Love in Action: An Integrative Approach to Last Chance Couple Therapy.

This article presents an integrative approach to the special challenges of therapy with couples on the brink of dissolution or divorce-who often describe this therapy as their "last chance." In some, one partner is considering ending the relationship, and in others, both partners are considering ending it. Often, these couples have had prior dissatisfying experiences in couple therapy. Four types of last chance couples are described: high-conflict couples; couples in which partners have differing goals for their lives or different timelines for reaching shared goals; couples in which one or both partners have acted in a manner that violates the values, expectations, emotional comfort, or safety of the other; and couples in which there has been a gradual loss of intimacy. The Therapeutic Palette, a multiperspectival, theoretically eclectic integrative approach, is enlisted as a general framework for selecting and sequencing use of particular theories and their associated practices, based on the three "primary colors" of couple therapy: time frame/focus, level of directiveness, and change entry point. An additional complementary framework, the creative relational movement approach, is proposed to provide an integrative frame encompassing both language-based and action-based practices, suggesting that meaning is held and expressed as much through interaction or "relational motion" as it is through language. Principles of change are described. Due to the couple's level of crisis and desire for immediate evidence of possible improvement, priority is given to action-based interventions in early stages of therapy, by engaging couples in "experiments in possibility." Typical action approaches are described. An extended vignette follows.

Association between Spouse/Child Separation and Migration-Related Stress among a Random Sample of Rural-to-Urban Migrants in Wuhan, China.

BACKGROUND: Millions of people move from rural areas to urban areas in China to pursue new opportunities while leaving their spouses and children at rural homes. Little is known about the impact of migration-related separation on mental health of these rural migrants in urban China. METHODS: Survey data from a random sample of rural-to-urban migrants (n = 1113, aged 18-45) from Wuhan were analyzed. The Domestic Migration Stress Questionnaire (DMSQ), an instrument with four subconstructs, was used to measure migration-related stress. The relationship between spouse/child separation and stress was assessed using survey estimation methods to account for the multi-level sampling design. RESULTS: 16.46% of couples were separated from their spouses (spouse-separation only), 25.81% of parents were separated from their children (child separation only). Among the participants who married and had children, 5.97% were separated from both their spouses and children (double separation). Spouse-separation only and double separation did not scored significantly higher on DMSQ than those with no separation. Compared to parents without child separation, parents with child separation scored significantly higher on DMSQ (mean score = 2.88, 95% CI: [2.81, 2.95] vs. 2.60 [2.53, 2.67], p < .05). Stratified analysis by separation type and by gender indicated that the association was stronger for child-separation only and for female participants. CONCLUSION: Child-separation is an important source of migration-related stress, and the effect is particularly strong for migrant women. Public policies and intervention programs should consider these factors to encourage and facilitate the co-migration of parents with their children to mitigate migration-related stress.

Living with bipolar disorder: the impact on patients, spouses, and their marital relationship.

OBJECTIVES: Patients with bipolar disorder are characterized by an unusually high divorce rate. As such, the purpose of the present study was to uncover information relating specifically to the impact of bipolar disorder on patients and spouses individually, and on the marital relationship from the perspectives of both patients and spouses. METHODS: Eleven patients with bipolar disorder and ten spouses were interviewed separately about the impact of bipolar disorder on their lives and on their marital relationship. Data were analyzed using the grounded theory method. RESULTS: The impact of bipolar disorder for spouses included self-sacrifice, caregiving burden, emotional impact, and a sense of personal evolution. The impact of bipolar disorder on patients included an emotional impact, responsibility for self-care, and struggling socially and developmentally. When comparing patient and spouse perspectives on the impact of the disorder, neither the patient nor the spouse was able to accurately assess the impact of the disorder on their partner's lives. The impact of bipolar disorder on the relationship included volatility in the relationship, strengthening the relationship, weakening the relationship, and family planning. CONCLUSIONS: The research indicated that patients and partners alike struggle with the tremendous impact of bipolar disorder on their lives and on their relationships. Given the high rates of divorce and volatility in these relationships, healthcare professionals can provide (or refer to) emotional and practical support both to patients and spouses on their own, and as a couple in their clinics.

Los programas educativos para parejas y matrimonios: una nueva propuesta clínica para Chile / Educational programs for couples and marriages: a new clinical proposal to Chile

La educación dirigida a parejas y matrimonios tiene un amplio desarrollo en el mundo y en varios países se encuentra incorporada como parte de las políticas públicas preventivas de la discordia, ruptura y establecimiento de relaciones de parejas saludables y comprometidas. Iniciativas que originalmente fueron promovidas por grupos religiosos, hoy constituyen una alternativa preventiva y de promoción de relaciones saludables, basada en los avances de las investigaciones psicológicas y evaluadas en forma rigurosa. El artículo tiene por objetivo: (a) dar a conocer la lógica que fundamenta las intervenciones preventivas (b) dar a conocer las iniciativas en educación para parejas y matrimonios en otros países (c) sistematizar los hallazgos acerca de su efectividad (d) argumentar las razones por las cuales sería provechoso incorporarlas en el país.

Education aimed at couples and marriage has a broad development in the world and in several countries has been incorporated into adult educational programs as part of preventive public policies of disharmony, rupture and relationship healthy couples. Initiatives that were originally promoted by religious groups today are a preventive alternative to promote healthy relationships, based on advances in psychological research and rigorously evaluated. The paper presents (a) to present the logic behind preventive interventions (b) make known the initiatives in education for couples and families in other countries (c) systematize the findings about their effectiveness (d) discuss the reasons which would be useful for incorporation into the country.

Is skills training necessary for the primary prevention of marital distress and dissolution? A 3-year experimental study of three interventions.

OBJECTIVE: Evidence in support of skill-based programs for preventing marital discord and dissolution, while promising, comes mainly from studies using single treatment conditions, passive assessment-only control conditions, and short-term follow-up assessments of relationship outcomes. This study overcomes these limitations and further evaluates the efficacy of skill-based programs. METHOD: Engaged and newlywed couples (N = 174) were randomly assigned to a 4-session, 15-hr small-group intervention designed to teach them skills in managing conflict and problem resolution (PREP) or skills in acceptance, support, and empathy (CARE). These couples were compared to each other, to couples receiving a 1-session relationship awareness (RA) intervention with no skill training, and to couples receiving no treatment on 3-year rates of dissolution and 3-year trajectories of self-reported relationship functioning. RESULTS: Couples in the no-treatment condition dissolved their relationships at a higher rate (24%) than couples completing PREP, CARE, and RA, who did not differ on rates of dissolution (11%). PREP and CARE yielded unintended effects on 3-year changes in reported relationship behaviors. For example, wives receiving PREP showed slower declines in hostile conflict than wives receiving CARE, and husbands and wives receiving CARE showed faster declines in positive behaviors than husbands and wives receiving PREP. CONCLUSIONS: These findings highlight the potential value of cost-effective interventions such as RA, cast doubt on the unique benefits of skill-based interventions for primary prevention of relationship dysfunction, and raise the possibility that skill-based interventions may inadvertently sensitize couples to skill deficits in their relationships.

Applying the creating lasting family connections marriage enhancement program to marriages affected by prison reentry.

Divorce proportions are currently high in the US and they are even higher among those who are incarcerated with substance abuse problems. Although much research has examined marital interventions, only two studies have examined marital interventions with prison populations. There is some empirical evidence that incarcerated couples benefit from traditional marital therapy (O'Farrell and Fals-Stewart, 1999, Addictions: A comprehensive guidebook, New York, Oxford University Press). An adaptation of the evidence-based Creating Lasting Family Connections program was implemented with 144 married couples, where one spouse was incarcerated, in a southern state with particularly high divorce and incarceration proportions. Results suggested that married men exposed to the program had larger improvements in some relationship skills relative to a convenience sample of men not so exposed. Both husbands and wives exposed to the program exhibited similar and significant increases in relationship skills. The results were comparable to a Prevention and Relationship Enhancement Program adaptation for inmates. The implications of the findings for prevention practitioners 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.

The impact of the within my reach relationship training on relationship skills and outcomes for low-income individuals.

A federal grant was awarded to provide the Within My Reach healthy relationships curriculum to low-income, at-risk individuals involved with various social service agencies. The effectiveness of this curriculum was evaluated for 202 participants through measures of training and relationship outcomes pre-, immediately post- and 6 months posttraining. Participants experienced high levels of training satisfaction; significant increases in knowledge, communication/conflict resolution skills, and relationship quality; as well as a trend in the reduction of relationship violence. An important implication of this research is that MFTs may broaden their service delivery to at-risk individuals by collaborating with community agencies to adapt established relationship enhancement programs, evidence-based tools, and principles that complement traditional couples therapy.

Collaboration of prevention science and the family court.

This paper describes 27 years of collaborative activities between a team of researchers at the Arizona State University Prevention Research Center (ASU PRC) and the Maricopa County Family Court Division of the Superior Court. The complementary goals and expertise of the family court and prevention science are described as providing the foundation in which the missions of each can be advanced through collaborative activities. Four kinds of collaborative activities are described, which are differentiated according to the initiator of the activity and the primary immediate beneficiary. Nineteen separate collaborative activities that were conducted over the 27 years are described. Finally, lessons learned from this long-term collaboration are described including; mutual benefits of each activity, the benefit of complementary perspectives, the cumulative value of collaborations over time, the key role of the local key champion, and the societal benefit from the synergistic roles of university-based research and the family courts.

The role of leaders' working alliance in premarital education.

Premarital (and general relationship) education programs, as a prevention method, have been shown to have a positive effect on marital quality and can prevent divorce. However, it is unclear whether these positive effects are consistent across leaders who conduct premarital education programs. Examining the variability in relationship outcomes attributed to the leaders of premarital education programs, and the role of general therapeutic factors such as working alliance in explaining relationship outcomes, may help increase the effectiveness of these programs. Accordingly, this study examined 31 leaders who trained 118 couples (236 attendees) in a randomized clinical trial of the Prevention and Relationship Enhancement Program (PREP), a research-based and empirically supported premarital education program being compared with a treatment as usual track. The results demonstrated that couples' relationship outcomes from pre- to post-training varied on the basis of the leader who provided the premarital education training. Both training in PREP and aggregated leader working alliance quality (as rated by attendees) explained variability between leaders in change in attendees' observed negative and positive communication. Leaders' aggregated working alliance quality also explained change in relationship satisfaction. In addition, attendees' ratings of their leaders' working alliance predicted change in their relationship satisfaction and confidence, and attendees had higher positive communication when they reported better working alliance with their leader.

Prevention of marital instability and distress. Results of an 11-year longitudinal follow-up study.

Divorce and destructive couple conflict are major risk factors for many forms of dysfunction and psychopathology in the family. Couple relationship education has been offered in an attempt to reduce those risks and enhance couple outcomes. The current effectiveness study had two aims: to assess (a) the long-term effects of relationship education and (b) the ability of partners to remember the skills typically taught during the communication skills training. One hundred and one couples from two studies, in which the effectiveness of the EPL (Ein Partnerschaftliches Lernprogramm für Paare [A Learning Program for Married Couples]) was investigated, were followed-up 11 years after the training. In the first study, EPL-takers had a significantly lower divorce and separation rate (27.5%) than non-EPL-takers (52.6%). This finding was replicated in a second study, showing a 20% dissolution rate in EPL-takers. For those couples still together, the rate of happy relationships was 80% at the eleven-year follow-up - thus, there is optimism for longer married couples who are willing to focus on improving their relationships. Only about 55% of the partners could remember at least one speaker skill whereas 70% remembered at least one listening skill taught during EPL. Consequences for prevention programs in the couple domain are discussed.

The lived experiences of brokered brides who have attempted suicide in Taiwan.

AIMS AND OBJECTIVES: The purpose of this study was to explore the lived experiences of brokered brides who have attempted suicide in Taiwan. BACKGROUND: There has been a significant rise in number of brokered brides since the 1970s in Western world and since the 1990s in several Asian countries. However, there is a great lack of research on brokered brides' suicide around the world. DESIGN: A descriptive phenomenological study was used to explore the lived experiences of brokered brides who have attempted suicide. METHODS: Purposive sampling, one-on-one, in-depth with semi-structural interviews were conducted to collect data. Narratives were analysed by Colaizzi's (1978) seven-step method. RESULTS: Data saturation was achieved after interviewing 12 brokered brides. The study group was comprised of females whose average age was 33. Three themes and the sub-themes were: being a chrysalis (loss of support, loneliness, suffering abused experience, loss of self-esteem), death of a chrysalis (loss of hope and seeking salvation) and birth of a chrysalis (regaining hope and sense of self-worth). CONCLUSIONS: These brokered brides suffered from numerous pressures and difficulties in life. Their hopelessness led to suicidal behaviours as a way to get out of trouble. Hence, the need to provide brokered brides with substantial assistance and support in their lives is an issue that cannot be neglected. The results of this study could be used as a reference to provide professionals and the public with a deeper understanding of suicide in this vulnerable group, and provide more appropriate help and care. Relevance to clinical practice. The suffering may be alleviated by giving brokered brides a reliable support system that they so obviously need. Several recommendations have been made, including amendments in terms of policy, society and the services offered by healthcare professionals.

Differential use of premarital education in first and second marriages.

Although second marriages are more likely to end in divorce than first marriages, and thus represent an important target for intervention, there have been no detailed examinations of the use of premarital education in second marriages. Using random-digit dialing methods, 398 individuals currently in a second marriage and 1,342 individuals currently in a first marriage participated. Compared with those in first marriages, individuals in second marriages were significantly less likely to receive premarital education for their current marriage. This difference was fully mediated by differences between individuals in first and second marriages in pre-engagement cohabitation, education level, having children from a previous relationship, and being married by a religious leader. In both first and second marriages, those couples at most risk for subsequent marital distress and divorce were less likely to receive premarital education. Results suggest that more needs to be done to understand the barriers to the use of premarital education for second marriages.

A randomized clinical trial of a computer based preventive intervention: replication and extension of ePREP.

This randomized clinical trial replicated the efficacy of the ePREP preventive intervention for mental health and relationship relevant outcomes in a sample of 77 college students. It extended previous research by demonstrating efficacy at a 10-month follow up. Participants in the ePREP condition experienced improved mental health and relationship relevant outcomes relative to those who received a placebo intervention. The impact of the ePREP intervention on these outcomes was durable to relationship dissolution with and without repartnering. The flexibility of this intervention empowers it to overcome key obstacles in the dissemination of relationship education.

Premarital education, marital quality, and marital stability: findings from a large, random household survey.

One of the limitations of experimental studies on the effectiveness of premarital education is the reliance on samples of mostly White, middle-class couples. In contrast, although survey methods allow only weak inferences about causal relations, representative surveys can yield important information about use and estimated effects across a diverse population. Using a large random survey of 4 middle American states, the authors found that participation in premarital education was associated with higher levels of satisfaction and commitment in marriage and lower levels of conflict-and also reduced odds of divorce. These estimated effects were robust across race, income (including among the poor), and education levels, which suggests that participation in premarital education is generally beneficial for a wide range of couples.

The impact of family formation change on the cognitive, social, and emotional well-being of the next generation.

How have recent changes in U.S. family structure affected the cognitive, social, and emotional well-being of the nation's children? Paul Amato examines the effects of family formation on children and evaluates whether current marriage-promotion programs are likely to meet children's needs. Amato begins by investigating how children in households with both biological parents differ from children in households with only one biological parent. He shows that children growing up with two continuously married parents are less likely to experience a wide range of cognitive, emotional, and social problems, not only during childhood but also in adulthood. Although it is not possible to demonstrate that family structure causes these differences, studies using a variety of sophisticated statistical methods suggest that this is the case. Amato then asks what accounts for the differences between these two groups of children. He shows that compared with other children, those who grow up in stable, two-parent families have a higher standard of living, receive more effective parenting, experience more cooperative co-parenting, are emotionally closer to both parents, and are subjected to fewer stressful events and circumstances. Finally, Amato assesses how current marriage-promotion policies will affect the well-being of children. He finds that interventions that increase the share of children who grow up with both parents would improve the overall well-being of U.S. children only modestly, because children's social or emotional problems have many causes, of which family structure is but one. But interventions that lower only modestly the overall share of U.S. children experiencing various problems could nevertheless lower substantially the number of children experiencing them. Even a small decline in percentages, when multiplied by the many children in the population, is a substantial social benefit.

Predicting participation in premarital prevention programs: the health belief model and social norms.

The development of effective programs to prevent marital dysfunction has been a recent focus for marital researchers, but the effective dissemination of these programs to engaged couples has received relatively little attention. The purpose of this study is to determine which factors predict couples' participation in premarital counseling. Predictive factors were derived from the health prevention literature, with a particular focus on the health belief model (HBM). Couples' beliefs and attitudes about premarital counseling were assessed at least six months before their wedding, and participation was assessed after their wedding. Results indicate that the strongest predictors of couples' participation were couples' perceptions of barriers to counseling and whether they had counseling recommended to them. These variables predicted participation even after controlling for important demographic variables. Recommendations for recruiting engaged couples for premarital counseling are made based on the findings.