Perceived overlap and therapy outcomes among couple clients.

This article explores couples' perceptions and expectations of closeness in a clinical setting, and how relationship perceptions and expectations are associated with treatment outcomes. Bowen's theory of differentiation suggests that healthy relationships require a balance of autonomy and connection. However, some research suggests that contemporary societal expectations are pushing couples to expect greater degrees of closeness and less autonomy. Utilizing a clinical sample of 185 couples from an on-campus Couple and Family Therapy training clinic, this article explores couples' perceptions and expectations of relationship closeness utilizing graphics of overlapping circles. Latent profile analysis was conducted to identify three different profile groups based on perceptions and expectations. Wald tests for significant mean differences among the profiles were performed. Results identified significant differences between the three groups for satisfaction and separateness and connectedness variables, number of sessions and termination.

Couple differentiation and health-related quality of life.

The purpose of this study was to examine whether couple differentiation influenced mental and physical health-related quality of life in couple members. Data for this study were derived from a larger study at a couple a family therapy clinic. One hundred and thirty-three couples were included in a latent profile analysis, and seventy-two couples were included in analyses of mean differences. The latent profile analysis resulted in three distinct groups by level of couple differentiation: high, moderate, or low in differentiation of self. Analyses of variance indicated evidence that couple differentiation influenced health-related quality-of-life measures. Findings are discussed in the context of Bowen Family Systems Theory and the existing literature.

Variations in the association between education and self-reported health by race/ethnicity and structural racism.

Research has documented a longstanding association between education achievement and physical health outcomes. However, research has suggested that the health benefits gained from education differ by race, with minoritized racial groups generally experiencing poorer health and fewer health benefits from education. One potential explanation for this phenomena of "diminished returns" is the influence of structural racism. The purpose of this paper is to assess how structural factors at the state level are associated with self-reported health and the association between education and health. Utilizing a sample (N = 6819) from the NLSY dataset, measures of structural racism (political participation, employment and job status, education attainment and judicial treatment) were used to assess the hypotheses. Results indicated significant differences in key areas, with some nuanced findings - indicating that structural racism is an important health factor. These indicators of structural racism are discussed in the context of complexity of linked lives. Further research regarding structural racism, education, health and developmental stages is warranted.

Structural racism and the education gradient for early all-cause mortality.

There are clear connections between education achieved and health over the course of a lifetime, with higher education achievement being associated with better health. However, the association between education and mortality have differed by race, with minoritized populations reaping fewer benefits from education attained. This paper aims to understand the moderating effect of structural racism (measured at the state level) on the association between education and all-cause early mortality for Black and White participants. We utilize a nationally representative longitudinal sample of youth (NLSY97), and estimates of structural racism for each state through measures of political participation, employment and job status, education attainment ratios, and judicial treatment. Random effects models were then utilized to compare associations between Black and White participants, and assess the association of education on early mortality. Results indicate significant, yet nuanced findings in each of the models assessed suggesting that Black and White participants experienced diminished returns of education on the probability of early mortality. Findings support previous research suggesting that structural racism is costing all citizens, but is especially harmful for minoritized populations.

Therapists' confidence in their theory of change and outcomes.

Previous research has sought to understand what therapist characteristics contribute to positive outcomes for clients. It is widely accepted knowledge that the alliance between the therapist and client is a significant contributing factor to client outcomes. With that said, few studies have examined specific characteristics within the therapist themselves that may contribute to client success, regardless of the therapeutic model being used. Using data from a sample of therapist-trainees at a large, midwestern institution, this study sought to explore therapist confidence in their theory of choice and its potential impact on client outcomes. Findings suggest that those clients who have therapists with greater confidence in their theory are less likely to terminate treatment prematurely or without agreement. These findings have the potential to inform the curriculum for training programs to focus more on developing confidence in the chosen theory.

Prospective Study of a Novel Risk Stratification Process for Opioid-Related Harm Reduction in Cancer Patients Seen in an Outpatient Palliative Care Clinic.

Background: Oncologists and palliative specialists prescribe opioids for millions of cancer patients despite limited research on effective screening and mitigation strategies to reduce risk of opioid-related harm in that population. Objective: To evaluate the efficacy of a novel opioid risk stratification process for predicting significant aberrant behaviors (SABs) related to prescribed opioid medications. Design and Setting/Subjects: This is a prospective, longitudinal study of 319 consecutive patients referred to an outpatient palliative care clinic between 2010 and 2012, a period during which prescription opioid-related deaths began to increase in the United States. Measures: Patients completed a psychodiagnostic/substance use risk assessment with a licensed clinical psychologist or social worker at the initial palliative clinic visit. Patients were assigned to Low-, Moderate-, or High-Risk groups based on predetermined stratification criteria and were managed via an opioid harm reduction approach. The primary dependent measure was the presence of at least one SAB after the initial visit. Results: Eighteen percent of patients (n = 56) demonstrated at least one major aberrant behavior. Odds of future aberrant behavior was 15 times greater in the High-Risk versus the Low-Risk category. Five risk factors significantly enhanced our risk model: age 18 to 45 years, job instability, history of bipolar diagnosis, history of substance abuse, and theft. Conclusion: Our risk stratification process provides a useful model for predicting those at greatest risk of future aberrant behaviors and most in need of comanagement. We recommend additional studies to test our proposed streamlined risk stratification tool.

Progress monitoring with couple clients.

Objective: The purpose of this paper was to assess differences in treatment progress in couple who were in a treatment as usual condition or a progress monitoring condition. Previous research has suggested that progress monitoring is useful for couples, but that research did not include change in relationship satisfaction over time. Method: Using a sample of 130 couples who sought services at an on-campus training clinic, treatment satisfaction, progress, alliance and relationship satisfaction data over the first four sessions of treatment were analyzed with couples in two conditions. In the treatment as usual condition, neither the couple nor their therapist were provided with that information. In the feedback condition, the therapist shared the after-session feedback data in the form of graphs with the couple. Results: The results were mixed. There was little evidence that the feedback condition resulted in clients staying in treatment longer or ending treatment with agreement more often than clients in the TAU condition. Increases in relationship satisfaction, especially for female partners, were decreased in the feedback condition when male partners had higher trauma scores.. Conclusion: It may be important for clinicians to consider what information they share with couple clients when using progress monitoring.

A Primer for the Use of Multilevel Models in Couple and Family Therapy Research.

This article serves as a primer for understanding how to use multilevel modeling (MLM) techniques in couple and family therapy outcome and process research. It outlines the use of HLM and Mplus-two of many software programs that can perform multilevel modeling-and provides an applied example of using MLM to investigate the use of postsession feedback on couple satisfaction and change, as well as the influence of trauma on the use of postsession feedback. Two graduate students in COAMFTE accredited PhD programs read the primer and provided questions to the first author that arose. Answers to these questions have been incorporated throughout the explanation of this methodological approach in hopes of addressing common stuck points for those using MLM.

Differentiation: Moderator or mediator for change in satisfaction in the early sessions of couple therapy.

OBJECTIVE: The purpose of this study was to investigate whether differentiation served as a moderator or a mediator for the association between initial levels of distress in couple members and change in satisfaction in the early sessions of couple therapy. Based on the call for more process research in couple and family therapy completed in naturalistic settings, the data from this study came from a larger ongoing data collection at an on-campus training clinic. METHOD: One hundred and seven couples completed intake questionnaires and after-session questionnaires for the first four sessions of couple therapy. RESULTS: Using a latent profile analysis for couple differentiation scores and then using a group comparison procedure to test the associations between initial levels of depressive symptoms and stress and change in relationship satisfaction, some evidence of moderation was demonstrated. Using an Actor Partner Interdependence model with mediation, there was no evidence of mediation. CONCLUSIONS: Findings are discussed in the context of Bowen Family Systems Theory and extant process literature.

Couple Differentiation: Mediator or Moderator of Depressive Symptoms and Relationship Satisfaction?

The purpose of this investigation was to determine whether differentiation at the couple level would act as a moderator or a mediator in the association between marital satisfaction and depressive symptoms over time. In a sample of 412 couples, a latent profile analysis was performed to determine how couple differentiation scores were clustered. An Actor/Partner Interdependence Model was then estimated via a group comparison procedure in structural equation modeling. There was no evidence of a moderating effect of differentiation. A mediating model was then estimated and there was evidence that differentiation mediated the association between depressive symptoms and relationship satisfaction via actor and partner effects.

Benefits to Children Who Participate in Family Therapy with their Substance-Using Mother.

It is rare that family members other than the identified patient are followed over time in studies of therapy effectiveness. Family therapy is believed to be effective because it targets processes within the system that maintain symptoms. If these processes are changed, then all family members can benefit. Using a sample of 183 mother-child dyads from a study comparing family therapy for adult substance use versus an attention control, change in child's substance use (tobacco, alcohol, and marijuana) was estimated. Children who participated in family therapy with their mothers showed greater decreases in alcohol and tobacco use and were less likely to begin using compared to children whose mothers participated in the attention control condition.

The Family System and Depressive Symptoms during the College Years: Triangulation, Parental Differential Treatment, and Sibling Warmth as Predictors.

Guided by Bowen theory, we investigated the relationships between parent-child triangulation, parental differential treatment (PDT), sibling warmth, and individual depressive symptoms in a sample of 77 sibling dyads, aged 18-25 years, recruited through undergraduate classes at a U.S. public University. Results of the actor-partner interdependence models suggested that being triangulated into parental conflict was positively related to both siblings' perception of PDT; however, as one sibling felt triangulated, the other perceived reduced levels of PDT. For both siblings, the perception of higher levels of PDT was related to decreased sibling warmth and higher sibling warmth was associated with fewer depressive symptoms. The implications of these findings for research and the treatment of depression in the college-aged population are discussed.

Therapist Differentiation and Couple Clients' Perceptions of Therapeutic Alliance.

Therapeutic alliance has been acknowledged as one of the catalysts for change within a therapeutic relationship. The contributions of therapists' characteristics to alliance are not often studied. From a Bowen System's Theory perspective, the therapist's level of differentiation would be highly relevant to the development of a therapeutic alliance. The hypothesis for this study was that therapists who are able to take a more differentiated stance in therapy will build a stronger therapeutic alliance. To test this hypothesis, multilevel modeling procedures were performed, using data from nine therapists and 93 couple cases collected at a large, Midwestern university. Therapist differentiation of self was found to be weakly associated with the clients' perception of therapeutic alliance across the early sessions of therapy, but not in the expected direction. Although the results were unexpected, this study provides an example of the potential of examining therapist characteristics from within one model of therapy, that can be applied across various clients and various models of therapy.

Collecting and Pooling Assessment and Outcome Data in Couple and Family Therapy Training Clinics: Reasons to Do It, Common Problems, and Some Suggestions for Avoiding Them.

The article by Johnson et al. (2015) is an excellent example of many of the advantages and challenges of collecting data in clinics associated with Couple and Family Therapy training programs. In the hopes of encouraging more use of clinic datasets for research, we suggest some ways to improve the feasibility, quality, and value of routinely collecting such data.

Reciprocity in Adolescent and Caregiver Violence.

Over a 2-year period, with assessments every six months, the reciprocity in violent behaviors (verbal and physical) was investigated in a sample of 161 adolescents, who met the criteria for substance or alcohol abuse or dependence, and their caregivers, who participated in a clinical trial for family treatment for adolescent substance abuse. Using observed variables in a structural equation model with panel data, there was very little stability in violent behaviors across time from the perspectives of both the adolescents and caregivers. Evidence for violence reciprocity between adolescent and caregiver was demonstrated toward the end of the study period. The results are discussed in the context of previous literature about adolescent-to-parent violence.

Relational Ethics, Depressive Symptoms, and Relationship Satisfaction in Couples in Therapy.

The purpose of this study was to examine depressive symptoms and relationship satisfaction as problems related to relational ethics in one's family of origin and current partner relationships in a sample of 68 other-sex couples seeking therapy at a large university clinic. We used the Actor Partner Interdependence Model to analyze dyadic data collected prior to beginning therapy. Specifically, we found significant actor effects between relational ethics in one's family of origin and depressive symptoms, as well as between depressive symptoms and low relationship satisfaction for both male and female partners. We also found significant partner effects for relational ethics in current partner relationship, depressive symptoms, and low relationship satisfaction. Clinical application of contextual therapy theory is discussed.

Connection to parents and healthy separation during adolescence: a longitudinal perspective.

The purpose of our study was to investigate how connection between parents and children influences the child's healthy separation during adolescence. We analyzed 3 waves of panel data from a study (Flourishing Families Project) of 500 families with children who were 10-13 years old at Time 1. This study includes information from the perspective of the child and his/her mother over a 4 year period for two-parent families and mother-headed households. Findings supported our hypothesis that a mutual sense of connection between mothers and adolescents supported the adolescent's healthy separation over time, with differences due to sex of the child, ethnicity and income. Pubertal maturation was negatively associated with the sense of connection between adolescents and mothers in our sample of young adolescents. We discuss these findings in relation to previous literature.

Couple communication, emotional and sexual intimacy, and relationship satisfaction.

Emotional and sexual aspects of intimacy in romantic relationships are important correlates of couples' relationship satisfaction. However, few studies have examined the effect of emotional and sexual aspects of intimacy on relationship satisfaction within the context of the interpersonal relationship processes. In addition, the association between emotional and sexual aspects of intimacy remains unclear. With a sample of 335 married couples from the Flourishing Families Project, the authors examined the associations between couple communication, emotional intimacy, sexual satisfaction, and relationship satisfaction, using the couple as the unit of analysis. The results of path analysis suggested that sexual satisfaction significantly predicted emotional intimacy for husbands and wives, while emotional intimacy did not appear to have a significant influence on sexual satisfaction. Further, mediation associations were suggested within as well as between spouses. Within spouses (for each spouse), emotional intimacy and sexual satisfaction mediated the association between spouses' appraisal of their partners' communication and their own relationship satisfaction. Gender differences were revealed in terms of how a spouse's perception of sexual satisfaction is associated with his or her partner's relationship satisfaction. In this study, although wives' relationship satisfaction was not associated with their husbands' sexual satisfaction, husbands tended to report high levels of relationship satisfaction when their wives reported greater sexual satisfaction. Findings suggest that both components of intimacy--emotional and sexual--should be comprehensively addressed in research and clinical work with couples.

Intervention with substance-abusing runaway adolescents and their families: results of a randomized clinical trial.

OBJECTIVES: To examine the efficacy of 3 theoretically distinct interventions among substance-abusing runaway adolescents and to explore individual differences in trajectories of change. METHOD: Adolescents (N = 179) between the ages of 12 and 17 were recruited from a runaway shelter in a midwestern city. The sample included 94 females (52.5%) and 85 males (47.5%); the majority of the adolescents were African American (n = 118, 65.9%). Adolescents were randomly assigned to the Community Reinforcement Approach (CRA, n = 57), Motivational Interviewing (MI, n = 61), or Ecologically-Based Family Therapy (EBFT, n = 61). Substance use was assessed at baseline, 3, 6, 9, 12, 18, and 24 months via Form 90 and urine screens. RESULTS: Hierarchical linear modeling revealed statistically significant improvement in frequency of substance use among runaways in all 3 treatment groups, with a slight increase at posttreatment. Latent trajectory profile analysis explored individual differences in change trajectories and yielded a 3-class model. The majority of adolescents (n = 136, 76%) showed reductions in substance use over time, with a slight increase at follow-up (Class 1: Decreasing). Twenty-four (13.4%) adolescents had shown high levels of substance use over time with patterns of increase and decrease (Class 2: Fluctuating high users), and 19 (10.6%) decreased but returned to baseline levels by 2 years postbaseline (Class 3: U shaped). Few differences among treatment conditions were noted; within the "decreasing" group, adolescents in MI treatment showed a quicker decline in their substance use but a faster relapse compared with those receiving EBFT. CONCLUSIONS: These findings suggest that CRA, EBFT, and MI are viable treatments for runaway substance-abusing adolescents.

Dating violence victimization across the teen years: abuse frequency, number of abusive partners, and age at first occurrence.

BACKGROUND: Prior longitudinal studies have shown high cumulative dating violence exposure rates among U.S adolescents, with 36 percent of males and 44 percent to 88 percent of females experiencing victimization across adolescence/young adulthood. Despite promising information characterizing adolescents' dating violence experiences longitudinally, prior studies tended to concentrate on physical and sexual types of violence only, and did not report information on the number of times dating violence was experienced across multiple abusive partners. We used a method similar to the timeline follow-back interview to query adolescents about dating violence victimization from age 13 to 19-including dating violence types (physical, sexual, and psychological), frequency, age at first occurrence, and number of abusive partners. METHODS: A total of 730 subjects were randomly sampled from university registrar records and invited to complete an online survey, which utilized methods similar to the timeline follow-back interview, to retrospectively assess relationship histories and dating violence victimization from age 13 to 19 (eight questions adapted from widely-used surveys covering physical, sexual, and psychological abuse). Then, for each dating violence type, we asked about the number of occurrences, number of abusive partners, and age at first occurrence. Of 341 subjects who completed the survey, we included 297 (64 percent females; 36 percent males) who had a dating partner from age 13 to 19. RESULTS: Fully 64.7 percent of females and 61.7 percent of males reported dating violence victimization between age 13 and 19, with most experiencing multiple occurrences. More than one-third of abused females had two or more abusive partners: controlling behavior (35.6 percent); put downs/name calling (37.0); pressured sex (42.9); insults (44.3); slapped/hit (50.0); and threats (62.5). Males also had two or more abusive partners, as follows: controlling behavior (42.1 percent); insults (51.2); put downs (53.3); threats (55.6); and unwanted calls/texts/visits (60.7). Among abused females, 44.7 percent first experienced controlling behavior between age 13 and 15, whereas the majority (62.5 percent) first experienced pressured sex between age 16 and 17. Among males, for most abuse types, 16 percent to 30 percent of victimization began before age 15. CONCLUSIONS: Our study adds information to a substantial, but still growing, body of literature about dating violence frequency, age of occurrence, and number of abusive partners among adolescents.