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Predictors of success and process of change research studies on Emotionally Focused Couples Therapy (EFT) have identified three active ingredients that are central to the success of EFT: Task alliance, experiential depth, and affiliative interactions. The goal of this paper is to provide concrete meaning to what the subtle details of the EFT process research findings look like in practice, in order to provide a process roadmap for implementing these key ingredients of change. Typically, process research describes processes that are important for the successful implementation of a therapeutic approach without delineating the specific meaning of these processes in concrete clinical terms. We elaborate on how the ingredients of change are defined and measured in process research studies. Exploring the specific elements of these active ingredients further illuminates their concrete meaning in everyday practice through specific interventions. We conclude with a clinical case example to illustrate following the process roadmap. [ABSTRACT FROM AUTHOR]

This article discusses unique considerations for a culturally sensitive emotionally focused therapy (EFT) for African American couples. EFT is an empirically supported treatment that significantly reduces relationship distress, yet efficacy with diverse populations remains unknown. African Americans' chronic exposure to racism and discrimination creates a cumulative racial stress that negatively impacts their couple relationships. We propose a racially sensitive intervention for African American couples that addresses five considerations most salient for successful EFT treatment: the impact of racial stress, client trust of the therapist, gender-role expectations, and racial–gender views of emotionality and vulnerability. A case study illustrates this approach. [ABSTRACT FROM AUTHOR]

Interracial couples continue to grow in numbers, though there has been little research aimed to understand the experiences and unique challenges of this population. Among these challenges are stressors associated with the interplay between cultural differences and similarities. In this paper, we present an intervention called the visible invisible grid, that can be used to help interracial and intercultural couples discuss their invisible and visible differences and similarities. To illustrate the intervention, a case example is provided along with contraindications and clinical implications. [ABSTRACT FROM AUTHOR]

Combined couples' therapy is an integrative format of couple therapy where the therapist combines the use of individual and conjoint sessions in therapy. However, little is known about the processes that occur in this type of therapy. In this study, a qualitative analysis of written records was undertaken to identify certain characteristics of combined couples' therapy themes and goals. There were 15 cases identified for inclusion in this study. The majority of the clients were young educated couples in their first family life cycle stage, from middle to upper socioeconomic status, having dual careers. Results show that while dyadic/systemic issues are discussed in individual and conjoint sessions, the sessions differ in goals addressed. Moreover, certain themes like self-in-marriage concerns, unresolved past conflicts, violence, and resistance for conjoint sessions are addressed exclusively in individual sessions. The findings have implications for individual and conjoint sessions in couples' therapy. [ABSTRACT FROM AUTHOR]

Humor and its historical presence in therapy is defined and examined through a review of the available literature. This article underlines various applications for humor in forming the alliance, delivering interventions, and assessment, particularly when working with family systems, dyadic relationships, or children clientele. Implications for the inappropriate use of humor, including the need for multicultural awareness, are presented. [ABSTRACT FROM AUTHOR]

The author focuses on the use of lifeline activity as a couple therapy to identify traumatic events in their life and treat post-traumatic stress disorders. The lifeline procedure that includes gathering diagnostic information from each partner and debriefing the lifeline with the couple, is discussed. Examples are provided to explain the use of lifeline as a psycho-educational tool. It also highlights the effectiveness of the activity in facilitating emotional closeness with couples.

Virginia Satir developed her therapeutic model over 4 decades. Her ability to be fully present, caring and accepting, open and genuine led many people to assume that her personality was responsible for the good therapeutic results she achieved with her clients. She had a strong belief that positive, growth-oriented change is always possible, both for individuals and for interpersonal systems. Satir’s work developed through different stages from the time she saw her first family in 1951 until her death in 1988, including the communication stage, the validation model, the change model, and finally, transformational systemic change. To bring about transformational change, however, there therapist has to ensure that five essential elements are present in the therapeutic relationship, namely it is experiential, positively directional, and change focused, it works within both the intrapsychic and interpersonal systems, and it draws on the self of the therapist in a congruent manner to engender hope and new possibilities. Accordingly, therapists use the transformational change process to assist couples and families in resolving differences rather than using conflict or distance as ways of coping with stress. By exploring intrapsychic impacts rather than exploring events and situations, clients become aware of their family members’ patterns of coping. They can then make experiential decisions for internal change and for relational change, leading to deeper connection, acceptance, and intimacy. [ABSTRACT FROM PUBLISHER]

Male sexual problems are common and offer exceptional opportunities for clinicians to not only relieve distress but enhance individual and relationship satisfaction. However, limited clinical focus on sex behaviors alone often overlook this opportunity. With more comprehensive approaches, clinicians are able to both facilitate improved sexual function and to promote positive, realistic principles for healthy and satisfying male and couple sexuality. Approaches such as the Good-Enough Sex model provide clinicians with crucial elements to resolve common male sexual problems and promote sexual health and couple satisfaction. This article summarizes realistic features for men's (and women's) sexual health including promoting the positive value of sex, promoting realistic expectations, supporting pleasure as well as physical function, promoting sexual flexibility by integrating 5 basic purposes for being sexual and 3 arousal styles, appreciating the variable quality of sex, building relationship cooperation as an “intimate team,” and integrating sex into one's real life. Such features promoting healthy, satisfying sexuality are illustrated with a case example. [ABSTRACT FROM AUTHOR]

In this article we elaborate on an inpatient clinical group program for couples suffering from nonpsychotic psychiatric disorders, personality disorders, and/or complex partner relational problems. In general, one of the partners has a long history in mental health care. The intervention history often includes at least some sessions of couple therapy but without sufficient success. These couples are part of that group of mental health patients that can be described as, or describe themselves as, "everything was done but nothing really helped." The clinical inpatient couple group program was initiated in 1991 and to date (February 2004) 415 couples have been treated in 91 groups. Although our Center for Relational Problems is situated in a rural area in the northern part of the Netherlands, these couples are referred from all over the country. This proves that there is a need for highly intensive couple treatment in an inpatient setting. Nevertheless, as far as we know, this type of treatment does not exist anywhere else in the world. In this article we give details of the program and the rationale behind it. [ABSTRACT FROM AUTHOR]

Current couples approaches to the treatment of depression show considerable promise but also room for improvement. Conjoint approaches that are efficacious may not benefit the majority of depressed persons in intimate relationships in the community. Depressed persons whose partners refuse to participate in therapy highlight the need for individual treatments that can enhance marital functioning without relying on a conjoint format. Depressed persons who report marital satisfaction highlight the need for ways to focus on the dyad without implying the relationship is distressed. Developing a more flexible set of options for implementing treatment with a marital focus seems important. [ABSTRACT FROM AUTHOR]

Family therapists often encounter couples who present with two very difficult conditions. One, partners are caught in power struggles that paralyze the relationship. The other condition is partners who either refuse or are incapable of discussing problems directly and openly with each other. This article suggests that a technique of shifting the partner's perceptions of each other and the relationship is very useful in breaking this deadlock and subsequently transforming the relationship. An important advantage of this method is that it draws on each partner's strengths. Furthermore, it avoids direct confrontation, which often leads to further power struggles and defensiveness from both sides. A case example is presented to demonstrate how this method can be implemented with couples. [ABSTRACT FROM AUTHOR]

Couple therapy for individuals with severe personality disorders is beginning to be recognized as a valuable therapeutic approach that could meaningfully impact the individuals' personality pathology. This paper highlights the potential role of couple therapy with couples with histrionic/obsessive-compulsive personality disorders and introduces the "paradox" of couples with "healthier" personality features. In spite of healthier personality styles, these couples are often more difficult to engage than couples with more severe personality pathology. Using the attachment concept to understand this paradox, the histrionic/obsessive-compulsive personality disordered couples have more options than more disturbed individuals to resolve marital distress. These options or patterns of relationships will inform the therapist about the possible difficulties ahead in engaging them in therapy. The controlling/triangulated pattern predicts difficulties with engagement while the couple with the distressed presentation engages quickly with couple therapy. Overall, our purpose is to raise awareness about the indications for couple therapy with individuals with personality disorders and to stimulate more empirical study to confirm our clinical observations. [ABSTRACT FROM AUTHOR]

The value of couple therapy for individuals with severe personality disorders (PDs) is only beginning to be recognized, although clinicians have long observed the healing aspects of intimate relationships. For patients with dependent personality disorder in intimate relationships, couple interventions may prove to be effective. The authors' clinical experience is used to describe two dimensions of dependency that might determine whether patients will benefit from couple therapy. The first dimension focuses on interpersonal dependency resulting from insecure attachment. In the first case example, the couple failed to benefit from couple therapy because of their enmeshed relationship. The second dimension relates to the lack of self-confidence and assertiveness that leads to an interpersonal crisis. A second case example is used to demonstrate that patients with this pattern of dependency may do well in couple therapy. By assessing which aspect of dependency predominates, the therapist can determine the appropriateness of couple therapy. This paper hopes to increase awareness of couple therapy for patients with PDs and to encourage further research into its applications with these patients. [ABSTRACT FROM AUTHOR]

Treatment options for couples when one or both partners use drugs have been limited. Empirical work in this area is beginning to explore the efficacy of couple therapy for substance abuse. Six couples participated in a 20-session treatment program for couples with a male substance user. Several relational themes and clinical considerations are discussed, the relevance of which may be applicable to other couples straggling with substance abuse. Recognizing patterns such as those discussed in this article can aid clinicians to implement intervention strategies to counter repeated destructive relational patterns associated with drug use. [ABSTRACT FROM AUTHOR]

Religious and spiritual experiences and practices comprise some of the most important aspects of many people's lives. Yet, for various reasons, mental health practitioners have been hesitant to bring these issues into overt discussions in therapy. This article proposes a four-part framework to assist therapists in addressing religion and spirituality in therapy. The four areas include spiritual issues raised by either the client or therapist, and religious issues raised by either the client or therapist. Guidelines for therapeutic conversation and clinical examples are offered for each of the four areas. [ABSTRACT FROM PUBLISHER]

The purpose of our study was to explore the experiences of marriage and family therapists in working with violent couples. In particular, we focused on therapists' questions and feelings of competency pertaining to violence assessment and treatment, the difficulties they face during their practices, and the factors that affect their practice. Data for this study was collected via a focus group that lasted approximately an hour. The participants included five marriage and family therapists. A set of questions were used to explore experiences of therapists who were working with clients who are experiencing domestic violence. The research team recorded the answers to these questions as well as associated discussion. A grounded theory approach was used to analyze the data. Six themes were derived from the coded data: acknowledgment and reliance on systemic foundations, therapist factors, assessment, treatment considerations, sex of batterers, and training in Marriage and Family Therapy programs.