Close relationships research: a resource for couple and family therapists

This article describes the relatively new field of close relationships research, offering a representative list of topics studied by relationship researchers. Some of the common interests shared by both close relationships researchers and couple and family therapists are described, with the shared emphasis on relationships as an anchor for both fields. Some representative love theories are discussed, and Love Styles theory and research are presented in considerable detail. A clinical case example indicates how love styles research may be employed to advantage by couple therapists, and the utility of other close relationships theories and measures for therapy is briefly discussed.     

The Norway Couple Project: Lessons Learned

Couple therapists in routine practice may find it difficult to apply findings from an increasingly expanding and complex body of couple therapy research. Meanwhile, concerns have been raised that competency in evidence‐based treatments is insufficient to inform many practice decisions or ensure positive treatment outcomes (American Psychological Association Presidential Task Force on Evidence‐Based Practice, American Psychologist, 2006, 271). This article aims to narrow the research/practice gap in couple therapy. Results from a large, randomized naturalistic couple trial (Anker, Duncan, & Sparks, Journal of Consulting and Clinical Psychology, 2009, 693) and four companion studies are translated into specific guidelines for routine, eclectic practice. Client feedback, the therapeutic alliance, couple goals assessment, and therapist experience in couple therapy provide a research‐informed template for improving couple therapy outcomes.     

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.     

Treating distressed couples with coexisting mental and physical disorders: directions for clinical training and practice

Relationship difficulties frequently coexist with significant emotional, behavioral, and physical health problems in one or both partners. Moreover, couple therapists report individual emotional and behavioral disorders as among the most difficult problems that they encounter in clinical practice. In this article, we summarize empirical evidence regarding the association between relationship distress and the onset, course, and treatment of mental and physical health problems. Based on these findings, we propose five critical implications for clinical training and the practice of couple therapy.     

Clinical practice with nonbehavioral methods: Strategies for evaluation

Social workers frequently complain that research is unrelated to issues of daily clinical practice, especially that single-case research which they see as more germane to behavior therapy. Considering the nature of non-behavioral clinical practice, this article discusses strategies for systematic evaluation.Portions of this article were presented at the NASW Conference on Clinical Social Work, November 21, 1982, Washington, D. C. The author would like to thank Joel Fischer, Rona L. Levy, and Susan P. Robbins for their hélpful comments on an earlier draft of the article.     

Couples treatment issues for recovering male compulsive gamblers and their partners

Until recently, the couple relationship has been relatively neglected in both clinical reports and systematic research in the compulsive gambling literature. This article suggests the need for family and intergenerational assessment as well as early interventions within the couple system. The following treatment issues are discussed: multiple addictions; finances; control and power; anger; sexuality; and emotional intimacy. Overcoming deficits in intimacy is viewed as central to couples recovery.     

The Gap Between Couple Therapy Research Efficacy and Practice Effectiveness

Meta‐analyses of randomized controlled trials of couple therapy find large improvements in couple adjustment, but published evaluations of the effectiveness of couple therapy in routine practice find only small‐to‐moderate effects. The current study analyzes possible explanations for the research‐efficacy to practice‐effectiveness gap and offers suggestions for enhancing couple therapy effectiveness. Major recommendations are that therapists should clarify whether couples’ therapy goal is to clarify commitment to the relationship or to improve the relationship; use standardized assessment of the individual partners and the relationship; and use systematic monitoring of therapy progress and the therapeutic alliance. It is also possible that the greater use of evidence‐based therapies when treating couple relationship distress could enhance couple therapy outcome.     

An Attachment Primer for Couple Therapists: Research and Clinical Implications

According to attachment theory, humans are relational beings and even a child's earliest experiences with caregivers have a profound effect on emotional development and an overall approach to relationships. With increasing regularity, couple therapy has utilized attachment language as a conceptual tool, but more work is needed to understand the full clinical implications of attachment theory. These include understanding the intergenerational nature of attachment and adapting the delivery, timing, and pace of interventions to client attachment strategies. In this article, we summarize the origins of attachment theory, its measurement, the role of attachment in couple relationships, attachment stability and change, and ways that attachment informs therapy process and intervention. We hope that this article will provide an impetus for couple therapists to expand their conceptualization and use of attachment in their clinical work and for couple researchers to conduct more clinically relevant, attachment‐oriented process 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.     

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     

Individual Therapy for Couple Problems: Perspectives and Pitfalls

Despite the demonstrated efficacy of conjoint couple therapy, many clients seeking help for couple problems ultimately find themselves in individual therapy for these concerns. Individual therapy for couple problems (ITCP) may evolve from a partner's refusal of conjoint therapy or from the treatment format preferences of either the client or therapist. Having acknowledged the role of partner refusals, we offer some perspectives about the idiosyncratic personal factors and professional background factors that may lead therapists to provide ITCP and discuss the significant pitfalls in its practice. We emphasize five central areas of concern in the ongoing practice of ITCP: structural constraints on change; therapist side‐taking and the therapeutic alliance; inaccurate assessments based on individual client reports; therapeutic focus; and ethical issues relevant to both attending and nonattending partners. We conclude by urging that this very important but largely neglected topic be paid greater attention in psychotherapy research, training and continuing education.     

Relationship education research: current status and future directions

The overarching aim of this article is to review the research on relationship education programs and approaches that has been published or accepted for publication since the last review article in 2003. This article provides a critical overview of the relationship education field and sets an agenda for research and practice for the next decade. A theme weaved throughout the article is the ways in which relationship education is similar and different from couples therapy, and we conclude that there can be a synergistic, healthy marriage between the two. We then provide recommendations for future directions for research in the relationship education field. Finally, the coauthors comment on our experiences in both the relationship education field and the couples therapy field as both researchers and interventionists.     

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.     

BOOK REVIEWS

Book reviewed in this article:
Rugel, R. P. (1977). Husband-ocused marital therapy: An approach to dealing with marital distress .
Selekman, Mathew D. (1997). Solution-focused therapy with children: Harnessing family strengths for systemic Change .
Taibbi, R. (1996). Doing amily therapy: Crat and creativity in clinical practice .
Bagarozzi, D. A. (1996). The couple and family in managed care: Assessment, evaluation, and treatment .
Friedman, S. (Ed.). (1995). The reflecting team in action: Collaborative practice in amily therapy .     

Is Who Delivers the Treatment More Important than the Treatment Itself? The Role of The Therapist in Common Factors

In this article, we discuss the role of the therapist in change in couple and family therapy. We argue that the therapist is a key change ingredient in most successful therapy. We situate our discussion in the common factors debate and show how both broad and narrow common factor views involve the therapist as a central force. We review the research findings on the role of the therapist, highlight the strengths and weaknesses of this literature, and provide directions for future research. We then use this review as a foundation for our recommendations for theory integration, training, and practice.     

Therapist effects on dropout in couple therapy

Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university‐based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.     

Internships for Future Faculty: Meeting the Career Goals of the Next Generation of Educators in Marriage and Family Therapy

A key component of a doctoral education in marriage and family therapy (MFT) is the completion of an internship. Virtually all MFT doctoral internships are focused on advanced clinical practice and often are located in agencies unconnected with an academic setting. This article describes an MFT doctoral internship specifically designed to foster the skills needed as a faculty member. The primary purpose of this "future faculty" internship is to expose doctoral interns to faculty life, including participation in graduate teaching, clinical supervision, research, and faculty service—while still meeting typical clinical requirements. Results of semistructured qualitative interviews with five doctoral interns associated with the site are reported. Guidelines for the development of other doctoral internships designed for future MFT faculty members are discussed.     

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.     

Couple Counselling Outcomes in an Australian Not for Profit: Evidence for the Effectiveness of Couple Counselling Conducted Within Routine Practice

Over 30 randomised controlled trials have shown the efficacy of couple therapy under controlled conditions. However only four studies explore effectiveness of couple therapy as commonly practised in the community (i.e., routine practice). These studies suggest effectiveness is about half that reported in randomised controlled trials. Further, there are no published couple therapy effectiveness data currently from Australia or New Zealand. This is troubling because (1) couple distress has negative effects on individual adults, couples, and families; (2) funders increasingly want proof of return on financial investment; and (3) clients want hope that their emotional investment in therapy is worthwhile. The first aim of this paper is to report the outcomes of a milestone multi‐centre study of over 1,500 Relationships Australia clients attending couple counselling. It outlines a simple, intuitive method for assessing effectiveness of couple counselling in routine practice that may motivate others to conduct effectiveness studies. The study used a cross‐sectional design and assessed current couple satisfaction and retrospective recall of couple satisfaction before attending counselling. Results revealed a moderate effect size improvement in relationship satisfaction. The results support previous published studies of couple therapy effectiveness in routine practice. The second aim of the paper is to increase interest in others doing similar research by addressing key barriers to the implementation of effectiveness studies within routine practice. These barriers include administrative burden, integration across services, and conceptual buy‐in by practitioners. The use of the retrospective measure of ‘pre counselling’ couple satisfaction measure overcomes these barriers in part. The paper concludes with a discussion of design limitations and suggestions for counselling agencies seeking to conduct their own effectiveness studies.