Objective: The Exeter Model is an integrative systemic-behavioural and systemic-empathic couple therapy for treating people with depression. ‘Attachment narratives’ is a component of the systemic-empathic approach, which seeks to help the couple understand how past relationships impact on the current relationship with the aim of rebuilding trust and security between the couple. This study sought to examine how attachment narratives in this Model are used by therapists. Method: Narrative Analysis was employed to explore attachment narratives in three couples who had completed therapy in an outpatient clinic where one member of the couple had been referred with depression. Results: Analysis highlighted four specific ways in which therapists used attachment narratives. These consisted of: therapist enabled stories of past relationships to be foregrounded; attachment theory employed to build hypothesis about attachment styles based on past relationships; therapist helped the couple understand how attachment styles maintain unhelpful cycles of relating and introduced alternative relationship narratives enabling improved trust and security. Analysis also demonstrated the structuring of these attachment narratives across the therapy sessions. Conclusion: This study shows that through the therapist paying attention to attachment styles, awareness of unhelpful cycles of relating within couples can be highlighted, and adjustments to how the couple can relate to each other suggested. This exploratory study serves to better inform the use of the Exeter Model.

Meta-analytic reviews of decades of comparative efficacy psychotherapy research consistently reveal that all tested models of marriage and family therapy (MFT) work, and they generally work equally well. Researchers have hypothesized that this may be due to factors common across models responsible for change. Despite a sizable body of common factors literature in psychology, such research in MFT is still in its infancy. The purpose of this study is to contribute to the development of a theory of common factors responsible for change in MFT. Semi-structured, open-ended qualitative interviews were conducted with three different MFT model developers (i.e., Dr. Susan M. Johnson, Emotionally Focused Therapy; Dr. Frank M. Dattilio, Cognitive Behavioral Therapy; and Dr. Richard C. Schwartz, Internal Family Systems Therapy), Dr. Johnson and Dr. Schwartz's former students, and each of their former clients who had terminated therapy successfully. Transcripts were coded using the grounded theory techniques of open coding, axial coding, and relational statements. Coding was done utilizing a constant comparative method in which data were simultaneously analyzed and coded. Common factors fell into two main categories of model-dependent factors and model-independent factors. Factors within the model-dependent category include those aspects of therapy directly informed by the therapist's model. Model-dependent categories include common conceptualizations, common interventions, and common outcomes. Factors within the model-independent category include general aspects of therapy that are not directly related to the therapist's model. Model-independent categories include client variables, therapist variables, the therapeutic alliance, therapeutic process, and expectancy and motivational factors. Each model-dependent and model-independent category has several subcategories. Results are discussed in both model-specific and common factors conceptualizations. A sequential model outlining how model-dependent factors appear to combine to produce therapeutic change while being mediated by model-independent variables is proposed. The findings are integrated with the current common factors literature in psychology and MFT. Clinical, training, and research implications are discussed. / Ph. D.

Research indicates that marital satisfaction is associated with levels of physical affection between partners. This is important because there is evidence of physical and mental health benefits of physical affection. Although past research has shown that marital therapy increases levels of marital and sexual satisfaction, the association between marital therapy and physical affection has not been explored. This study used a treatment group and a control group of 108 married couples to assess the relationship between marital therapy and physical affection over a course of 12 weeks. Using structural equation modeling and an actor partner analytic model, results indicated that marital therapy was significantly associated with increases in physical affection for husbands, but not wives.

Many scholars have noted the pervasiveness of individualism in American culture, particularly in the marriage culture. Unfortunately, assuming individualism in the marriage culture poses very specific threats to marriage as an institution. Some claim that these individualistic assumptions have also infiltrated the marital sciences, undermining the efforts of researchers who hope to defend marriage. This dissertation explores that claim by analyzing seven of the most popular marital outcome instruments used by marital researchers today for individualistic assumptions. Using a conceptual analysis called "contrasting relations," the meanings of both the content and the process of the instruments are laid out according to their underlying ontological assumptions. Two types of ontology guide the analysis: weak relationality, that from which individualism arises, and strong relationality. As the results demonstrate, the instruments are in fact almost entirely underlain with individualistic assumptions. It is argued that outcome instruments used by marital researchers can only measure individualistic relationships (weak relationality), and are incapable of measuring strong relationships, implying that marital researchers are ill-equipped to measure relationships. Implications and future directions are explored.

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A series of interpretive dialogues with one object relations, couple therapy, case study were performed to research the role of projective and introjective identification within an intersubjective context. The method, Gadatner's (1993) philosophical hermeneutics, involved a dialectical moving back and forth between the more intrapsychic standpoint of the case study and the intersubjective perspectives of philosophical hermeneutics and recent object relations thinking (Ogden, 1994). These interpretive dialogues became written mediations yielding increasingly coherent and in depth understandings of projective and introjective identification. The mediations delineated three turning points in the case study. In each, projective and introjective identification was critical to understanding the marriage's conflict and possible repair. Further interpretation of these turning points yielded an understanding of projective and introjective identification as a part of what Klein (Ogden, 1989, 1994) and Fairbairn (1952) have called the paranoid-schizoid position, as opposed to the higher functioning depressive position. Ogden's (1994) contention that these positions are in dialectical relationship, and not developmentally exclusive, avoided the objections (Kemberg, 1974) (Meissner, 1974) that projective and introjective identification is a psychotic defense mechanism. While most couples are in the depressive position, the mediations revealed that under stress, couples regress to the paranoid-schizoid position, where projective and introjective identifications render the relationship chaotic but also repairable through the re-enactment of old conflicts. Projective and introjective identification also was central to the process of transference and countertransference by which the therapist gained understanding of the couple and enabled then1 to work toward repair. Projective and introjective identification was understood as an intersubjective process that occurred between persons, as opposed to some form of mind invasion. This intersubjective perspective enabled the research understandings to be highly interpersonal without denying the richness of the intrapsychic world. As a research method, philosophical hermeneutics proved, as anticipated, unwieldy, circular and highly dependent on the researcher's interpretive abilities. However, this method was highly commensurate with the subject matter at a depth inconceivable in a quantitative analysis. This post-modem method valued the relationship between subjects over objectivity in a way that was congruent with therapy relationships and helpful in understanding them. / Ph. D.

Married couples often face serious issues that require them to make difficult decisions in their relationships. Many couples turn to marital counseling as a means to improve the marriage. The purpose of this phenomenological study was to understand and describe the experiences of heterosexual married individuals who participated in the Prevention and Relationship Enhancement Program (PREP) and how they felt their participation had influenced their perceived satisfaction in their marriages. The theoretical framework that guided this study was social exchange theory, which is a basis for thinking about the influence individuals have on each other in personal relationships. The research questions in this study addressed the experiences of individuals in PREP and the subsequent impact on marital satisfaction. This qualitative phenomenological study was used to better understand the individuals' experiences through interviews with 10 married individuals who were selected using criterion sampling. Data analysis included reading transcripts, coding, labeling, and interpreting the experiences. The results of this study revealed that communication and conflict resolution had an impact on marital satisfaction and extended support and supplemental programs influenced the experiences of the participants. The implications for positive social change relate to improved communication between married couples that may result in lasting improvements in their marriages. Others can learn from these experiences to create further positive change. Counselors could provide support outside of class and provide a supplemental program in order to improve the experience, possibly increase marital satisfaction, and decrease the likelihood of divorce.

The present study investigates the role of attachment in a time-limited marital therapy. The study explores Brief Contextual Modular Psychotherapy (BCMT). This approach to practice provides a model that integrates principles and techniques from the major psychotherapies. BCMT can be distinguished from other brief therapies by its theoretical integration, its six-session time limit, its specific clinical focus, and its techniques for dealing with dissatisfaction and distress. The therapy sets out practice modules—six-session treatment plans—for a diverse range of presenting issues such as the anxiety disorders, depression, trauma, loss and grief, marriage and the phobias. BCMT emphasises the collaboration of the therapist and the client. A community-based psychological counselling centre has practised BCMT for over ten years, applying it in cases of wide diversity and maladjustment. Prior to this research, a comprehensive analysis of the theory underlying the BCMT model or the theory of change it endorses had not been carried out. The study provides a detailed description of the conceptual and treatment elements of the marital module developed in the treatment manual for BCMT. The study explores how the construct of attachment provides an organising framework or metaperspective for theory construction and therapeutic intervention in the clinical application of this time-limited marital therapy. To achieve this objective, one de-facto and four married couples participated in the time-limited therapy. They completed a questionnaire on adult attachment and also a self-report questionnaire to assess the effectiveness of the therapy. Narrative analysis was used to assess the praxis or the experience of participating in the therapy. The results show that the integrated model provided a treatment method for differing expressions of marital disturbance and psychopathology. Three of the five couples and eight of the ten participants reported positive treatment outcomes. The research sample included the paraphilias, a major depressive episode with postpartum psychosis, the narcissistic borderline syndrome and childhood sexual abuse. The study supports the association between the role of adult attachment styles and intrapsychic responses in conflicted intimate relationships. From the point of view of clinical applications of attachment theory, the research highlights how theoretical ideas can be integrated, specific clinical methods can be incorporated and certain treatment perspectives can be derived from one another. Several implications for the treatment process flow from this integration. The integration of attachment theory in BCMT demonstrates how the therapeutic process progressed through three separate yet interrelated stages: past, present and future. In addition, it led to the identification of three stage-related mourning processes associated with the time-limited therapeutic process: protest, despair and detachment. From a clinical perspective, the research finds that the theoretical and treatment model does not need to be restricted to marital therapy. The findings suggest that the integrated model could be applied across a wide range of presenting issues. By defining the theory of personality and psychopathology and the therapeutic change processes associated with it, the integration of attachment theory results in BCMT taking its place in the literature as a theory of psychotherapy.

[pt] Este trabalho teve como objetivo avaliar o papel da terapia de casal no tratamento e na prevenção da violência quando ela ocorre de forma recorrente no casal. Para tanto foram entrevistados quatro psicólogos, terapeutas de família e casal, que realizaram a especialização nesta área em instituições de formação da cidade do Rio de Janeiro. Das entrevistas emergiram cinco categorias de análise: Compreensão sobre a dinâmica da violência; Fatores associados à emergência da violência; A questão do enquadre terapêutico; O problema da identificação dos diversos tipos de violência; Recursos disponíveis disponíveis para o trabalho com violência. Os profissionais entrevistados romperam com uma concepção disjuntiva e reducionista da violência, que procura identificar os agressores e as vítimas, para em seguida responsabilizar os primeiros por seus atos violentos. Como alternativa a essa concepção, os terapeutas se apropriaram da perspectiva sistêmica para compreender a dinâmica da violência no casal. Sob a influência dessa perspectiva o foco recai sobre as relações cujas interações possibilitam a manutenção da violência. Os processos anestésicos que reduzem a sensibilidade à violência e que se encontram presentes nas famílias onde ocorrem abusos de toda ordem, a escolha do enquadre terapêutico e os procedimentos para se identificar os diferentes tipos de violência foram outros temas que se mostraram relevantes para o tratamento de casais em situação de violência. A análise das entrevistas demonstrou que a terapia de casal, pelo menos sob a ótica dos profissionais entrevistados, demonstra ser um importante recurso para lidar com a problemática em questão. / [en] This work has the goal to evaluate the role of couples therapy in the treatment and prevention of recurrent violence among couples. Four psychologists - family and couples therapists - who had specialized in this area in educational institutions in Rio de Janeiro were interviewed. Five analytical categories emerged from the interviews: Understanding violence dynamics; Factors associated to the emergence of violence; The question of therapeutic framing; The problem of identifying various kinds of violence; Available resources to work with violence. The interviewed professionals deconstructed a disjunctive and reductionist conception of violence, which aims to identify perpetrators and victims to hold the latter responsible for their violent acts. As an alternative to this conception, therapists had appropriated a systemic perspective to understand the dynamics of violence among couples. From this perspective the focus is on the relationships marked by interactions that elicit the maintenance of violence. The anesthetic processes that diminish the sensitivity to violence and that are present in families where different forms of abuse take place, the choice for the therapeutic framing and the procedures to identify the different forms of violence were other themes that turned out relevant in treating couples in violent situations. The analysis of interviews showed that couples therapy, at least from the perspective of the interviewed professionals, is an important resource to deal with the problem in question.

This study evaluated the therapy process for married couples recovering from addictive use of pornography. The author's proposal was that in conjoint couple therapy, clinicians are able to help organize the relationship to sponsor recovery while helping both members of the relationship heal individually. The prevalence and effects of pornography are discussed through a review of the current literature. Six couples were interviewed following the termination of their treatment in marital therapy to gain a holistic view of the process of recovery and gain groundwork for future development of a concise model of treatment. Results demonstrated that an increase in understanding of each other's position in the sexual addiction and recovery process (i.e., emotional, cognitive and behavioral) increases a) marital trust and faith in the future, b) softening towards each other, c) the ability to discern key points of intervention in helping the other spouse during recovery, and d) client-perceived marital enhancement. These preliminary findings suggest that couples perceive that conjoint marital therapy is a useful component in treating addiction to pornography.