Digging Deeper: An Object Relations Couple Therapy Update.

Over the past two decades, neurobiology research has added clarity to the process of emotional and behavioral change. In turn, this has led to endorsement of interventions that appear to be most helpful in individual and couple therapy. In addition to research on emotional dysregulation, contemporary studies have focused on the construction of meaning and its relevance to interpersonal relationships. According to Lisa Barrett, Richard Lane, and others, the brain references concepts to rapidly arrive at the most probable conclusions. Encoded experience and memory fragments guide this process and are vital in understanding partners' emotional responses. These findings support an object relations perspective that emphasizes the importance of past relational experiences that inform the present. This is particularly relevant in work with couples, as each individual's beliefs, expectations, and capacity for intimacy are invariably tied to earlier relationships. Research findings on memory reconstruction provide a basis for interventions that can add to the existing treatment approach, as it is suggested that working in a specific way with emotionally based memories has the potential to modify and reduce their predictive power and ability to unleash beliefs and behaviors that work against intimacy. The therapist who is informed by emerging neuroscience research can better uncover and actively work with memories that may be compromising a couple's relationship.

Durante las últimas dos décadas, la investigación sobre neurobiología ha aclarado el proceso de cambio emocional y conductual. A su vez, esto ha conducido a la aprobación de intervenciones que parecen ser más útiles en la terapia individual y de pareja. Además de la investigación sobre la desregulación emocional, algunos estudios contemporáneos se han centrado en la construcción de significado y su relevancia para las relaciones interpersonales. De acuerdo con Barrett (2018), Lane (2015) y otros, el cerebro nombra conceptos para llegar rápidamente a las conclusiones más probables. La experiencia codificada y los fragmentos de recuerdos guían este proceso y son fundamentales para comprender las respuestas emocionales de las parejas. Estos hallazgos respaldan una perspectiva de la relación de objetos que enfatiza la importancia de las experiencias relacionales anteriores que respaldan el presente. Esto es particularmente relevante en el trabajo con parejas, ya que las creencias, las expectativas y la capacidad de intimidad de cada persona están invariablemente ligadas a relaciones anteriores. Los resultados de las investigaciones sobre la reconstrucción de la memoria ofrecen una base para las intervenciones que puede potenciar el método de tratamiento existente, ya que se sugiere que trabajar de una forma específica con recuerdos basados en las emociones tiene el potencial de modificar y reducir su poder predictivo y su capacidad de desatar creencias y conductas que funcionan en contra de la intimidad. El terapeuta que se base en la investigación emergente sobre neurociencia podrá descubrir mejor y trabajar activamente con recuerdos que pueden estar comprometiendo una relación de pareja.

Maintenance of Gains in Relationship and Individual Functioning Following the Online OurRelationship Program.

In the United States, more than 40% of marriages end in divorce and more than one third of intact marriages are distressed. Unfortunately, only a minority of couples seek couple therapy to improve their relationships. Online interventions, with their increased reach and reduced costs, offer the potential to improve relationships nationwide. The online OurRelationship program has been shown in previous nationwide studies to improve relationship and individual functioning. The present study examined whether initial gains in the OurRelationship program were maintained in the following year and whether the extent of maintenance varied across important demographic and individual factors. In this study, 151 distressed heterosexual couples (302 individuals) who were randomized to the OurRelationship program were assessed 3 and 12 months following the intervention. Initial gains in relationship satisfaction, relationship confidence, and negative relationship quality were maintained through 12 months; positive relationship quality significantly improved over follow-up. Furthermore, couples maintained their initial gains in depressive symptoms, perceived health, work functioning, and quality of life; anxious symptoms continued to significantly decrease over follow-up. Finally, there was no evidence that historically underserved groups-racial/ethnic minorities, lower income couples, or rural couples-experienced greater deterioration. In fact, Hispanic couples reported continued improvement in relationship confidence and negative relationship quality in the 12 months following the program. The ability of the OurRelationship program-an 8-hour, primarily self-help program-to create long-lasting improvements in distressed relationships indicates it may have the potential to improve the lives of distressed couples on a broad scale.

Integrative Systemic Therapy: Lessons on Collaboration and Training for the 21st Century.

The field of couple, marital, and family therapy (CMFT) is at an important juncture of identity development and synthesis. Integrative Systemic Therapy (IST) is a problem-centered metaframeworks approach that meets the growing needs of family therapists working with diverse and complex family systems and restores the field to its original focus on collaboration. This paper describes the process by which IST developed featuring anecdotes from live interviews with the founders. We briefly outline IST's theoretical pillars and the essential way IST practitioners deliver treatment including a blueprint for therapy. Finally, we propose that IST is a comprehensive, systemic guide uniquely beneficial to CMFT training and discuss our approach to integrating IST into our training of students in a COAMFTE accredited program.

25 years of systemic therapies research: progress and promise.

OBJECTIVE: In this article we describe and assess the state of the science on systemic psychotherapies. In the quarter century since the first issue of Psychotherapy Research was published, considerable progress has been made. There is an increasingly solid evidence base for systemic treatments, which includes a wide range of approaches to working conjointly with couples and families. Moreover, there are exciting new developments that hold promise for explicating the dynamic processes of therapeutic change in couple and family systems. METHOD: We begin by explaining how we view "systemic therapies" as different from individual approaches and then summarize what we have learned in the past 25 years about this set of treatments, how we have learned it, and what we have yet to learn. RESULTS AND CONCLUSIONS: We consider current trends in research on outcomes and change process mechanisms, and end with speculations about what lies ahead in the interrelated domains of systemic research and practice.

Translation of Integrative Behavioral Couple Therapy to a web-based intervention.

Couple therapy-across a number of different theoretical approaches-has been shown to be an effective treatment for a variety of individual and relationship difficulties. Moreover, recent studies have demonstrated that the effects of several approaches last at least 2-5 years after the end of treatment. However, couple therapy has a critical limitation: most distressed couples--including those who eventually divorce--do not seek couple therapy. Thus, although we recognize there are notable advances in the treatment approaches described in this special section, we argue that traditional approaches to couple therapy need to be supplemented by alternative interventions before we can make a profound, population-level impact on relationship distress and divorce. To this end, we translated Integrative Behavioral Couple Therapy into a self-help, web-based program-www.OurRelationship.com. Through a combination of tailored feedback, filmed examples, and interactive education, the online program first helps couples identify a core problem in their relationship. The program then assists partners in coming to a new and more accurate understanding of the problem they jointly identified and subsequently brings them together in a structured conversation to share their new understandings with each other. Finally, based on this shared conceptualization, the program supports couples in making concrete changes in their relationship. In this article, we discuss the rationale for the program, describe the core components of the website, and illustrate these components with a case example. Relative advantages and disadvantages compared with traditional couple therapy are presented.

Behavioral couples therapy for substance abusers: where do we go from here?

Behavioral couples therapy (BCT) is an evidence-based family treatment for substance abuse. The results of numerous investigations over the past 30 years indicate that participation in this treatment by married or cohabiting substance-abusing patients, compared with more traditional individual-based interventions, results in greater reductions in substance use, higher levels of relationship satisfaction, greater reductions in partner violence, and more favorable cost outcomes. This review examines the rationale for using BCT, the empirical literature supporting its use, methods used as part of this intervention, and future research directions.

Current status and future directions in couple therapy.

Couple therapy research affirms that various approaches to couple treatment produce statistically and clinically significant improvement for a substantial proportion of couples in reducing overall relationship distress. Recent studies have extended these findings in indicating the effectiveness of couple-based interventions for a broad range of coexisting emotional, behavioral, or physical health problems in one or both partners. In contrast to these encouraging results, research also indicates that a sizeable percentage of couples fail to achieve significant gains from couple therapy or show significant deterioration afterward. Research on processes of change and predictors of treatment outcome in couple therapy provides preliminary evidence regarding factors potentially contributing to variable treatment response. The chapter concludes with 12 recommendations regarding future directions in couple therapy research and clinical training.

The "coming of age" of couple therapy: a decade review.

This article overviews significant developments in couple therapy over the last decade. Key trends include: (1) couple therapy becoming firmly established as the accepted treatment of choice for couple problems, (2) the blossoming of the science of relationships, (3) strong evidence supporting the effectiveness of couple therapy both for relationship problems and DSM disorders, (4) greater understanding of the ramifications of gender, (5) new respect for the diversity of family forms, (6) increased accent on the role of emotion, (7) the influence of postmodernism, (8) greater recognition of couple violence, and (9) the move toward integration across models of treatment.

Clínica da família e do casal: tendências da demanda contemporânea / Family and couple clinic: tendences of contemporary demand

O trabalho procura abordar as tendências atuais da demanda na clínica do casal e da família. Enfatizam-se as transformações sociais ocorridas nas últimas décadas e suas conseqüências para a estrutura e a dinâmica da família e do casal. Na tentativa de caracterizar a demanda clínica, ressaltam-se algumas questões e algumas configurações conjugais e indivudualidade e conjugalidade, famílias recasadas, famílias monoparentais, casais e famílias com crianças com sintomas, casais homossexuais (AU)

The ongoing evolution of behavioral couples therapy: retrospect and prospect.

Behavioral couples therapy (BCT) was first described thirty years ago, and the conceptual basis of the approach has been evolving ever since. Whilst BCT in its current form is a well established treatment for relationship problems, there are significant limitations to its efficacy, and there are a number of new developments intended to enhance the efficacy of the approach. Currently BCT primarily is a skills training therapy, targeting change in couple's interactions to promote greater relationship satisfaction. Current developments focus on broadening this traditional emphasis on changing couple interactions to greater attention to reducing negative emotional responses to partner behaviors (increasing acceptance), and increasing self-directed personal change efforts. Future developments of BCT are likely to pay greater attention to different types of couple interaction which are associated with sustained relationship satisfaction, the individual vulnerabilities partners bring to relationships, and the environmental stresses impinging upon the couple.

Behavioral couples treatment of alcohol and drug use disorders: current status and innovations.

Research suggests that Behavioral Couples Therapy (BCT), tailored to treat alcohol problems, produces significant reduction in alcohol consumption and improvement in marital functioning. Having established basic clinical protocols for Alcohol Behavioral Couples Therapy (ABCT) and provided support for their efficacy, clinical researchers around the country continue to develop and study new applications of the basic ABCT treatment models, such as adding relapse prevention or Alcoholics Anonymous components. Recent research supporting the heterogeneity in the population of individuals with alcohol problems has prompted some researchers on ABCT to consider additional adaptations of the treatment models for specific subgroups of alcoholics, and for particular individual and couples characteristics. Adaptation of ABCT to treat new populations such as drug abusers, female alcoholics, and problem drinkers is under investigation. The current article provides an overview of theoretical and clinical aspects of ABCT, and research on efficacy of the basic model and on areas of innovation and adaptation to new populations. Directions for future research on ABCT are suggested.

The enhancement of traditional behavioral couples therapy: consideration of individual factors and dyadic development.

There has been little effort by behavior therapists to develop couple interventions that view marriage from a content-relevant or developmental perspective. Consequently, we have delineated ways in which a perspective of intimate relationships including individual factors and dyadic development might guide the enhancement of traditional behavioral couples therapy (TBCT) with novel and improved techniques that will ultimately allows us to reach a wider range of distressed couples than our current interventions allows. Specifically, we examined the potential benefits to intervention that could occur by considering the impact of individual factors on relationship quality, using the literature on attachment patterns as an example. Further, we have discussed the potential gains to couple interventions that could occur by considering the impact of dyadic development on relationship satisfaction. We first addressed gradual changes in marriage, using intimacy as an example. Next we examined "stage of marriage" issues, using child behavior problems as an example. Finally, we considered whether or not a problem was chronic. Throughout, we have proposed utilizing TBCT as a starting point, and considering ways to enhance TBCT specifically, as it is the marital therapy for which we have the most information and empirical support.

Changes in premarital counseling as related to older cohorts of married couples.

Within a sample of 256 current and former members of the Christian Church (Disciples of Christ), it was found that the longer the time since husbands or wives had married, the less likely they were to report that premarital counseling had been available and voluntary, that it involved more hours of training, and that they had participated in it. However, the reported effectiveness of their premarital counseling experience was not significantly related to years since marriage. It is possible that even though the quality of premarital counseling may have improved over time, the challenges and complexity of marriage may have changed at a similar rate, resulting in no net change in the perceived effectiveness of such interventions.