This article evaluates the efficacy, effectiveness, and clinical significance of empirically supported couple and family interventions for treating marital distress and individual adult disorders, including anxiety disorders, depression, sexual dysfunctions, alcoholism and problem drinking, and schizophrenia. In addition to consideration of different theoretical approaches to treating these disorders, different ways of including a partner or family in treatment are highlighted: (a) partner-family-assisted interventions, (b) disorder-specific partner-family interventions, and (c)more general couple-family therapy. Findings across diagnostic groups and issues involved in applying efficacy criteria to these populations are discussed.Since the 1970s, there has been a major shift in knowledge regarding the effectiveness of couple-based and family-based interventions for treating adult mental health problems. During this period, various theoretical perspectives have been articulated, specific manual-based intervention strategies have been developed, and controlled treatment outcome investigations have explored a number of specific issues of importance. The current article examines the empirical status of these couple-and family-based interventions for treating (a) marital distress and (b) adult individual diagnosable disorders. More explicitly, the primary goal of this article is to use the criteria put forth by Chambless and Hollon (1998) to evaluate the efficacy, clinical significance, and effectiveness of various interventions that involve a couple or family format.The criteria provide a unifying framework for evaluating the wide variety of psychological interventions. As we reviewed the literature on couple-and family-based interventions, we became aware that there were a number of decisions that had to be made with regard to the application of these criteria. Given that other reviewers may have interpreted and applied the Chambless and Hollon (1998) guidelines in a different manner, we begin this We thank Emily Sartor for her assistance in the preparation of this article.Correspondence concerning this article should be addressed to Donald H. Baucom, Davie Hall CB 3270, Psychology Department, University of North Carolina, Chapel Hill, North Carolina 27599-3270. Electronic mail may be sent via Internet to email@example.com by articulating how we have applied them so that the reader can better understand the bases of our conclusions.One of the major decisions that affects the empirical status of an intervention involves what investigations to include in reviewing the literature. In determining the efficacy status of a treatment, we restricted our consideration to published investigations. Attempts to obtain a comprehensive set of findings from conference presentations, unpublished dissertations, and so forth necessarily result in an incomplete and potentially skewed set of data. At times, unpublished findings are cited if mey help to make a certain point or clarify issues, but they are not considered in dete...
Research emanating from the field of developmental science indicates that initial risk factors for substance use disorder can be evident in early childhood. One dominant developmental pathway connecting these initial risk factors with subsequent substance use disorders focuses on the central role of disinhibited or externalizing behaviors. In the current paper, we delineate a second pathway that focuses on problems with emotion regulation associated with internalizing symptomatology. Several studies indicate that internalizing symptoms in early and middle childhood predict substance involvement in adolescents and young adulthood. We describe a risk model that traces the potential developmental markers of this internalizing pathway to substance use disorders and that identifies a population potentially vulnerable to this risk process, namely children of alcoholic parents. We consider the relation between the internalizing pathway and the more widely researched externalizing pathway. We then conclude with a discussion of the implications of this model for prevention efforts. In this manner, we strive for a translational goal, linking our existing understanding of internalizing processes and substance use disorders with our efforts to develop effective prevention programs.
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.
Infidelity is a common phenomenon in marriages but is poorly understood. The current study examined variables related to extramarital sex using data from the 1991-1996 General Social Surveys. Predictor variables were entered into a logistic regression with presence of extramarital sex as the dependent variable. Results demonstrated that divorce, education, age when first married, and 2 "opportunity" variables--respondent's income and work status--significantly affected the likelihood of having engaged in infidelity. Also, there were 3 significant interactions related to infidelity: (a) between age and gender, (b) between marital satisfaction and religious behavior, and (c) between past divorce and educational level. Implications of these findings and directions for future research are discussed.
The discovery or disclosure of an extramarital affair can have a devastating impact on partners, both individually and on the relationships. Research suggests that affairs occur relatively frequently in relationships and are a common presenting problem in couple therapy. However, despite their prevalence, there is little empirical treatment research in this area, and most therapists describe this problem as one of the more difficult to treat. In this study, we used a replicated case-study design to explore the efficacy of an integrative treatment designed to help couples recover from an affair. Six couples entered and completed treatment. The majority of these couples were less emotionally or maritally distressed at the end of treatment, and the injured partners reported greater forgiveness regarding the affair. Details of the intervention, suggested adaptations of the treatment, and areas for future research are discussed.
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