Contribution of attachment insecurity to the role and outcome expectations of romantic partners entering couple therapy.

We investigated insecure attachment in relation to how actively romantic partners expect to participate in couple therapy (role expectations for self and partner) and, consequently, how much they expect to benefit from doing so (outcome expectations). Specifically, we used the mediated actor-partner interdependence model (Ledermann et al., 2011) with archived data from 297 heterosexual couples in a research-practice network (L.

Heterosexual couples' initial role and outcome expectations as predictors of the therapeutic alliance and relationship satisfaction prior to the fourth session.

We sampled routinely collected measures of role and outcome expectations, the expanded therapeutic alliance, and relationship satisfaction completed by 253 heterosexual couples seen by 35 therapists in the Marriage and Family Research Practice Network (Johnson et al., 2017) and investigated these variables as interdependent dyadic processes using the latent congruence model (Cheung, 2009) and the mediated actor-partner interdependence model (Ledermann et al., 2011).

Mapping the progress of the process: Codevelopment of the therapeutic alliance with maltreated adolescents.

We used a longitudinal actor-partner interdependence model to examine the codeveloping alliance in alliance empowerment therapy (AET; Escudero, 2013), a manualized team-based approach developed in Spain specifically for child welfare-involved youth. In this first evaluation of AET, we sampled 102 adolescents, 83% of whom had been removed from their homes due to abuse or neglect, and 40% of whom were in crisis at the time of referral. Before each session, clients rated their improvement-so-far; after each session, both clients and therapists completed a brief alliance measure, an adaptation of the System for Observing Family Therapy Alliances (SOFTA-s; Friedlander et al.

Illustrating systemic change in family therapy: How therapists' and clients' alliance perceptions codevelop over time.

Research showing that caregivers', adolescents' and therapists' perceptions of the therapeutic alliance become more similar over time has not examined conceptual models, like emotional contagion and interdependence, that are theorized to account for this convergence. We modeled codevelopment in systemic family therapy to examine mutual influence and shared environment processes among the alliance perceptions of youth, caregivers, and therapists. The self-report version of the System for Observing Family Therapy Alliances (SOFTA-s) was administered after sessions 3, 6 and 9-156 Spanish maltreating families and 20 therapists.

Couple and family therapists' experiences with Telehealth during the COVID-19 pandemic: a phenomenological analysis.

In designing this study, we aimed to obtain a rich, phenomenological understanding of the experiences of couple and family therapists who transitioned their practice to telehealth due to the COVID-19 pandemic. Twelve experienced therapists from the U.S.

Toward a broader understanding of split alliances in family therapy: Adding the therapist to the mix.

To broaden our understanding of a split alliance in family therapy, we investigated the frequencies and correlates of sessions in which therapists, youth, and caregivers reported markedly different perceptions of the alliance. The sample consisted of 156 Spanish families who received Alliance Empowerment Family Therapy (Escudero, Adolescentes y familias en conflicto, 2013) for child maltreatment. Family members and therapists rated the alliance on the SOFTA-s (Friedlander et al.

Family therapy for maltreated youth: Can a strengthening therapeutic alliance empower change?

We tested the process of change in Alliance Empowerment Family Therapy (AEFT; Escudero, 2013), a systemic, team-based approach for treating child welfare involved families. Since building and balancing strong personal and within-family therapeutic alliances are crucial for motivating and sustaining change in these multistressed, overburdened families, we assessed alliance perceptions over time in relation to two indices of therapy outcome, youth functioning, and family-specific goal attainment. Specifically, we administered the self-report version of the System for Observing Family Therapy Alliances (Friedlander et al.

How Effective is Online Couple Relationship Education? A Systematic Meta-Content Review.

Due to logistical and financial barriers that keep many distressed couples from seeking psychotherapy, online relationship education is a more accessible alternative. In the decade since a web-based program showed equivalent effectiveness to traditional marriage education (Duncan et al., 2009), several fully online programs have been developed and evaluated.

Medically Unexplained Physical Symptoms: What They Are and Why Counseling Psychologists Should Care about Them.

Medically unexplained symptoms and syndromes (MUS) affect the health of 20%-30% of patients seen in primary care. Optimally, treatment for these patients requires an interdisciplinary team consisting of both primary care and mental health providers. By developing an expertise in MUS, counseling psychologists can improve the care of patients with MUS who are already in their practice, expand the number of patients they help, and enhance the integration of counseling psychology into the broader medical community.

A close look at therapist contributions to narrative-emotion shifting in a case illustration of brief dynamic therapy.

In a secondary analysis of Friedlander et al.'s [(2018). "If those tears could talk, what would they say?" multi-method analysis of a corrective experience in brief dynamic therapy.

Introducing the Expectations and Preference Scales for Couple Therapy (EPSCT): Development, Psychometric Evaluation, and Suggested Use in Practice and Research.

While it is known that client factors account for the largest proportion of outcome variance across treatment modalities, little is known about how clients' characteristics affect the process and effectiveness of couple therapy. To further knowledge in this area, we created a brief, practice-friendly measure, the Expectation and Preference Scales for Couple Therapy (EPSCT). Three self-report scales assess clients' Outcome expectations (e.

Meta-analysis of the alliance-outcome relation in couple and family therapy.

This article reviews meta-analytic evidence for the alliance-outcome relation in couple and family therapy (CFT), with implications for clinical practice. We begin by describing the unique features of CFT alliances and their measurement, followed by two case descriptions. We explain that due to the systemic context of CFT, each patient's personal alliance with the therapist affects and is affected by other family members' levels of collaboration.

Toward a nuanced understanding of nondisclosure in psychotherapy supervision.

Previous research indicates that trainees often withhold important information related to their clients' progress and their reactions to supervision. Moreover, factors associated with the occurrence of supervisee nondisclosure (SND) are not well established. As one of the few studies to compare clinically related with supervision-related nondisclosure, we tested the relation of these two dimensions of the construct, as measured by Siembor and Ellis's (2012) Supervisee Nondisclosure Scales, to three important process variables: perceptions of (a) the supervisory alliance, as measured by Bahrick's (1989) Working Alliance Inventory-Trainee; (b) collaborative supervision, as measured by Rousmaniere and Ellis's (2013) Collaborative Supervision Behavior Scale; and (c) explicitly relational supervisor behaviors, as measured by Shaffer and Friedlander's (2017) Relational Behavior Scale.

Illustrating novel techniques for analyzing single-case experiments: Effects of pre-session mindfulness practice.

In this article we describe and illustrate various visual and nonparametric techniques that can be used to evaluate the effectiveness of interventions in single-case experiments. Using an alternating treatments design across 2 cases, we tested whether practicing mindfulness would help a novice therapist stay focused and respond to a client more empathically and genuinely. Specifically, after taking a brief workshop on mindfulness, one male and one female doctoral trainee were asked, immediately before beginning each of 10 sessions, either to engage in a guided mindfulness practice for three minutes or a control activity of their choice.

"If those tears could talk, what would they say?" Multi-method analysis of a corrective experience in brief dynamic therapy.

We analyzed master theorist/therapist Hanna Levenson's six-session work with "Ann" in American Psychological Association's Theories of Psychotherapy video series to determine if and how this client had a corrective experience in Brief Dynamic Therapy. First, we identified indicators of a corrective experience in the therapist's and client's own words. Complementing this analysis, we used observational coding to identify, moment by moment, narrative-emotion markers of shifts in Ann's "same old story"; the frequency, type, and depth of immediacy; and the client's and therapist's behavioral contributions to the working alliance.

What do "interpersonally sensitive" supervisors do and how do supervisees experience a relational approach to supervision?

Objective: In two investigations, we identified explicitly relational supervision strategies and examined whether use of these strategies was associated with perceptions of the supervisory alliance and evaluations of the supervisor.

Method: First, ratings by nine supervision researchers identified five clearly relational in-session strategies (focus on countertransference, exploration of feelings, attend to parallel process, focus on the therapeutic process, focus on the supervisory alliance) in the Critical Events model of supervision. Based on these expert ratings, we created and assessed the Relational Behavior Scale (RBS).

Therapeutic Alliance and Retention in Brief Strategic Family Therapy: A Mixed-Methods Study.

We explored how the therapeutic alliance contributed to retention in Brief Strategic Family Therapy by analyzing videotapes of eight-first sessions in which four therapists worked with one family that stayed in treatment and one family that dropped out. Although behavioral exchange patterns between clients and therapists did not differ by retention status, positive therapist alliance-related behavior followed negative client alliance behavior somewhat more frequently in the retained cases. In the qualitative aspect of the study, four family therapy experts each viewed two randomly assigned sessions and commented on their quality without knowing the families' retention status.

25 years of systemic therapies research: progress and promise.

Objective: In this article we describe and assess the state of the science on systemic psychotherapies. In the quarter century since the first issue of Psychotherapy Research was published, considerable progress has been made. There is an increasingly solid evidence base for systemic treatments, which includes a wide range of approaches to working conjointly with couples and families.

Use of relational strategies to repair alliance ruptures: How responsive supervisors train responsive psychotherapists.

Inasmuch as therapist responsiveness is the crucial ingredient in psychotherapy success, teaching supervisees to be optimally responsive to their clients is the primary function of supervision. Responsive supervision is particularly critical when a trainee experiences a faltering or problematic working alliance with a client. In this article, I describe and illustrate how supervisors can work responsively, both explicitly (through instruction) and implicitly (through modeling) when their supervisees report a serious alliance rupture.

Predicting depressive symptoms from acculturative family distancing: A study of Taiwanese parachute kids in adulthood.

We applied Hwang's (2006a) acculturative family distancing (AFD) theory to Taiwanese "parachute kids," who had immigrated to the United States or Canada as unaccompanied minors and remained in North American as adults. It was hypothesized that each dimension of AFD-communication breakdown and cultural value incongruence-would uniquely predict conflict with participants' family members in Taiwan, which would, in turn, predict their depressive symptoms. In a sample of 68 former parachute kids aged 18 to 36 years, the relation between communication breakdown and depressive symptoms was fully mediated by family conflict.

Lessons offered, lessons learned: reflections on how doing family therapy can affect therapists.

Only in working conjointly with couples and families do therapists literally witness clients struggling to improve their most intimate relationships. In writing this article, we realized that, in true systemic fashion, not only have many of our clients benefited from working with us, but also we have learned some invaluable lessons from them. Indeed, practicing couple and family therapy gives therapists many opportunities to learn about themselves, especially when it is done thoughtfully.

When psychotherapy is indefinite and there is no final outcome: case study of a community mental health clinic.

Little is known about long-term patients for whom there is no anticipated endpoint to treatment. In this qualitative case study, we used a focus group methodology to understand how psychotherapists at a community mental health clinic work with low-income adult patients who are seen indefinitely. Narrative themes that emerged from the focus group discussion include the nature of these patients' diagnoses and life problems; the sociocultural contexts in which they live; the kinds of treatment goals and interventions; the internal and external barriers to termination; and how therapists recognize the need to work indefinitely with some patients to keep them alive or functioning in the community.

Applying Group Cognitive Behavioral Therapy for Anxiety Disorders in Community Settings: Retention, Outcome, and Clinical Considerations.

The efficacy, and to a lesser extent, effectiveness, of individual cognitive behavioral therapy (CBT) for anxiety disorders has been demonstrated, but whether manualized treatments work in a group format in community settings is less established. We investigated the predictors of retention and outcome in 26 groups (11 Generalized Anxiety Disorder, 11 Panic, 4 Social Phobia groups), conducted for more than 10 years in a semirural community mental health center by 19 therapists. Members of the Anxiety Disorders Treatment Team delivered manualized group CBT treatments.