toward an integration of Bakhtin’s theoretical concepts with good practices in qualitative research (e.g., dialogical tools and concepts of a narrative processes coding system) in order to make sense of family therapy dialogues. A specific method that we have called Dialogical Methods for Investigations of Happening of Change is described. This method allows for a general categorization of the qualities of responsive dialogues in a single session, and also for a detailed focus on particular sequences through a microanalysis of specific topical episodes. The particular focus is on the voices present in the utterances, the positioning of each speaker, and the addressees of the utterances. The method is illustrated via an analysis of a couple therapy session with a depressed woman and her husband.     

A Model of Engagement Promotion in a Professionally Facilitated Online Intervention for Couples Affected by Breast Cancer

Professionally facilitated web‐based interventions for couples affected by an illness such as cancer are growing in popularity. Attrition rates for such online programs, however, are substantially higher than what is observed in face‐to‐face therapeutic contexts, and lower levels of participant engagement are associated with poorer outcomes. In the present investigation, a task analysis was employed to develop a model of engagement promotion in an online intervention for couples affected by breast cancer called “Couplelinks.” Results indicated that facilitators utilized a variety of meta‐processes, such as humanizing the technology, and associated “eBehaviors,” to maintain three relationships involved in promoting online engagement: (a) between the facilitator and couple; (b) between the intervention and couple; and (c) between the partners within the couple.     

Interpersonal Forgiveness in Emotion‐Focused Couples' Therapy: Relating Process to Outcome

The objective of this study was to relate the in‐session processes involved in interpersonal forgiveness to outcome. The sample consisted of 33 couples who received 10–12 sessions of Emotion‐focused couple therapy with the aim of resolving various forms of emotional injuries (i.e., transgression that violates the expectations of a close relationship, which leaves one partner feeling hurt and angry). The results of the present study were based on the analyses of 205 video‐taped segments from 33 couples' therapies. Hypotheses relating the role of three in‐session components of resolution, the injurer's “expression of shame”; the injured partner's “accepting response” to the shame, and the injured partner's “in‐session expression of forgiveness”, to outcome were tested using hierarchical linear regression analyses. Outcome measures included the Enright Forgiveness Inventory (The Enright Forgiveness Inventory user's manual. Madison: The International Forgiveness Institute, 2000), the Dyadic Adjustment Scale (Journal of Marriage and Family, 1976; 13: 723) and the The Interpersonal Trust Scale (Trust; Journal of Personality and Social Psychology, 1985; 49: 95).