Lost in translation: Therapeutic Alliance as a mediator in the relationship between teletherapy and marital satisfaction.

The global impact of the SARS-COV-2 pandemic necessitated a rapid shift to online/teletherapy psychotherapy services. While research suggests the feasibility and efficacy of teletherapy, there is limited investigation into couple teletherapy's impact on satisfaction and therapeutic alliance. This study aimed to address this gap by examining changes in couple satisfaction during tele- and in-person therapy sessions over 12 sessions and exploring whether therapeutic alliance development mediates these changes. Using growth curve modeling in a sample of 416 couples, it found that teletherapy participants initially reported higher couple satisfaction, but improvement in this domain was slower than in-person therapy recipients. The development of the therapeutic alliance mediated this effect via two indirect paths. Implications include the need for focused attention on alliance development in teletherapy and more empirically-informed approaches in couple teletherapy.

Validation of the intersession alliance measure: Individual, couple, and family versions.

Monitoring the therapeutic alliance throughout treatment can improve client outcomes and lead to improved care. The individual, couple, and family versions of the intersession alliance measure (IAM) were developed to facilitate routine monitoring of the expanded therapeutic alliance. Psychometric properties of the three versions of the IAM were examined using a clinical sample. Participants were drawn from clinics in the United States participating in the Marriage and Family Therapy Practice Research Network. Using this sample, results indicate that items on each version of the IAM load on one factor, are invariant across sex, and that each version has good internal consistency, test-retest reliability, and concurrent validity. The IAM-C and IAM-F also have good predictive validity, while the IAM-I has more limited evidence for its predictive validity. These results suggest that the IAMs are valid and reliable measures that can facilitate the routine monitoring of the expanded therapeutic alliance in psychotherapy.

The trajectory of anxiety in therapy: The role of ACEs.

The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing anxiety symptoms. Yet more needs to be known about how ACEs may shape the process of therapy and the trajectory of anxiety symptoms. This study was designed to compare the trajectory of improvement in anxiety symptoms over the course of 12 sessions of therapy in adults (N = 472), who reported more (greater than four) and fewer (fewer than four) ACEs using a multigroup latent growth curve analysis. Data were drawn from the Marriage and Family Therapy Practice Research Network database. Results suggested that the rate of improvement in those with more and fewer ACEs was not significantly different; however, those with more ACEs had a significantly higher average starting point of anxiety symptoms.

Heterosexual couples' initial role and outcome expectations as predictors of the therapeutic alliance and relationship satisfaction prior to the fourth session.

We sampled routinely collected measures of role and outcome expectations, the expanded therapeutic alliance, and relationship satisfaction completed by 253 heterosexual couples seen by 35 therapists in the Marriage and Family Research Practice Network (Johnson et al., 2017) and investigated these variables as interdependent dyadic processes using the latent congruence model (Cheung, 2009) and the mediated actor-partner interdependence model (Ledermann et al., 2011). Taken together, we found a direct association between a couple's mean role and outcome expectation scores at Session 1 and individual partners' alliance perceptions at Session 3. Further, men rated the alliance more favorably when their outcome expectations were higher and the partners' outcome expectations were less discrepant. In terms of role expectations, both men and women began therapy expecting to be more actively engaged in the process than their partner. Whereas women rated the alliance more favorably when they had high role expectations for their partner as well as themselves, men rated the alliance more favorably when they had high expectations for their female partner's engagement in the therapy. Notably, alliance at Session 3 did not mediate the association between initial expectations and Session 4 relationship satisfaction due to a strong association (r = 0.85) between relationship satisfaction rated prior to Sessions 1 and 4. In other words, although the best predictor of relationship status before the fourth session was how the relationship was perceived before couple therapy began, men's and women's initial role and outcome expectations were important contributors to the early alliance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Call me maybe? In-person vs. teletherapy outcomes among married couples.

ABSTRACTObjective: The objective of this study was to investigate the effectiveness of teletherapy compared to in-person couple therapy in outcomes such as couple satisfaction, sexual satisfaction, and the therapeutic alliance.Method: Data from 1157 married clients seeking couple therapy were examined. Individual growth curve models were used to analyze changes in the aforementioned outcomes, with teletherapy as a predictor. The study also examined client age and clinic type as moderators.Results: The results indicated that overall, teletherapy is as effective as in-person therapy in improving outcomes. However, there were notable differences in the development of the therapeutic alliance. The alliance improved at twice the rate in in-person therapy as in teletherapy. Clinic type was also found to be a moderator of changes in sexual satisfaction. Clients in group and private practices reported improvements in sexual satisfaction; whereas clients seen in training clinics reported decreases in sexual satisfaction.Conclusion: The study concludes that although teletherapy may be a viable alternative to in-person couple therapy, there are nevertheless differences in the development of the therapeutic alliance that warrant care and further investigation. The setting of the therapy also plays a role in the effectiveness of therapy, although not specific to therapy modality.

The development of a reliable change index and cutoff score for the SCORE-15.

The Systemic Clinical Outcome and Routine Evaluation version 15 (SCORE-15) is a measure used to assess family-level change in family therapy. The SCORE-15 has been demonstrated to be a reliable and valid measure, with high clinical utility; however, the SCORE-15 lacks the ability to determine whether the change in family functioning during the course of therapy is clinically significant. This study aimed to establish a reliable change index (RCI) and clinical cutoff score so that researchers and clinicians can determine clinically significant change in family therapy. US samples of 71 clinical participants and 244 community participants completed the SCORE-15. Results indicated a cutoff score of 40.37 and an RCI of 9.52. Consequently, family members who improve their SCORE-15 score during the course of therapy by at least 9 points and who cross the threshold of 40 during the course of therapy are considered to have experienced clinically significant change.

Emotion dysregulation and couple relationship satisfaction of clinical couples: An actor-partner interdependence model.

Despite the pivotal role that emotion regulation is thought to occupy for individual and relational wellbeing, emotion regulation in couples has been surprisingly understudied. With a clinical sample consisting of 275 couples starting therapy from 2017 to 2022, this study sought to clarify the actor and partner effects of clinical couples' emotion dysregulation on relationship satisfaction. Our results showed that, for partners' emotion dysregulation dimensions, while impulse control difficulties, lack of emotional awareness, and limited emotion regulation strategies were negatively predictive of couple relationship satisfaction, nonacceptance of negative emotions had a positive association with relationship satisfaction. Further, compared with other dimensions of emotion dysregulation, female limited emotion regulation strategies were greater predictors of decreased female relationship satisfaction. We also found significant gender differences in partners' emotion dysregulation dimensions and relationship satisfaction. These results show the significance of addressing emotion dysregulation for both partners at intra- and inter-personal levels simultaneously in couple therapy. Notably, the 275 couples in our sample did not report a clinically distressed relationship, though they attended at least one couple therapy session. Clinical implications and directions for future study are discussed.

What to expect physiologically when you're expecting couples in therapy: A Changing Hearts and Minds in relationshiPS (CHAMPS) descriptive study.

Recent efforts to improve marital therapy interventions have begun investigating psychophysiologic processes in therapy. These studies are novel and represent initial investigations into relevant phenomena associated with the therapy process. Grounded in Polyvagal Theory, this study introduces an on-going multimethod couple therapy process research (CHAMPS) and highlights the importance of establishing norms among distressed couples in therapy, which can provide context for other studies' results and instigate further investigation of physiology in marital therapy. Using a sample of 24 married, heterosexual couples (N = 48), we examine trends in markers of sympathetic (SNS) and parasympathetic nervous system (PNS) functioning; namely, electrodermal activity (SNS), cardiac impedence (SNS), and respiratory sinus arrhythmia (PNS) before and during therapy sessions and shifts in these measures over the course of four therapy sessions. We discuss clinical implications and provide recommendations for further investigations.

The Couple Relationship Scale: A brief measure to facilitate routine outcome monitoring in couple therapy.

Routine outcome monitoring (ROM) is an important component of evidence-based practice. To implement ROM in their practice, couple therapists need a brief measure that can quickly assess the relevant aspects of a couple's relationship. The Couple Relationship Scale (CRS) is a 10-item measure of relational functioning that assesses emotional intimacy, commitment, trust, safety, cohesion, acceptance, conflict, physical intimacy, overall happiness, and personal well-being. Three studies examined the initial psychometric properties of the CRS. Study One used a sample of 300 individuals to examine the concurrent validity, factor structure, and reliability of the CRS. In Study Two, 53 individuals completed the CRS twice to establish test-retest reliability. In Study Three, 214 distressed individuals and 135 non-distressed individuals were used to identify a clinical cutoff and reliable change index (RCI). Results indicated that the CRS has a strong concurrent and construct validity and good reliability. The clinical cutoff was 70.9 with an RCI of 16.

Therapist effects on dropout in couple therapy.

Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university-based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.

An Introduction and Illustration of Bayesian Modeling in Couple and Family Therapy Research.

Bayesian modeling is becoming increasing popular as a method for data analyses in the social sciences and can move couple, marriage, and family therapy (C/MFT) research forward. Bayesian modeling helps researchers better understand the uncertainty of findings and incorporate previous research into analyses. Other benefits of Bayesian modeling are the straightforward interpretation of findings, high-quality inferences even with small samples (in combination with an informative prior), and the ability to work with complex data structures (observations nested in relationships and time points) which are common in C/MFT research. This article introduces the benefits of Bayesian modeling and provides an example of an Actor-Partner Interdependence Model using R. Information on how to conduct the same analyses using Stata and MPlus is provided in the Supplemental Information.

Pressure to Attend Therapy, Dyadic Adjustment, and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy.

In this study we examine the role that pressure to attend therapy, dyadic adjustment, and adverse childhood experiences (ACEs) play in developing the therapeutic alliance. A total of 351 couples received treatment as usual at three family therapy training clinics. Participants rated predictor variables at intake and alliance at the fourth session. Results of a path analysis indicate that each partner's dyadic adjustment is directly associated with the quality of her or his own alliance. In addition, when male partners report more ACEs and pressure to attend treatment, their own alliance scores decrease. Additionally, when one partner reports feeling pressure to attend therapy, the other partner's alliance decreases. Finally, for males, there is an indirect effect of dyadic adjustment on alliance through pressure to attend therapy. These results suggest that clinicians should routinely assess relationship adjustment, how pressured each partner is feeling to attend treatment, and ACEs; as these may impact alliance quality.

The stigma of widowhood in war and disaster affected communities of Sri Lanka: Contextual paths between trauma exposure and mental health distress.

To add to the dialogue regarding the long-term recovery and wellbeing of war and tsunami-affected women in Sri Lanka, we utilised the Conservation of Resources Theory (COR, Hobfoll, 2009) to inform an investigation of direct and indirect effects. The study was specifically designed to assess how traumatic exposure may represent a form of loss which may associate with related losses in the form of external and internal stigma which may then associate with poor mental health outcomes. The data for this study were collected in 2016 from a sample of 379 widowed women in Eastern Sri Lanka; participant spouses died in the civil war, in the tsunami, or from health or other problems. Our analyses yielded a model suggesting associations between remembered trauma event exposure from war and disaster, external stigma, internalised stigma and mental health symptom distress. Results further yielded direct and indirect effects suggesting that trauma may represent a form of loss, and potentially lead to distress through the weight and challenges of stigma.

They May Disapprove, but I Still Love You: Attachment Behaviors Moderate the Effect of Social Disapproval on Marital Relationship Quality.

The degree of approval for a relationship from one's social network has been shown to predict relationship outcomes. Additional research has shown that attachment can buffer the negative effects of various factors (e.g., depression) on relationships. Using an actor-partner interdependence model in an SEM framework, we research the effects of disapproval from parents and friends for one's relationship on marital relationship quality for self and partner in a sample of 858 married couples. We also examine whether each spouse's attachment behaviors can moderate these effects. Results indicated that one's own attachment behaviors moderate the effects of their own parents' and friends' disapproval on their self-reported relationship quality for both men and women. Partner's attachment behaviors moderate own friend's disapproval on self-reported relationship quality for men and women; additionally, the main effect of partner's friends' and parents' disapproval became nonsignificant with that test. The findings provide evidence that attachment behaviors of both partners play a role in buffering the negative effects of the social network disapproval on relationship outcomes. Clinical implications are discussed.

Se ha demostrado que el grado de aprobación de una relación desde la red social de una persona predice los resultados de las relaciones. Otras investigaciones han demostrado que el apego puede moderar los efectos negativos de varios factores (p. ej.: la depresión) en las relaciones. Utilizando un modelo de interdependencia actor-pareja en un marco de modelos de ecuaciones estructurales, investigamos los efectos de la desaprobación por parte de los padres y los amigos de la relación de una persona en la calidad de la relación conyugal para la persona y su pareja en una muestra de 858 parejas casadas. También analizamos si las conductas de apego de cada cónyuge pueden moderar estos efectos. Los resultados indicaron que las conductas de apego propias de la persona moderan los efectos de la desaprobación por parte de sus propios padres y amigos en la calidad de la relación autoinformada tanto en el caso de los hombres como en el de las mujeres. Las conductas de apego del cónyuge moderan la desaprobación de sus propios amigos en la calidad de la relación autoinformada tanto en el caso de los hombres como en el de las mujeres. Además, el efecto principal de la desaprobación por parte de los padres y los amigos del cónyuge se volvió no significativo con esa prueba. Los resultados ofrecen pruebas de que las conductas de apego de ambos integrantes de la pareja desempeñan un papel en la moderación de los efectos negativos de la desaprobación por parte de la red social en los resultados de las relaciones. Se debaten las implicancias clínicas.

Using Attachment to Better Understand the Therapy Alliance: The Attachment Based Alliance Questionnaire.

Questionnaires on the therapeutic alliance are available, but most show inflated scores, limited variability, and few significant findings on the bonds domain. Results of a study of 251 clinical couples, on the development of an Attachment Based Alliance Questionnaire (ABAQ), are presented. Factor analysis (EFA and CFA), show that a one-factor or two-factor structure fit the data, with more support for a one-factor model. Both models map closely with attachment constructs. Results also show that the ABAQ is predictive of changes couples make early in therapy and demonstrated adequate reliability and validity. The ABAQ provides a tool for clinicians as they learn how to attune to relationships in couple therapy and is helpful to researchers in understanding the alliance.

Predictive validity of the R-URICA.

OBJECTIVES: Measuring client motivation to change, and then using information from that assessment to plan and conduct treatment, has been of great interest to therapists. Researchers have modified a measure of motivation to change to develop the R-URICA (Tambling & Johnson, 2012, Fam. J., 20, 59). DESIGN: This manuscript presents the results of an exploration of the validity of the R-URICA in a sample of individuals in couple therapy. Sample included 581 couples from a treatment-as-usual sample of counselling clinic clients. This study presents the results of inquiry into the ways in which scores on the R-URICA are modified over time in therapy, an indicator of the predictive validity of the instrument. MEASURES: R-URICA, RDAS. RESULTS: Results indicated that scores on the Action Subscale of the R-URICA change over time, indicating that therapy positively impacts this aspect of motivation to change. Results also suggested that the aspects of the R-URICA are related to where couples present for couple therapy and changes in dyadic adjustment in couple therapy. PRACTITIONER POINTS: Practitioners should inquire about motivation to change at the outset of therapy. Further, practitioners should be sensitive to differences in motivation to change among families or couples as not all clients may be equally motivated. Practitioners may wish to devote time to engagement of male partners in therapy as males are more variable in their motivation to change and seem to impact outcomes. Practitioners may wish to consider the use of the R-URICA as an alternative measure of motivation to change in therapy.

Daily Events for Clinical Couples: Examining Therapy Interventions, Positive Events, Arguments, and Exercise in the Beginning Stage of Therapy.

This study examined the daily association of several events within the beginning phase of couple therapy. Events examined were as follows: trying something from therapy, an argument, a positive event, and physical exercise. Participants were 33 couples in a treatment-as-usual setting who completed the Daily Diary of Events in Couple Therapy (DDECT). A dyadic multilevel model was used to explore the daily associations between predictor and outcome variables. Results showed when male partners tried something from therapy at rates greater than the average their female partners reported a more positive relationship while when female partners tried something from therapy at rates greater than the average it contributed to a more negative relationship. In addition, results showed that clients in couple therapy rarely try things from therapy on a daily basis. Finally, relative to other predictors trying something from therapy had a smaller, but significant relationship with outcomes.

The Marriage and Family Therapy Practice Research Network (MFT-PRN): Creating a More Perfect Union Between Practice and Research.

This article describes the Marriage and Family Therapy Practice Research Network (MFT-PRN). The MFT-PRN is designed to build a professional community based on practice-informed research and research-informed practice, increase the diversity of participants in MFT research, and unify researchers and clinicians. Clinics choose measures from a list that best represent their clinic needs. Clients' outcomes are assessed regularly, and therapists receive immediate graphical feedback on how clients are progressing or digressing. Data are pooled to create a large and diverse database, while improving client outcomes. We will discuss advantages of the MFT-PRN for researchers, therapists, clients, and agencies, and provide one model that we hope will inform other collaborative clinical-research models in the field of marriage and family therapy. Video Abstract is found in the online version of the article.

The Association between the Parent-Child Relationship and Symptoms of Anxiety and Depression: The Roles of Attachment and Perceived Spouse Attachment Behaviors.

Research shows that the parent-child relationship affects attachment security, which correlates with anxiety and depression in adulthood. Additional research shows that romantic attachment behaviors may supersede individual attachment security and buffer against negative processes. Using data from 680 married couples in the general population, we examined whether attachment mediates the link between the parent-child relationship and depressive and anxiety symptoms in adulthood. In addition, we tested whether perceived spouse attachment behaviors moderate the effects of attachment insecurity. There was an indirect effect of poor parent-child relationships on symptoms via insecure attachment. Perception of spouse's attachment behaviors was related to depression for both spouses, and they moderated the effect of attachment insecurity on depressive symptoms for husbands. Clinical implications are discussed.

Examining Attachment Avoidance and Attachment Anxiety Across Eight Sessions of Couple Therapy.

This study examined initial levels of attachment anxiety and avoidance, as well as their patterns of change, across eight sessions of couple therapy. Participants were 461 couples in a treatment-as-usual setting. Dyadic latent growth modeling was used to determine whether couples started therapy at similar levels of attachment anxiety and avoidance and whether attachment anxiety and avoidance changed. An actor partner interdependence model was used to see whether partner attachment anxiety was related to avoidance. Results showed relative stability of attachment anxiety and avoidance over the course of therapy, with the only change being a slight decline in attachment anxiety among women. Results showed that a person's attachment anxiety was not related to their partner's avoidance and vice versa.