"Ethical Care in Secret": Qualitative Data from an International Survey of Exploratory Therapists Working with Gender-Questioning Clients.

This is a mixed methods international survey of therapists (n = 89) belonging to Therapy First, an organization supporting the use of exploratory therapy, rather than gender affirmative therapy, with gender-questioning clients. The method used was an electronic questionnaire, producing a 33% response rate from members. Responses were analyzed using thematic analysis. This article reports qualitative responses relating to therapists' experiences of anxiety in working in a hostile professional environment, and their adoption of strategies to minimize risk of allegations of conversion therapy. Therapist strategies included refining existing marketing approaches to serve preferred client groups, and reliance on proven therapy models.

Marital communication skills training to promote marital satisfaction and psychological health during pregnancy: a couple focused approach.

BACKGROUND: Studies showed that decreased marital satisfaction and increased risk of depression and anxiety were mutually related. Therefore, this study was conducted to evaluate the effect of communication skills training with a couple focused approach on marital satisfaction and psychological symptoms among pregnant women. METHODS: This experimental study was performed on 60 pregnant women with low marital satisfaction who were divided into two groups of intervention and control. The women in the intervention group and their husbands participated in a communication training program based on the couple focused approach. The levels of anxiety, depression, and marital satisfaction were evaluated before and then one and three months after the intervention using valid questionnaires. RESULTS: The results indicated that after the intervention, compared to the pre-intervention period, the levels of marital satisfaction increased while the levels of depression and anxiety decreased significantly in the intervention group (p < 0.05). The comparison of the groups revealed significant differences in the scores of marital satisfaction, depression, and anxiety in the intervention and control groups at the intervals of one month and three months after the intervention (p < 0.05). CONCLUSIONS: The research findings indicated that communication skills training program based on the couple focused approach and an emphasis on the needs of pregnant women during the pregnancy can improve the marital satisfaction and psychological health of pregnant women. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT2017012932264N2, Date of registration: 2017-06-28 Retrospectively registered.

Infidelity in the Time of COVID-19.

Infidelity occurs in approximately 25% of marriages and is associated with various negative consequences for individuals (e.g., depression, anxiety, and post-traumatic stress), the couple relationship (e.g., financial loss, increased conflict, and aggression), and the couple's children (e.g., internalizing and externalizing behaviors). Infidelity is also one of the most frequently cited reasons for divorce. The increased stress brought on by the pandemic may be putting couples at an increased risk for experiencing infidelity, and data collected during the pandemic have shown that people across the United States are engaging in behaviors that are associated with a high likelihood of experiencing infidelity. The negative consequences of infidelity are also likely to be exacerbated for couples during the pandemic due to the intersection with the social, emotional, and financial consequences of COVID-19. Furthermore, couples are likely to experience disruptions and delays to the affair recovery process during the pandemic, which can negatively impact their ability to heal. Therefore, recommendations for navigating affair recovery during the pandemic, including adaptations for therapy, are also discussed.

La infidelidad se da en aproximadamente el 25 % de los matrimonios y está asociada con varias consecuencias negativas en las personas (p. ej.: depresión, ansiedad, estrés postraumático), la relación de pareja (p. ej.: pérdida económica, aumento de conflictos y agresiones) y los hijos de la pareja (p. ej.: comportamientos de internalización y de externalización). La infidelidad también es uno de los motivos de divorcio más frecuentes. El aumento del estrés que genera la pandemia puede aumentar el riesgo de las parejas de ser infieles, y los datos recogidos durante la pandemia han demostrado que las personas de los Estados Unidos están teniendo conductas asociadas con una alta probabilidad de ser infieles. Además, durante la pandemia, las consecuencias negativas de la infidelidad tienden a exacerbarse en las parejas debido a la combinación con las consecuencias sociales, emocionales y económicas de la COVID-19. Asimismo, el proceso de recuperación de la aventura amorosa tiende a interrumpirse y retrasarse durante la pandemia, lo cual puede influir negativamente en la capacidad de sanar de las parejas. Por lo tanto, también se dan recomendaciones para orientarse en el proceso de recuperación de la aventura amorosa durante la pandemia, por ejemplo, adaptaciones relacionadas con la terapia.

The EIS Model: A Pilot Investigation of a Multidisciplinary Sex Therapy Treatment.

Marital couples not experiencing a satisfying sexual relationship are less satisfied in their overall relationship. There is, however, a paucity of controlled outcome studies researching the effectiveness of sex therapy interventions. This study was a pilot investigation of a new manual-based sex therapy called the EIS (empathy, intimacy, and sexual satisfaction) model. Results showed significant improvement in sexual and marital satisfaction, marital intimacy, and verbal sexual intimacy for men and women, and sexual function for women. Effect sizes were large for these variables and posttreatment differences. Results provide initial support for the theory and interventions of the EIS model. Treatment should include addressing vulnerable communication, relational intimacy, conflict resolution, sexual functioning, sexual medicine care, and sensual and sexual skills.

Polarized Couples in Therapy: Recognizing Indifference as the Opposite of Love.

How can a couple "fall in love" and then subsequently "stumble out of love"? For centuries, this question has perplexed partners, researchers, and therapists alike. Unlike falling out of love, which may be a long-term gradual decline in love, falling in love may occur without much deliberation like the famous "love at first sight." During a developing love relationship, couples are more susceptible to ignoring a myriad of factors that will eventually influence their relationship. These ignored personal and general factors become increasingly conspicuous after the relationship is established. When facing relationship difficulties, the presence or absence of mutual love and intimacy steers the couple's relationship toward continuity or termination. Emotional indifference (which is the opposite of love) diminishes love and care; the terms marital disaffection and romantic disengagement are used synonymously to represent emotional indifference in couples. Marital disaffection is one of the central concerns of couples entering therapy. Nevertheless, spouses may enter therapy with divergent goals that may be polar opposites. Therefore, treatment of polarized or different agenda couples is challenging because disaffected spouses may be seeking counseling to break the bond at a safe venue, while their partners may still be obliviously hoping for the rebirth of their lost love. This article reviews marital disaffection/romantic disengagement and discusses counseling options for polarized couples.

Alternative or Nontraditional Sexualities and Therapy: A Case Report.

A traditionally marginalized subset of couples engage in consensual nonmonogamy (CNM: open marriage, polyamory, swinging, etc.) or alternative sexualities, such as kink or bondage/discipline, dominance/submission, and sadism/masochism. Nonmonogamous and sexually diverse individuals often experience discrimination or stigma in various domains of professional services, including mental healthcare. These cases require knowledge, skills, and awareness to provide culturally sensitive care, which is often called "kink aware therapy" or "poly-friendly therapy" within alternative sexuality communities. This article explores one application of a kink-focused and CNM-focused therapeutic framework for working with a couple who is exploring nontraditional sexualities. This case incorporates evidence-based clinical practice and identifies the limitations and significant gaps in the empirical research literature.

Outcome predictors of Internet-based brief sex therapy for sexual dysfunctions in heterosexual men.

The authors investigated whether baseline and therapy process characteristics of 82 heterosexual men participating in an Internet-based sex therapy study predict posttreatment sexual functioning. Problem severity, baseline sexual desire and baseline sexual satisfaction, but also partner problems and quality of the therapeutic relationship are predictive for sexual functioning and sexual satisfaction after finishing Internet-based sex therapy. The obtained outcome predictors could benefit men with sexual dysfunctions by tailoring online therapy programs to their individual characteristics. In addition, therapists should realize that clients suffering from erectile dysfunction or premature ejaculation in online sex therapy attach great importance to the therapeutic relationship.

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.

Methodological review of treatments for nonparaphilic hypersexual behavior.

Research on nonparaphilic hypersexual behavior has increased in recent years. In the present article, the authors conducted a methodological review of empirical studies that evaluated a treatment for nonparaphilic hypersexual behavior. The authors reviewed several characteristics of the extant studies, including the participants, research designs, treatments evaluated, assessment of nonparaphilic hypersexual behavior, and outcomes. Despite several attempts to explore treatments aimed at attenuating the symptoms of nonparaphilic hypersexual behavior, the findings from this review indicate that much of the outcome research in the field contains significant methodological limitations. The authors conclude by offering recommendations to enhance future outcome research among investigators working with hypersexual populations.

Accounting for therapist variability in couple therapy outcomes: what really matters?

This study examined whether therapist gender, professional discipline, experience conducting couple therapy, and average second-session alliance score would account for the variance in outcomes attributed to the therapist. The authors investigated therapist variability in couple therapy with 158 couples randomly assigned to and treated by 18 therapists in a naturalistic setting. Consistent with previous studies in individual therapy, in this study therapists accounted for 8.0% of the variance in client outcomes and 10% of the variance in client alliance scores. Therapist average alliance score and experience conducting couple therapy were salient predictors of client outcomes attributed to therapist. In contrast, therapist gender and discipline did not significantly account for the variance in client outcomes attributed to therapists. Tests of incremental validity demonstrated that therapist average alliance score and therapist experience uniquely accounted for the variance in outcomes attributed to the therapist. Emphasis on improving therapist alliance quality and specificity of therapist experience in couple therapy are discussed.

Hypnotherapeutic treatment for anxiety-related relational discord: a short-term hypnotherapeutic protocol.

Hypnotherapeutic interventions are currently used to treat both anxiety disorders and relational discord between couples, yet few hypnotherapeutic interventions specifically address anxiety disorders within the context of a romantic partnership. This article explores a short-term hypnotherapeutic treatment protocol designed for couples' therapy in which the relational dynamic has been impacted by one partner's anxiety disorder. Anxiety not only causes suffering for the anxious patient, but can negatively impact intimate relationships as well. The hypnotherapeutic treatment protocol advanced in this article is specifically designed to address relational discord which is fueled by the presence of one partner's anxiety, and complements more standard individual treatment for anxiety disorders. Strategies to assess for the presence of relational discord with individual patients presenting with an anxiety disorder are included, as well as implications for longer-term couples' treatment.

The influence of profession and therapy type on the treatment of sexual dysfunctions.

Sexual dysfunctions are serious mental health issues that affect an estimated 1 in 3 Americans, yet many people with sexual dysfunctions do not seek treatment. Health services research on variables related to access, barriers, costs, and outcomes of treatment may help improve the quality of care. The current research is a retrospective analysis of administrative data from CIGNA that explores whether the type of profession (i.e., psychologist, social worker, marriage and family therapist, or professional counselor) or therapy modality (i.e., individual, conjoint, or mixed-mode, a combination of individual and conjoint therapy) influence the outcomes of mental health treatment. Participants included 230 men and 189 women between the ages of 18 to 101 years from all regions of the United States who received treatment for sexual disorders from 2001 to 2006. Results indicate that outcomes are similar across the different license types. Results also suggest that mixed-mode therapy has lower dropout rates and longer retention than individual or conjoint therapy. These results suggest that using a combination of relational and individual sessions may be beneficial for the treatment of sexual dysfunctions.

New strategies in assessing, treating, and relapse prevention of extramarital affairs.

Understanding, assessing, treating, and preventing relapse of extra-marital affairs has involved significant changes in the past 10 years. This conceptual/clinical article expands on the groundbreaking work of Snyder, Gordon, and Baucom (2007), and has a special focus placed on the process of sexual recovery from an extra-marital affair. Secondly, this article focuses on the importance of creating a relapse prevention agreement. Both traditional and non-traditional agreements with regard to monogamy are described. Recognizing individual, couple, cultural, and value differences in norms and expectations exhibits a particular challenge in the study and treatment of extra-marital affairs. The clinician honors these complexities and differences by designing a treatment program that meets the needs of each couple.

Alliance and group cohesion in relationship education.

Relationship education programs have been shown as an effective way to increase relationship functioning. There is less known about how process factors, such as alliance with the leader or group dynamics, affect outcomes in these interventions. We examined group cohesion and alliance with the leader in a relationship education program tailored for individuals. Specifically, we examined whether participants' ratings (n = 126) of the group cohesion and alliance with the leader were associated with changes in relationship adjustment, relationship confidence, and communication quality from pre- to postintervention. The results demonstrated that participants' perceptions of the cohesion among the members in their relationship education group, but not the leader-participant alliance, made a significant contribution to the changes in participants' relationship functioning. These results suggest that the group dynamics among the members in the group are important ingredients in relationship education. Implications for relationship programs are provided.

Outcomes of an intensive couple relationship education program with fragile families.

Couple relationship education (CRE) has been proposed as one means to help fragile families stabilize their relationships. The current research is one of the first studies to look at the outcomes of a CRE program with fragile families in the areas of couple stability and marriage formation. Data were from the Family Formation Project, a federal and state funded program working with fragile family couples (n = 96) in a metropolitan area. A historical cohort control group quasi-experimental research design was used with a matched control group from the Fragile Family and Child Well-being Study. The intervention consisted of in-home education and support, group educational events, and social service referrals. Findings showed that couples had the same rate of couple stability as the control group but an increased rate of marriage. These findings suggest that CRE can help fragile families achieve marriage when that is their goal, but that some fragile families may need more than CRE to help them stabilize their relationship, or they may be better off separating.

Applying the creating lasting family connections marriage enhancement program to marriages affected by prison reentry.

Divorce proportions are currently high in the US and they are even higher among those who are incarcerated with substance abuse problems. Although much research has examined marital interventions, only two studies have examined marital interventions with prison populations. There is some empirical evidence that incarcerated couples benefit from traditional marital therapy (O'Farrell and Fals-Stewart, 1999, Addictions: A comprehensive guidebook, New York, Oxford University Press). An adaptation of the evidence-based Creating Lasting Family Connections program was implemented with 144 married couples, where one spouse was incarcerated, in a southern state with particularly high divorce and incarceration proportions. Results suggested that married men exposed to the program had larger improvements in some relationship skills relative to a convenience sample of men not so exposed. Both husbands and wives exposed to the program exhibited similar and significant increases in relationship skills. The results were comparable to a Prevention and Relationship Enhancement Program adaptation for inmates. The implications of the findings for prevention practitioners are discussed.

[Functioning of the marriages applying for marital therapy]. / Funkcjonowanie malzenstw zglaszajacych sie do terapii malzenskiej.

AIM: Assessment of functioning of the marriages applying for marital therapy. METHOD: The research included 44 marriages: 22 of them were qualified for the marital therapy and 22 constituted a control group - were not taking part in therapy. Participants evaluated themselves and their relation using: SCORE-15 (Systematic Clinical Outcome and Routine Evaluation), UMACL (UWIST Mood Adjective Check List), KKM (Marriage Communication Questionnaire). RESULTS: Marriages applying for the therapy, when compared with control group, showed worse general functioning, lower adaptability, more disrupted communication and were overwhelmed by difficulties in higher degree. The lower level of engagement and support, as well as the higher level of depreciating behavior were present in their communication. In this group the lower mood expressed in lower degree of Hedonic Tone and higher degree of Tense Arousal was also recorded. CONCLUSIONS: The specific functioning of marriages in crisis applying for the marital therapy is an important indication for the family therapists, in respect to their interventions during therapy process. When working with couples, it is important to consider their difficulties in communication, the tendency to depreciating each other, the lower mood and estimating the therapy as helpful and needful with simultaneous devaluating of their own styles of coping.

Trajectories of therapeutic alliance in couple versus individual therapy: three-level models.

Research concerning therapeutic alliance and outcome is prevalent but relies heavily on data from individual treatment. In this article, the authors present data from cases in which an individual was seen and cases in which a couple was seen in order to investigate differences in therapeutic alliance and its trajectory depending on case type, therapist experience, and therapist sex. Participants included 96 couples and 52 individuals with 15 therapists from a large Midwestern training clinic for couple and family therapy. Data include the use of the Working Alliance Inventory-Shortened Version, and three-level models were estimated using hierarchical linear modeling. The results highlight differences in the trajectories of individual and couple clients' therapeutic alliance, including evidence for a curvilinear trend in work scores for individual clients but not couple clients. The results also highlight differences in the sources of variation for couple cases versus individual cases. There is clearly complexity in the building of alliance with clients in general, and even more so with couple clients.

United we stand: emotionally focused therapy for couples in the treatment of posttraumatic stress disorder.

We present emotionally focused therapy (EFT) for couples as a viable treatment option for posttraumatic stress disorder (PTSD). We outline the empirical evidence of a link between interpersonal relationships and posttraumatic stress, with an emphasis on social support as a buffer for the development of PTSD symptoms. This leads into a discussion of the usefulness of attachment theory in the conceptualization and treatment of PTSD, followed by a description of the EFT approach and its empirical evidence. We present a clinical case with excerpts from EFT couple therapy sessions in which one partner was diagnosed with PTSD. The article concludes with clinical recommendations for helping people confront and overcome the pain and the fear that PTSD provokes.

Couple therapy for depression.

Relationship problems and depression often influence one another in a bidirectional, recursive fashion. Results from several clinical trials have demonstrated that couple therapy is effective in improving depression and reducing relationship problems. In this article, we describe an approach to working with depression in partnered individuals who are also unhappy in their relationship. This cognitive-behavior approach strives to (a) eliminate major stressors and reestablish positive activities in the relationship, (b) improve communication and problem solving in the relationship, and (c) solidify gains made in therapy and prevent relapse. The typical course of therapy is described and demonstrated in a case illustration. Couple therapy is a promising treatment for depressed individuals in distressed relationships.