Analyzing Nonindependent Outcomes in Couple Therapy Using the Actor-Partner Interdependence Model.

The nonindependent components of couple data require data-analytic strategies tailored to the interpersonal processes occurring between relationship partners. This article examines the benefits of a specifically dyadic analytic method, the actor-partner interdependence model (APIM), for evaluating interpartner influence across time. Both conceptual and methodological features of the APIM are exemplified by applying this model to observations of negative and positive affect and global distress in spouses participating in a randomized trial of couple therapy. In addition to elucidating specific advantages of the APIM relative to alternative data-analytic strategies, the current results shed new light on previous findings from a comparative treatment outcome study evaluating behavioral and insight-oriented approaches to couple therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of response to treatment in a randomized clinical trial of marital therapy.

This study investigated demographic, intrapersonal, and interpersonal predictors of treatment response in a randomized clinical trial of 134 distressed married couples, which examined traditional (N. S. Jacobson & G. Margolin, 1979) and integrative (N. S. Jacobson & A. Christensen, 1996) behavioral couple therapy. Results based on hierarchical linear modeling revealed that interpersonal variables were the strongest predictors, but their effects were largely limited to predicting initial marital dissatisfaction; greater individual mental health was also associated with less distress initially. Couples who were married longer demonstrated stronger treatment gains, and exploratory analyses suggested that sexually dissatisfied couples showed slower initial, but overall more consistent, gains in the integrative versus the traditional approach. Findings are considered in light of the previous literature on predicting response to marital therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical dilemmas in contemporary psychotherapy: The search for clinical wisdom.

Examines the concept of the clinical dilemma in the contemporary practice of psychotherapy. The notion of "dilemma management" by the psychotherapist is viewed as a ubiquitous phenomenon in the psychotherapeutic process. Dilemmas in a range of areas of clinical practice are discussed. These include (1) differing treatment modalities, such as insight-oriented psychotherapy, behavior therapy, marital and family therapy, and group therapy; (2) systemic issues such as spousal codependency and family homeostasis; (3) transference and countertransference; (4) therapeutic neutrality and management of the therapeutic boundary; and (5) psychological assessment and psychiatric diagnosis. Finally, observations are made about the interpersonal process of dilemma management in psychotherapy that models for patients an effective way of approaching the pervasive conflicts and dilemmas in their own lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial functioning and depression: Distinguishing among antecedents, concomitants, and consequences.

In this article we attempt to distinguish empirically between psychosocial variables that are concomitants of depression, and variables that may serve as antecedents or sequelae of this disorder. We review studies that investigated the relationship between depression and any of six psychosocial variables after controlling for the effects of concurrent depression. The six variables examined are attributional style, dysfunctional attitudes, personality, social support, marital distress, and coping style. The review suggests that whereas there is little evidence in adults of a cognitive vulnerability to clinical depression, disturbances in interpersonal functioning may be antecedents or sequelae of this disorder. Specifically, marital distress and low social integration appear to be involved in the etiology of depression, and introversion and interpersonal dependency are identified as enduring abnormalities in the functioning of remitted depressives. We attempt to integrate what is known about the relationships among these latter variables, suggests ways in which they may influence the development of depression, and outline specific issues to be addressed in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital adjustment and outcome following treatments for depression.

Marital adjustment and treatment outcome were evaluated in the Treatment of Depression Collaborative Research Program, a multicenter clinical trial evaluating interpersonal psychotherapy, cognitive therapy, imipramine, and placebo. Marital adjustment and depression were assessed pre- and posttreatment, and depression was assessed at 6, 12, and 18 months after treatment. Results indicate that (1) there was a significant improvement in marital adjustment after treatment, (2) this effect was not moderated by treatment type, and (3) this effect was mediated by change in depression. Poor pretreatment marital adjustment was modestly associated with negative outcome, whereas poor posttreatment marital adjustment was strongly associated with negative outcome during follow-up. The findings suggest that poor marital adjustment at the end of active treatment is a risk factor for increases in depression severity during follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distinctiveness of behavioral versus insight-oriented marital therapy: An empirical analysis.

The present study determined whether behavioral and insight-oriented marital therapy could be rendered in a distinct and uncontaminated fashion in manual-guided outcome research in which therapists were crossed with treatment condition. Results indicated that therapist interventions could be reliably coded into techniques specific to the respective approaches and into additional interventions not specific to either treatment modality. When provided with explicit treatment manuals and ongoing case supervision, therapists were able to administer both treatment conditions faithfully without contamination from techniques that were inconsistent with that theoretical approach. Behavioral marital therapy (BMT) was shown to be highly structured, with 93% of therapist interventions reflecting techniques specific to that approach. In contrast, insight-oriented marital therapy (IOMT) comprised a large percentage of nonspecific interventions (62%) compatible with but not unique to a psychodynamic orientation. Implications for the two treatment approaches and for future marital therapy outcome research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment change processes in the early years of marriage.

The authors examined 4 models of attachment change: a contextual model, a social–cognitive model, an individual-difference model, and a diathesis-stress model. Models were examined in a sample of newlyweds over the first 2 years of marriage, using growth curve analyses. Reciprocal processes, whereby attachment representations and interpersonal life circumstances affect one another over time, also were studied. On average, newlyweds became more secure over time. However, there was significant within-subject variability on attachment change that was predicted by intra- and interpersonal factors. Attachment representations changed in response to contextual, social–cognitive, and individual difference factors. Reciprocal processes between attachment representations and marital variables emerged, suggesting that these factors influence one another in an ongoing way. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived change processes in emotionally focused couples therapy.

Investigated reports from 21 couples (Ss aged 24–50 yrs) of critical change incidents in their marital therapy experience. These reports, which were sorted into 5 categories of change processes, were collected 4 mo after the completion of 8 sessions of therapy. The reports revealed 5 major change processes: expression of underlying feelings by one of the partners leading to change in interpersonal perception, expressing feelings and needs, acquiring understanding, taking responsibility for experience, and finally receiving validation. These empirically derived processes were compared with the theoretically derived processes. Findings demonstrate the importance of studying what clients say about change to enrich the understanding of change processes in marital therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some ethical concerns regarding the individual psychotherapy of the married client.

A brief review of the literature establishes the high potential for disturbance of a client's marital relationship following individual psychotherapy. Several problems possibly inherent in the conduct of therapy with only one member of a marital dyad are discussed, as well as some of their probable sources. The importance of informed consent to treatment is stressed with regard to ensuring that potential clients are aware of the possible negative effects of therapy on their marital relationship. The systemic view of the spouse as necessarily involved in the maintenance and modification of the client's complaints, provides an alternative to individual psychotherapy: The spouse must be a part of their therapy from the beginning. It is suggested that the ethical responsibility of the therapist is toward the greatest overall benefit for the client and should concern the interpersonal as well as the psychological environments of the clients they serve. (French abstract) (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment style.

This article provides a brief review of attachment theory and recent research studies on its implications for individual psychotherapy. Attachment theory offers a conceptual framework that helps illuminate how past experiences with caregivers might influence current transactions between therapist and patient. Both patients and therapists may form internal working models that are based, in part, on early experiences of interpersonal responsiveness. Such working models are reflected in secure, anxious-ambivalent, and anxious-avoidant attachment styles, which describe whether patients (and therapists) tend to be comfortable and confident in relationships, fearful of abandonment, or defensively separate. Recent studies showed that attachment styles in the context of therapy can be measured reliably and related to therapeutic process (e.g., the alliance) and outcome (e.g., treatment response). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special series.

Provides an introduction to the special series on the assessment and treatment of marital and family dysfunction. Despite the absence of a dominant, coherent theoretical model, both clinical practice and research in marital and family therapy have demonstrated exponential growth in the last two decades. More recently, attention has turned to the role of marital and family dynamics not only in psychological difficulties in children or domestic violence but also in such "individual" disorders as depression, schizophrenia, and substance abuse. The series begins with three articles examining the role of marital and family dysfunction in more traditional psychiatric disorders. Three additional articles examine considerations in marital therapy from both conceptual and empirical perspectives. Altogether, the series argues for the adoption of a broad interpersonal perspective in investigating and treating all emotional, behavioral, and even physical difficulties, regardless of presenting symptoms or diagnostic classifications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Les corrélats des attributions de causalité et de responsabilité des couples qui consultent en thérapie conjugale.

This exploratory study aimed to identify the clinical correlates of partner's attributions in 165 couples beginning couple therapy. Results revealed that marital satisfaction, the interpersonal problem of dominance, and psychological distress were significatively linked to men's attributions. Marital satisfaction, the interpersonal problem of the tendency to self-sacrifice, and women's age were significatively associated with women's attributions. At a dyadic level, only men's marital satisfaction was linked to women's causality attributions. The importance of studying both dyadic and individual correlates of attributions is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Studying group dynamics with the social relations model.

Although the interdependence of group members is one of the defining characteristics of group dynamics, most traditional statistical methods require each observation to be independent. D. Kenny's (1994) social relations model (SRM) provides a statistical technique for studying interdependence in groups. The components of the SRM (e.g., actor, partner, relationship) and the ways in which this model can be used to study interpersonal behavior and perception in groups are reviewed. Findings from social relations analyses of leadership and group therapy are discussed to demonstrate the ways in which the SRM can contribute to the study of group dynamics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuroticism, marital interaction, and the trajectory of marital satisfaction.

Theories of how initially satisfied marriages deteriorate or remain stable over time have been limited by a failure to distinguish between key facets of change. The present study defines the trajectory of marital satisfaction in terms of 2 separate parameters—(a) the initial level of satisfaction and (b) the rate of change in satisfaction over time—and seeks to estimate unique effects on each of these parameters with variables derived from intrapersonal and interpersonal models of marriage. Sixty newlywed couples completed measures of neuroticism, were observed during a marital interaction, and provided reports of marital satisfaction every 6 months for 4 years. Neuroticism was associated with initial levels of marital satisfaction but had no additional effects on rates of change. Behavior during marital interaction predicted rates of change in marital satisfaction but was not associated with initial levels. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Attributions in marriage: Review and critique.

The prevailing behavioral account of marriage must be expanded to include covert processes. This article therefore examines the attributions or explanations that spouses make for marital events. A review indicates that dissatisfied spouses, compared with satisfied spouses, make attributions for the partner's behavior that cast it in a negative light. Experimental, clinical outcome, and longitudinal data suggest further that attributions may influence marital satisfaction. Rival hypotheses for these findings are examined. Because continued empirical development in this domain depends on conceptual progress, a framework is presented that integrates attributions, behavior, and marital satisfaction. This framework points to several topics that require systematic study, and specific hypotheses are offered for research on these topics. It is concluded that the promising start made toward understanding marital attributions holds considerable potential for enriching behavioral conceptions of marriage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal Mediators in the Intergenerational Transmission of Marital Dysfunction.

Intergenerational transmission of marital functioning was examined in a sample of 60 newlywed couples by collecting (a) retrospective reports of conflict and divorce in spouses' families of origin, (b) data on demographic variables and interactional processes likely to increase risk for adverse marital outcomes, and (c) couples' actual 4-year marital outcomes. The association between wives' parental divorce and marital outcome was mediated by their verbal and physical aggression. The association between negativity in husbands' family of origin and marital outcome was mediated by dyadic expressions of negative affect. Demographic variables did not operate as mediators. Negative interpersonal processes appear to be a vehicle by which experiences in the family of origin are carried forward into the next generation of relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working models of attachment to parents and partners: Implications for emotional behavior between partners.

This study examined whether working models of attachment are associated with observed positive emotion, sadness, and anger during marital conflict. Individuals (n = 176) from a longitudinal study of families participated in the current cross-sectional study. Narrative interviews assessed the unique and combined contribution of attachment representations based on parents (adult attachment) and partner (couple attachment). The influence of partner’s attachment, depression symptoms, and sex of participant was also examined. Hierarchical linear models demonstrated that one’s couple attachment security predicts one’s observed positive emotion, whereas the partner’s couple attachment security predicts one’s observed negative emotion. Partner’s depression symptoms moderated the effects of partner’s couple attachment. Adult attachment was not related to observed emotional behavior between partners. These findings have important clinical implications for individual, couple, and family therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Scientific ideology and women: Implications for marital research and therapy.

Examines the relationship between scientific ideology and marital research and therapy, arguing that traditional science restricts research findings and therapists' activities in ways that make meaningful change for women difficult. It is asserted that there is a need in marital therapy to expand beyond the personal and interpersonal to the cultural, historical, and political. Researchers need to recognize more explicitly their own role in generating the data they seek. Recommended changes are said to be consistent with approaches to social science advocated in phenomenology, social constructionism, and contextualism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An open trial of integrative therapy for generalized anxiety disorder.

Cognitive-behavioral therapy (CBT), although effective, has the lowest average effect size for generalized anxiety disorder (GAD), when compared to effect sizes of CBT for other anxiety disorders. Additional basic and applied research suggests that although interpersonal processes and emotional avoidance may be maintaining GAD symptomatology, CBT has not sufficiently addressed interpersonal issues or emotion avoidance. This study aimed to test the feasibility and preliminary efficacy of an integrative psychotherapy, combining CBT with techniques to address interpersonal problems and emotional avoidance. Eighteen participants received 14 sessions of CBT plus interpersonal emotional processing therapy and three participants (for training and feasibility purposes) received 14 sessions of CBT plus supportive listening. Results showed that the integrative therapy significantly decreased GAD symptomatology, with maintenance of gains up to 1 year following treatment. In addition, comparisons with extant literature suggested that the effect size for this new GAD treatment was higher than the average effect size of CBT for GAD. Results also showed clinically significant change in GAD symptomatology and interpersonal problems with continued gains during the 1-year follow-up. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)