Constructing We-ness: A Communal Coping Intervention for Couples Facing Chronic Illness.

Communal coping occurs when relationship partners view a stressful health problem as "ours," rather than yours or mine, and take collaborative action to deal with it. Although research employing linguistic (we-talk) and other measures of communal coping demonstrates relevance to a variety of chronic illnesses, the literature offers little about how clinicians can actively promote we-ness and teamwork to help patients and their partners achieve the health benefits this appears to confer. This paper highlights clinical and supporting scientific features of a narrative intervention designed to foster communal coping by couples in which one partner has a chronic illness.

Beyond the "self" in self-regulation: Family interaction modulates situational self-control by adolescent drug users.

Prevailing views of adolescent self-regulation (ASR) as a relatively stable disposition or skill that an individual possesses in various degrees stand in contrast to a complementary, situational perspective from family systems theory casting ASR as intertwined with ongoing family processes and malleable depending on interpersonal interactions. Using observational data from a large, ethnically diverse sample of substance-using adolescents ( = 458), the current study examines the social context of ASR across 3 increasingly conflictual family interaction tasks. Coders rated ASR and 3 concurrent family interaction patterns: enmeshment, conflict avoidance, and negative affect.

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis.

As evidence-based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies.

A Semantic Corpus Comparison Analysis of Couple-Focused Interventions for Problematic Alcohol Use.

Unlabelled: Incorporating spouses into interventions for problematic alcohol use is associated with increased efficacy; yet, little is known about the therapeutic processes that may explain these effects. In a study of partner language use during couple-focused alcohol interventions, we utilized a linguistic corpus comparison tool, Wmatrix, to identify semantic themes that differentiated couples with successful and unsuccessful treatment outcomes and may therefore also reflect potential change processes. Thirty-three couples participated in a randomized control trial of Family Systems Therapy (FST) or Cognitive Behavioural Therapy (CBT).

Partner Pronoun Use, Communal Coping, and Abstinence during Couple-Focused Intervention for Problematic Alcohol Use.

Communal coping-a process in which romantic partners view a problem as ours rather than yours or mine, and take collaborative action to address it -has emerged as an important predictor of health and treatment outcomes. In a study of partners' pronoun use prior to and during couple-focused alcohol interventions, we examined first-person plural (we-talk) and singular (I-talk) pronouns as linguistic markers of communal coping and behavioral predictors of treatment outcome. Thirty-three couples in which one partner abused alcohol were selected from a randomized control trial (N = 63) of couple-focused Cognitive-Behavioral or Family Systems Therapy if they had unambiguously successful or unsuccessful treatment outcomes (i.

A cross-sectional assessment of the long term effects of brief strategic family therapy for adolescent substance use.

Background: Young adult drug use and law-breaking behaviors often have roots in adolescence. These behaviors are predicted by early drug use, parental substance use disorders, and disrupted and conflict-ridden family environments.

Aim: To examine long-term outcomes of Brief Strategic Family Therapy (BSFT) compared to treatment as usual (TAU) in the rates of drug use, number of arrests and externalizing behaviors in young adults who were randomized into treatment conditions as adolescents.

Old wine in new bottles: decanting systemic family process research in the era of evidence-based practice.

Social cybernetic (systemic) ideas from the early Family Process era, though emanating from qualitative clinical observation, have underappreciated heuristic potential for guiding quantitative empirical research on problem maintenance and change. The old conceptual wines we have attempted to repackage in new, science-friendly bottles include ironic processes (when "solutions" maintain problems), symptom-system fit (when problems stabilize relationships), and communal coping (when we-ness helps people change). Both self-report and observational quantitative methods have been useful in tracking these phenomena, and together the three constructs inform a team-based family consultation approach to working with difficult health and behavior problems.

Asymmetric partner pronoun use and demand-withdraw interaction in couples coping with health problems.

Recent research links first-person plural pronoun use (we-talk) by individual romantic partners to adaptive relationship functioning and individual health outcomes. To examine a possible boundary condition of adaptive we-talk in couples coping with health problems, we correlated asymmetric couple-level we/I-ratios (more we-talk relative to I-talk by the spouse than the patient) with a concurrent pattern of directional demand-withdraw (D-W) interaction in which the spouse demands change while the patient withdraws. Couples in which a partner who abused alcohol (n = 65), smoked cigarettes despite having heart or lung disease (n = 24), or had congestive heart failure (n = 58) discussed a health-related disagreement during a video-recorded interaction task.

Parallel demand-withdraw processes in family therapy for adolescent drug abuse.

Isomorphism, or parallel process, occurs in family therapy when patterns of therapist-client interaction replicate problematic interaction patterns within the family. This study investigated parallel demand-withdraw processes in brief strategic family therapy (BSFT) for adolescent drug abuse, hypothesizing that therapist-demand/adolescent-withdraw interaction (TD/AW) cycles observed early in treatment would predict poor adolescent outcomes at follow-up for families who exhibited entrenched parent-demand/adolescent-withdraw interaction (PD/AW) before treatment began. Participants were 91 families who received at least four sessions of BSFT in a multisite clinical trial on adolescent drug abuse (Robbins et al.

Perceptions of smoking-related risk and worry among dual-smoker couples.

Introduction: Quit rates are lower and relapse rates are higher for people in close relationships with a partner who smokes. Although desire to quit is often related to health concerns for one's self, much less is known about psychosocial factors associated with quitting in dual-smoker couples. This study investigated relations among beliefs about smoking and desire to quit from both partners' perspectives.

Family consultation for psychiatrically complicated health problems.

We describe a social cybernetic view of health behavior problems and a team-based family consultation (FAMCON) format for strategic intervention based on that view. This approach takes relationships rather than individuals as the primary unit of analysis and attaches more importance to problem maintenance than to etiology. Treatment aims to interrupt two types of interpersonal problem maintenance-ironic processes and symptom-system fit (conceptualized, respectively, as positive and negative feedback cycles)-and to mobilize communal coping as a relational resource for change.

We-talk, communal coping, and cessation success in a couple-focused intervention for health-compromised smokers.

We investigated first-person plural pronoun use (we-talk) by health-compromised smokers and their spouses as a possible implicit marker of adaptive, problem-resolving communal processes. Twenty couples in which one or both partners used tobacco despite one of them having a heart or lung problem participated in up to 10 sessions of a smoking cessation intervention designed to promote communal coping, where partners define smoking as "our" problem, rather than "your" problem or "my" problem, and take collaborative action to solve it. We used the Linguistic Inquiry Word Count automatic text analysis program to tabulate first-person pronoun use by both partners from transcripts of a pretreatment marital interaction task and later intervention sessions.

Gender Differences in Quit Support by Partners of Health-Compromised Smokers.

In a study of spousal support for smoking cessation, 34 couples in which one partner continued to smoke despite having a heart or lung problem used an adaptation of Cohen & Lichtenstein's (1990) Partner Interaction Questionnaire to describe the spouse's attempts to help the primary (ill) smoker quit. Female smokers received less support for quitting from their spouse or partner than male smokers did, regardless of whether the support was positive or negative, whether the partner also smoked, or whether the smoker or partner rated the partner's support behavior Female patients in a treatment sub-sample were also less likely than men to achieve stable 1-year cessation if the couple had rated partner support at baseline as coercive or unhelpful. Given known gender differences in relapse risk, cessation interventions for health-compromised female smokers might profitably include partners in addition to the smokers themselves.

Health consequences of partner distress in couples coping with heart failure.

Background: Chronic heart failure (HF) is associated with psychologic distress for patients and their spouses. Although research indicates that a patient's distress can influence the course of illness, less is known about possible effects of a spouse's distress on the patient or of a patient's distress on the health of the spouse.

Methods And Results: Baseline home interviews of 60 patients with HF (43 men, 17 women) and their spouses included assessments of each partner's psychologic distress (Hopkins Symptom Checklist-25) and perceived general health (Short Form-36 Questionnaire), as well as severity of patients' HF symptoms.

Affective synchrony in dual- and single-smoker couples: further evidence of "symptom-system fit"?

Couples in which one or both partners smoked despite one of them having a heart or lung problem discussed a health-related disagreement before and during a period of laboratory smoking. Immediately afterwards, the partners in these 25 couples used independent joysticks to recall their continuous emotional experience during the interaction while watching themselves on video. A couple-level index of affective synchrony, reflecting correlated moment-to-moment change in the two partners' joystick ratings, tended to increase from baseline to smoking for 9 dual-smoker couples but decrease for 16 single-smoker couples.

Prognostic significance of spouse we talk in couples coping with heart failure.

Recent research suggests that marital quality predicts the survival of patients with heart failure (HF), and it is hypothesized that a communal orientation to coping marked by first-person plural pronoun use (we talk) may be a factor in this. During a home interview, 57 HF patients (46 men and 16 women) and their spouses discussed how they coped with the patients' health problems. Analysis of pronoun counts from both partners revealed that we talk by the spouse, but not the patient, independently predicted positive change in the patient's HF symptoms and general health over the next 6 months and did so better than direct self-report measures of marital quality and the communal coping construct.

Symptom-system fit in couples: emotion regulation when one or both partners smoke.

In a laboratory smoking experiment, 25 couples in which 1 or both partners continued to smoke despite 1 of them having heart or lung disease discussed a health-related disagreement before and during a period of smoking. Immediately afterward, the partners used independent joysticks to recall their continuous emotional experience during the interaction while watching themselves on video. Participants in dual-smoker couples reported increased positive emotion contingent upon lighting up, whereas those in single-smoker couples reported the opposite.

A family consultation intervention for health-compromised smokers.

Although spousal support predicts the success of a smoker's cessation efforts, "social-support" interventions based on teaching partners better support skills have had consistently disappointing results. We examined the potential utility of a family consultation (FAMCON) intervention based on family-systems principles in a treatment-development project involving 20 couples in which one partner (the primary smoker) continued to smoke despite having or being at significant risk for heart or lung disease. The 50% rate of stable abstinence achieved by primary smokers over at least 6 months exceeds benchmark success rates reported in the literature for other comparably intensive interventions, suggesting that a couple-focused intervention different in concept and format from social-support interventions tested in the past may hold promise for health-compromised smokers.

Effect of marital quality on eight-year survival of patients with heart failure.

Recent evidence suggests that psychosocial factors such as self-efficacy, psychological distress, perceived social support, and marital quality have prognostic significance for morbidity and mortality after heart failure. Previously, we reported that interview and observational measures of marital quality obtained from 189 patients with heart failure (139 men and 50 women) and their spouses predicted all-cause patient mortality during the next 4 years, independent of the baseline illness severity (New York Heart Association class). We present additional follow-up results for this sample, with Cox regression analyses showing that a couple-level composite measure of marital quality continued to predict survival during an 8-year period (p <0.

Beyond the "self" in self-efficacy: Spouse confidence predicts patient survival following heart failure.

Ratings of patient efficacy to manage illness, made by 191 congestive heart failure patients and their spouses, were examined as predictors of patients' survival over the next 4 years. When considered alone, both the patient's self-efficacy and the spouse's confidence ratings predicted survival, but only spouse confidence remained significant when both partners" efficacy ratings were included in the same Cox regression model. The overlapping prognostic significance of spouse confidence and a global, multicomponent measure of marital quality positioned the former as a proxy for the latter, reflecting a fundamentally social protective factor in patient survival.

Couples coping with congestive heart failure: role and gender differences in psychological distress.

Psychological distress and marital quality were assessed with male (n = 128) and female (n = 49) congestive-heart-failure (CHF) patients and their spouses. Hopkins Symptom Check List--25 scores were in the distressed range for 57% of patients and 40% of spouses. This role difference was greater for men than for women, and a gender difference (more distress in women than men) was greater for spouses than for patients.

Brief Therapy Based on Interrupting Ironic Processes: The Palo Alto Model.

The model of brief therapy developed by Fisch, Weakland, Watzlawick, and colleagues in Palo Alto is based on identifying and interrupting ironic processes that occur when repeated attempts to solve a problem keep the problem going or make it worse. Formulations of ironic problem-solution loops provide a template for assessment and strategic intervention, indicating where to look to understand what keeps a problem going (look for "more of the same" solution) and what needs to happen for the complaint to be resolved (someone must apply "less of the same" solution). Supporting research is preliminary but suggests this approach may be well suited for change-resistant clients.