Nearly 80% of women currently infected with HIV are of childbearing age. As women of childbearing age continue to be at risk of contracting HIV, there will be an increased need for choices about whether or not to have biological children. The purpose of this exploratory study was to investigate the influence of partners, physicians, and family members on pregnancy decisions, as well as the impact of HIV stigma on these decisions. Results indicated that most women chose not to become pregnant since learning their HIV diagnosis and the woman's age at the time of diagnosis is significantly associated with this decision. Additional factors included fear of transmitting HIV to their child, personal health-related concerns, and desire to have children. Women with a procreative inclination were more likely to choose to become pregnant which outweighed social support and personal health concerns. Implications and suggestions for future research are noted.

This study explores the decision making of 66 HIV-positive women regarding disclosing their serostatus to their children and the child's perceived immediate and long-term reactions. Data came from a larger investigation of the disclosure process of HIV-infected women. Children included 27 boys and 39 girls between the ages 5 and 18 years. Forty-one children knew of their mother's diagnosis and 32 were disclosed to by their mother. Results suggest that women are interested in taking a leading role in disclosing to their children and make the decision based on the child's ability to handle the information and not be psychologically harmed.

The study uses 457 clients to investigate the impact of initial client factors on the development of therapeutic alliance. Data were collected longitudinally over the early portion of treatment. Cases included both individual and couple clients, allowing for examination of differences by case type. The study used the Working Alliance Inventory-Shortened Version (Tracey & Kokotovic, 1989) to measure therapeutic alliance. Initial factors considered included age, differentiation levels, prior stress, and depression. Couple clients showed differences from individual clients, and the variability prompted further investigation into relationship satisfaction and commitment as factors influencing the development of therapeutic alliance. Results highlight the increased complexity of developing an alliance with couples, and recommendations are provided for clinicians.

Therapeutic alliance research in couple therapy using multiple perspectives and longitudinal data has been sparse. This study used structural equation modelling to explore relationships between changes in alliance and in progress from clients' and therapists' perspective in a fairly large sample of couples (N 5 195) during the initial stage of therapy at an oncampus training clinic. Self-rated alliance was measured after sessions 2 through 4 with the Working Alliance Inventory. There was very little change in alliance over the early sessions of therapy, and changes in alliance did not always account for changes in relationship satisfaction. Husbands' perceptions of satisfaction and alliance seem to play an important role in the dynamics of the therapeutic process. Findings suggest a reciprocal relationship between perceptions of alliance and progress in therapy when combining perceptions of therapists and couple clients. Clinical implications and future research are discussed.

Much of the empirical data available about therapeutic alliance and its relationship to termination status come from individual psychotherapies. We know less about therapeutic alliance in couple therapy. A unique characteristic of alliance in couple or family therapy is the possibility of discrepancies in alliance between system members. In this study we sought to demonstrate three statistical techniques: standard deviations, the intraclass correlation to assess discrepancies in alliance over time during the initial stage of couple therapy, and the use of these various measures to predict termination status using a sample of 72 couples from a university-based training clinic. Differences in partners' alliances operationalized either as categorical or continuous variables but when analyzed separately at each time point were not predictive of termination status. When multilevel modeling was used, a difference in the way the discrepancies changed over a period of time was related to termination status.