Understanding barriers to couples therapy.

What prevents couples from entering therapy? Given that the rate of couple help-seeking is low, we need a better understanding of barriers to couple help-seeking. To expand our understanding of these barriers, we asked almost 300 people who expressed an interest in couples therapy, to clarify what kept them from seeking help. A content analysis of participant's responses found six distinctive categories: cost of treatment, logistics, the modality of treatment, trustworthiness, relational factors, and a clear therapeutic process. Additionally, some responses suggested that stigma and concerns around the emotional work involved deterred couples from seeking help. This expanded understanding of barriers to couples therapy can assist both researchers and clinicians address them in more intentional ways.

Online relationship education programs improve individual and relationship functioning: A meta-analytic review.

Online access to relationship enhancing educational resources are needed now more than ever, and there is a growing number of available programs for couples to choose. But, what is the evidence that these programs improve individual and relationship well-being? We conducted a meta-analysis, using random-effects, examining individual and relationship outcomes of online relationship education programs. We identified 12 publications included in the analysis, and found that online relationship education programs produced significant effects in increasing relationship satisfaction, communication skills, relationship confidence, positive relationship qualities, and decreasing negative relationship qualities. At the individual-level, we found that online relationship programs reduced anxiety and depressive symptoms, increased health satisfaction, and overall quality of life. Additionally, we found no differences related to gender, whether or not couples were identified as "distressed," whether or not the programs were "enhanced," or length of the program.

Are We Acute-Care or Recovery-Oriented? Exploring Ideals and Practices Expressed Within the Substance Use Treatment and Correctional Systems.

AIM: The aim of this study was to explore whether treatment and probation professionals describe ideals and practices more aligned with the recovery-oriented systems of care (ROSC) model or the acute-care model. Methods: Semi-structured individual interviews were used to gather qualitative data on the ideals and practices of nine probation professionals and nine treatment professionals. Results: Directed content analysis revealed that all treatment professionals interviewed and eight out of nine probation professionals described more ideals and practices in line with the ROSC model than those in line with the acute-care model. Of all the meaning units coded for model alignment, 81.7% aligned with ROSC and 18.3% with acute care. Of the meaning units coded as ROSC, 51.4% were from treatment professionals and 48.6% from probation professionals. Of the meaning units coded as acute care, 30.2% came from treatment professionals and 69.8% from probation professionals. In building a ROSC, it seems the concern is less about buy in for recovery-oriented characteristics and more about shedding characteristics of the acute-care model. Although professionals have many ideals and practices in line with the ROSC model, some acute-care characteristics linger and could continue to exist without intervention.

Inviting Autonomy Back to the Table: The Importance of Autonomy for Healthy Relationship Functioning.

Autonomy, or self-determination, is a key ingredient in promoting relationship flourishing. Although autonomy has long been an important concept in the family therapy field (labeled differentiation; Family therapy in clinical practice, 1978), definitional confusions and the ascendency of attachment theory and attachment-based clinical approaches to treating couples have relegated autonomy to a minor role at best and a caricature of rugged individualism and antirelational separateness at worst. Given recent research showing the importance of autonomy for the development of secure attachment in children and the key role autonomy plays in healthy intimate partner functioning, the concept of autonomy needs to take a more central role in our research and clinical practice with couples.

The Associations Between Perceived Harsh and Controlling Parenting, Shame Proneness, and Psychological Aggression Among Chinese Dating Couples.

Using dyadic data from 198 dating heterosexual couples (aged 18-31) in Mainland China, the current study tested the direct associations between perceptions of their parents' harsh and controlling parenting and psychological aggression and indirect associations via shame proneness. Results demonstrated that for women, greater perceived harsh and controlling parenting was directly related to higher levels of psychological aggression and indirectly related through higher levels of shame proneness. For men, perceived harsh and controlling parenting was not related to either shame proneness or psychological aggression. These findings provide initial insights into how shame, traditionally a valued and celebrated emotion in Chinese culture, can be maladaptive by contributing to psychological aggression in young adult intimate relationships. Although these findings merit further testing, especially for men, this study provides evidence that shame is an important mechanism for psychological dating violence.

Temporality of couple conflict and relationship perceptions.

Using 5 waves of longitudinal survey data gathered from 3,405 couples, the present study investigates the temporal associations between self-reported couple conflict (frequency and each partner's constructive and withdrawing behaviors) and relationship perceptions (satisfaction and perceived instability). Autoregressive cross-lagged model results revealed couple conflict consistently predicted future relationship perceptions: More frequent conflict and withdrawing behaviors and fewer constructive behaviors foretold reduced satisfaction and conflict frequency and withdrawal heightened perceived instability. Relationship perceptions also shaped future conflict, but in surprising ways: Perceptions of instability were linked with less frequent conflict, and male partner instability predicted fewer withdrawing behaviors for female partners. Higher satisfaction from male partners also predicted more frequent and less constructive conflict behavior in the future. These findings illustrate complex bidirectional linkages between relationship perceptions and couple conflict behaviors in the development of couple relations. (PsycINFO Database Record

Evaluative coping, emotional distress, and adherence in couples with Type 2 diabetes.

INTRODUCTION: Spousal support is one of the strongest and most consistent predictors of Type 2 diabetes treatment adherence. However, the effects of both spouses' evaluations of dyadic coping on emotional distress and patients' physical health remain largely unknown. METHOD: Dyadic data from 117 married couples in which one member is diagnosed with Type 2 diabetes were evaluated in two separate models to explore the associations between (a) patients' and spouses' depression symptoms and patients' adherence to dietary and exercise regimens, and (b) patients' and spouses' acute stress levels and patients' adherence to dietary and exercise regimens. Finally, evaluative dyadic coping was included as a possible moderator between these associations. RESULTS: Results from an actor-partner interdependence model revealed significant actor effects of patients' depression symptoms on patients' adherence to dietary and exercise regimens. Spouses' evaluation of dyadic coping attenuated the direct paths between spouses' depression symptoms and patients' adherence to dietary regimens. No direct pathways were found from patients' or spouses' acute stress to patients' adherence to dietary and exercise regimens. However, spouses' evaluation of dyadic coping attenuated the direct paths between spouses' acute stress and patients' adherence to dietary regimens. DISCUSSION: Tapping into spouses' evaluations of dyadic coping has significant implications for patients' diabetes health outcomes (e.g., adherence to dietary and exercise treatment regimens). Findings from this study highlight the need for systemic interventions targeting both partners. (PsycINFO Database Record

Associations Between Economic Pressure and Diabetes Efficacy in Couples With Type 2 Diabetes.

Objective: The purpose of this study was to explore dyadic associations between economic pressure and diabetes self-efficacy via emotional distress in patients with type 2 diabetes and their partners. Background: Understanding how economic pressure is associated with successful diabetes management is an important area for research, as couples with type 2 diabetes can incur heavy economic pressures that could likely influence diabetes outcomes. Method: Data from 117 married couples were used to test actor-partner associations using moderated mediation analyses in a structural equation modeling framework. Problem-solving communication was tested as a possible moderator of the economic pressure-emotional distress pathway. Results: Results revealed that greater patient economic pressure was associated with lower patient and spouse confidence in the patient's diabetes management ability through higher levels of patient emotional distress. The deleterious association between economic pressure and emotional distress was less pronounced when spouses reported more effective problem-solving communication. Conclusion: These results provide evidence that the economic pressure couples with type 2 diabetes face may reduce the patient and spouse's confidence in the patient's diabetes management ability. Implications: This study demonstrates the importance of couple's relationship processes in buffering the impact of economic pressure on diabetes management, providing a clear target for intervention and education efforts.

Does Personality Matter in Diabetes Adherence? Exploring the Pathways between Neuroticism and Patient Adherence in Couples with Type 2 Diabetes.

BACKGROUND: Personality has received some attention in the Type 2 diabetes literature; however, research has not linked personality and diabetes adherence behaviors (diet and exercise), identified pathways through which they are associated, nor taken into consideration important contextual factors that influence behavior (the patient's partner). METHODS: Dyadic data from 117 married, heterosexual couples in which one member is diagnosed with Type 2 diabetes was used to explore associations between each partner's neuroticism and patient dietary and exercise adherence through the pathways of negative affect, depression symptoms, and couple-level diabetes efficacy (both patient and spouse report of confidence in the patient's ability to adhere to diabetes management regimens). RESULTS: Results revealed that higher levels of neuroticism were associated with lower patient dietary and exercise adherence through (1) higher levels of depression symptoms (for patients' neuroticism) and negative affect (for spouses' neuroticism), and (2) lower levels of couple-level diabetes efficacy. CONCLUSIONS: The results from this study provide evidence that both patient and spouse personality traits are associated with patient dietary and exercise adherence through increased emotional distress-albeit different emotional pathways for patients and spouses-and lower couple confidence in the patients' ability to manage their diabetes.

A dyadic multiple mediation model of patient and spouse stressors predicting patient dietary and exercise adherence via depression symptoms and diabetes self-efficacy.

Using dyadic data from 117 married couples in which one partner was diagnosed with Type 2 diabetes, the purpose of this study was to determine whether a number of specific patient and spouse stressors (chronic life stress, diabetes-specific stress, and physical health stress in the form of the number of comorbidities) were associated with Type 2 diabetes patients' dietary and exercise adherence through two potentially modifiable patient and spouse factors-depression symptoms and diabetes self-efficacy. We found that patient and spouse stressors, particularly patient and spouse diabetes stress and the number of patient comorbidities, were related to patient dietary and exercise adherence through patient depression symptoms and both patient and spouse diabetes self-efficacy. These conclusions were strengthened by incorporating a number of relevant control variables in our models and by testing four alternative models which supported our proposed model. These results are important because they provide further evidence of the significant role spouses' play in managing diabetes and they provide diabetes educators and clinicians with specific targets for intervention programming.

Skip the dishes? Not so fast! Sex and housework revisited.

Using data from 1,338 couples who remained partnered over the first 5 waves of the German Panel Analysis of Intimate Relationships and Family Dynamics (pairfam) project, this study investigated longitudinal associations between male partner contributions to housework and couple sexual satisfaction and frequency. The effect of 2 housework variables was examined: male partners' share of housework and perceived fairness of male partners' housework contributions. Results from a series of autoregressive cross-lagged models revealed no direct or indirect longitudinal associations between male partner share of housework and sexual frequency or satisfaction. Rather, when male partners reported making a fair contribution to housework, the couple experienced more frequent sexual encounters, and each partner reported higher sexual satisfaction 1 year later. This study provides a robust counterpoint to recent findings suggesting that men's participation in housework is harmful to a couple's sex life.

Associations Between Family of Origin Climate, Relationship Self-Regulation, and Marital Outcomes.

Using dyadic data from 961 married couples from the Relationship Evaluation Questionnaire project, the current study explored the direct association between family of origin climate and marital outcomes and the indirect association via relationship self-regulation (RSR). Results from the actor-partner interdependence model analysis indicated that family of origin climate was positively associated with marital stability directly and indirectly via the effects of RSR and marital satisfaction for both men and women. Results suggest that the experience one has in their family of origin is associated with their marital outcomes through their RSR. Actor-partner direct and indirect effects indicate that spouses' RSR may have important consequences for both partner's evaluation of the marriage. Implications for intervention and future research are discussed.

Spousal overprotection is indirectly associated with poorer dietary adherence for patients with type 2 diabetes via diabetes distress when active engagement is low.

OBJECTIVES: The current study sought to explore the indirect association of spousal overprotection on patient dietary adherence through the mechanism of diabetes distress and whether the link between overprotection and diabetes distress was moderated by spouse active engagement. METHOD: Participants were 117 married couples in which one member had been diagnosed with type 2 diabetes and were recruited from a patient registry at a Midwestern (USA) medical centre. Data were gathered from spouses and patients through a self-report survey instrument. The research questions were answered with structural equation modelling using the latent moderated structural equations (LMS) approach and dyadic data analytic procedures. RESULTS: Overprotection was associated with reduced dietary adherence indirectly via increased diabetes distress only at low levels of active engagement. The proposed model also proved superior when compared to two plausible alternatives. CONCLUSIONS: These findings highlight the importance of understanding the nuanced associations among the different ways spouses cope with illness to achieve better diabetes outcomes and the mechanisms responsible for linking coping and dietary adherence. Statement of contribution What is already known on this subject? Spousal coping behaviour can influence dietary adherence among patients diagnosed with type 2 diabetes, positively and negatively. Spouses simultaneously engage in different ways of coping with partner illness, but little is known about the interactive nature of coping styles or possible mechanisms that might link coping with illness outcomes. What does this study add? Spousal overprotection is only associated with reduced patient dietary adherence when spouses are also engaging in low levels of active engagement. Diabetes distress is an important mechanism linking spousal coping with patient dietary adherence.

Spousal protective buffering and type 2 diabetes outcomes.

OBJECTIVE: Guided by the developmental-contextual model of couples coping with chronic illness (Berg & Upchurch, 2007), the purpose of this study is to explore moderated associations between spousal protective buffering and illness outcomes for partners diagnosed with type 2 diabetes (dietary adherence, frequency of exercise, and HbA1c level). Patient diabetes appraisals (distress, control, self-efficacy, and consequences) were explored as potential moderators. METHODS: Participants were 117 married couples in which one member had been diagnosed with type 2 diabetes. Data were gathered from spouses and patients through a survey instrument and analyzed with path analysis. RESULTS: Protective buffering was associated with fewer days of exercise when patients reported low diabetes distress and diabetes consequences. Additionally, protective buffering was associated with higher HbA1c when patients reported high diabetes control. CONCLUSIONS: Protective buffering did not exhibit a uniform association with the type 2 diabetes outcomes. Rather, the association between spousal protective buffering and patient illness adjustment was dependent on patient appraisal of the illness. These findings contribute a nuanced addition to the literature documenting the role of couple coping in chronic illness management and also provide impetus for further, longitudinal investigation of the ways healthy spouses cope with partner illness.

Common dyadic coping is indirectly related to dietary and exercise adherence via patient and partner diabetes efficacy.

Using cross-sectional data from 117 married couples in which one member is diagnosed with type 2 diabetes, the current study sought to explore a possible indirect association between common dyadic coping and dietary and exercise adherence via the mechanism of patient and spouse reports of diabetes efficacy. Results from the structural equation model analysis indicated common dyadic coping was associated with higher levels of diabetes efficacy for both patients and spouses which, in turn, was then associated with better dietary and exercise adherence for the patient. This model proved a better fit to the data than three plausible alternative models. The bootstrap test of mediation revealed common dyadic coping was indirectly associated with dietary adherence via both patient and spouse diabetes efficacy, but spouse diabetes efficacy was the only mechanism linking common dyadic coping and exercise adherence. This study highlights the importance of exploring the indirect pathways through which general intimate relationship functioning might be associated with type 2 diabetes outcomes.

Relationship beliefs and illness appraisals are differentially associated with specific ways of coping in spouses of patients with type 2 diabetes.

Using data from 117 spouses of patients diagnosed with type 2 diabetes and multiple-group path analysis, the current study explored the association of four relationship beliefs (satisfaction, sacrifice, confidence and instability) and four diabetes appraisals (consequences, distress, control and efficacy) with illness-specific coping behaviour: active engagement, protective buffering and overprotection. The potential moderating effect of gender was also tested. Results indicated gender did moderate the associations among the variables in the model, with the association of relationship satisfaction and active engagement being significantly stronger for men, while diabetes control was more strongly related to protective buffering for women. The only variables associated with active engagement were three relationship-specific cognitions: higher levels of relationship satisfaction (for men only), satisfaction with sacrifice and relationship confidence were all related to higher active engagement. The diabetes appraisals were the only variables associated with protective buffering and overprotection. Higher diabetes distress and diabetes control (for women only) and lower diabetes efficacy were predictive of greater protective buffering. Lower diabetes efficacy and higher diabetes control were associated with greater overprotection. Implications for theory, research and practice are discussed.

The longitudinal association of marital confidence, time spent together, and marital satisfaction.

Using three waves of dyadic data collected at 18-month intervals from a community-based sample of 610 newly married heterosexual couples (1 220 individuals), we examined the relationship between marital confidence, time spent together, and marital satisfaction using a modified actor-partner interdependence model. Results indicate that after controlling for marital satisfaction and time spent together at Time 1, marital confidence around the time of marriage was associated with marital satisfaction approximately 3 years later. In addition, marital confidence was associated with how much time husbands and wives spent together at Time 2, which was related to marital satisfaction at Time 3. Tests of the mediating paths from marital confidence to marital satisfaction trended toward significance. The results suggest the importance of assessing for relationship confidence when working with couples in the early stages of their relationship.

Immigrant and nonimmigrant women: factors that predict leaving an abusive relationship.

This research used logistic regression to test components of Choice and Lamke's (1997) two-part decision-making model and Hamby's (2008) holistic risk assessment as predictors of the decision to separate from an abusive partner, comparing significant predictors for immigrant (n = 497) and nonimmigrant (n = 808) women. Findings demonstrated that immigrant women reported higher levels of perceived risks/barriers to leaving, provided some support for the use of a holistic risk assessment in understanding women's decisions to leave, and demonstrated that immigrant and nonimmigrant women have both similarities and differences in the factors that predict leaving. Clinical and policy implications are addressed.

Attitudes toward dating violence among college students in mainland China: an exploratory study.

This study investigates attitudes toward psychological and physical dating violence among college students in mainland China (n = 245). The results of this study indicate that among our sample of college students in mainland China, men and women were relatively similar in their attitudes toward male perpetrated and female perpetrated physical dating violence and female perpetrated psychological dating violence. As has been found in previous research, men and women in our sample were more accepting of female perpetrated physical and psychological dating violence than male perpetrated physical and psychological dating violence. Finally, among several variables that predicted dating violence attitudes, shame emerged as a potentially important variable to include in future studies on dating violence in Chinese populations.

Developmental trajectories of marital happiness in continuously married individuals: a group-based modeling approach.

Most contemporary studies of change in marital quality over time have used growth curve modeling to describe continuously declining mean curves. However, there is some evidence that different trajectories of marital quality exist for different subpopulations. Group-based trajectory modeling provides the opportunity to conduct an empirical investigation of the variance in marital quality trajectories. We applied this method to analyze data from continuously married individuals from the Marital Instability over the Life Course Study (N = 706). Instead of a single continuously declining trajectory of marital happiness, we found 5 distinct trajectories. Nearly two thirds of participants reported high and stable levels of happiness over time, and the other one third showed either a pattern of continuous low happiness, low happiness that subsequently declined, or a curvilinear pattern of high happiness, decline, and recovery. Marital problems, time spent in shared activities, and (to a lesser degree) economic hardship were able to distinguish trajectory group membership. Our results suggest that marital happiness may have multiple distinct trajectories across reasonably diverse populations. Implications for theory, research, and practice are discussed.