THE PROCESS OF CHANGE IN COUPLES THERAPY: A QUALITATIVE INVESTIGATION

Open-ended interviews with 24 couples therapy clients regarding their experience of the process of change revealed shifts in clusters of affect, communication, and cognition. Six additional contextual preconditions for change were also identified. The change process within couples was uniformly reported to be gradual.     

I, THOU, AND WE: A DIALOGICAL APPROACH TO COUPLES THERAPY

This paper examines the relational view of the person in Martin Buber's philosophy of dialogue. Shifts toward the relational are considered in the context of human development, gender studies, psychotherapy, and family therapy. A dialogical cpproach to couples therapy is presented, in which partners are encouraged to move toward a more collaborative, empathic relationship–a relationship of I and Thou.     

RELATING PROCESS TO OUTCOME IN MARITAL THERAPY

Although there are a growing number of outcome research studies in marital therapy, there is a complete absence of research on change processes, and how such processes relate to outcome. This study attempts to analyze the process of change in the "best" sessions of Emotionally Focused Marital Therapy (EFT) (Greenberg & Johnson, 1986). Client performance in therapy was rated on depth of experiencing and the quality of interpersonal interactions. The occurrence of particular change events arising from the theoretical principles of EFT was also noted. Results confirmed hypotheses that higher levels of experiencing and more autonomous and affiliative interactions characterized "best" sessions of couples who were successful in therapy. The implications for treatment are discussed.     

BATTERING AND COUPLES THERAPY: UNIVERSAL SCREENING AND SELECTION OF TREATMENT MODALITY

As family therapists begin to experiment with couples treatment models for batterers and their partners, a basic question is: Which couples can be safely treated with conjoint therapy? Following a definition of battering and a review of rationales for considering couples therapy in cases of domestic violence, a framework for assessment of domestic violence is outlined, including sample questions, criteria for excluding couples from conjoint therapy, how to conduct a lethality assessment, and how to conceptualize postassessment treatment recommendations. This article also introduces family and couples therapists to domestic violence literature that is often not well integrated in family therapy theory and practice.     

DIFFERENTIAL ASSESSMENT OF FINANCIAL AND RELATIONSHIP DISTRESS: IMPLICATIONS FOR COUPLES THERAPY

The study examined the role of financial conflicts, problem-solving communication deficits, and global relationship distress among couples in marital therapy and couples seeking assistance at a nonprofit agency providing financial counseling services. Analyses comparing these two groups of couples with each other and with a third group of couples from the general community yielded a two-component model for differential assessment and intervention with couples experiencing financial concerns. Differences in findings for husbands and wives provided additional implications for effective interventions with these couples.     

PROCESS, ROBLEMS, AND SOLUTIONS IN BRIEF THERAPY

The MRI problem-solving and the recently popular solution-amplifying approaches to brief therapy are described as based upon the same process point of view. A process view is described in contrast to a structural view of human interactions. It is argued that an exclusive focus on amplifying perceived solutions without clearly defining problem patterns may become a problem. Clear articulation of a therapist's assumptions about human interaction, problems, and therapeutic solutions is strongly advocated. Creativity, flexibility, effectiveness, and efficiency are likely to be by-products of such clarity. Without it, our therapeutic zeal in searching for solutions is likely to become a problem.
A Japanese coastal village was once threatened by a tidal wave, but the wave was sighted in advance, far out on the horizon, by a lone farmer in the rice fields on the hillside above the village. At once he set fire to the fields, and the villagers who came swarming up to save their crops were saved from the flood.     

WHY FAMILY THERAPY SHOULD GO BEYOND HOMEOSTASIS: A KUHNIAN REPLY TO ARIEL,CAREL AND TYANO

The thesis of “Beyond Homeostasis” is (a) that the discourse of family therapists unquestionably shows that family therapists have tended to see homeostasis as a trait of families; and (b) that such a view of homeostasis is inconsistent with the systemic paradigm. Therefore, family therapy should go beyond such an understanding of homeostasis. Ariel et al. may have failed to grasp this argument; they have certainly chosen to ignore it. Ariel et al. have provided a logical empiricist explication of the nonsystemic version of homeostasis which is portrayed in the discourse of family therapists. I still argue that family therapy should go beyond such an understanding of homeostasis.     

GENDER-RELATED THERAPIST ATTRIBUTIONS IN COUPLES THERAPY: A PRELIMINARY MULTIPLE CASE STUDY INVESTIGATION

Differential treatment by gender has been an ongoing area of concern and uncertainty both in society at large and in clinical research. In this investigation, therapist attributions over the course of therapy for three different couples were coded and analyzed to determine if cause for positive and negative events was assigned differentially to females and males. Additionally, the stability and globality dimensions of the therapist's attributions about the couples were examined for stereotypical gender-related patterns. Results indicate no gender differences in locus of causal attributions but some gender-related patterns in stability and globality dimensions. Implications for both couples therapy and gender bias in couples research are discussed.     

MARITAL THERAPY: QUALITIES OF COUPLES WHO FARE BETTER OR WORSE IN TREATMENT

To evaluate the effectiveness of couples therapy and determine the characteristics and qualities of couples who fare best in treatment, 139 couples presenting at a nonlaboratory sliding-fee clinic in Dallas, Texas, were evaluated. Observational and self-report measures of the Beavers Systems Model were taken at the first session and, for some subjects, at termination. Therapists also rated the couples on goal attainment and on dimensions of the therapeutic alliance. Not surprisingly, there was a direct association between number of sessions and goal attainment, with couples attending only one or two sessions having the lowest goal attainment. There were also significant family functioning qualities associated with success: more competent couples fared better in therapy. Another consistent finding was that couples with no children did better in treatment than those who were also parents. It is interesting that remarried couples without children did best in treatment, followed by first-married couples with no children, first-married couples with children, and, finally, remarried couples with children. Implications for screening and clinical work with couples are presented.     

EFFECTS OF A COMMUNICATION TRAINING COMPONENT ADDED TO AN EMOTIONALLY FOCUSED COUPLES THERAPY

In this study a 4-session communication skills training component was added to an 8-session Emotionally Focused couples therapy package. This treatment (EFT + CT) was compared to 12 sessions of Emotionally Focused therapy (EFT) to investigate whether the communication training component enhanced the effectiveness of EFT, and both treatments were compared to a wait-list control. Both treatments achieved superior gains at posttest compared to the control group on measures of marital adjustment and target complaint improvement (but not on intimacy and passionate love), with EFT + CT being superior on communication. The only differential treatment effect was EFT's superiority on target complaints at follow-up.     

EMOTIONALLY FOCUSED COUPLES THERAPY: AN OUTCOME STUDY*

In a within-subjects design in which couples acted as their own controls, assessment was completed at four times: at the time of intial contact, after an eight-week waiting period, after eight sessions of Emotionally Focused Marital Therapy, and at an eight-week follow-up. Couples reported no significant changes on measures of dyadic adjustment, intimacy, target complaint reduction and goal attainment after the waiting period, but significant changes were found after treatment.     

EXPOSURE TO MARITAL AND FAMILY THERAPY IN MEDICAL SCHOOL: A STUDENT PERSPECTIVE

Most marital and family therapists, both medically and nonmedically trained, regularly interact with physicians on a professional basis. Though some physicians receive specific training in marital and family therapy in their postgraduate residency programs, (notably those in psychiatry and family medicine), for many, the only academic exposure they receive to this field comes during a 6- to 10-week clinical clerkship in psychiatry during their third or fourth year of medical school. No study could be located which examined marital and family therapy training in undergraduate medical education. The purpose of this study was to gain a better understanding of the level of marital and family therapy training in medical school and to provide information concerning physicians who are not family therapists, and how much knowledge about the field they can be expected to have.     

THE CULTURAL CONTEXT MODEL: THERAPY FOR COUPLES WITH DOMESTIC VIOLENCE

This article offers a brief analysis of heterosexual dominance within various cultures toward a larger understanding of domestic violence. It then describes the Cultural Context Model, developed over 15 years of experience treating domestic violence in its broader context, utilizing separate "culture circles" for men and women before and during couple therapy. It then identifies guidelines for assessment and intervention with a discussion of the special issues raised when substance abuse is involved.     

MODES OF EXPRESSION IN FAMILY THERAPY: A PROCESS STUDY OF ROLES AND GENDER*

Twenty-two two-parent families with a referred adolescent were seen by 11 male and 11 female trainees in family therapy. Mothers, fathers, adolescents, and therapists were rated for verbal expression in affective, behavioral, and cognitive! attributional modes during the first session. Results clearly point to role and content difference in modes of expression. Of particular importance are differences by role which occured as a function of therapist gender. These differences suggest that therapist gender has an impact on family therapists' and family members' verbalizations in first sessions of family therapy.     

CLINICAL PROCESS RECORDING IN FOCAL FAMILY THERAPY*

A method for systematically recording the process of family therapy (the Focal Therapy Record Sheet) is described, based on the focal approach developed in earlier papers by the authors. It demands a conceptual distinction between assessment of families and treatment techniques and embodies continuous evaluation of family improvement according to specific criteria. A detailed case illustration showing the Sheets completed for each of 14 sessions after two diagnostic interviews is provided, together with an anecdotal-style account. The value of the instrument for teaching purposes, in routine clinical work and for research is discussed.     

HETEROGENOUS COUPLES IN HETEROSEXUAL MARRIAGES: GAY MEN AND STRAIGHT WOMEN*

This article, which is based on in-depth interviews of gay men who had been married, focuses on the nature of the spousal relationship and the almost inevitable marital disruption. It describes the conditions which bring about the man's disclosure of his homosexuality, the means of disclosure he uses, the wife's response, and the interactional effects the disclosure and response have on the marriage relationship. Most of the marriages ended in divorce. Regardless of whether the wife was accepting or rejecting of her husband as a homosexual, she appeared to be an enabler of his transition to a homosexual lifestyle. Implications for counseling are discussed.