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.

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.

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.

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.

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.

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.

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.

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.

Baby with the Bathwater? Examining the Relationship between Video Game Use and Relationship Outcomes and the Moderating Effects of Attachment Behaviors among Married Casual Gamers.

We examined whether time together as a problem mediates the link between frequency of video game use and relational outcomes (relationship quality, relational aggression, physical aggression) among 431 married couples. We also examined the moderating effect of couple attachment behaviors on the association between time together as a problem and outcomes. There was no support for a direct or indirect relationship between gaming and outcomes; however, time together as a problem was consistently related to outcomes. Additionally, husband's and wife's attachment behaviors moderated the association between women's reports of time together as a problem and men's relational aggression. Clinical implications are discussed.

Examining the Influence of Relational Aggression on Sexual Satisfaction With Attachment Behaviors as a Potential Mediator.

The purpose of this study was to investigate the relationship between relational aggression and sexual satisfaction, as well as to determine if attachment behaviors could mediate this relationship. Data came from the Relate Institute Questionnaire (RELATE) and were drawn from the matched-pair responses of 539 heterosexual married couples. Results showed the greater the perceived relational aggression, the lower the sexual satisfaction for both self and partner, regardless of gender. Mediation analyses suggest that attachment behaviors may be a mechanism through which relational aggression influences sexual satisfaction. Implications for clinicians and future research are discussed.

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 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.

Differentiating Between Attachment Styles and Behaviors and their Association with Marital Quality.

The purpose of this study was to distinguish between the influence of attachment styles and behaviors on marital quality for couples. Data were gathered from 680 couples in a married relationship. Results showed attachment style and behaviors predicted marital quality for both men and women, with higher levels of attachment related to greater quality. Attachment behaviors predicted more of the variance in quality than did styles. Specific implications regarding how therapists may wish to foster behaviors that promote attachment security in marriages 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.

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.

A joined-up approach to improving older people's health and wellbeing.

This article describes how a joined-up approach to housing, health and wellbeing is making a difference to the lives of older people and particularly the lives of frail individuals. It looks at the services available at ExtraCare Charitable Trust's retirement villages and discusses how investing in the right staff and tools produces the best results and helps to keep people out of hospital.

Gender differences in couple attachment behaviors as predictors of dietary habits and physical activity levels.

This study used an Actor-Partner Interdependence Model to examine the relationship between attachment behaviors and health practices, as measured by physical activity levels and dietary habits. The sample included 1031 married couples, the majority of which is Caucasian (83.8%). Results suggest that women's attachment behaviors significantly influenced their own health practices (p = .038), such that for every unit increase in poor attachment behaviors, women were 199.8 percent more likely to have poor diet and low physical activity levels (exp(1.098) = 2.998). Men's attachment behaviors were not significantly related to their own health practices. There were also no significant partner paths. Implications for treating women who present with health problems are discussed, as are directions for future research.

If We Build It, They Will Come: Exploring Policy and Practice Implications of Public Support for Couple and Relationship Education for Lower Income and Relationally Distressed Couples.

Over the past decade, public funding for Couple and Relationship Education programs has expanded. As program administrators have been able to extend their reach to low-income individuals and couples using this support, it has become apparent that greater numbers of relationally distressed couples are attending classes than previously anticipated. Because psychoeducational programs for couples have traditionally served less distressed couples, this dynamic highlights the need to examine the policy and practice implications of more distressed couples accessing these services. This paper reviews some of the most immediate issues, including screening for domestic violence and couple needs, pedagogical considerations, and the potential integration of therapy and education services. We also make suggestions for future research that can inform policy and practice efforts.

A Longitudinal View of the Association Between Therapist Warmth and Couples' In-Session Process: An Observational Pilot Study of Emotionally Focused Couples Therapy.

This longitudinal dyadic clinical process study used coded data from eleven couples to determine the influence of therapist warmth behaviors on couples' warmth behaviors over time in therapy. A mixed effects model was used to examine within- and between-individual variability. Men and women were modeled separately. A series of two-level multilevel models of change were examined, where Time is Level 1 and Individual is Level 2. Findings were mixed. There was no significant relationship between therapist warmth toward wife and wife warmth toward husband; however, there was a significant relationship between therapist warmth toward husband and husband warmth toward wife. Findings demonstrated that 62.9% of the variance in husband warmth toward wife was accounted for by therapist warmth to husband across time in therapy. Specifically, therapist warmth toward husband was significantly and positively related to husband warmth toward wife over time in therapy. Clinical implications and directions for future research are discussed.

Insecure attachment behavior and partner violence: incorporating couple perceptions of insecure attachment and relational aggression.

Intimate partner violence and insecure attachment are therapeutically relevant concepts when working with couples. The link between attachment and intimate partner violence has been examined in the literature, but an area of aggression that often goes unexamined is relational aggression, or using third parties as a means of being aggressive toward a partner. We asked how participants' attachment behaviors were related to their own and partners' relational and physical aggression. We used structural equation modeling to estimate actor-partner interdependence among these relationships in 644 heterosexual couples. Results indicated significant partner paths from attachment to relational aggression, as well as significant actor paths between relational aggression and physical aggression. Implications were discussed. Data for this study were collected from the RELATE assessment.