Fostering connection: A dyadic analysis of the relationships between mattering, attachment, and mental health.

In this study, we used data from 100 heterosexual couples in a committed, romantic relationship to better understand the relationship between perceived mattering (PM) and attachment, and to explore how PM relates to various mental health and relationship outcomes. A linear mixed-effects model examining both actor and partner effects revealed that men reported lower PM in the relationship when their female partner was higher in attachment avoidance. In addition, higher levels of attachment avoidance or attachment anxiety were significantly associated with lower PM for both men and women. A dyadic path analysis model revealed that higher actor and partner PM was significantly associated with higher couple satisfaction and stronger constructive communication patterns for men and women. Stronger needs-based communication was significantly associated with stronger constructive communication for men and women, as well as lower anxiety for women.

Power dynamics in couple relationships: A review and applications for systemic family therapists.

Power dynamics, generally defined as the patterns of partners enacting or resisting influence, are inherent in all relationships. Power structures and processes play a role in people's perceptions of themselves and others, their feelings and emotions, and both their implicit and explicit behaviors. As such, understanding power dynamics is crucial for fully conceptualizing and intervening within relationships. Although power was not always given high priority in many of the early systemic family therapy models, that has changed over the years, with scholars working to address how power is manifested in relationships, how power imbalances affect relationships, and how power can be addressed more explicitly in treatment. Nonetheless, there is much additional work needed to ensure that systemic therapists have an appropriate depth of understanding regarding power dynamics to fully recognize their manifestations in relationships and then intervene appropriately. To help in these efforts, this paper aims to synthesize relational power research into a more complete description of what power is and how it is enacted in couple relationships. To do this, we introduce relevant perspectives of power not fully integrated with family therapy theories. Overall, we provide a brief history of power-oriented research in the fields of family therapy, outline couple research regarding the sources of power that can inform therapeutic case conceptualizations and interventions, describe how power is addressed in specific couple therapy models, and highlight some important clinical applications that can help systemic therapists more fully address power.

An attachment perspective on couple interaction: Helping couples signal needs clearly and respond appropriately.

Attachment theory provides some important insights into couple relationships, including highlighting the importance of communicating one's needs clearly while also having a partner who is properly attuned and appropriately responsive to those needs. The purpose of this study was to provide an initial empirical examination of the signal-response dynamic. More specifically, we used data from 63 couples to examine the efficacy (in terms of psychophysiological arousal and feelings toward their partner) of a micro-intervention designed to help couples improve their signaling and responding when compared to a seminatural condition where the discussion more closely resembled how couples interact at home. We also explored the emotional experience of participants in various signaling and responding roles. Overall, we found preliminary evidence for addressing signaling and responding dynamics. We also found evidence that emotional experience varied according to signaling or responding roles. These findings have important potential clinical implications, which we discuss in depth.

Reshaping Couple Configurations that Get in the Way of Relationship Repair and Healing.

In the context of relationship trauma, partners' reactive patterns of engagement can disrupt and derail attempts at relationship correction and healing. A circumplex typology of couple patterns of engagement in relational trauma context is defined in terms of partners' underlying views of self in relation to other (VSIRO). VSIRO is conceptualized along a continuum anchored at opposite poles by inflated (self-aggrandizing) versus collapsed (self-abnegating) VSIRO, with a balanced (egalitarian) VSIRO, characterized by accountability and forbearance, as the target position. The circumplex model delineates four problematic couple configurations-a dejected couple, a taker-enabler couple, an ultimate fighting couple, and a debtor-collector couple. Where problematic engagement occurs, therapists need to reshape couple engagement toward the balanced, egalitarian position prior to relational trauma work. Clinical vignettes depict these couples and springboard an analysis of unique needs and interventions associated with each couple configuration. Reshaping couple patterns of engagement using a circumplex model of couple configurations is an essential prerequisite to effective and ethical relational trauma work.

Randomized controlled trial of emotionally focused couple therapy compared to treatment as usual for depression: Outcomes and mechanisms of change.

This randomized controlled trial examined the effectiveness of Emotionally Focused Therapy (EFT) for depression and relationship satisfaction versus usual care (i.e., couple therapy other than EFT), and explored mechanisms of change. Mixed model trajectory analyses of 16 couples indicated EFT was associated with greater improvement in relationship satisfaction among men and women. Men receiving EFT reported greater improvements in depressive symptoms compared to usual care. Unified structural equation modeling revealed changes in relationship satisfaction preceded changes in depressive symptoms in one cluster of partners, while changes in depression preceded changes in relationship satisfaction in a second cluster. Two other clusters reported simultaneous changes in satisfaction and depression. This study provides encouraging results on the effectiveness of EFT for depression, and insight into mechanisms of change.

The Role of Sexual Communication in Couples' Sexual Outcomes: A Dyadic Path Analysis.

In a study of 142 couples, we gathered survey data to show how sexual communication influences sexual and relationship satisfaction as well as sexual and orgasm frequency. In two dyadic data path analyses, we observed the significant paths of influence that sexual communication has on sexual and relationship satisfaction, as well as sexual and orgasm frequency. Our findings revealed greater amounts of sexual communication were associated with increased orgasm frequency in women and greater relationship and sexual satisfaction in both sexes. We also observed important differences in the associations of sexual communication and general communication on satisfaction levels. With these analyses, we expand the current literature to broaden our understanding of the role that sexual communication plays in committed relationships.

The Systemic Interaction of Attachment on Psychophysiological Arousal in Couple Conflict.

Attachment in adult romantic relationships has long been linked to conflict styles. Psychophysiological measures have provided additional insight into this association by accessing less conscious and controlled responses to conflict. The aim of this study was to explore the relationship between attachment anxiety, attachment avoidance, and the interaction between attachment styles on skin conductance responses during conflict and recovery from conflict. Using dyadic analysis of 50 heterosexual couples, we found evidence of a systemic effect of attachment, where psychophysiological arousal increased when one partner had higher levels of attachment anxiety and the other partner had higher levels of attachment avoidance. Attachment avoidance was also negatively associated with increased levels of arousal. Relationship and clinical implications of these findings are discussed.

Anger Can Help: A Transactional Model and Three Pathways of the Experience and Expression of Anger.

Anger is a significant human emotion with far-reaching implications for individuals and relationships. We propose a transactional model of anger that highlights its relational relevance and potentially positive function, in addition to problematic malformations. By evolutionary design, physical, self-concept, or attachment threats all similarly trigger diffuse physiological arousal, psychologically experienced as anger-emotion. Anger is first a signaling and motivational system. Anger is then formed to affirming, productive use or malformed to destructive ends. A functional, prosocial approach to anger organizes it for protective and corrective personal and relational adaptation. In our model, threat perception interacts with a person's view of self in relation to other to produce helpful or harmful anger. Inflated or collapsed views of self in relation to other produce distinct manifestations of destructive anger that are harmful to self, other, and relationship. Conversely, a balanced view of self in relation to other promotes constructive anger and catalyzes self, other, and relationship healing. Clinical use of the model to shape healing personal and relational contact with anger is explored.

Attachment Change in the Beginning Stages of Therapy: Examining Change Trajectories for Avoidance and Anxiety.

The purpose of this study was to investigate the nature of self-reported attachment change (avoidance and anxiety) in the context of six sessions of couple therapy designed to emphasize both therapist-centered and couple-centered (i.e., enactment-based) clinical process during the beginning stages of therapy. A total of 48 couples with at least one partner who reported clinically significant relationship dissatisfaction participated in this study. Findings confirmed that some couples experience positive attachment-related change (anxiety or avoidance), while also identifying a subset of individuals who may not experience optimal levels of attachment-related change. In addition, findings point toward both differences and similarities between change trajectories for avoidance and anxiety. Finally, there was evidence that socio-demographic factors may be associated with attachment change.

Monitoring by Parents and Hypothesized Male-Female Differences in Evidence from a Nationally Representative Cohort Re-sampled from Age 12 to 17 Years: An Exploratory Study Using a "Mutoscope" Approach.

The link between adept parental monitoring (PM) and later positive behavioral and health outcomes already has motivated intervention trials, but questions remain about which specific facets and mechanisms of PM make a difference. Our current research questions concern fundamental male-female differences in PM facets as manifest in a US cohort, re-sampled each year at age 12 through 17 years during an interval from 2004 to 2009. We hypothesized emergence, by mid-adolescence, of a specific male-female difference in a "limit time with friends" (LTF) facet of adept PM, with overall PM levels held constant. The data, arranged using a "mutoscope" approach, are from six successive nationally representative independent cross-sectional sample surveys of the cohort, with each adolescent measured only once, via a multi-item PM module nested within the larger survey. Estimates and tests of male-female differences are from a "multiple indicators, multiple causes" latent structure model appropriate for complex survey data. In evidence consistent with the advance hypothesis and with PM level held constant via the model, the LTF facet generally was more relaxed for boys as compared to girls, in a difference that emerged by mid-adolescence, possibly due to greater LTF constraints for girls at mid-adolescence. This research adds to the knowledge base about male-female similarities and differences in facets of PM. As a specific PM facet, LTF might function as a mechanism suitable for deliberate intervention and as a possible specific target in "micro-trials" of new prevention research. We acknowledge limitations such as omitted variables, including social media effects, not measured in this investigation's national surveys, but of potential importance in future research on peer influence as might have more distal parenting determinants.

Diversity, social justice, and intersectionality trends in C/MFT: a content analysis of three family therapy journals, 2004-2011.

In this study, we analyzed the amount of attention given to diversity, social justice, and an intersectional approach to social inequalities over an 8-year period (769 articles) in three family therapy journals. Overall, 28.1% of articles addressed at least one diversity issue, and a social justice framework was utilized in 48.1% of diversity articles. A systemic, intersectional approach to conceptualizing and analyzing multiple social inequalities was utilized in 17.6% of diversity articles. The most common goals addressed in diversity articles, articles using a social justice framework, and articles using an intersectional approach are also identified. Findings indicate that, despite important work being carried out, more work remains to further identify how addressing diversity issues can improve client outcomes.

Risk estimates for starting tobacco, alcohol, and other drug use in the United States: male-female differences and the possibility that 'limiting time with friends' is protective.

BACKGROUND: A specific facet of parental monitoring is known as 'limiting time with friends' (LTF). Here, we aim to learn whether LTF-associated differences in adolescent risk of starting to use tobacco, alcohol, and other drugs now might be as large as observed male-female risk differences. METHODS: Data are from the US National Surveys on Drug Use and Health, with annual large scale nationally representative samples of community-dwelling civilian age 12 years and older, conducted 2002-2009. Focus is on 12-17-year-old participants, assessed via computerized self-interviews. Risk differences are estimated for all 12-17 year olds, males and females separately, and in relation to the LTF facet of parenting. RESULTS: Contingency table analyses disclose a female excess risk of initiating use of tobacco, alcohol, cocaine, opioids, and EMIRD, with male-female risk differences ranging from 0.1% (cocaine) to 1.6% (alcohol). LTF-associated risk differences were of similar magnitude for young people whose parents 'always' limit time with friends versus those with parents who are more relaxed about the LTF facet of parenting [e.g., RD=0.4% (cocaine); 1.5% (alcohol)]. CONCLUSIONS: Not just for tobacco, but also for other drugs, there now is female excess risk of extra-medical drug use. Drug-by-drug, observed LTF-associated risk differences are about the same size as the female excess risk. This evidence provides a rationale to sustain focus on the LTF facet of parenting if the goal is to enhance prevention of precocious drug involvement and to delay its onset until later in the adolescent or adult years.

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.

Emotional congruence within couple interaction: the role of attachment avoidance.

Attachment strategies refer to the conscious representations individuals make of their relationships, including the level of perceived comfort and safety that relationships offer during distressing times. From early in life, some individuals learn the coping strategy of attachment avoidance. When distressed, these individuals shut down emotionally and seek to mask what they are feeling. This represents incongruence between emotional experience and expression. Yet congruence is an important part of interpersonal relationships. In addition, incongruence has been identified as a core aspect of repressive coping, about which research has identified several potential long-term health risks. In this study, we examined the relationship between attachment avoidance and congruence between what individuals experience physiologically and what they report. A total of 63 couples completed the Experiences in Close Relationships Scale (ECR; Brennan, Clark, & Shaver, 1998) and participated in a seminatural couple interaction and an interaction with a therapist/coach. Using dyadic data analysis and multilevel modeling, we found that, while avoidance was not associated with elevated skin conductance, it was indeed associated with greater incongruence between skin conductance and reports of feelings toward one's partner. Whereas individuals lower in attachment avoidance were likely to report more negative feelings toward their partners in the context of psychophysiological distress, those higher in attachment avoidance were more likely to report positive feelings toward their partners. We discuss implications of this incongruence and its potential to adversely influence individual and relationship health. We also discuss some important clinical considerations when working to increase emotional congruence.

Facilitated disclosure versus clinical accommodation of infidelity secrets: an early pivot point in couple therapy. Part 1: couple relationship ethics, pragmatics, and attachment.

A critical and potentially polarizing decision in treating infidelity is whether facilitating partner disclosure or accommodating nondisclosure is most beneficial following private disclosure of infidelity to the therapist. Given couple distress and volatility following disclosure, understandably some therapists judge accommodating an infidelity secret both efficient and compassionate. Employing Western ethics and an attachment/intimacy lens, we consider ethical, pragmatic, and attachment intimacy implications of accommodating infidelity secrets. Issues bearing on the decision to facilitate disclosure or accommodate nondisclosure include (a) relationship ethics and pragmatics; (b) attachment and intimacy consequences; and (c) prospects for healing. We conclude that facilitating voluntary disclosure of infidelity, although difficult and demanding, represents the most ethical action with the best prospects for renewed and vital attachment intimacy.

Common pitfalls of beginning therapists utilizing enactments.

Empirical data, clinical observation, and theoretical rationales support use of enactments as a fundamental mechanism of change in relationship therapies. Yet beginning therapists may lack an adequate conceptual framework and operational training essential to effectively utilize enactments. Inadequate training may contribute to ineffective execution, and in turn to negative results, which could lead to abandonment of enactments. This study sought to identify proficiencies and nonproficiencies of beginning therapists in conducting enactments. Twenty beginning therapists from three Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE)-accredited programs were briefly trained in an indirect therapy style that incorporates enactments. Twenty-six therapist enactments were coded using a comprehensive observational measure designed to assess proficiencies and nonproficiencies in executing enactment phases, component tasks, and subcomponent operations. Results suggest that beginning therapists struggle with numerous clinical operations conceptually linked to the successful engagement of relationships in marriage and family therapy. In light of these findings, specific recommendations for additional enactment training in COAMFTE-accredited programs are offered.

The effect of proxy voice intervention on couple softening in the context of enactments.

In this study we evaluated the effectiveness of proxy voice (therapist acting as client's "voice") intervention, embedded within couple enactments, on client-perceived softening. The primary research question was whether use of proxy voice would be more likely to bring about softening, or if its use was counterintuitive to enactment conceptualization and would elicit struggle behavior (e.g., withdrawal or negativity). Results indicate that proxy voice has a significant, positive association with softening and is inversely related to withdrawal or negativity. Preliminary findings suggest that proxy voice intervention embedded within a fluid, carefully delineated, and discriminating model of enactments effectively facilitates essential elements of couple interaction (expression of primary affect and articulation of self-concept and attachment threats) while promoting self-reliant couple interaction and increased softening.