When the World Health Organization declared the coronavirus outbreak a pandemic, clinicians were challenged to maintain continuity of care. Teletherapy became the primary means of service delivery for many who had never or only sparingly used it. The Family Institute at Northwestern University, in response to encouraging findings with respect to the effectiveness of teletherapy and recognizing advantages with respect to access to care, launched our teletherapy services in 2018. As a relationship‐based organization, we were keen to exploit the opportunity that teletherapy provides to integrate additional members of the client system into the treatment. Over these two plus years, we have learned a great deal. Our learning was greatly accelerated by our transition to a 100% teletherapy practice in the wake of the pandemic. Teletherapy is a different context. Intentionally managing the context’s constraints and exploiting its strengths is key to providing high‐quality couple and family therapy. This step is often overlooked or resisted when teletherapy is an occasional add‐on to a face‐to‐face practice.

Background 5-HT1B autoreceptors regulate release of serotonin from terminals of dorsal raphe nucleus (DRN) projections. 5-HT1B expression in the DRN correlates with behavioral measures of emotion, and viral-mediated overexpression of 5-HT1B receptors in the middle DRN reduces measures of fear and anxiety in unstressed rats. Since the caudal subregion of the DRN is important in translating stress into emotional dysregulation, we explored behavioral functions of 5-HT1B autoreceptors in the caudal DRN. Methods We manipulated 5-HT1B autoreceptor function in rats using either viral-mediated gene transfer into the caudal DRN or systemic injections of the 5-HT1B agonist 3-(1,2,5,6-tetrahydro-4-pyridyl)-5-propoxypyrrolo[3,2-b]pyridine (CP-94,253). Rats were tested in forced swim test, open field test, and contextual fear conditioning. Results 5-HT1B overexpression in the caudal DRN increased swimming in the forced swim test. It did not alter locomotion or thigmotaxis in the open field test, but did reduce conditioned freezing. Freezing was reduced when 5-HT1B overexpression was present only during testing, but not training. CP-94,253 exerted an inverted U-shaped dose response curve on conditioned freezing, with most pronounced effects seen at 1 mg/kg. At this dose, CP-94,253 administered before a fear retention test reduced freezing both during that session and in subsequent drug-free testing, but only when drug was paired with re-exposure to the fear context. Conclusions 5-HT1B autoreceptors originating in the caudal DRN regulate behavioral expression of helplessness and fear. Since systemic pharmacological treatment with a 5-HT1B agonist facilitates reductions in fear, 5-HT1B receptors may be a target for the treatment of certain anxiety disorders.

Child sexual abuse has the potential to cause distress for the victim across the lifespan. Romantic relationships may be particularly difficult for victims of child sexual abuse. This retrospective study examined differences in adult romantic attachment, sexually compulsive behaviors, and emotion regulation by history of child sexual abuse in a large, nonclinical sample. Those with a history of child sexual abuse reported more attachment anxiety in romantic relationships and engaged in more sexually compulsive behaviors. Overall, males displayed more sexually compulsive behaviors than females regardless of history of sexual abuse. Males with a history of sexual abuse displayed the greatest number of sexually compulsive behaviors. Surprisingly, no differences were observed in emotion regulation or attachment avoidant behaviors by history of child sexual abuse. Future research should seek to replicate current findings and examine emotion regulation difficulties experienced as a result of trauma.