Recruitment strategies in couple intervention studies: A systematic review of recruitment methods and sample characteristics in the United States from 2015 to 2020.

Including diverse participants in couple intervention studies is critical for developing an evidence base that informs best practices for all potential clients. Research has shown that subgroups of clients respond differently to different interventions and that interventions that have been adapted to fit the needs of a given population are more effective than non-adapted interventions. Unfortunately, couple intervention samples often exclude participants with marginalized identities and culturally adapted couple intervention research is limited. The lack of information about best practices for diverse client subgroups perpetuates mental and relational health disparities. We conducted a systematic review to examine recruitment strategies and sampling characteristics of diverse races/ethnicities, incomes, ages, and sexual identities. We reviewed articles published between January 2015 and December 2020. Articles were eligible for inclusion in our review if they implemented an intervention with couples in the United States. Of 4054 articles identified, 54 articles were eligible for our review. Findings suggest that couple intervention studies lack diversity across multiple identity domains (i.e., races/ethnicities, incomes, ages, and sexual identities). Further, descriptions of recruitment strategies are often vague, limiting opportunities to better understand methods used to recruit diverse samples.

Gendering of care and care inequalities in couple therapy.

Reciprocal partner or spousal caregiving in romantic relationships has been identified as a key determinant of the quality of couple relationships. In this article, we interrogate this premise concerning the presumed reciprocity of caregiving in romantic relationships, focusing on cisgender heterosexual relationships and offering implications for relationships of all genders and sexualities. Looking beyond the conventional focus on individual or dyadic processes, we theorize imbalances in care as gendered. Feminists have repeatedly critiqued gender ideology that devalues caring labor and allocates it to women. Gendered power dynamics can lead to imbalances in care-seeking and care provision. We discuss how the gendering of care and care inequalities can manifest in couple therapy, illustrating with examples from recorded interactions. Implications for therapy practice are discussed.

A randomized trial of relationship education using Within Our Reach for economically vulnerable couples.

Couples relationship education is grounded in teaching couples' skills and strategies to form and sustain healthy relationships. The purpose of this investigation was to examine the impact of a relationship education intervention on emotion regulation, individual distress, dyadic coping, and relationship adjustment utilizing a randomized control trial for economically vulnerable couples. The analysis sample included 1418 couples (2836 individuals) who were randomly assigned to receive the 12-h Within Our Reach curriculum immediately, or to a wait-list control group. We estimated multilevel growth curve models over time among outcomes between treatment and wait-list control conditions. Treatment group couples demonstrated statistically significant improvements over the 6-month study period on emotional regulation and dyadic coping when compared to their wait-list group counterparts. Although models showed improvements in individual distress and relationship adjustments, these improvements did not amount to statistically significant group differences. Implications and limitations are also noted.

The Couple Therapist as Moral Agent.

Partners in intimate relationships rely on each other to meet essential emotional needs. This mutual dependence creates reciprocal obligations, engendering a moral dimension to intimate relationships. This moral dimension involves questions of fairness, equity, and justice which are often central to couples' presenting complaints in treatment. This paper proposes that moral considerations in couple therapy are not only inevitable, but potentially beneficial, and illustrates how they can inform the therapist's case conceptualizations and interventions. This paper will also explore the therapist's responsible use of her moral influence through an examination of personal values. This paper utilizes concepts from psychodynamic and family systems theory to illustrate key points, but the ideas presented apply to therapists with diverse theoretical orientations.

Cada integrante de una relación amorosa confía en el otro integrante para satisfacer necesidades emocionales esenciales. Esta dependencia mutua crea obligaciones recíprocas, generando un aspecto moral de las relaciones amorosas. Este aspecto moral implica cuestiones de honestidad, equidad y justicia, que generalmente están en el centro de las quejas que presentan las parejas en tratamiento. En el presente artículo se propone que las consideraciones morales en la terapia de pareja no son solamente inevitables, sino posiblemente beneficiosas, y se ejemplifica cómo pueden respaldar las conceptualizaciones y las intervenciones en el caso del terapeuta. En este artículo también se analizará el uso responsable del terapeuta de su influencia moral mediante un análisis de los valores personales. También se emplean conceptos de la teoría de sistemas psicodinámica y familiar para ejemplificar puntos clave, pero las ideas presentadas les incumben a terapeutas con orientaciones teóricas diversas.

Sociocultural Attunement to Vulnerability in Couple Therapy: Fulcrum for Changing Power Processes in Heterosexual Relationships.

Increasingly, couple therapists are called to promote equity in their clinical practice, yet little research illuminates the intricacy of doing this work. The purpose of this study was to clarify the clinical processes involved when therapists facilitate a more equitable balance of power in couple relationships while utilizing a sociocontextual frame of reference. It is part of larger research explicating Socio-Emotional Relationship Therapy (SERT), an approach that places equity and social justice at the core. The sample included 72 SERT sessions with nine heterosoexual couples in which there was an observable power difference between partners. Using Charmaz's (2014, Constructing grounded theory: A practical guide through qualitative analysis, Sage) grounded theory coding, theoretical sampling, and interpretive methods, we examined therapist/client responses over multiple sessions to explain shifts in the couples' power balance. Analysis identified sociocultural attunement to vulnerability as the core clinical process and detailed five sociocultural expressions: socialized vulnerability, socialized invulnerability, reactive (in)vulnerability, reactive vulnerability, and shared vulnerability. Shifts in power involved each of three therapist stances: (a) identification of the societal power context of vulnerability, (b) therapist leadership and responsive persistence, and (c) facilitating mutual sociocultural attunement to vulnerability to promote shared relational responsibility and influence. Implications address the connections between power and vulnerability in couples work and what therapists can do to more effectively facilitate relational equity.

Cada vez más, se exige a los terapeutas de pareja que promuevan la igualdad en su práctica clínica, sin embargo, existen pocas investigaciones que diluciden la complejidad de hacer este trabajo. El propósito de este estudio fue aclarar los procesos clínicos implicados cuando los terapeutas facilitan un equilibrio de poder más equitativo en las relaciones de pareja y a su vez utilizan un marco de referencia sociocontextual. Este estudio forma parte de una investigación más extensa que expone la terapia relacional socioemocional, un método que ubica a la igualdad y a la justicia social como ejes centrales. La muestra incluyó 72 sesiones de terapia relacional socioemocional con nueve parejas heterosexuales en las cuales había una diferencia de poder visible entre los integrantes de la pareja. Utilizando la codificación en la teoría fundamentada, el muestreo teórico y los métodos interpretativos de Charmaz (2014, Constructing grounded theory: A practical guide through qualitative analysis, Sage), analizamos las respuestas de los terapeutas/los pacientes durante varias sesiones para explicar los cambios en el equilibrio de poder de las parejas. El análisis identificó la adaptación sociocultural a la vulnerabilidad como proceso clínico principal y detalló cinco expresiones socioculturales: la vulnerabilidad socializada, la invulnerabilidad socializada, la (in)vulnerabilidad reactiva, la vulnerabilidad reactiva y la vulnerabilidad compartida. Los cambios en el poder implicaron cada una de tres posturas del terapeuta: (a) identificación del contexto de vulnerabilidad del poder social, (b) liderazgo del terapeuta y persistencia receptiva, y (c) facilitación de la adaptación sociocultural mutua a la vulnerabilidad para promover la responsabilidad y la influencia relacionales compartidas. Las implicancias abordan las conexiones entre el poder y la vulnerabilidad en el trabajo de las parejas y qué pueden hacer los terapeutas para facilitar más eficazmente la igualdad relacional.

The Black Lives Matter Movement: A Call to Action for Couple and Family Therapists.

The frequent police killings during the COVID-19 pandemic forced a reckoning among Americans from all backgrounds and propelled the Black Lives Matter movement into a global force. This manuscript addresses major issues to aid practitioners in the effective treatment of African Americans via the lens of Critical Race Theory and the Bioecological Model. We place the impacts of racism on Black families in historical context and outline the sources of Black family resilience. We critique structural racism embedded in all aspects of psychology and allied fields. We provide an overview of racial socialization and related issues affecting the parenting decisions in Black families, as well as a detailed overview of impacts of structural racism on couple dynamics. Recommendations are made for engaging racial issues in therapy, providing emotional support and validation to couples and families experiencing discrimination and racial trauma, and using Black cultural strengths as therapeutic resources.

Las frecuentes muertes a manos de la policía durante la pandemia de la COVID-19 obligaron a los estadounidenses de todos los orígenes a hacer una evaluación e impulsaron el movimiento Black Lives Matter hasta convertirlo en una fuerza mundial. Este manuscrito aborda las cuestiones principales con el fin de ayudar a los profesionales en el tratamiento eficaz de los afroestadounidenses desde la perspectiva de la teoría crítica de la raza y el modelo bioecológico. Ubicamos los efectos del racismo en las familias negras en un contexto histórico y describimos las fuentes de resiliencia de estas familias. Analizamos el racismo estructural incorporado en todos los aspectos de la psicología y en áreas afines. Ofrecemos un resumen de la socialización racial y de cuestiones relacionadas que afectan las decisiones de crianza en las familias negras, así como un panorama detallado de los efectos del racismo estructural en la dinámica de pareja. Se dan recomendaciones para integrar las cuestiones raciales en la terapia, brindar apoyo emocional y validación a parejas y familias que sufren discriminación y trauma racial, y usar las ventajas culturales de las personas de color como recursos terapéuticos.

Cinematherapy with African American couples.

Cinematherapy is the use of movies as an intervention with clients. When done well, it is used to evoke and process emotion, psychoeducate, increase empathy, and problem-solve. However, there is no literature on utilizing movies as an intervention with African American couples. Based on literature and research about culture-informed interventions and media literacy, cinematherapy with African American couples would be more meaningful and effective if clinicians utilize Black-oriented movies.

Group Versus Standard Behavioral Couples' Therapy for Alcohol Use Disorder Patients: Cost-Effectiveness.

OBJECTIVE: The purpose of this study was to evaluate the costs and cost-effectiveness of two treatments for 101 alcohol use disorder patients and their intimate partners--group behavioral couples' therapy plus individual-based treatment (G-BCT), or standard behavioral couples' therapy plus individual-based treatment (S-BCT). METHOD: We estimated the per-patient cost of each intervention using a microcosting approach that allowed us to estimate costs of specific components in each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of G-BCT relative to S-BCT. Immediately after treatment and 12 months after treatment, we computed incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves for percentage days abstinent, adverse consequences of alcohol and drugs, and overall relationship functioning. RESULTS: The average per-patient cost of delivering G-BCT was $674, significantly less than the cost of S-BCT ($831). However, 12 months after treatment, S-BCT participants performed better on all outcomes compared with those in G-BCT, and the calculated ICER moving from G-BCT to S-BCT ranged from $10 to $12 across these outcomes. The current findings indicated that, except at very low willingness-to-pay values, S-BCT is a cost-effective option relative to G-BCT when considering 12-month posttreatment outcomes. CONCLUSIONS: As expected, G-BCT was delivered at a lower cost per patient than S-BCT; however, S-BCT performed better over time on the clinical outcomes studied. These economic findings indicate that alcohol use disorder treatment providers should seriously consider S-BCT over G-BCT when deciding what format to use in behavioral couples' therapy.

Terapia on-line com casais e famílias: prática e formação na pandemia de covid-19 / Online therapy with couples and families: practice and training in the covid-19 pandemic / Terapia de parejas y familias on line: práctica y formación en la pandemia de covid-19

Resumo A pandemia de Covid-19 potencializou o já emergente processo de intensificação das conexões virtuais. Para terapeutas de casal e família, essa grave crise de saúde pública acarretou mudanças na forma de atender clientes e interagir com colegas, exigindo a rápida transição da modalidade presencial para a modalidade remota, em muitos casos. O presente estudo sistematizou conhecimentos sobre terapia on-line com casais e famílias, trazendo considerações para a prática e a formação profissional diante da pandemia. Por meio de revisão narrativa da literatura, foram sumarizados resultados de estudos empíricos, bem como recomendações sobre aspectos técnicos, éticos e formativos. Destacaram-se, em particular, potencialidades e desafios para a utilização de tecnologias da informação e da comunicação na prática clínica com casais e famílias, incluindo indicações e contraindicações, recursos mais apropriados e seguros, relação terapêutica on-line, capacitação e supervisão. Entende-se que a Covid-19 representa uma oportunidade para revisão e reflexão da prática clínica e da formação profissional de terapeutas de casal e família no Brasil, país em que as intervenções on-line permaneciam relativamente pouco exploradas até a pandemia.

Abstract The Covid-19 pandemic has boosted the already emerging process of virtual connections. For couple and family therapists, this major public health crisis has led to changes in the way of treating clients and interacting with colleagues, requiring rapid transition from face-to-face to remote mode, in many cases. This study systematized knowledge about online therapy with couples and families, bringing considerations for practice and professional training in the face of the pandemic. By conducting a narrative literature review, we summarized results from empirical studies, as well as recommendations on technical, ethical, and formative aspects. Specifically, we highlighted both the potential and the challenges of using information and communication technologies in clinical practice with couples and families, including indications and contraindications, more appropriate and safer resources, online therapeutic relationship, training, and supervision. Covid-19 represents an opportunity for reviewing and analyzing the clinical practice and professional training of couples and family therapists in Brazil, a country in which online interventions remained relatively little explored until the pandemic.

Resumen La pandemia de Covid-19 potenció el proceso ya emergente de conexiones virtuales. Para terapeutas de parejas y familias, esa grave emergencia de salud pública acarreó cambios en la forma de atender a clientes e interactuar con colegas, exigiendo la rápida transición de la modalidad presencial para la modalidad remota, en muchos casos. El presente estudio sistematizó conocimientos sobre terapia de parejas y familias on line, trayendo consideraciones para la práctica y la formación profesional en la pandemia. Por medio de revisión narrativa de la literatura, fueron obtenidos resultados de estudios empíricos, así como recomendaciones sobre aspectos técnicos, éticos y formativos. Se destacaron, en particular, potencialidades y desafíos para usar tecnologías de la información y de la comunicación en la práctica clínica con parejas y familias, incluyendo indicaciones y contraindicaciones, recursos más apropiados y seguros, relación terapéutica on line, capacitación y supervisión. Se entiende que el Covid-19 representa una oportunidad para la revisión y reflexión de la práctica clínica y de la formación profesional de terapeutas de parejas y familias en Brasil, donde las intervenciones on line permanecían relativamente poco exploradas hasta la pandemia.

Psicoterapia de pareja ante el descubrimiento del involucramiento del varón en actividades sexuales por Internet / Couple Psychotherapy in front of the discovery of male involvement in sexual activities on the Internet

Resumen El desarrollo tecnológico de Internet ha facilitado la conectividad entre personas con motivaciones muy diversas. Una de ellas, es acceder a contenidos sexuales y conectarse con otros que comparten este interés. El uso de internet con fines sexuales incluye una amplia gama de comportamientos, algunos de los cuales pueden generar una crisis en una relación de pareja estable y comprometida, al ser significados como una infidelidad. Las características propias del medio y de los usuarios de internet con fines sexuales, desafía a los terapeutas a adquirir nuevas herramientas psicoterapéuticas para ayudar a las parejas en conflicto. El artículo tiene por objetivo a) dar a conocer los principales conceptos vinculados al uso de internet con fines sexuales (b) describir las características del cyber affair y comportamientos significados como infidelidad (c) establecer lineamientos psicoterapéuticos para el tratamiento de este tipo de casos.

Abstract The technological development of the Internet has facilitated the connectivity between people with very diverse motivations. One is accessing sexual content and connecting with others who share this interest. The use of the Internet for sexual purposes includes a wide range of behaviors, some of which can generate a crisis in a stable and committed couple relationship, being signified as an infidelity. The characteristics of the media and Internet users for sexual purposes, challenges therapists to acquire new psychotherapeutic tools to help couples in conflict. The article aims to a) to disclose the main concepts related to the use of the Internet for sexual purposes (b) to describe the characteristics of the cyber affair and behaviors signified as infidelity (c) to establish psychotherapeutic guidelines for the treatment of this type of cases.

The Relationship Between Social Support and Family Relationships Among Low-Income Couples Attending Relationship Education.

Results are mixed for relationship education (RE) interventions with low-income couples. For couples who experienced positive changes, it is not clear what aspects of program models contributed to change. Many low-income couples attend government-funded RE with limited access to social and community resources. Program models often provide related resources complimentary to RE skill-building. We examined the relationship between income, social support, and family functioning for low-income, ethnically diverse couples (N = 856) who attended RE, as well as the mediating effects of social support on family functioning outcomes. Analyses included three separate dyadic models that examined associations among constructs at baseline and immediately following the RE intervention. Results demonstrated relationships between participants' reported social support and family functioning such that (a) social support was associated with baseline family functioning for both men and women; (b) men's baseline social support was influenced by women's baseline family functioning; and (c) men's and women's social support change score had a positive influence on their own family functioning change score. However, social support was not a significant mediator of change in family functioning. Implications for RE practice and research are also discussed.

Los resultados de las intervenciones sobre educación para las relaciones (ER) con parejas de bajos recursos son variados. En el caso de las parejas que tuvieron cambios positivos, no está claro qué aspectos de los modelos del programa contribuyeron al cambio. Muchas parejas de bajos recursos asisten a ER financiadas por el gobierno con acceso limitado a recursos sociales y comunitarios. Los modelos del programa generalmente proporcionan recursos relacionados complementarios al desarrollo de habilidades para la ER. Analizamos la relación entre los ingresos, el apoyo social y el funcionamiento familiar en las parejas de bajos recursos y étnicamente diversas (N = 856) que asistieron a la ER, así como los efectos mediadores del apoyo social en los resultados del funcionamiento familiar. Los análisis incluyeron tres modelos diádicos independientes que examinaron las asociaciones entre los constructos al inicio del estudio e inmediatamente después de la intervención sobre ER. Los resultados demostraron las relaciones entre el apoyo social informado por los participantes y el funcionamiento familiar, por lo que (a) el apoyo social estuvo asociado con el funcionamiento familiar al inicio del estudio tanto en los hombres como en las mujeres; (b) el apoyo social de los hombres al inicio del estudio estuvo influenciado por el funcionamiento familiar de las mujeres al inicio del estudio; y (c) el puntaje de cambio del apoyo social de los hombres y las mujeres tuvo una influencia positiva en su propio puntaje de cambio del funcionamiento familiar. Sin embargo, el apoyo social no fue un mediador de cambio significativo en el funcionamiento familiar. También se debaten las implicancias para la investigación y la práctica en RE.

A Comparison of Low-Income Versus Higher-Income Individuals Seeking an Online Relationship Intervention.

Compared to higher-income couples, low-income couples experience higher rates of relationship disruption, including divorce and breakup of cohabiting relationships. In recognition of this disparity in relationship outcomes, relationship interventions have increasingly been targeted at this population. However, these interventions have had limited impacts on the relationships of low-income couples. Developing interventions that are effective and responsive to the needs of low-income couples requires descriptive data on the challenges those couples perceive in their own relationships and an assessment of how their needs compare to the more affluent couples typically served by relationship interventions. The current study sampled over 5,000 individuals at the time they were seeking an online relationship intervention and compared the relationship functioning and life circumstances reported by low-income individuals to that of higher-income individuals. Results indicate that low-income individuals seeking a relationship intervention had higher levels of relationship distress (lower relationship satisfaction, more intense primary relationship problems, and less relationship stability), and had greater levels of contextual stress (more children living at home, less likely to be employed full-time, and lower levels of perceived health). Results suggest that future interventions designed to target low-income couples, as well as practitioners working with low-income couples, should be prepared to handle higher levels of relationship distress and contextual stressors than they may typically see in more affluent couples.

En comparación con las parejas de recursos más altos, las parejas de bajos recursos tienen índices altos de dificultades en las relaciones, incluidos el divorcio y la ruptura de las relaciones de convivencia. En reconocimiento de esta disparidad en las consecuencias de las relaciones, se han destinado cada vez más a esta población intervenciones en las relaciones. Sin embargo, estas intervenciones han tenido efectos limitados en las relaciones de las parejas de bajos recursos. El desarrollo de intervenciones que sean eficaces y sensibles a las necesidades de las parejas de bajos recursos exige datos descriptivos sobre las dificultades que esas parejas perciben en sus propias relaciones y una evaluación de cómo sus necesidades se comparan con las de las parejas más pudientes que normalmente reciben intervenciones en las relaciones. El presente estudio tomó muestras de más de 5000 personas en el momento en que estaban buscando una intervención en las relaciones por internet y comparó el funcionamiento de las relaciones y las circunstancias de vida informadas por personas de bajos recursos con las de personas de recursos más altos. Los resultados indican que las personas de bajos recursos que buscaban una intervención en las relaciones tenían niveles más altos de distrés relacional (una menor satisfacción con las relaciones, problemas más intensos en las relaciones principales y menos estabilidad relacional) y tenían niveles más altos de estrés contextual (más niños viviendo en la casa, menos probabilidades de estar empleados tiempo completo y niveles más bajos de salud percibida). Los resultados sugieren que las futuras intervenciones diseñadas para las parejas de bajos recursos, así como los profesionales que trabajan con estas parejas deberían estar preparados para manejar niveles más altos de distrés relacional y factores de estrés contextual que los que pueden ver normalmente en las parejas más pudientes.

Relative Cost Effectiveness of In-Person and Internet Interventions for Relationship Distress.

While the efficacy of couple therapy has been repeatedly demonstrated, most distressed couples do not seek treatment. To improve reach and overcome barriers to therapy, Integrative Behavioral Couple Therapy (IBCT) was translated into a web-based program, OurRelationship (OR). While both IBCT and OR have been shown to improve relationship and individual functioning, the goal of the present study was to compare the relative cost effectiveness of these two treatment modalities. In IBCT, 74% of couples experienced reliable improvement, compared to 55% of couples in OR. Within-group Cohen's d effect sizes during treatment for relationship satisfaction were d = 0.87 for IBCT and d = 0.96 for OR. Relative cost effectiveness analyses revealed that even at the highest expense estimates for OR and the lowest expense estimates for IBCT, OR was more cost effective in creating reliable improvement once at least 229 couples were served and was more cost effective in creating large-size effects once at least 153 couples were served. Cost-effectiveness increases for both IBCT and OR as more couples are served; however, this cost savings occurs at a much more rapid rate for OR. These findings demonstrate that despite higher initial development costs, Internet programs are a cost-effective option for dissemination either as a stand-alone service or as an initial intervention in a stepped care model with more intensive in-person services.

Si bien la eficacia de la terapia de pareja se ha demostrado repetidamente, la mayoría de las parejas con distrés no recurren a un tratamiento. Para mejorar el alcance y superar los obstáculos para la terapia, la terapia conductual integradora de pareja (IBCT) se tradujo en un programa basado en la web, denominado en inglés: OurRelationship, OR ("Nuestra relación"). Si bien tanto la IBCT (Christensen, Atkins, Berns, Wheeler, Baucom, & Simpson, 2004) como el programa OR (Doss et al., 2016) han demostrado mejorar la relación y el funcionamiento individual, el objetivo del presente estudio fue comparar la conveniencia económica relativa de estas dos modalidades de tratamiento. En la IBCT, el 74 % de las parejas experimentaron una mejora fiable en comparación con el 55 % de las parejas del programa OR. Los tamaños del efecto de la d de Cohen dentro del grupo durante el tratamiento para la satisfacción con la relación fueron d = 0.87 para la IBCT y d = 0.96 para el programa OR. Los análisis de conveniencia económica relativa revelaron que incluso teniendo en cuenta los cálculos de mayor gasto del OR y los de menor gasto de la IBCT, el OR fue más económico a la hora de crear una mejora fiable una vez que se atendió al menos a 229 parejas y fue más económico a la hora de crear grandes tamaños del efecto una vez que se atendió a, por lo menos, 153 parejas. La conveniencia económica aumenta tanto para la IBCT como para el OR a medida que se atiende a más parejas; sin embargo, estos ahorros en los costos se producen a un ritmo mucho más rápido para el OR. A pesar de tener costos iniciales de desarrollo más altos, los programas de internet son una opción económica para su difusión como servicio independiente o como una intervención inicial en un modelo de atención escalonado con más servicios intensivos en persona.

Gay, Lesbian, and Heterosexual Couples About to Begin Couples Therapy: An Online Relationship Assessment of 40,681 Couples.

We currently have little idea of precisely who goes for couples therapy. This is a report of the results of a validated online assessment of relationship and individual functioning based on 39,251 heterosexual, 1,022 lesbian, and 438 gay couples about to begin couples therapy. Using validated and reliable questionnaires of relationship and individual functioning, this report presents and compares, for each sexual-orientation, the percentage of couples, pre-therapy, who are coping with a variety of relationship problems. To test for the replicability of results, the sample was divided randomly into two subsamples and statistical tests were performed on each sample. Couples initiating therapy suffer from greater distress and many more co-morbidities than has been presumed in previous literature, and same-sex couples present a particular set of both strengths and challenges compared to heterosexual couples. Gay-male and lesbian couples were very different on trust and monogamy, as were heterosexual and lesbian couples. Based on this epidemiologically sized sample, the challenge to our field may be to create interventions with much larger effect sizes than we currently have.

International Adaptation of a Treatment Program for Situational Couple Violence.

Intimate Partner Violence (IPV) is a serious international problem. Stith, S. M., McCollum, E. E., and Rosen, K. H. received funding from the US National Institute of Mental Health to develop and test a program for couples experiencing IPV: Domestic Violence Focused Couples Treatment (DVFCT). This article provides an overview of DVFCT, and presents three case studies illustrating how DVFCT has been adapted for use in Colombia, Iran, and Finland. This article emphasizes the need for adapting treatment models to be culturally informed, provides practice-based evidence for DVFCT as a treatment model, and highlights the importance of careful screening and assessment when working with couples who have experienced violence, no matter the country or location where treatment is being conducted.

African American Couples in the 21st Century: Using Integrative Systemic Therapy (IST) to Translate Science into Practice.

The complexity of the African American community in the United States continues to evolve. The growing number of professional African Americans who grew up in the postcivil rights era combined with the persistent reminders of inequity paints a complex backdrop for understanding African American relationships. The majority of our knowledge about African American couples disproportionately comes from nonclinical social science fields such as sociology and demography. Unfortunately, the scholarly literature on how to work with African American couples is relatively scant. This paper seeks to add to this limited literature by providing clinicians and scholars with a proposed set of issues to consider when conceptualizing and treating African American couples. In particular, the complexity and nuance needed to work with African American couples are best done by using an integrative model. Thus, this paper will discuss how the Integrative Systemic Therapy (IST) model is particularly well suited for working with African American couples. This paper will summarize the science on African American marriages with a focus on salient factors such as gender, SES, and trust, which will then be translated into clinical practice by utilizing a case example. The case example will be of a middle-class couple in order to delineate the challenges and the growing heterogeneity of African Americans. The article will conclude with a commentary on the evolving heterogeneity of African Americans, which sheds light on how an integrative perspective is important for disentangling and embracing the growing complexity of African American couples.

La complejidad de la comunidad afroamericana de los Estados Unidos continúa evolucionando. El número cada vez mayor de afroamericanos profesionales que crecieron en la era posterior a los derechos civiles combinado con los recordatorios constantes de inequidad pinta un telón de fondo complejo para comprender las relaciones afroamericanas. La mayoría de nuestro conocimiento acerca de las parejas afroamericanas proviene desproporcionadamente de ámbitos de las ciencias sociales no clínicas, como la sociología y la demografía. Desafortunadamente, la bibliografía científica sobre cómo trabajar con parejas afroamericanas es relativamente escasa. Este artículo tiene como finalidad incrementar esta bibliografía limitada proporcionando a los clínicos y a los académicos un conjunto de asuntos propuestos para tener en cuenta al conceptualizar y tratar a las parejas afroamericanas. En particular, la complejidad y los matices necesarios para trabajar con las parejas afroamericanas se logran mejor usando un modelo integrativo. Por lo tanto, en este artículo se debatirá cómo el modelo de terapia sistémica integrativa (TSI) (Pinsof et al., 2017) se adapta perfectamente para trabajar con parejas afroamericanas. En este artículo se resumirá la ciencia sobre los matrimonios afroamericanos haciendo hincapié en factores prominentes, como el género, el nivel socioeconómico y la confianza, que luego se trasladarán a la práctica clínica utilizando un caso ilustrativo. El caso ilustrativo será de una pareja de clase media a fin de describir los desafíos y la heterogeneidad creciente de los afroamericanos. El artículo concluye con un comentario sobre la creciente heterogeneidad de los afroamericanos, donde se aclara cómo una perspectiva integrativa es importante para desenmarañar y aceptar la complejidad creciente de las parejas afroamericanas.

A Research Program Testing the Effectiveness of a Preventive Intervention for Couples with a Newborn.

Noxious family environments are associated with a wide range of adverse child outcomes. In order to prevent couple and parent-child relationship problems, a number of programs have been developed for couples with newborns. The current paper describes a program of research evaluating the American version of couple CARE for parents of newborns. This version of CCP was administered to low-income, unmarried couples with a new baby in an uncontrolled demonstration project (Study 1), compared with a waitlist control condition in a randomized controlled trial (Study 2), and evaluated with low-income parents recruited from urban hospitals in two major metropolitan areas of the United States (Study 3 and Study 4). Despite participant satisfaction with CCP, preventive effects of the program were limited and there was one potential iatrogenic effect. Results were likely impacted by major challenges with recruiting participants and maintaining their engagement in CCP for the duration of the program. We discuss methodological differences between this series of studies and previous trials of prevention programs and make recommendations for improving service delivery to at-risk new parents. These results have implications for public policies that aim to benefit children and families.

Los latinos de bajos recursos están expuestos a amplias desigualdades relacionadas con la salud mental en los Estados Unidos. Recientemente, un resurgimiento de relatos antiinmigratorios han llevado a los inmigrantes latinos vulnerables a sufrir considerables factores desencadenantes de estrés contextual con varias consecuencias perjudiciales para su bienestar general, por ejemplo, interrupciones significativas a sus prácticas de crianza. Dentro de este contexto de adversidad, y a pesar de los múltiples beneficios asociados con las intervenciones preventivas de capacitación para padres, la disponibilidad de intervenciones de capacitación para padres contextualmente y culturalmente relevantes siguen siendo limitadas en las comunidades latinas marginadas. Este artículo constituye un aporte a este déficit de conocimiento mediante la presentación de un modelo de aplicación de intervenciones utilizado en la difusión de versiones culturalmente adaptadas de la intervención de base factual, conocida como GenerationPMTO.© El modelo propuesto también describe un proceso de cambio que hemos documentado en la investigación empírica con padres inmigrantes latinos de bajos recursos que han estado expuestos a las intervenciones adaptadas. El manuscrito está organizado en cuatro secciones. Primero, se debate una presentación general del modelo junto con un breve resumen de teorías principales. Luego, se describen los componentes principales del modelo, complementados por la presentación de un caso práctico. Finalmente, se debaten las consecuencias para la prevención y la intervención clínica.

Social Justice and Race in the United States: Key Issues and Challenges for Couple and Family Therapy.

Social justice tends to be narrowly defined as equality without due recognition of human dignity and respect for those whose daily lives continue to be adversely impacted by race. This article seeks to explore key issues and challenges at the intersection of social justice and race for couple and family therapy. These include: (a) defining social justice; (b) diversity and inclusion; (c) power and privilege; (d) witness; and (e) personal responsibility.

Incorporating Multicultural Couple and Family Therapy Into Incarcerated Settings.

Incarceration rates have increased significantly since the 1990s, with more than two million adults in federal, state, and local facilities. More than half of the offenders report a history of mental health issues, highlighting the importance of offenders having access to effective therapeutic approaches, including individual, couples, and family counseling. Traditionally, the focus of mental health services has been individual treatment; however, family members are also significantly impacted by the offender's absence during incarceration. Incorporating family members into treatment can serve to improve relationships, leading to better outcomes at reentry and reductions in recidivism rates. Given the preponderance of persons of color in the incarcerated population, diversity issues in counseling must also be addressed. The purpose of the underlined article is to explore the implications of incorporating multicultural family therapy into incarcerated settings.

Conversations for Connection: An Outcome Assessment of the Hold-Me-Tight Relationship-Education Program, and Recommendations for Improving Future Research Methodology in Relationship Education.

The Hold Me Tight (HMT) program is a new approach to relationship education based on Emotionally-Focused Therapy (Johnson, 2004), an evidence-based approach to couple therapy. In this exploratory longitudinal research, we examined individual growth in relationship satisfaction and trust for partners in 95 couples in 16 HMT groups across four occasions of measurement: Baseline, Pre-Program, Post-Program and at either 3- or 6-month Follow-Up. We found that relationship satisfaction and trust increased during program participation, and declined during follow-up. We believe our findings provide support for the short-term effectiveness of the HMT program, and suggest a longer period of program delivery may result in improved retention of gains. Finally, we present recommendations for improving the design of future longitudinal research in relationship education.