Sexual intimacy and aging: An integrative framework to promote intimacy resilience in couple therapy.

In our work at the Intimacies Project at The Ackerman Institute for the Family we became aware of a gap in attention about sexuality and aging in the couple and family therapy field. In this article, we provide an integrative framework to guide therapists on how to address problems of sexuality and aging in the therapy room. Starting from considerations about the social context of aging and the self of the therapist, we contend that when normative sexual challenges become entangled with stigma, misconceptions about sexuality, limiting gender narratives, vulnerabilities, and defensive postures, they often result in emotional and sexual shutdowns. Through a combination of the vulnerability cycle with an expansive definition of sexuality, we demonstrate how we deconstruct impasses, disentangle normative quandaries from reactive dynamics, and help couples transform their sexual narratives. We outline how we conduct individual sessions to obtain relational sexual histories, utilize Sensate Focus as a mindful touch exercise, and help partners expand their sexual menus beyond penetration and orgasms. We also describe relational skills that may need to be strengthened to help aging couples deal with the ebb and flow of intimacy, sustaining resilience over time.

Spiritually incorporating couple therapy in practice: Christian-accommodated couple therapy as an illustration.

Spiritually incorporating couple therapy (SICT)-couple therapy that incorporates spiritual interventions-has a growing research base. Information is limited on how spiritual interventions are used in practice; thus we studied treatment-as-usual (TAU). SICT is treatment that, at a couple's request, sometimes draws upon spiritual resources when addressing relational issues. We tracked 65 couples from 29 couple therapists (who advertised as spiritually incorporating therapists) over 402 sessions of SICT. Couple spirituality predicted use of spiritual interventions more than did therapist spirituality. The most used spiritual interventions included silent prayer for the couple, discussions of hope and forgiveness, and encouragement to consult their heart. In SICT, therapists used evidence-based couple therapy approaches. SICT should (a) treat highly religious couples in high distress as being at risk for early drop out; (b) follow couples' leads in using spiritual methods; and (c) draw on evidence-based couple and spiritual practices. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Thematic analysis of therapists' experiences integrating EMDR and EFT in couple therapy: Theoretical and clinical complementarity, and benefits to client couples.

In this article, we present partial findings from a thematic analysis study that examined integrating emotionally focused therapy (EFT) and eye-movement desensitization and reprocessing (EMDR) as clinical frameworks in couple therapy. The purpose of the study is to better understand how therapists integrate EFT and EMDR therapy in their clinical work. Thirteen licensed therapists (n = 13) trained in EFT and EMDR were interviewed about their experiences integrating these two models in their couple therapy practice. The findings included in this article are related to how these models complement each other as well as the clinical benefits associated with their integration. Findings provide preliminary evidence that there are benefits and challenges when integrating both models, although we emphasize complementarity in this article. Limitations and implications for future research on the integration and efficacy of these two models are also discussed.

Thinking under fire: Mentalization-based couple therapy for high conflict and domestically abusive couples'.

BACKGROUND: The question of working psychotherapeutically with high conflict and domestically abusive couples is one that continues to raise anxieties within the field. AIMS: Embracing a relational approach offers an alternative perspective to the more familiar individual-based treatment interventions. MATERIALS AND METHODS: Drawing on my therapy with a married couple who presented in a crisis following an abusive incident, I will outline how I approached the assessment, my understanding of their presenting problem and the basis on which the therapy was conducted. RESULTS: During the eight months of treatment, the couple had frequent breakdowns in communication, and I found myself drawing on a range of mentalization-based techniques that supported and maintained the working alliance. DISCUSSION: Helping the couple break the damaging effects of the abuse, which was seriously affecting them and impacting their children, provides a particular focus for this submission. CONCLUSION: The rationale for undertaking couple therapy in situations of domestic violence and abuse was examined. The dynamic elements of theory underpinning practice, together with mentalization-based techniques designed to tackle disregulated states of mind that may lead to violent and abusive exchanges, were considered through the presentation of a case example.

The effects of psychological counseling and acupressure based on couple therapy procedure for alleviation of vomiting and nausea in pregnant women in Iran country.

OBJECTIVES: Nausea and vomiting have psychological negative effects on some pregnant women during gestation. Different strategies have been used for the treatment of nausea and vomiting during pregnancy, such as acupressure and psychological interventions. This study was conducted to evaluate the effects of psychological counseling and acupressure based on couple therapy procedures on vomiting and nausea in pregnant women in Iran. METHODS: Two hundred and eight women were divided into four groups (n=52): 1) they did not any intervention (control group), 2) they received the psychological intervention, 3) they received acupressure intervention, and 4) they received a combination of psychological + acupressure interventions. To investigate the effects of interventions on nausea and vomiting, the Rhodes index of nausea, vomiting and retching were used. The counseling period has lasted for 4 weeks. The pressure intervention on the site was conducted in clockwise form for 1 min and anticlockwise form for another 1 min. RESULTS: Groups did not have a significant difference for abortion and income (p>0.05). The effects of counseling, and acupressure interventions on severity and period of vomiting and nausea were not significant (p>0.05), but the intervention based on counseling and acupressure decreased severity of vomiting and nausea (p<0.05). CONCLUSIONS: The intervention based on counseling and acupressure could not reduce nausea and vomiting during the gestation, but the intervention based on a combination of both decreased nausea and vomiting. It can be suggested to apply an intervention based on a combination of counseling and acupressure in short-time period for decreasing nausea and vomiting in women during pregnancy.

Intimidade conjugal: papel discriminante dos níveis de mindfulness / Conjugal intimacy: discriminating role of levels of mindfulness / Intimidad conyugal: papel discriminatorio de los niveles de mindfulness

Esse estudo parte do pressuposto de que o mindfulness poderia estar relacionado com a intimidade conjugal. Investigou-se o papel discriminante da intimidade em dois grupos de indivíduos com maiores e menores níveis de mindfulness. Partiparam 281 sujeitos, maiores de 18 anos, em relacionamento estável e em coabitação. Os mesmos responderam à Escala Filadélfia de Mindfulness e à Escala de Avaliação Pessoal de Intimidade em Relacionamentos (PAIR). Os resultados indicaram que os fatores da intimidade avaliados (comunicação, validação pessoal e abertura ao exterior) discriminaram o grupo com maiores níveis de mindfulness. O estudo sugere que indivíduos com maiores níveis de mindfulness possuem maior facilidade de desenvolver intimidade em seus relacionamentos, contribuindo para o entendimento do papel considerável dessa habilidade na conjugalidade.

This study assumes that mindfulness could be related to conjugal intimacy. The discriminating role of intimacy was investigated in two groups of individuals with higher and lower levels of mindfulness. 281 subjects, over 18 years old, participated in a stable relationship and cohabitation. They responded to the Philadelphia Mindfulness Scale and the Personal Relationship Intimacy Scale in Relationships (PAIR). The results indicated that the factors of intimacy evaluated (communication, personal validation and openness to the outside) discriminated against the group with the highest levels of mindfulness. The study suggests that individuals with higher levels of mindfulness have an easier time developing intimacy in their relationships, contributing to the understanding of the considerable role of this ability in conjugality.

Este estudio asume que la atención plena podría estar relacionada con la intimidad conyugal. El papel discriminador de la intimidad se investigó en dos grupos de individuos con niveles más altos y más bajos de atención plena. 281 sujetos, mayores de 18 años, participaron en una relación estable y en convivencia. Respondieron a la Escala de atención plena de Filadelfia y la Escala de intimidad en las relaciones personales (PAIR). Los resultados indicaron que los factores de intimidad evaluados (comunicación, validación personal y apertura al exterior) discriminaban al grupo con mayores niveles de mindfulness. El estudio sugiere que las personas con niveles más altos de atención plena tienen más facilidad para desarrollar la intimidad en sus relaciones, lo que contribuye a comprender el papel considerable de esta capacidad en la conyugalidad.

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.

Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy.

This paper introduces the concept of "dissociative collusion" as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well-documented "couple collusion," describes relational unconscious dynamics where split-off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self-other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.

Este artículo presenta el concepto de "colusión disociativa" como herramienta teórica y clínica útil para comprender y trabajar con pacientes con antecedentes de trauma en la terapia de pareja. El artículo describe maneras de diagnosticar y tratar la colusión disociativa basándose en la integración de un enfoque de la relación de objeto, un enfoque relacional y un enfoque narrativo. La colusión disociativa, una versión única de la bien documentada "colusión de pareja", describe una dinámica relacional inconsciente donde los aspectos de la separación de uno o ambos integrantes de la pareja están disociados mutuamente de una manera complementaria que se vuelve parte del inconsciente compartido y se restablece de maneras destructivas. El concepto de colusión disociativa es especialmente relevante para los terapeutas de pareja que trabajan con pacientes con antecedentes de trauma, quienes con frecuencia usan la disociación como mecanismo de defensa principal. Sugerimos que el desafío y el objetivo para la terapia de pareja con esta población es ayudarlos a reconectarse y a oscilar mejor entre configuraciones disociadas del otro yo. Se presenta un caso de terapia de pareja de una esposa que había sido víctima de abuso sexual en la infancia y su esposo que demostró el uso frecuente de defensas disociativas.

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.

Intervenciones no farmacológicas para reducir síntomas depresivos en mujeres con cáncer de mama / Non-pharmacological interventions to reduce depressive symptoms in women with breast cancer

Resumen: Objetivo: Describir y discutir los resultados de las intervenciones no farmacológicas (INF) adyuvantes en el tratamiento de los síntomas depresivos entre mujeres con cáncer de mama (CaMa). Material y métodos: Se realizó una revisión sistemática sobre INF, aplicadas a pacientes con cáncer y síntomas depresivos en siete bases de datos. La revisión se limitó del 1 de enero de 2006 al 31 de diciembre de 2017 y a los idiomas inglés, español y portugués. Los descriptores médicos empleados fueron "breast neoplasm" y "depression". Resultados: Existen diversas INF que pueden estimular principalmente las dimensiones físicas o psicosociales. En este artículo se propone una clasificación basada en nueve estrategias terapéuticas identificadas, entre las que sobresalen el ejercicio, la psicoterapia y el yoga con meditación. Conclusiones: Con base en la evidencia disponible, se concluye que la psicoterapia y yoga con meditación reducen los síntomas depresivos en pacientes con CaMa. Se requiere mayor investigación para determinar la magnitud de la reducción de los síntomas depresivos, de acuerdo con su gravedad, presencia de comorbilidades y diversidad de INF.

Abstract: Objective: To describe and discuss the results of non-pharmacological interventions (NPI) adjuvants in the treatment of depressive symptoms among women with breast cancer (BC). Materials and methods: A systematic review on NPI was performed, which was applied to patients with cancer and depressive symptoms in seven databases. The review was limited from January 1, 2006 to December 31, 2017 and to English, Spanish and Portuguese languages. The medical descriptors used were "breast neoplasm" and "depression". Results: There are several NPI that are able stimulate the physical or psychosocial dimensions. In this article we propose a classification based on nine identified therapeutic strategies, among which exercise, psychotherapy and yoga with meditation stand out. Conclusions: Based on the available evidence, we concluded that psychotherapy and yoga with meditation reduce depressive symptoms in patients with CaMa. More research is needed to determine the magnitude of the reduction of depressive symptoms, according to their severity, presence of comorbidities and diversity of INF.

Current Issues in the Practice of Integrative Couple and Family Therapy.

This paper provides an overview of current issues in integration in couple and family therapy. It summarizes the evolution of integration in couple and family therapy, the various traditions in integration, the strengths of integrative approach, and the possible pitfalls involved. It highlights the extent to which most couple and family therapy is now integrative practice. It concludes with a consideration of an emerging trend toward methods of practice centered on modules of intervention that have been identified as effective with certain presenting phenomena. The example of therapy for high conflict divorce is utilized to illustrate how various components can be brought together to create a maximally effective intervention.

Este artículo ofrece un panorama de temas actuales en la integración en la terapia de pareja y familias. Resume la evolución de la integración en la terapia de pareja y familias, las diversas tradiciones en integración, los puntos fuertes del enfoque integrador, y las posibles trabas que conlleva. Resalta hasta qué punto la mayor parte de la terapia de pareja y familias se ha convertido en práctica integradora. Concluye con una consideración de una tendencia emergente hacia métodos de práctica centrados en módulos de intervención cuya efectividad con ciertos fenómenos que se presentan se ha identificado. Se emplea el ejemplo de la terapia para divorcio de alto conflicto para ilustrar cómo pueden reunirse varios elementos para crear una integración de máxima eficacia.

[Non-pharmacological interventions to reduce depressive symptoms in women with breast cancer]. / Intervenciones no farmacológicas para reducir síntomas depresivos en mujeres con cáncer de mama.

OBJECTIVE: To describe and discuss the results of non-pharmacological interventions (NPI) adjuvants in the treatment of depressive symptoms among women with breast cancer (BC). MATERIALS AND METHODS: A systematic review on NPI was performed, which was applied to patients with cancer and depressive symptoms in seven databases. The review was limited from January 1, 2006 to December 31, 2017 and to English, Spanish and Portuguese languages. The medical descriptors used were "breast neoplasm" and "depression". RESULTS: There are several NPI that are able stimulate the physical or psychosocial dimensions. In this article we propose a classification based on nine identified therapeutic strategies, among which exercise, psychotherapy and yoga with meditation stand out. CONCLUSIONS: Based on the available evidence, we concluded that psychotherapy and yoga with meditation reduce depressive symptoms in patients with CaMa. More research is needed to determine the magnitude of the reduction of depressive symptoms, according to their severity, presence of comorbidities and diversity of INF.

OBJECTIVE: Describir y discutir los resultados de las intervenciones no farmacológicas (INF) adyuvantes en el tratamiento de los síntomas depresivos entre mujeres con cáncer de mama (CaMa). MATERIALS AND METHODS: Se realizó una revisión sistemática sobre INF, aplicadas a pacientes con cáncer y síntomas depresivos en siete bases de datos. La revisión se limitó del 1 de enero de 2006 al 31 de diciembre de 2017 y a los idiomas inglés, español y portugués. Los descriptores médicos empleados fueron "breast neoplasm" y "depression". RESULTS: Existen diversas INF que pueden estimular principalmente las dimensiones físicas o psicosociales. En este artículo se propone una clasificación basada en nueve estrategias terapéuticas identificadas, entre las que sobresalen el ejercicio, la psicoterapia y el yoga con meditación. CONCLUSIONS: Con base en la evidencia disponible, se concluye que la psicoterapia y yoga con meditación reducen los síntomas depresivos en pacientes con CaMa. Se requiere mayor investigación para determinar la magnitud de la reducción de los síntomas depresivos, de acuerdo con su gravedad, presencia de comorbilidades y diversidad de INF.

Family secret and artistic-expressive resources in family psychotherapy: a theoretical-clinical study / Segredo familiar e os recursos artísticos-expressivos na psicoterapia familiar: um estudo teórico-clínico / Secreto familiar y los recursos artísticos-expresivos en la psicoterapia familiar: un estudio teórico-clínico

This study aimed to discuss the use of artistic-expressive resources in the psychoanalytic psychotherapy of couples and families through a theoretical-clinical study based on the clinical-qualitative method. The family secret consists of a message that cannot circulate freely in the family because it is associated with a traumatic or shameful situation experienced by one of the members of the family, with its disclosure possibly putting the maintenance of the family bonds at risk. Therefore, this defense mechanism of the family dynamic is implicated as one of the leading causes of couples and families withdrawing from psychotherapy. For the discussion, clinical vignettes of a case attended at a psychology school-service of a public university were used. It was observed that the use of artistic-expressive resources favored the emergence of unconscious contents and the development of the therapeutic process.

Objetivou-se discutir o uso de recursos artísticos-expressivos na psicoterapia psicanalítica de casal e família por meio de um estudo teórico-clínico pautado no método clínico-qualitativo. O segredo familiar consiste em uma mensagem que não pode circular livremente na família por estar associado a uma situação traumática ou vergonhosa vivenciada por um dos membros da família, com sua revelação podendo colocar em risco a manutenção dos vínculos familiares. Sendo assim, tal mecanismo de defesa da dinâmica familiar implica uma das principais causas de desistência da psicoterapia por parte de casais e famílias. Para a discussão, foram utilizadas vinhetas clínicas de um caso atendido em um serviço-escola de psicologia de uma universidade pública. Observou-se que o uso de recursos artísticos-expressivos favoreceu a emergência de conteúdos inconscientes e o desenvolvimento do processo terapêutico.

Se objetivó discutir el uso de recursos artísticos-expresivos en la psicoterapia psicoanalítica de pareja y familia por medio de un estudio teórico-clínico pautado en el método clínico-cualitativo. El secreto familiar consiste en un mensaje que no puede circular libremente en la familia por estar asociado a una situación traumática o vergonzosa vivida por uno de los miembros de la familia, con su revelación pudiendo poner en riesgo el mantenimiento de los vínculos familiares. Siendo así, este mecanismo de defensa de la dinámica familiar implica una de las principales causas de desistimiento de la psicoterapia por parte de parejas y familias. Para la discusión, se utilizaron viñetas clínicas de un caso atendido en un servicio-escuela de psicología de una universidad pública. Se observó que el uso de recursos artístico-expresivos favoreció la emergencia de contenidos inconscientes y el desarrollo del proceso terapéutico.

Principle-Based Integrative Therapy with Couples: Theory and a Case Example.

The Principle-Based Integrative Therapy (PBIT) framework harnesses the principles of change underlying each theoretical model within integrative couple therapy treatments. PBIT has commonalities with other integrative approaches, and additional advantages stemming from its four tenets that guide therapists in combining strengths across models and overcoming each of their deficiencies. Tenet 1 advises that each model adds a core principle or mechanism of action that other models do not automatically address. Tenet 2 focuses on how techniques of one model may actualize the principles of other models. Tenet 3 ensures complementarity and a lack of conflict across principles. A case study and common case considerations are presented to illustrate how Tenets 1-3 can work in integrating Cognitive-Behavioral, Multicultural, and Emotionally Focused Therapy models in working with a couple. Finally, Tenet 4 advocates for the use of models and empirically supported principles that also have received empirical support with diverse populations. Prerequisites and training implications for PBIT, and future clinical and research directions to further the utility of PBIT are discussed.

El marco de la Terapia Integrativa Basada en Principios (PBIT) aprovecha los principios de cambio que subyacen a cada modelo teórico dentro de los tratamientos de la terapia integrativa de pareja. La PBIT tiene similitudes con otros enfoques integrativos y otras ventajas que surgen de sus cuatro principios que guían a los terapeutas en la combinación de los puntos fuertes de los distintos modelos y en la superación de cada una de sus deficiencias. El primer principio recomienda que cada modelo agregue un principio o mecanismo fundamental de acción que otros modelos no aborden automáticamente. El segundo principio se centra en cómo las técnicas de un modelo pueden actualizar los principios de otros modelos. El tercer principio garantiza la complementariedad y la falta de conflictos entre los principios. Se presentan las consideraciones de un caso práctico y de casos comunes para ilustrar cómo estos tres principios pueden funcionar en la integración de los modelos de terapia congnitivo-conductual (CB), multicultural (MC) y centrada en las emociones (EFT) a la hora de trabajar con una pareja. Finalmente, el cuarto principio propone el uso de modelos y principios factuales que también hayan recibido apoyo empírico con diversas poblaciones. Se debaten los prerrequisitos y las consecuencias de la capacitación para la PBIT, así como las futuras direcciones clínicas y de investigación para impulsar la utilidad de la PBIT.

The Relational Mind in Couple Therapy: A Bateson-Inspired View of Human Life as an Embodied Stream.

Research on human intersubjectivity has found that humans participate in a dialogue throughout their life, and that this is manifested not only via language, but also nonverbally, with the entire body. Such an understanding of human life has brought into focus some basic systemic ideas concerning the human relational mind. For Gregory Bateson, the mind works as a system, formed from components that are in continuous interaction with each other. In our Relational Mind research project, we followed twelve couple therapy processes involving two therapists per session, looking at the ways in which the four participants attuned to each other with their bodies, including their autonomic nervous system activity. Using observations from the project, we here describe the ways through which the relational and embodied mind can be realized in a couple therapy setting.

Abrir a possibilidade para novas narrativas: um desafio / Open the possibility for new narratives: a challenge / Abrir la posibilidad para nuevas narrativas: un desafio

Uma diversidade de narrativas pode enriquecer a vida humana, dada a possibilidade de atribuir significado à experiência relacional desde a vida intrauterina até a morte, postula Linares (2003; 2014). Por outro lado, conta-se com a resistência do ser humano a rever suas visões. Dada tal resistência, neste trabalho tem-se como objetivo mostrar uma ferramenta para auxiliar na construção de novas narrativas: a atividade artística-lúdica no atendimento a casais e famílias sob a ótica da abordagem sistêmico-integrativa. Tal ferramenta tanto permite que o ser humano, sem se dar conta, expresse sua angústia, quanto permite ser uma intervenção terapêutica propriamente dita. Através de um caso clínico, será ilustrado o planejamento da atividade lúdica; o uso da atividade proposta; e seus resultados. Constatou-se que novas percepções puderam ser referidas, e as mesmas permitiram a construção de novas narrativas familiares.

A variety of narratives can enrich human life, given the possibility of assigning meaning to the relational experience from intrauterine life until the death, postulates Linares (2003, 2014). On the other hand, there is the resistance of the human being to revise its visions. Given this resistance, this work aims to present a tool to assist in the construction of new narratives: the artistic-ludic activity to care for couples and families from the perspective of the systemic-integrative approach. Such a tool allows the human being, without realizing it, to expresses his anguish, as it allows to be a therapeutic intervention properly said. Through a clinical case, will be illustrated the planning of the ludic activity; the use of the proposed activity; and their results. It was observed that new perceptions could be referred to, and they allowed the construction of new family narratives.

Una diversidad de narrativas puede enriquecer la vida humana, dada la posibilidad de atribuir significado a la experiencia relacional desde la vida intrauterina hasta la muerte, postula Linares (2003; 2015). Por otro lado, se cuenta con la resistencia del ser humano a revisar sus visiones. Dada tal resistencia, en este trabajo se tiene como objetivo mostrar una herramienta para auxiliar en la construcción de nuevas narrativas: la actividad artística-lúdica en la atención a parejas y familias bajo la óptica del abordaje sistémico-integrativa. Tal herramienta permite tanto que el ser humano, sin darse cuenta, expresa su angustia, como permite ser una intervención terapéutica propiamente dicha. A través de un caso clínico, se ilustra la planificación de la actividad lúdica; el uso de la actividad propuesta; y sus resultados. Se constató que nuevas percepciones pudieron ser referidas, y las mismas permitieron la construcción de nuevas narrativas familiares.

Exploring the effectiveness of couples interventions for adults living with a chronic physical illness: A systematic review.

OBJECTIVE: Partners have a significant role in a person's ability to adjust to a chronic physical illness, which warrants their inclusion in couples interventions. However to deliver more specific, tailored support it is necessary to explore which types of couples interventions are most effective across certain chronic illness populations and outcomes. METHODS: Five databases were searched using selected terms. Thirty-five articles met the eligibility criteria for inclusion. RESULTS: The majority of studies were from the US, and most interventions targeted cancer populations. Couples interventions fell into two categories according to therapeutic approach; Cognitive Behavioural Skills Training (CBST) and Relationship Counselling (RC). When compared with a patient-only intervention or controls, CBST interventions effectively targeted behavioural, physical/somatic and cognitive outcomes, while RC more effectively targeted interpersonal outcomes. CONCLUSION: Couples interventions can be more effective than patient-only interventions or controls across various patient and partner outcomes. Couples interventions tend to favour a skills-based or a relationship-based approach, which strongly influences the types outcomes effectively targeted. PRACTICE IMPLICATIONS: Our findings suggest it could be therapeutically useful to integrate these two approaches to more holistically support couples living with chronic illness. We also identify the need to target understudied illness groups and ethnicities.

Structured Approach Therapy for Combat-Related PTSD in Returning U.S. Veterans: Complementary Mediation by Changes in Emotion Functioning.

To address the impact of combat-related posttraumatic stress disorder (PTSD) on U.S. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans, the investigators developed a 12-session manualized PTSD treatment for couples called structured approach therapy (SAT). A randomized controlled trial had shown that 29 OEF/OIF veterans with combat-related PTSD who had participated in SAT showed significantly greater reductions in PTSD compared to 28 veterans receiving a 12-session PTSD family education intervention (Sautter, Glynn, Cretu, Senturk, & Vaught, 2015). We conducted supplemental follow-up and mediation analyses, which tested the hypothesis that changes in emotion functioning play a significant role in the decreases in PTSD symptoms primarily observed in veterans who had received SAT. Veterans assigned to the SAT condition showed significantly greater decreases than those assigned to PTSD family education in emotion regulation problems (p < .001, Cohen's f(2) = .18) and fear of intense emotions (p < .001, Cohen's f(2) = .152). Decreases in both emotion regulation problems (mediated effect:ab̂= .36), and fear of intense emotions (mediated effect:ab̂ = .24) were found to be complementary mediators of reductions in PTSD symptoms greater with SAT. These findings suggest that SAT may aid veterans in improving their ability to regulate trauma-related emotions.

Alcohol-Focused Behavioral Couple Therapy.

Alcohol Behavioral Couple Therapy (ABCT) has emerged over the last 30 years as a highly efficacious treatment for those with alcohol use disorders. This review highlights the historical and conceptual underpinnings of ABCT, as well as the specific treatment elements and structure. Proposed active ingredients, moderators, and mediators of treatment outcome are discussed. Efficacy is evaluated for reductions in identified patient drinking, improved relationship functioning, and reductions in intimate partner violence. Adaptations of ABCT for substances other than alcohol are described. Other adaptations, including brief interventions, interventions addressing PTSD and TBI along with alcohol use, and interventions deliverable via technology platforms are described. Additional cost-benefit and cost-effectiveness findings supporting the economic value of ABCT are noted. Future directions for research in this area include possible adaptations for female identified patients, nontraditional couples, LGBT partners and dyads involving nonintimate partner relationships. The development of more flexible models and enhanced dissemination strategies may improve clinical uptake and utility as well as increasing the feasibility of this treatment for integrated healthcare settings.

Expanding Empathy in Our Clinical Work: A Response to Wickramasekera II's (2015) "Mysteries of Hypnosis and the Self Are Revealed by the Psychology and Neuroscience of Empathy.".

Empathy is a central tenet of psychotherapeutic process. This article builds upon Wickramasekera II's (2015) "Mysteries of Hypnosis and the Self are Revealed by the Psychology and Neuroscience of Empathy," with particular focus on "empathetic involvement theory." A brief transtheoretical and research review of empathy is provided. A couple's therapy case illustration is provided to elucidate how one can expand "empathetic involvement theory" into clinical practice. Emphasis is placed upon the dimensions of sensation and body/mind connectedness.