I and thou in dialogue: Becoming more relational in couple therapy.

Couple therapists have the unique and challenging opportunity of helping people find deeper connection in their intimate relationships. These clinicians apply therapeutic models and interventions designed to help couples. However, many of these models are derived from theoretical, scientific, and sociocultural traditions that conceptualize human phenomena as individualistic and reductionistic, and the language in these theories may not match clients' experiences, which include deeply relational phenomena such as love and loss. We review how Western scientific and sociocultural traditions have shaped conceptualization of problems and clinical intervention in couple therapy. In contrast, we provide an alternative, strongly relational framework for couple therapy that draws upon philosophical perspectives asserting that relational, rather than individual, experience is fundamental in human interaction. These ideas provide relational language which can influence how couple therapy is viewed and enacted. Specifically, we discuss how a strongly relational approach changes how therapists understand and intervene with conflict, abuse, love, and deception. This relational framework can help couples in their own goals to become more unified. Implications for the therapeutic relationship, interventions, and scholarship are provided.

Justifying by degrees: A grounded theory of men's decision-making process in infidelity.

Infidelity is a common reason couples seek therapeutic help as betrayed partners are often hurt and dismayed by their partners' decision to engage in an extradyadic relationship. Despite its common occurrence, there are very few empirical studies of the decision-making process behind infidelity. To address this gap, the current study used grounded theory, a qualitative approach commonly used to develop theories from participants' experiences, to explore men's processes in deciding to engage in infidelity. Analysis of interviews with participants (n = 13) resulted in a grounded theory of decision-making by cisgender men who participated in infidelity while in a committed, heterosexual relationship. The results suggest that the decision involves a continuous process of justification and rationalization. Major categories of the theory include the preaffair context, snowballing, motivated reasoning, and postaffair decisions. Clinical implications are also included.

Answering the ethical call of the other: A test of the Strong Relationality Model of Relationship Flourishing.

The philosophical framework of strong relationality has gained greater attention in scholarship and yet empirically testing models built on this important framework are rare. The present study tests predictions made by the Strong Relationality Model of Relationship Flourishing (SRM), which centers on the role of Ethical Responsiveness for relationship health. In doing so, we introduce common fate modeling as a methodological approach for strong relationality research. We used longitudinal data from 1512 couples collected as part of the German longitudinal panel study of families. Results support the Strong Relationality Model's prediction that Ethical Responsiveness (as measured by perceived partner support) positively alters the impact of stress on Gratitude-Recognition (elements of the Responsible Action domain of the SRM), which then increases couples' intimacy (an element of the Relational-Connectivity domain of the SRM). Recommendations for clinical assessment and intervention are given as well as recommendations for future research on the Strong Relationality Model.

A Mixed Methods Study of Sexual Communication in Various Couple Typologies Part II: Qualitative Content Analysis.

This study presents the second part of a mixed methods exploration of couple sexual communication. The purpose of this study was to better understand the sexual communication processes that characterize various couple typologies. A qualitative content analysis was used to examine the responses of couples who were grouped together according to the typologies developed from the cluster analysis conducted in Part I of this study (Jones & Lucero Jones, 2022). The results revealed 3 primary themes regarding sexual communication: sexual communication behaviors, sexual decision-making processes, and sexual communication outcomes. Most importantly, the 15 subthemes revealed the inner workings of sexual communication in couples of varying typologies. Clinicians may use the findings from this study to recognize communication patterns in couples that may be contributing to sexual dissatisfaction. Furthermore, the study highlights critical sexual communication behaviors and patterns for improvement and connection in the sexual relationship.

Way of being and the therapeutic pyramid: Expanding the application of a common factors meta-model.

Common factors proponents have suggested the need for principle-based meta-models to explain how various factors interact with each other to produce change. The therapeutic pyramid is a common factors meta-model that outlines how therapeutic skills and techniques, the therapeutic alliance, and a therapist's way of being interactive to produce therapeutic change. Skills and techniques occupy the smallest top portion of the pyramid, with the therapeutic alliance in the middle and a therapist's way of being forming the foundation of the pyramid. The success of any layer rests on the quality of the immediately underlying layer. This study illustrates the broad applicability of common factors meta-models by applying the therapeutic pyramid to couples therapy, family therapy, training and supervision, and professional ethics.

Clients' perceptions of marriage and family therapists' way-of-being: a phenomenological analysis.

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way-of-being, a relational concept that refers to how the therapist regards a client-either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20-33). Although this case has been made conceptually, there is little empirical research on therapists' way-of-being with clients. The primary purpose of this research is to investigate clients' perceptions of their therapists' way-of-being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists' way-of-being and (b) the influence therapists' way-of-being has on clients' engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi-structured face-to-face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way-of-being as an overarching construct for several well-established therapist factors. Clinical and training implications are discussed.

Treating systemic issues in families affected by cystic fibrosis: A solution-focused approach.

Cystic fibrosis (CF) presents with various symptoms that impair day-to-day functioning and require lifelong treatment. Due to the chronic and severe nature of this disease, families are often impacted by the stress associated with treatment, complications of the disease, and the understanding that their loved one will one day die from CF. This article seeks to address a perceived gap in the literature for providing a model-specific approach to address psychosocial stress in families affected by CF. We provide a rationale for using solution-focused brief therapy (SFBT) to work with this population based on its empirically supported effectiveness, versatility, and capacity to be brief in nature. We describe how SFBT interventions can be used by practitioners working with this population, present a fictitious case illustration depicting the clinical use of specific SFBT interventions, and offer suggestions for future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A 20-Year Review of Common Factors Research in Marriage and Family Therapy: A Mixed Methods Content Analysis.

Introduced by Sprenkle, Blow & Dickey (1999), common factors in marriage and family therapy (MFT) have been discussed over the past two decades. Although the MFT common factors literature has grown, there are misconceptions and disagreements about their role in theory, practice, research, and training. This content analysis examined the contributions of the common factors paradigm to MFT theory, practice, research, and training over the past 20 years. We identified 37 scholarly works including peer-reviewed journal articles, books, and chapters. Using mixed methods content analysis, we analyze and synthesize the contributions of this literature in terms of theoretical development about therapeutic effectiveness in MFT, MFT training, research, and practice. We provide commentary on the substantive contributions that the common factors paradigm has made to these areas, and we discuss the implications and limitations of the common factors literature, and provide recommendations for moving common factors research forward.

How Can I Become More Secure?: A Grounded Theory of Earning Secure Attachment.

The purpose of this study was to develop a grounded theory of earning secure attachment. This study included 15 women and 5 men who met the criteria of having a self-reported history of attachment insecurity and demonstrated evidence of earned security. The grand tour research question, How do adults with a history of insecure attachment earn security?, was explored using constructivist grounded theory and semi-structured interviews emphasizing processes of positive attachment change. The results describe a process model of change hinging on three interrelated categories: meta-conditions of positive attachment change, making intrapsychic changes, and making interpersonal changes. Clinical implications include the importance of clients committing to the process, clients working with a clinician trained in trauma-focused therapy, and clinicians being surrogate attachment figures for clients.

Marriage and Family Therapy Students' Experience with Common Factors Training.

With the increased empirical and theoretical support for common factors in the psychotherapy literature, marriage and family therapy (MFT) scholars have begun discussing the inclusion of common factors in MFT training. However, there is very little empirical research on common factors training or how to include common factors in MFT curricula. The purpose of this phenomenological study was to investigate MFT students' experience with common factors training. Seventeen master's degree students who received training in common factors participated in the study. Data was comprised of participants' journal reflections and focus group interviews on their experience learning about common factors and how this influenced their work with clients. Participants' responses to the training were overwhelmingly positive and highlighted the ways in which studying common factors enhanced their confidence, understanding of MFT models, conceptual abilities, and clinical practice. Additional results and discussion about incorporating common factors in MFT training are presented.

Common Factors' Role in Accredited MFT Training Programs.

Common factors proponents discuss the benefits and methods of including common factors in marriage and family therapy (MFT) training; yet there are no empirical investigations of how common factors are incorporated into MFT curricula. The purpose of this study was to obtain a baseline understanding of common factors' role in MFT training. Thirty-one directors of COAMFTE- and CACREP-accredited MFT training programs responded to a survey about the inclusion of common factors in their training program, as well as the benefits, challenges, and students' reactions to common factors training. Findings show that common factors are regularly included in MFT training programs and have garnered largely positive responses. Additional results are discussed regarding the implications of common factors in MFT training.

The therapeutic pyramid: a common factors synthesis of techniques, alliance, and way of being.

Common factors in therapy such as the therapeutic alliance and client motivation have been found to account for more change than therapy models. But common factors have been critiqued as only lists of variables that provide little practical guidance. Some researchers have demonstrated that certain common elements (e.g., the therapeutic alliance) account for more variance than others (e.g., techniques), suggesting that some factors should be emphasized over others. Such findings suggest the need for alternatives to model-based therapy, with one alternative being meta-models, or "models of models," that focus on how therapeutic factors interact with each other to produce change. The purpose of this article is to propose a meta-model describing the relationship between two specific common factors-the therapeutic alliance and interventions. We also propose a new factor-a therapist's way of being-that we believe is foundational to effective therapy. The model is proposed in pyramid format, with techniques on top, the therapeutic alliance in the middle, and therapist way of being as the foundation. The hierarchical relationships between these three concepts are discussed, along with implications for training, research, and therapy.

Appraisal distortions and intimate partner violence: gender, power, and interaction.

In relationships characterized by control, abuse, or violence, many appraisal distortions occur including denial and minimization. However, the nature of the distortion varies depending on the individual's role in the relationship (i.e., abuser or victim). Reducing these distortions is an important component in treatment success and involves accepting responsibility for actions and attributions. This study used constructivist grounded theory methods to explore the following questions: (1) What are the types of distortions that are used by individuals who have been in violent or abusive relationships? (2) What are the gender and power differences in the appraisal distortions used? (3) What are the functions and interactions of the distortions in the relationship dynamics? Qualitative analysis of interviews with 29 individuals who had been in abusive relationships found that there were several types of distortions used by participants, but there were differences in the function of the distortion, depending on the individual's role in the abuse. These generally corresponded to power and gender, where the male as perpetrator used different distortions (or used similar distortions for different reasons) than did the female as victim. Suggestions for research as well as treatment implications for both offenders and survivors of abuse are given.

Integrity of the marriage and family therapy research literature: perceptions and recommendations.

Reports of falsification, fabrication, plagiarism, and other violations of research integrity across the sciences are on the increase. Joining with other disciplines to actively protect the integrity of the marriage and family therapy (MFT) research literature is of utmost importance to both the discipline and the future of the profession. To inform the issues raised, results are presented of an informal survey among MFT clinical members on their perceptions about the literature together with their preferences for how best to protect its integrity. This article initiates an important discussion about the honesty of MFT research.

"Languaging" factors affecting clients' acceptance of forgiveness intervention in marital therapy.

Forgiveness is a significant intervention for healing interpersonal injury. Yet therapists do not often use forgiveness intervention. Employing a semantic perspective and a survey design (n = 307), this study investigated whether the language used to rationalize forgiveness intervention (set at five levels: personal growth, relationship reconciliation, spiritual issue, others' growth, and pardoning/condoning) may affect its acceptability. Gender, problem type, and choice were also included in the analyses. Overall, forgiveness was found to be an acceptable intervention. A pardoning/condoning rationale led to significantly lower acceptability ratings. Other results are discussed. We conclude that therapists should be less apprehensive about using forgiveness, but need to inform themselves better concerning its purpose, process, and articulation.