A test of the dyadic associations between ineffective arguing, emotional distress, and violence perpetration and victimization among couples seeking therapy.

Researchers have tested associations between ineffective arguing and emotional distress among couples without relationship violence. Moreover, studies have demonstrated associations between physical violence perpetration and victimization in the aftermath of emotional distress. However, there is a paucity of research examining linkages between ineffective arguing, emotional distress, and physical violence perpetration or victimization. Dyadic data from 231 married, heterosexual couples seeking therapy were used to test a model examining pathways between ineffective arguing and physical violence perpetration and victimization through emotional distress. The hypothesized model was compared to two plausible alternative models. Results revealed higher levels of men's ineffective arguing were positively associated with men's physical violence perpetration, both directly and indirectly, through higher levels of emotional distress. Higher levels of men's ineffective arguing were associated with lower men's physical violence perpetration through higher levels of women's emotional distress. Results can inform the clinical treatment of interpersonal violence by targeting ineffective arguing and emotional distress.

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.

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.

The Role of the Facilitator in Couple Relationship Education.

While much of the Couple Relationship Education (CRE) research has focused on participant factors, unexpectedly little research has considered how characteristics of those providing the programming shape its efficacy. The current study draws upon a diverse sample of 225 couples who received CRE from community educators to examine how facilitation alliance is related to relationship outcomes for men and women and whether having a facilitator with similar demographic characteristics is related to the alliance. Results suggest that the facilitation alliance is related to some-though not all-postprogram outcomes and these effects were uniform across gender and relationship status (married vs. unmarried). Having a facilitator of the same gender was associated with a stronger alliance. Implications are discussed.

It's About Time! Examining Received Dosage and Program Duration as Predictors of Change Among Non-Distressed and Distressed Married Couple and Relationship Education Participants.

Although Couple and Relationship Education (CRE) programs were intended to be preventive in nature, an emerging reality is that relationally distressed couples are attending programs. This has raised questions about both its general usefulness and what is known regarding predictors of change in CRE for distressed couples particularly. Previous work has identified dosage and duration as important moderators of changes, and there are myriad program contexts offered, highlighting the need to examine these among distressed couples. This study utilized a sample of community CRE participants and examined received dosage and program duration as predictors of change. Comparing results for distressed and non-distressed participants, we found several group differences. Findings suggest that it is important to consider distress level and time spent in programs when placing participants. In addition, research should continue to examine these groups separately (or comparatively) to find out what works for whom.

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.

The development of a reliable change index and cutoff for the Revised Dyadic Adjustment Scale.

The Revised Dyadic Adjustment Scale (RDAS; Busby, Crane, Larson, & Christensen, 1995) is a measure of couple relationship adjustment that is often used to differentiate between distressed and non-distressed couples. While the measure currently allows for a determination of whether group mean scores change significantly across administrations, it lacks the ability to determine whether an individual's change in dyadic adjustment is clinically significant. This study addresses this limitation by establishing a cutoff of 47.31 and reliable change index of 11.58 for the RDAS by pooling data across multiple community and clinical samples. An individual whose score on the RDAS moves across the cutoff changes by 12 or more points can be classified as experiencing clinically significant change.

Exploring processes of change in couple relationship education: predictors of change in relationship quality.

In the past several decades, a number of largely atheoretical individual and meta-analytic studies of couple relationship education (CRE) programs have focused on program effectiveness without considerations of how these programs work and for whom. To address this gap in the literature, the current study drew upon assumptions from social-cognitive and behavioral theories that are implicit in CRE design to assess the influence of short-term changes from pre- to posttreatment in behaviors and commitment on changes in relationship quality among a racially and economically diverse group of 2,824 individuals who participated in a CRE program. Findings from structural equation modeling indicated that the best-fitting model for both men and women was one in which changes in behaviors predicted changes in relationship quality via their influence on changes in commitment. Further, a series of moderational analyses provided some evidence to suggest that the strength of the relationships between these variables may depend to a small extent on the social address of the participants (race, income) and to a greater extent on characteristics of the CRE experience (i.e., beginning the class at lower levels of functioning, attending with a partner). Findings help us begin to understand the influences among domains of change that occur as a result of participating in a CRE program, as well as offering some useful information to practitioners on demographic and contextual moderators of program outcomes. Implications for future research on the mechanisms of change for CRE are presented.

Change in the health of tsunami-exposed mothers three years after the natural disaster.

BACKGROUND: Women's experiences with secondary stressors resulting from natural disasters, such as increased economic insecurity, expanded caregiving responsibilities and disrupted family life, may contribute to women's mental and physical health problems. AIMS: The present study investigates change and stability in post-tsunami depressive symptoms and perceived physical health of tsunami-exposed mothers over three and a half years. METHODS: Using data from 160 tsunami-affected mothers, the present study uses structural equation modelling to investigate (1) change, stability, cross-lagged reciprocal influences of mental and physical health and (2) the meditation effect of negative life events on the relationship between tsunami exposure and post-tsunami depressive symptoms and perceived physical health of tsunami-exposed mothers from 2005 to 2008. RESULTS: Tsunami exposure contributed to depressive symptoms among mothers independently of pre-tsunami family adversities. Average depressive symptoms showed a decline whereas poor physical health showed an increase over this period. The results also revealed an interrelated health process between depression and physical health over time. Continuity of health problems were mediated by secondary stressors that also exerted an additive effect on later health problems. CONCLUSIONS: Post-disaster intervention and recovery programmes should focus not only on mothers' exposure to natural disasters, but also their pre- and post-natural disaster adversities. They should reach disaster-exposed mothers directly and have an integrated health approach to disrupt continuities of health problems.

The therapy alliance: a moderator in therapy outcome for families dealing with child abuse and neglect.

The role of the therapy alliance in therapy outcome for families dealing with child abuse and neglect was examined using the family as the unit of analysis. The alliance was tested as a moderator in relationship to posttreatment levels of symptom distress and physical violence. Results show that the bonds, goals, and tasks subscale scores are significantly related to posttreatment levels of symptom distress and that the goals subscale score is significantly related to posttreatment level of violence. There is an interaction between bonds and level of violence at intake, suggesting that the greater the level of violence at intake, the more important the bonds domain.

Integrating research and clinical training in marriage and family therapy training programs.

The future of the profession and practice of marriage and family therapy (MFT) rests with those who promote the integration of research and clinical practice. The Boulder scientist-practitioner model is useful in conceptualizing MFT training, but it is not the perfect solution. Four MFT programs (two master's and two doctoral) are featured in this article for their work in integrating research and practice. Helpful strategies presented include: Encouraging students to question the therapy process; integrating research in the curriculum and supervision; discussing the positives and negatives of empirically supported treatments; focusing on change; and developing creative classroom experiences to use within the scientist-practitioner model.

The therapeutic alliance in home-based family therapy: is it predictive of outcome?

This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented.