"What Next?": Toward telebehavioral health sustainability in couple and family therapy.

As a response to the COVID-19 global crisis, many in the couple/marital and family therapy (CMFT) professional community quickly met the challenge of providing services to clients via telebehavioral health (TBH) services. As this public health emergency endures, family therapists must continue to engage in TBH practice professionally and ethically. The rapid adoption of TBH with minimal training and experience during this public health emergency can result in crises for both individual therapists as well as for the profession in implementing electronic record-keeping, conducting virtual sessions, and communicating online with various clinical populations. The risk of insufficient training and supervision create a challenge to new and experienced family therapists. This article summarizes the work done by the profession thus far to respond to this public health emergency and presents a roadmap of recommendations for navigating those challenges into the future and offers ideas about how to sustain quality TBH practice.

Interventions for Couples.

Because relationship discord and dissolution are common and costly, interventions are needed to treat distressed couples and to prevent distress among vulnerable couples. We review meta-analytic evidence showing that 60-80% of distressed couples benefit from behavioral and emotion-focused approaches to couple therapy, but we also note that treatment effects are weaker in actual clinical practice than in controlled studies, dissipate following treatment for about half of all couples, and may be explained by factors that are common across models. Meta-analyses of prevention programs reveal reliable but smaller effects, reflecting a need to know more about whether and how communication mediates effects, about how risk and diversity moderate effects, and about how technology-enabled interventions can reduce attrition in vulnerable populations. Interventions for couples are improving and expanding, but critical questions remain about how and for whom they work.

Benchmarking Community-Based Couple Therapy: Considering Measurement Reactivity.

Couple therapy has been shown to be effective in randomized clinical trials; however, results from naturalistic couple therapy have been less consistent. This study utilized a benchmarking approach to compare the effectiveness of couple therapy in a community-based setting with findings from efficacy treatments, such as treatment within randomized clinical trials. The current study is the largest couple therapy sample published to date (N = 3,347 couples). Clients in couple therapy were asked to provide initial and weekly ratings of symptomology on the Outcome Questionnaire (OQ-45.2). We found that treatment effect sizes found at community clinics were smaller than efficacy studies (i.e., the benchmark). However, when taking into account measurement reactivity, the effect sizes were comparable. This is the first benchmarking study for community-based couple therapy, allowing for meaningful comparisons and understanding of outcomes in real-world couple therapy. Implications for the field are offered in terms of evaluating community-based psychotherapy studies with benchmarking for couple therapy. Results of this study provide clinicians and researchers a way to meaningfully compare couple therapy outcomes, accounting for differences in community-based practices and randomized clinical trials. This benchmark also underscores the impact of measurement sensitivity, an issue commonly overlooked in psychotherapy research and practice.

Se ha demostrado que la terapia de pareja es eficaz en los ensayos clínicos aleatorizados, sin embargo, los resultados de la terapia de pareja naturalista han sido menos consecuentes. Este estudio utilizó un enfoque comparativo para comparar la eficacia de la terapia de pareja en un entorno basado en la comunidad con hallazgos de los tratamientos de eficacia, como los tratamientos dentro de los ensayos clínicos aleatorizados El presente estudio es la muestra más grande de terapia de pareja publicado hasta la fecha (N = 3347 parejas). Se pidió a los pacientes en terapia de pareja que proporcionen calificaciones iniciales y semanales de la sintomatología en el cuestionario para evaluación de resultados (OQ-45.2).Descubrimos que los tamaños del efecto de los tratamientos hallados en las clínicas comunitarias fueron más pequeños que los de los estudios de eficacia (p. ej.: el estudio comparativo). Sin embargo, cuando se tomó en cuenta la reactividad a la medición, los tamaños del efecto fueron comparables. Este es el primer estudio comparativo para la terapia de pareja basada en la comunidad, el cual permite comparaciones significativas y comprensión de los resultados en la terapia de pareja en el mundo real. Se ofrecen las implicancias para el área en cuanto a la evaluación de los estudios de la psicoterapia basada en la comunidad con evaluación comparativa de la terapia de pareja. Los resultados de este estudio proporcionan a los clínicos y a los investigadores una manera de comparar significativamente los resultados de la terapia de pareja, así como de explicar las diferencias en las prácticas basadas en la comunidad y en los ensayos clínicos aleatorizados. Esta evaluación comparativa también subraya el efecto de la sensibilidad a la medición, una cuestión comúnmente pasada por alto en la investigación y la práctica de la psicoterapia.

Evaluación de la asociación entre el estilo de apego parental y los celos románticos en una muestra de estudiantes universitarios colombianos / Evaluation of the association between the style of parental attachment and the romantic jealouses in a colombian college student sample

Resumen El objetivo del presente estudio fue analizar la relación entre el estilo de apego parental y los celos románticos en un grupo de jóvenes universitarios colombianos entre los 18 y 25 años. Participaron de manera voluntaria 614 jóvenes, 421 mujeres (69%) y 193 hombres (31%), con una relación de pareja vigente de más de seis meses de duración. Los instrumentos utilizados fueron el Inventario de Apego con Padres y Pares (IPPA, Armsden y Greenberg, 1987, adaptada por Rocha, Benítez, De-Irala, sin publicar), con el cual se evaluó el apego parental con respecto a su cuidador primario, y la Escala Interpersonal de Celos (Mathes y Severa, 1981, adaptada por Martínez-León, Mathes, Avendaño, Peña y Sierra, 2018) con la cual se midieron los celos románticos en la relación de pareja de los participantes. Los resultados mostraron que en la variable estrato socioeconómico nivel medio (estratos 3 y 4) existe una relación significativa (p = .023) la cual indica que, en esta muestra específica, el estilo de apego parental está asociado con el nivel de los celos románticos en la relación de pareja.

Abstract The objective of the present study is to analyze the relationship between parental attachment style and romantic jealousy in a group of Colombian students between 18 and 25 years old. Volunteers participated 614 young people, 421 (69%) women and 193 (31%) men, with a current relationship of more than six months. The instruments used were the Inventory of Attachment with Parents and Peers (IPPA, Armsden y Greenberg, 1987, adapted by Rocha, Benítez, De-Irala, unpublished), with which assessed parental attachment with respect to their primary caregiver, and the Interpersonal Scale of Jealousy (Mathes & Severa, 1981, adapted by Martínez-León, Mathes, Avendaño, Peña and Sierra, 2018), with which was measured romantic jealousy in the couple's relationship of the participants. The results showed that in the variable socioeconomic mid-level (strata 3 and 4) there is a significant relationship (p = .023) which indicates that, in this specific sample, the Parental attachment style is associated with the level of romantic jealousy in the couple's relationship.

The Profession of Couple, Marital, and Family Therapy (CMFT): Defining Ourselves and Moving Forward.

The field of Couple, Marital, and Family Therapy (CMFT) has evolved and strengthened, but we still have work to do when it comes to identity, comprehensive scholarly resources, empirical support, and name brand recognition. We explore the reasons for these challenges and propose ways to address them: embracing the interdisciplinary nature of the field, consistently organizing treatment effectiveness by problem rather than by intervention model, continuing innovation in theory development, and utilizing more diverse and meaningful research methods. This approach provides a more accurate representation of the scope of practice of CMFTs, the range of mental and physical health problems we address, and the depth and extent of the existing research on the effectiveness of relational therapies.

Enhancing Father Involvement in Low-Income Families: A Couples Group Approach to Preventive Intervention.

To address the problem of fathers' absence from children's lives and the difficulty of paternal engagement, especially among lower income families, government agencies have given increasing attention to funding father involvement interventions. Few of these interventions have yielded promising results. Father involvement research that focuses on the couple/coparenting relationship offers a pathway to support fathers' involvement while strengthening family relationships. Relevant research is reviewed and an exemplar is provided in the Supporting Father Involvement intervention and its positive effects on parental and parent-child relationships and children's outcomes. The article concludes with policy implications of this choice of target populations and the need to develop new strategies to involve fathers in the lives of their children.

Cultural Attunement in Therapy With Mexican-Heritage Couples: A Grounded Theory Analysis of Client and Therapist Experience.

There is a need for culturally attuned approaches for couple therapy with Mexican/Mexican-Americans. This qualitative grounded theory study utilized interviews with 11 client couples of Mexican heritage and 14 marital and family therapists to shed light on how Latino and non-Latino therapists co-construct positive experiences of cultural attunement with Mexican and Mexican-American couple clients. Analysis identified a model of cultural connection through personal engagement with four interrelated phases: (a) mutual invitation, (b) shared engagement, (c) expanding personal connection, and (d) creating cultural connections. Clients in this study valued professionalism and expertise of the therapist, but felt attuned to and respected when therapists demonstrated humility, shared personal stories and emotion, and engaged in a collaborative process.

The Gap Between Couple Therapy Research Efficacy and Practice Effectiveness.

Meta-analyses of randomized controlled trials of couple therapy find large improvements in couple adjustment, but published evaluations of the effectiveness of couple therapy in routine practice find only small-to-moderate effects. The current study analyzes possible explanations for the research-efficacy to practice-effectiveness gap and offers suggestions for enhancing couple therapy effectiveness. Major recommendations are that therapists should clarify whether couples' therapy goal is to clarify commitment to the relationship or to improve the relationship; use standardized assessment of the individual partners and the relationship; and use systematic monitoring of therapy progress and the therapeutic alliance. It is also possible that the greater use of evidence-based therapies when treating couple relationship distress could enhance couple therapy outcome.

The Norway Couple Project: Lessons Learned.

Couple therapists in routine practice may find it difficult to apply findings from an increasingly expanding and complex body of couple therapy research. Meanwhile, concerns have been raised that competency in evidence-based treatments is insufficient to inform many practice decisions or ensure positive treatment outcomes (American Psychological Association Presidential Task Force on Evidence-Based Practice, American Psychologist, 2006, 271). This article aims to narrow the research/practice gap in couple therapy. Results from a large, randomized naturalistic couple trial (Anker, Duncan, & Sparks, Journal of Consulting and Clinical Psychology, 2009, 693) and four companion studies are translated into specific guidelines for routine, eclectic practice. Client feedback, the therapeutic alliance, couple goals assessment, and therapist experience in couple therapy provide a research-informed template for improving couple therapy outcomes.

Competencies for addressing gender and power in couple therapy: a socio emotional approach.

Power imbalances between partners are intrinsic to relationship distress and intricately connected to emotional experience, couple communication processes, and socio cultural contexts such as gender. The ability to work with the power dynamics between partners is thus critical to the practice of couple therapy. However, few practical guidelines for dealing with this issue are available. The authors present seven clinical competencies regarding gender and power issues that they identified by examining their own work: (a) identify enactments of cultural discourse, (b) attune to underlying socio cultural emotion, (c) name underlying power processes, (d) facilitate relational safety, (e) foster mutual attunement, (f) create a model of equality, and (g) facilitate shared relationship responsibility. Each competency is illustrated through a case example. The competencies represent an over-arching guide to practice that may be integrated with other clinical approaches and is particularly useful for training and supervision.

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.

Dismantling study of prevention and relationship education program: the effects of a structured communication intervention.

Couples Relationship Education (CRE) programs have been shown to improve many facets of relationship functioning; however, less is known about the specific effects of various components of CRE programs. The current study examined two versions of the Prevention and Relationship Education Program (PREP), one where a structured communication intervention was taught and one where it was not. Outcome variables included couples' communication behaviors, communication patterns, and overall relationship adjustment. Twenty-six couples (52 participants) completed a 4-week, 12-hr PREP workshop. Generally, the couples reported low to moderate relationship distress. Study measures were completed preintervention, 4-6 weeks post, and 6 months post. Couples in the structured communication condition reported more positive and fewer negative communication behaviors at 6-month follow up and they reported faster gains in positive communication behaviors compared with the no structured communication group. Both groups reported decreased negative communication patterns and no change in relationship adjustment; these changes were statistically similar for both groups. Implications for couples' communications and relationship education programs are discussed.

A randomized clinical trial of the effectiveness of premarital intervention: moderators of divorce outcomes.

This study examined the effects of premarital relationship intervention on divorce during the first 8 years of first marriage. Religious organizations were randomly assigned to have couples marrying through them complete the Prevention and Relationship Education Program (PREP) or their naturally occurring premarital services. Results indicated no differences in overall divorce rates between naturally occurring services (n = 44), PREP delivered by clergy at religious organizations (n = 66), or PREP delivered by professionals at a university (n = 83). Three moderators were also tested. Measured premaritally and before intervention, the level of negativity of couples' interactions moderated effects. Specifically, couples observed to have higher levels of negative communication in a video task were more likely to divorce if they received PREP than if they received naturally occurring services; couples with lower levels of premarital negative communication were more likely to remain married if they received PREP. A history of physical aggression in the current relationship before marriage and before intervention showed a similar pattern as a moderator, but the effect was only marginally significant. Family-of-origin background (parental divorce and/or aggression) was not a significant moderator of prevention effects across the two kinds of services. Implications for defining risk, considering divorce as a positive versus negative outcome, the practice of premarital relationship education, and social policy are discussed.

Do therapists address gender and power in infidelity? A feminist analysis of the treatment literature.

Sociocontextual factors such as gender and power play an important role in the etiology of affairs and in recovery from them, yet it is unclear how current treatment models address these issues. Drawing on feminist epistemology, this study utilized a grounded theory analysis of 29 scholarly articles and books on infidelity treatment published between 2000 and 2010 to identify the circumstances under which gender and power issues were or were not part of treatment. We found five conditions that limit attention to gender and power: (a) speaking (or assuming) as though partners are equal, (b) reframing infidelity as a relationship problem, (c) limiting discussion of societal context to background, (d) not considering how societal gender and power patterns impact relationship dynamics, and (e) limiting discussion of ethics on how to position around infidelity. Analysis explored how each occurred across three phases of couple therapy. The findings provide a useful foundation for a sociocontextual framework for infidelity treatment.

Assessing readiness for couple therapy: the Stages of Relationship Change Questionnaire.

Client readiness for change is garnering increased interest both conceptually and methodologically. This article describes the reliability, validity, and utility of a measure of readiness for couple relationship change, Schneider's (2003) Stages of Relationship Change Questionnaire (SRCQ). Based on the Transtheoretical Model of Change, the instrument measures change along nine domains of marital functioning. Results indicate that this one-factor instrument may reliably measure readiness for change and discriminate between various stages of change. Most in this sample (n = 406) were in early stages of change, with men more often in the stage of precontemplation and women more often in contemplation. The SRCQ can be completed and scored in under 10 min. Clinical use and research implications are discussed.

The effectiveness of couple therapy in Germany: a replication study.

The utility of couple therapy has been investigated in a number of controlled clinical efficacy investigations, demonstrating the superiority of most forms of couple therapy relative to control groups. Despite its widespread use, the effectiveness of couple therapy in field settings is largely unknown. In 1997, Hahlweg and Klann published an effectiveness study of couple therapy as practiced in German and Austrian marital counseling agencies. The purpose of the current investigation was to replicate their earlier findings in a similar setting with identical measures. The findings demonstrate that the results are remarkably similar across the two studies and that couple therapy in these applied settings helps to alleviate relationship distress as well as individuals' depression.

Moving up the continuum of hope: developing a theory of hope and understanding its influence in couples therapy.

For years therapists have suggested that hope is an important catalyst in the process of change. This study takes a grounded theory approach to address the need for a clearer conceptualization of hope, and to place interventions that increase hope within a therapeutic context so that therapists know how and when to use those interventions. Fifteen active and experienced marriage and family therapists from across the United States participated in hour-long phone interviews about hope in couples therapy. Moving Up the Continuum of Hope emerged as the core category from the grounded theory analysis of the data. This category represents a process, with general and specific conditions and consequences that increase a couple's level of hope. This study serves as a foundation for future process research on couples therapy, as well as research on hope in other contexts (e.g., individual and family therapy) and with other perspectives (e.g., clients).