Teaching fidelity

Working therapeutically with individuals or couples either following an affair or prior to its occurrence requires teaching them about risks to monogamy and the challenges of recovering from infidelity. Risks to monogamy include cultural myths about both infidelity and marriage that may be shared not only by lay persons, but also by their ill-informed therapists. Exacerbating risks to fidelity are physiological components of emotional and physical attraction that contribute to cognitive and affective disorientation. Therapists can promote fidelity and recovery from infidelity by attending to the fundamental tasks of modeling compassion, debunking myths regarding infidelity, confronting individuals with their own choices, promoting emotional closeness, and helping individuals to understand both their own and their partner's learned attitudes that distract them from maintaining a faithful marriage. Several cases illustrate these fundamental therapeutic tasks.     

Marital therapy as a treatment for depression

The purpose of this study was to compare cognitive-behavioral therapy (CT; n = 20), behavioral marital therapy (BMT; n = 19), and a treatment combining BMT and CT (CO; n = 21) in the alleviation of wives' depression and the enhancement of marital satisfaction. BMT was less effective than CT for depression in maritally nondistressed couples, whereas for maritally distressed couples the two treatments were equally effective. BMT was the only treatment to have a significant positive impact on relationship satisfaction in distressed couples, whereas CO was the only treatment to enhance the marital satisfaction of nondistressed couples. On marital interaction measures CO was the only treatment to significantly reduce both husband and wife aversive behavior and to significantly increase wife facilitative behavior.     

Problem-solving skills in happy and distressed couples: Effects of videotape and verbal feedback

Investigated communication in happy and distressed married couples, in two studies. Fifty-eight couples' problem-solving behaviors were evaluated by the spouses themselves and by trained observers. Some distressed couples viewed their own videotape; others received a placebo intervention. Half of the distressed couples received written feedback before a second discussion. Results indicated that (a) distressed and happy couples differed on some behavioral measures; (b) both happy and distressed wives engaged in more negative behaviors than husbands; (c) videotape and written feedback were ineffective in altering behaviors; (d) husbands' and wives' negative behaviors were correlated highly; and (e) spouses' and observers' ratings were independent. Implications for research on marriage and for behavioral couple therapy are discussed.     

The multidimensional and developmental nature of infidelity: practical applications

When a partner has been unfaithful, an important therapeutic task is to assess factors that contributed to the affair and that may affect the individual's and couple's healing. This article provides a framework to assess multiple factors and their influence on an affair over time, as well as on responses to an affair. We address factors related to the person involved in an affair, his or her partner, their relationship, and the external context. These factors are considered across six phases of an affair: predisposition, approach, initial involvement, maintenance, disclosure or discovery, and response. A case study is presented to illustrate the usefulness of the framework in working with couples in which there has been an affair.     

Treating infidelity in same-sex couples

Psychotherapy with same-sex couples does not differ markedly from standard couple therapies; this is also true for treating couples facing infidelity. However, same-sex couples often design their relationships differently, without tradition and formal marital contracts to prescribe behavior. Based on clinical experience and the empirical research, this article addresses the differing norms involved in affirmatively treating infidelity in gay and lesbian couples within the framework of integrative behavioral couple therapy (IBCT). Two cases illustrate the process and outcome of IBCT with same-sex couples.     

The Prevention of Extramarital Involvement: Steps Toward "Affair Proofing" Marriage

In this paper I provide comments on the Allen et al. paper (this issue). I note that it provides the first critical, comprehensive, and integrative review of extramarital involvement (EMI) to appear in the literature, and I summarize some of its major contributions to the field. I then focus on how the review stimulated my thinking about current and future best practices in marriage education for the prevention of EMI. I conclude by suggesting several directions for future research and practice. Key words: affair prevention, infidelity, couples.     

The effect of group psychosocial support on survival in metastatic breast cancer.

BACKGROUND: Supportive-expressive group therapy has been reported to prolong survival among women with metastatic breast cancer. However, in recent studies, various psychosocial interventions have not prolonged survival. METHODS: In a multicenter trial, we randomly assigned 235 women with metastatic breast cancer who were expected to survive at least three months in a 2:1 ratio to an intervention group that participated in weekly supportive-expressive group therapy (158 women) or to a control group that received no such intervention (77 women). All the women received educational materials and any medical or psychosocial care that was deemed necessary. The primary outcome was survival; psychosocial function was assessed by self-reported questionnaires. RESULTS: Women assigned to supportive-expressive therapy had greater improvement in psychological symptoms and reported less pain (P=0.04) than women in the control group. A significant interaction of treatment-group assignment with base-line psychological score was found (P相似文献   

Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples

A randomized clinical trial compared the effects of traditional behavioral couple therapy (TBCT) and integrative behavioral couple therapy (IBCT) on 134 seriously and chronically distressed married couples, stratified into moderately and severely distressed groups. Couples in IBCT made steady improvements in satisfaction throughout the course of treatment, whereas TBCT couples improved more quickly than IBCT couples early in treatment but then, in contrast to the IBCT group, plateaued later in treatment. Both treatments produced similar levels of clinically significant improvement by the end of treatment (71% of IBCT couples and 59% of TBCT couples were reliably improved or recovered on the Dyadic Adjustment Scale; G. B. Spanier, 1976). Measures of communication also showed improvement for both groups. Measures of individual functioning improved as marital satisfaction improved.     

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.     

Why are infertile patients not using psychosocial counselling?

The purpose of this study was to examine the sources of support that infertile patients relied on when distressed, and the factors that prevented them from using psychosocial counselling. The sample consisted of 143 infertile patients (49 couples plus 45 additional women) who were in their mid-thirties and had been infertile for approximately 6 years. Before their clinic appointment, participants completed (anonymously) a short questionnaire concerning various sources of support and factors related to the uptake of counselling. The results showed that patients relied primarily on their spouse and family when distressed, rather than on formal support resources such as psychosocial counselling. The principal reason preventing patients from using counselling varied as a function of current distress level. Less distressed patients reported that the coping resources available to them were sufficient to cope with the strains of infertility, while the more distressed patients failed to initiate contact with a counsellor because of practical concerns such as knowing who to contact and/or the cost of counselling. The findings of this study indicate that alternative ways of intervening with infertile patients would need to be developed, as few use the type of psychosocial services most frequently offered.     

Videotape and verbal feedback in behavioral couple therapy: a review

Reviewed the experimental evidence for the efficacy of videotape and verbal feedback in behavioral couple therapy; it is concluded that research to date does not permit definitive conclusions concerning the efficacy of either procedure. Studies on behavioral differences between happy and distressed couples also were summarized. The evidence indicates that it is, as yet, difficult to ascertain just how the communication behaviors of happy and distressed couples differ.     

Factors influencing help seeking in mentally distressed young adults: a cross-sectional survey.

BACKGROUND: Young adults, especially men, are among those least likely to consult healthcare professionals when mentally distressed or suicidal. AIMS: To investigate the help-seeking behaviours of mentally distressed young adults. Design of study: Cross-sectional survey. SETTING: Bristol and surrounding areas, including inner-city, suburban and urban locations. METHOD: A questionnaire was sent to a sample of 3004 young adults aged 16-24 years. This assessed probable mental disorder (using the 12-item general health questionnaire [GHQ-12]), suicidal thoughts (GHQ-28 suicide subscale), and help-seeking behaviours. RESULTS: Most responders who were assessed as having probable mental disorders (GHQ "cases") had not sought help. Help seeking was more common in female GHQ cases than male cases (34.8% and 21.8%,respectively; P = 0.003) and women with suicidal thoughts more commonly sought help than men with suicidal thoughts (41.6% and 30.9%, respectively; P = 0.15). Small proportions of male and female GHQ cases (7.5% and 8.9%, respectively; P = 0.6), and less than one in five responders with suicidal thoughts, had consulted a general practitioner. In more female than male cases, help was sought from family and friends (30.7% and 18.4%, respectively; P = 0.004). GHQ score was the strongest predictor of help seeking. Men had a higher threshold of severity at which they would seek help than women. Recent experience of suicidal thoughts appeared to be a stronger predictor of formal help seeking in mentally distressed women than mentally distressed men. CONCLUSION: Distressed young adults are reluctant to seek help. Men are particularly unlikely to do so unless severely distressed and tend not to seek lay support. Sex differences in help seeking may be important in understanding the high suicide rate for men.     

Effects of behavioral marital therapy: a meta-analysis of randomized controlled trials

This meta-analysis summarizes results from 30 randomized experiments that compare behavioral marital therapy with no-treatment control with distressed couples. Results showed that behavioral marital therapy is significantly more effective than no treatment (d=.585). Although behavioral marital therapy research studies tend to be conducted under conditions that are less clinically representative than other samples of studies, representativeness was not significantly related to outcome. However, evidence also suggested that publication bias may exist in this literature whereby small sample studies with small effects are systematically missing compared with other studies. This bias may inflate the effects of behavioral marital therapies reported in previous meta-analyses, though we also explore a number of alternative explanations for this small sample bias.     

Couple and individual adjustment for 2 years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy

Follow-up data across 2 years were obtained on 130 of 134 couples who were originally part of a randomized clinical trial comparing traditional versus integrative behavioral couple therapy (TBCT vs. IBCT; A. Christensen et al., 2004). Both treatments produced similar levels of clinically significant improvement at 2 years posttreatment (69% of IBCT couples and 60% of TBCT couples). Both treatments showed a "hockey-stick" pattern of change in which satisfaction dropped immediately after treatment termination but then increased for most of follow-up. The break point when couples reversed courses and gained in satisfaction occurred sooner for IBCT than TBCT couples, and those couples who stayed together generally fared better in IBCT than in TBCT. Finally, there was evidence of greater stability during follow-up in IBCT than in TBCT couples. There was little change in individual functioning over follow-up, but when change occurred it was strongly related to change in marital satisfaction. Given that this sample was selected for its significant and chronic distress, the data are encouraging about the long-term impact of behavioral couple therapy.     

Helping themselves to get pregnant: a qualitative longitudinal study on the information-seeking behaviour of infertile couples

BACKGROUND: Couples seeking infertility treatment are generally hungry for information about available therapeutic options and how to help themselves achieve pregnancy. This study examined couples' perceptions of the information available from various sources in the context of achieved pregnancy or continuing treatment. METHODS: A 3 year prospective interview study started in April 2004, following couples undergoing infertility treatment at a tertiary fertility clinic at Aberdeen Maternity Hospital. Fifty-four couples were invited to participate. Up to three semi-structured interviews took place, and were analysed thematically using a variation of grounded theory. RESULTS: Twenty-seven couples agreed to participate and of the 25 couples followed up, 11 were diagnosed with unexplained infertility. The age range of the women was 22-41 years. All hoped to be given information on helping themselves to achieve pregnancy, spontaneous or assisted, and 19 of the 25 couples became pregnant. Most couples were dissatisfied with the written and verbal information routinely provided by the fertility clinic because it suggested lifestyle changes they had already attempted to adopt. They sought additional information from the internet, books and magazines. Those who became pregnant were generally empowered by the experience and thought that it had helped them to conceive. Women who were still undergoing treatment however, sometimes became distressed, blaming themselves for failing to follow the lifestyle advice provided. CONCLUSIONS: Couples, especially those diagnosed with unexplained infertility, seek information to help themselves conceive, but only those who succeed find it an empowering experience.     

Communication, conflict, and psychological distance in nondistressed, clinic, and divorcing couples

This study compared communication patterns and conflicts over psychological distance in 25 nondistressed couples, 15 clinic couples, and 22 divorcing couples. Data consisted of questionnaire reports completed independently by husbands and wives. The two distressed groups, compared with nondistressed couples, had less mutual constructive communication, more avoidance of communication, more demand/withdraw communication, and more conflict over psychological distance in their relationships. In addition, the divorcing group had less mutual constructive communication than the clinic group and evidenced a trend for more conflict over psychological distance than the clinic group. Consistent with past research, wife demand/husband withdraw communication was more likely across all groups than husband demand/wife withdraw communication. Results are discussed in terms of skills deficits and incompatability models of marital discord.     

Predicting work stress compensation claims and return to work in welfare workers.

Occupational stress is prevalent in work areas in which there is high contact with distressed or dependent members of the public. However, little is known about the prediction and management of stress-related compensation claims, which can be expensive for employers. The authors interviewed all staff members of a large public sector welfare agency who had made a compensation claim for work-related stress during a 12-month period (N = 19) and obtained in-depth information from 16 of the 17 who were still available. A clear relationship was found between type of stress precipitant and length of stress-related leave, suggesting that the organizational response to specific stressful incidents was much more effective than its response to chronic work stressors. Demographic data for all 19 claimants showed that they had taken twice as many days of sick leave as the organizational average in the year preceding their claim. There are important implications for personnel management practices that may reduce and prevent work stress for vulnerable workers.     

Anonymous or identity-registered sperm donors? A study of Dutch recipients' choices

BACKGROUND: The aim of the present study was to gain insight into parents' own donor preferences within a system offering the choice between an anonymous and identity-registered donor. A comparison was made between recipients choosing for an anonymous donor (AD choosers) and those choosing for an identifiable donor (ID choosers) with regard to their sexual orientation, demographic characteristics, disclosure issues and infertility distress. METHODS: Data from 105 couples (61% heterosexual, 39% lesbian) were registered on a standardized form during implication counselling sessions previous to treatment. RESULTS: Sixty-three per cent of the heterosexual couples and 98% of the lesbian couples had chosen an ID donor. Major differences between ID and AD choosers were identified. Among the ID choosers secrecy towards the child was no option, whereas 83% of the AD choosers did not intend to inform their child. Compared with heterosexual ID choosers, AD choosers were more distressed about their infertility and had a lower educational level. CONCLUSION: Legislation imposing ID donors appears to be acceptable for the majority of this study population. For a vulnerable group of heterosexual couples, who remained secretive about the use of a donor, adaptation to the new system is not self-evident.     

Behavioral couples therapy for female substance-abusing patients: effects on substance use and relationship adjustment

Married or cohabiting female drug-abusing patients (N = 75) were randomly assigned to either a behavioral couples therapy condition (BCT; n = 37), which consisted of group, individual, and behavioral couples therapy sessions, or to an equally intensive individual-based treatment condition (IBT; n = 38), which consisted of group and individual counseling. During most of the 1-year follow-up, compared with participants who received IBT, those who received BCT reported (a) fewer days of substance use, (b) longer periods of continuous abstinence, (c) lower levels of alcohol, drug, and family problems, and (d) higher relationship satisfaction. However, differences in relationship satisfaction and number of days of substance use dissipated over the course of the posttreatment follow-up period and were not significantly different by the end of 1 year.     

Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV

Highly active antiretroviral therapy (HAART) has been shown to be highly effective in reducing plasma levels of HIV RNA; therefore, these treatments could diminish the risk of transmission. We analyzed 393 steady heterosexual couples, of which one partner had been previously diagnosed with HIV infection (index case) and where the nonindex partner reported his or her sexual relationship with the index case as the unique risk exposure. These couples were consecutively enrolled in the period 1991 through 2003 when the nonindex partners took their first HIV test. HIV prevalence among partners of index cases who had not received antiretroviral therapy was 8.6%, whereas no partner was infected in couples in which the index case had been treated with HAART (P = 0.0123). HIV prevalence among nonindex partners declined from 10.3% during the pre-HAART period (1991-1995) to 1.9% during the late HAART period (1999-2003; P = 0.0061). In the multivariate analysis, this decline held (odds ratio = 0.14, 95% confidence interval: 0.03-0.66) after adjusting for length of partnership, unprotected coitus, and pregnancies as well as gender, CD4 lymphocyte count, AIDS-defining diseases, and sexually transmitted infections in the index case. When HAART became widely available, a reduction of approximately 80% in heterosexual transmission of HIV was observed, irrespective of changes in other factors that affect transmission.