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Marriage and Family Therapy Theses and Dissertations

Theses/dissertations from 2019 2019.

Attachment and Relationship Quality: A Longitudinal Cross-Lagged Panel Model Examining the Association of Attachment Styles and Relationship Quality in Married Couples , Meagan Cahoon Alder

Coding Rupture Indicators in Couple Therapy (CRICT): An Observational Coding Scheme , AnnaLisa Ward Carr

We Shall Overcome: The Association Between Family of Origin Adversity, Coming to Terms, and Relationship Quality for African Americans , Kylee Marshall

Sri Lankan Widows' Mental Health: Does Type of Spousal Loss Matter? , Katrina Nicole Nelson

The Role of the Autonomic Nervous System in the Relationship Between Emotion Regulation and Conflict Tactics in Couples , Natalie Gold Orr

A Content Analysis of Ethnic Minorities in the Professional Discipline of Clinical Psychology , Pedro L. Perez Aquino

Sleep, Stress, and Sweat: Implications for Client Physiology Prior to Couple Therapy , Christina Michelle Rosa

Theses/Dissertations from 2018 2018

A Content Analysis of the Journal of Adolescent Health: Using Past Literature to Guide Healthcare Research of US Ethnic Minority Adolescents , Kate Amanda Handy

Stress of Trying Daily Therapy Interventions , Emily Kathryn Hansen

U.S. Racial/Ethnic/Cultural Groups in Counseling Psychology Literature: A Content Analysis , Jared Mark Hawkins

Can Attachment Behaviors Moderate the Influence of Conflict Styles on Relationship Quality? , Cameron W. Hee

Therapist Behaviors That Predict the Therapeutic Alliance in Couple Therapy , Bryan C. Kubricht

Insider Perspectives of Mate Selection in Modern Chinese Society , Szu-Yu Lin

The Development of a Reliable Change Index and Cutoff for the SCORE-15 , Cara Ann Nebeker Adams

Difference in Therapeutic Alliance: High-Conflict Co-Parents vs Regular Couples , Andrea Mae Parady

Effects of Exercise on Clinical Couple Interactions , Samantha Karma-Jean Simpson

The Effect of Common Factor Therapist Behaviors on Change in Marital Satisfaction , Li Ping Su

Theses/Dissertations from 2017 2017

Physiological Attunement and Influence in Couples Therapy: Examining the Roots of Therapeutic Presence , Julia Campbell Bernards

Youth Disclosure: Examining Measurement Invariance Across Time and Reporter , Robb E. Clawson

A Pilot Study Examining the Role of Treatment Type and Gender in Cortisol Functioning , Stephanie Young Davis

Longitudinal Relations Between Interparental Conflict and Adolescent Self-Regulation: The Moderating Role of Attachment to Parents , Lisa Tensmeyer Hansen

Cost Outcomes for Major Depressive Disorder and Bipolar Disorder Across Professional License Types and Modalities , Julia H. Jones

The Relationship Between Relational Aggression and Sexual Satisfaction: Investigating the Mediating Role of Attachment Behaviors , Melece Vida Meservy

The Effects of Family Stressors on Depression in Latino Adolescents as Mediated by Interparental Conflict , Jenny Carolina Mondragon

A Longitudinal Examination of Parental Psychological Control and Externalizing Behavior in Adolescents with Adolescent Internalized Shame as a Mediating Variable , Iesha Renee Nuttall

Multiculturalism and Social Work: A Content Analysis of the Past 25 Years of Research , Lauren Christine Smithee

Implicit Family Process Rules Specific to Eating-Disordered Families , Mallory Rebecca Wolfgramm

The Impact of Timing of Pornography Exposure on Mental Health, Life Satisfaction, and Sexual Behavior , Bonnie Young

Theses/Dissertations from 2016 2016

The Relationship Between the Poor Parenting in Childhood and Current Adult Symptoms of Anxiety and Depression: Attachment as a Mediator , Kayla Lynn Burningham

Longitudinal Examination of Observed Family Hostility and Adolescent Anxiety and Depression as Mediated by Adolescent Perspective Taking and Empathic Concern , Trevor Dennis Dahle

The Influence of Client General Anxiety and Attachment Anxiety onAlliance Development in Couple Therapy , Erica Leigh Delgado

U.S. Ethnic Groups in the Journal of Family Psychology : A Content Analysis , Jessica Croft Gilliland

Passion and Sexuality in Committed Relationships , Emilie Iliff

Does Self-Esteem Mediate the Effect of Attachment on Relationship Quality , Alexis Lee

A Content Analysis and Status Report of Adolescent Development Journals: How Are We Doing in terms of Ethnicity and Diversity? , Jason Bernard Lefrandt

The Effect of Marital Therapy on Physical Affection , Tiffany Ann Migdat

Predicting Externalizing Behaviors in Latino Adolescents Using Parenting and EducationalFactors , Sergio Benjamin Pereyra

Pathways to Marriage: Relationship History and Emotional Health as Individual Predictors of Romantic Relationship Formation , Garret Tyler Roundy

Examining the Link Between Exercise and Marital Arguments in Clinical Couples , Bailey Alexandra Selland

Cost-Effectiveness of Psychotherapy and Dementia: A Comparison by Treatment Modality and Healthcare Provider , Megan Ruth Story

Childhood Abuse Types and Adult Relational Violence Mediated by Adult Attachment Behaviors and Romantic Relational Aggression in Couples , Tabitha Nicole Webster

Theses/Dissertations from 2015 2015

The Effects of Marital Attachment and Family-of-Origin Stressors on Body Mass Index , Merle Natasha Bates

Shame, Relational Aggression, and Sexual Satisfaction: A Longitudinal Study , Austin Ray Beck

Parent and Adolescent Attachment and Adolescent Shame and Hope with Psychological Control as a Mediator , Natasha K. Bell

The Relationship Among Male Pornography Use, Attachment, and Aggression in Romantic Relationships , Andrew P. Brown

The Moderating Effect of Attachment Behaviors on the Association Between Video Game Use, Time Together as a Problem, and Relationship Quality , Stella Christine Dobry

Attachment Behaviors as a Moderator of the Relationship Between Disapproval and Relationship Satisfaction , Lauren Drean

Effects of Interparental Conflict on Taiwanese Adolescents’ Depression and Externalizing Problem Behavior: A Longitudinal Study , Chih Han Hsieh

The Cost Effectiveness of Psychotherapy for Treating Adults with Post-Traumatic Stress Disorder , Micah LaVar Ingalls

Effects of Positive and Negative Events on Daily Relationship Effect for Clinical Couples: A Daily Diary Study , Kayla Dawn Mennenga

A Longitudinal Study of Therapist Emotion Focused Therapy Interventions Predicting In-Session Positive Couple Behavior , Josh Novak

Facilitative Implicit Rules and Adolescent Emotional Regulation , Lexie Y. Pfeifer

Avoidant Parental and Self Conflict-Resolution Styles and Marital Relationship Self-Regulation: Do Perceived Partner Attachment BehaviorsPlay a Moderating Role? , Erin L. Rackham

Individual Personality and Emotional Readiness Characteristics Associated with Marriage Preparation Outcomes of Perceived Helpfulness and Change , Megan Ann Rogers

Interactions Between Race, Gender, and Income in Relationship Education Outcomes , Andrew K. Thompson

Theses/Dissertations from 2014 2014

Partner Attachment and the Parental Alliance , Ashley B. Bell

A Glimmer of Hope? Assessing Hope as a Moderator of the Relationship Between Parenting and Adolescent Depressive Symptoms , Lisa D. Bishop

Father Influence on Adolescent Sexual Debut , Daniel Joseph Blocker

Stable Conflict Resolution Styles and Commitment: Their Roles in Marital Relationship Self-Regulation , Rebecca Suzanne Boyd

Me, You, and Porn: A Common-Fate Analysis of Pornography Use and Sexual Satisfaction Among Married Couples , Cameron C. Brown

The Relationship Between Partner Perceptions of Marital Power and Sexual Satisfaction as Mediated by Observed Hostile Interaction , Amanda Claire Christenson

The Impact of Parentification on Depression Moderated by Self-Care: A Multiple Group Analysis by Gender for South Korea and the U.S. , Sunnie Giles

Romantic Relational Aggression in Parents and Adolescent Child Outcomes , Jennifer Nicole Hawkley

Cost-Effectiveness of Treating Oppositional Defiant Disorder: A Comparison by Treatment Modality and Mental Health Provider Type , Julie Denise Malloy

Constructive vs. Destructive Anger: A Model and Three Pathways for the Expression of Anger , Kierea Chanelle Meloy

Treatment Outcomes for Mood Disorders with Concurrent Partner Relational Distress: A Comparison by Treatment Modality and Profession , Holly Pack

Cost Effectiveness of Treating Generalized Anxiety Disorder in Adolescence: A Comparison by Provider Type and Therapy Modality , Kathryn Evelyn Reynolds

Commitment, Forgiveness, and Relationship Self-Regulation: An Actor-Partner Interdependence Model , Heather Michele Smith

A Comparison of Contemporary Filial Piety in Rural and Non-Rural China and Taiwan , Li Ping Su

A Dyadic Analysis of Couple Attachment Behaviors as Predictors of Dietary Habits and Physical Activity Levels , Stephanie Young

Theses/Dissertations from 2013 2013

Cost-Effectiveness of Treating Pervasive Developmental Disorders: A Comparison by Treatment Modality , Jaime Elizabeth Ballard

Couples' Experience of Attachment-Related Change in Context of Couple-Centered, Enactment-Based Therapy Process and Therapist-Centered Therapy Process: A Qualitative Study , James Waid Ballard

Links between High Economic Distress and School Engagement as Mediated through Negative Marital Interaction and Parental Involvement , Lauren Alyssa Bone Barnes

The Relationship Between Frequency of Incest and Relational Outcomes with Family-of-Origin Characteristics as a Potential Moderating Variable , Kathleen Diane Baxter

Parental Involvement, Parent-Child Warmth and School Engagement as Mediated by Self-Regulation , Jeffrey James Bentley

The Effect of Attachment on the Therapeutic Alliance in Couples Therapy , Shawn A. Bills

Intrinsic Religiosity and Adolescent Depression and Anxiety: The Mediating Role of Components of Self-Regulation , Brent Charles Black

The Relationship Between Romantic Relationship Initiation Processes of Single LDS Emerging Adults and Change in Attachment Working Models with Implications for Practice , Matthew Lloyd Call

Attachment and Covert Relational Aggression in Marriagewith Shame as a Potential Moderating Variable: A Two Wave Panel Study , Charity Elaine Clifford

Family Implicit Rules, Shame, and Adolescent Prosocial and Antisocial Behaviors , Jeffrey Paul Crane

Infidelity and Forgiveness: Therapists' Views on Reconciliation and Restoration of Trust Following Disclosure of Infidelity , Miranda Mae Goldie

Power of Shame: The Moderating Effects of Parental and Peer Connection on the Relationship Between Adolescent Shame and Depression, Self-Esteem, and Hope , Alexander L. Hsieh

Couple Attachment and Sexual Desire Discrepancy: A Longitudinal Study of Non-Clinical Married Couples at Mid-Life , Anthony Allen Hughes

Factors Relating to Romantic Relationship Experiences for Emerging Adults , Sabra Elyse Johnson

Attachment Behaviors as Mediators Between Family-of-Origin Quality and Couple Communication Quality in Marriage: Implications for Couples Therapy , Darin Justin Knapp

Division of Labor and Marital Satisfaction in China and Taiwan , Bryan C. Kubricht

Stability and Change in Women's Personality Across the Life Course , Carly D. LeBaron

The Cost Effectiveness of Collaborative Mental Health Services In Outpatient Psychotherapy Care , Ashley Ann Maag

The Relationship Between Insecure Attachment and Premarital Sexual Timing , Carly Ostler

A Longitudinal View of the Association Between Therapist Behaviors and Couples' In-Session Process: An Observational Pilot Study of Emotionally Focused Couples Therapy , Lori Kay Schade

Conflict Resolution Styles as Mediators of Female Childhood Sexual Abuse Experience and Couple Relationship Satisfaction and Stability in Adulthood , Ashlee Elizabeth Sloan

The Relationship Between Video Game Use and Couple Attachment Behaviors in Committed Romantic Relationships , Jamie McClellan Smith

Psychological Control, Parental Support, Adolescent Grades and School Engagement , David Brian Thompson

Shame Not the Same for Different Styles of Blame: Shame as a Mediating Variable for Severity of Childhood Sexual Abuse and Trauma Symptoms in Three Attribution of Blame Groups , Tabitha Nicole Webster

Theses/Dissertations from 2012 2012

The Mediating Influence of Child Self-Regulation on the Relationship Between Couple Attachment Security in Parents and Anxiety in Their Children , David P. Adamusko

Couple Communication as a Mediator Between Work-Family Conflict and Marital Satisfaction , Sarah J. Carroll

The Role of Trait Forgiveness in Moderating the Relationship between Materialism and Relationship Instability in Couples , Lance J. Dome

Relationship Between Observed Parental Optimism and Adolescent Optimism with Parental Involvement as a Mediating Variable: Two Wave Panel Study , Allison Ellsworth

Mental Health Treatment for Children and Adolescents: Cost Effectiveness, Dropout, and Recidivism by Presenting Diagnosis and Therapy Modality , David Fawcett

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Language: English | Chinese

Couple therapy in the 2020s: Current status and emerging developments

1 Family Institute of Northwestern, Northwestern University, Evanston Illinois, USA

Douglas K. Snyder

2 Department of Psychological and Brain Sciences, Texas A&M University, College Station Texas, USA

This paper provides a critical analysis and synthesis of the current status and emerging developments in contemporary couple therapy. Its narrative centers on the evolution of couple therapy into a prominent intervention modality and coherent body of practice. The review begins with the consideration of the field's strong empirical underpinnings derived from research on couple therapy and basic relational science. Couple therapy comprises the widely accepted method for reducing relationship distress and enhancing relationship quality. Moreover, both as a stand‐alone intervention and in conjunction with other treatment formats, couple‐based interventions have garnered considerable empirical support for their effectiveness in addressing a broad spectrum of specific relational dysfunctions as well as individual emotional and physical health problems. We highlight the convergence of methods through common factors, shared strategies, and remarkably similar arrangements across approaches. Our review also points to key differences among approaches, the importance of recognizing respective strengths and limitations linked to these differences, and building on differences across models when selecting and tailoring interventions for a given couple. The discussion concludes with a consideration of recent trends in the field including the impact of telehealth and related digital technologies, the expansion of specific treatments for specific problems and diverse populations, the interface of couple therapy with relationship education, and enduring challenges as well as new opportunities addressing broader systemic and global dynamics.

本文对当代伴侣治疗的现状和新发展进行了批判性地分析和综合。整个叙述集中在伴侣治疗演变成一个突出的干预模式和连贯的实践体系。该综述首先考虑了该领域从伴侣治疗和基础关系科学的研究中获得的强有力的经验基础。伴侣治疗包括被广泛接受的减少伴侣关系困扰和提高伴侣关系质量的方法。此外，以伴侣为基础的干预，无论是作为独立的干预手段还是与其他治疗形式相结合，在解决各种各样的特定关系功能障碍以及个人情感和身体健康问题方面的有效性，都获得了相当多的经验支持。我们强调实现各种方法的融合，主要通过共同因素、共享策略和不同方法之间非常相似的组合安排来实现。本综述研究还指出了不同方法之间的关键的差异点，认识到与这些差异相关的各自优势和局限性的重要性，以及在为特定的伴侣选择和定制干预措施时建立在不同模式的差异上。讨论最后考虑了该领域最近的发展趋势，包括远程医疗和相关数字技术的影响，针对特定问题和不同人群的特定治疗的扩展，伴侣治疗与关系教育的衔接，以及持久的挑战和解决更广泛的系统和全球动态的新机遇。.

INTRODUCTION

This paper is occasioned by our completing the editing of a major handbook of couple therapy (Lebow & Snyder, 2023 ). In experiencing the breadth of the field of couple therapy over the 4 years of preparing that book, we noticed emerging trends in the field, shared visions, differences among approaches, and exciting recent developments. Here, we summarize what is in part simply a “sifting of the data” from what we read but also inevitably our own effort to make sense of the common ground and diversity in couple therapy. We look to extrapolate from the vast array of writing and presentations about couple therapy, broad trends in the field, as well as commonalities and continuing major points of difference and controversy across approaches. So, what then can we say of couple therapy?

THE PROMINENCE OF COUPLE THERAPY

Couple therapy has emerged as an important, widely disseminated form of therapy. Although there was a time when couple therapy was mostly an afterthought in considerations of psychotherapy and counseling, primarily consisting of methods derived from individual or family therapy and adapted to couples, couple therapy has evolved into a form of treatment that stands on its own, is widely practiced, and has its own distinct methods. The largest international study of psychotherapists found that 70% of psychotherapists treat couples (Orlinsky & Ronnestad,  2005 ). A survey of expert psychotherapists' predictions about future practices in psychotherapy showed couple therapy to be the format likely to achieve the most growth in the next decade (Norcross et al.,  2013 ) and this projection appears to have been confirmed.

Three key factors have driven the development and widespread adoption of couple therapy as a prominent therapeutic modality. The first is the high prevalence of couple distress. In the United States, 40%–50% of first marriages end in divorce (Kreider & Ellis,  2011 ). Globally, across almost all countries for which data are available, divorce rates increased from the 1970s to the beginning of this century (Organization of Economic Cooperation and Development,  2011 ) and divorce has become commonplace even in countries where it once was rarely encountered (Doherty et al.,  2021 ). Even for those less at risk for divorce, many couple relationships experience periods of significant turmoil.

The second factor prompting the rising profile of this set of methods is the adverse impact of relationship distress on the emotional and physical well‐being of adult partners and their offspring. In a survey in the United States, the most frequently cited causes of acute emotional distress were couple relationship problems (Swindle et al.,  2000 ). Partners in distressed relationships are significantly more likely to have a mood disorder, anxiety disorder, or substance use disorder (McShall & Johnson,  2015 ) and to develop more physical health problems (Waite & Gallagher,  2000 ). Moreover, couple distress has been related to a wide range of deleterious effects on children, including mental and physical health problems, poor academic performance, and a variety of other concerns (Bernet et al.,  2016 ).

A third factor propelling the prominence of couple therapy is the evolution of higher expectations for relationship life. Whereas once relational misery was simply to be tolerated, today couples have much higher expectations of relational life and see couple therapy as the pathway to better relationships (Cherlin,  2009 ; Dowbiggin,  2014 ; Finkel,  2017 ).

COUPLE THERAPY: AN EVOLVING FIELD

Couple therapy is a constantly evolving field. Principles of couple therapy have emerged that transcend theoretical orientation, as have several widely disseminated specific approaches to couple therapy aimed at reducing couple distress and improving relationship quality. Still, other couple‐based interventions have been developed targeting specific couple or individual problems (e.g., partner aggression, infidelity, and depression) and populations (e.g., emerging adults, LGBTQ couples, and stepfamily couples). Although there remain threads of both theoretical and technical connection to various methods of individual and family therapy (Lebow,  2014 ), the field now includes a distinct set of prominent approaches, builds on an enormous body of basic research focused on intimate relationships, and offers a substantial body of empirical evidence supporting the efficacy and effectiveness of its methods. Thus, it has become abundantly clear that effective intervention with couples requires its own set of theories, approaches, and methods anchored in relational science.

A brief history of couple therapy

In their classic overview of couple therapy, Gurman and Fraenkel ( 2002 ) described stages in the development of the field. First, in the early 20th century, atheoretical marriage counseling began to be practiced, featuring a pragmatic mix of psychoeducation and advice giving. During this stage, most of those working with couples did not label themselves as psychotherapists, and often they did not see spouses together. The second stage of the field, psychoanalytic experimentation, began in the 1930s, expanding from the then predominant form of therapy, psychoanalytic psychotherapy, to work with couples. Mostly, partners tended to be seen separately in this treatment by the same therapist in what has come to be called concurrent therapy, though eventually, this work segued into the beginnings of conjoint therapies in which both spouses participated in sessions with a therapist. Nonetheless, Michaelson ( 1963 ) estimated that in the 1940s, only 5% of couples were seen conjointly, and by the mid‐1960s, this number had only increased to about 15%. The third phase of couple therapy stemmed from the cataclysmic impact of the family therapy revolution in the 1960s and 1970s, in which several prominent models of systemic therapy emerged sharing the common ground of being highly influenced by systems theory. Subvariations of such core family systems therapies as experiential, strategic, structural, psychoanalytic, intergenerational, and behavioral therapies focused on couples and couple therapy (Gurman & Kniskern,  1981 ). In these therapies with their interactional basis, partners were almost always seen conjointly.

Through a different lens, couple therapy also evolved in relation to sociocultural influences. Dowbiggin ( 2014 ) described a historical shift in couples' looking for guidance primarily from family and community to their seeking help from counseling professionals. He also suggested that marriage counseling—with its emphasis on personal happiness, sexual satisfaction, and more modern gender roles—both fit within and contributed to the cultural context of middle‐class 20th‐century America. Doherty ( 2020 ) similarly situated the development of couple therapy in the context of 20th‐century family life, subject to larger system factors such as the rise in the divorce rate, the emergence of feminism, the explication of multicultural perspectives, and changes in American culture's view of marriage.

In the most recent phase of couple therapy in the 21st century, couple therapy has emerged as a mature discipline. Couple therapy has come to incorporate a wide array of distinct treatments, and a stronger evidence base both in the efficacy of therapies and in its foundation in the emerging body of relational science. Couple therapy has also broadened its conceptual framework to incorporate feminism, multiculturalism, and a broader view of gender and sexuality. Thus, “couple” now speaks to a much broader diversity of couples, and with this change has come an update from labeling “marital therapy” to “couple therapy.” Indeed, the continuing evolution of couple therapy now incorporates the increased use of social media and technology as well as open discussions about LGBTQ rights, gender equity, racism, social justice, politics, sexuality, individuality, freedom, and gender identity (Doherty,  2020 ). This era also includes the flourishing of numerous integrative methods and the development of couple therapy as a format for treating problems of individual partners.

COUPLE THERAPY WORKS!

Reviews and meta‐analyses affirm the effectiveness of couple therapy in reducing relationship distress (Bradbury & Bodenmann,  2020 ; Doss et al.,  2022 ; Lebow et al.,  2012 ; Roddy et al.,  2020 ; Shadish & Baldwin,  2003 ). Cognitive‐behavioral couple therapy, integrative behavioral couple therapy, and emotionally focused couple therapy each have sufficient evidence to be considered specific well‐established treatments for relationship distress. Nonetheless, broadly, meta‐analyses show behavioral and nonbehavioral therapies to have similar rates of impact (Shadish & Baldwin,  2005 ). The average person receiving couple therapy is better off at termination than 70%–80% of individuals not receiving treatment—an improvement rate that rivals or exceeds the most effective psychosocial and pharmacological interventions for individual mental health disorders. A variety of couple treatments have also garnered evidence supporting their effectiveness for specific relationship problems including sexual difficulties (McCarthy & Thestrup,  2008 ), infidelity (Baucom et al.,  2006 ), and intimate partner violence (Epstein et al.,  2015 ; Stith et al.,  2011 ). Yet, there is some indication that effectiveness in clinical settings in which treatments are not closely monitored is somewhat lower than in controlled trials (Bradbury & Bodenmann,  2020 ). Further, there is evidence that as with many problems, the impact of most couple therapies dissipates for about half the couples over several years of follow‐up (Bradbury & Bodenmann,  2020 ).

In addition to reducing either general or specific relationship difficulties, evidence from several clinical trials supports the beneficial impact of couple therapies for coexisting emotional, behavioral, and physical health concerns (Babinski & Sibley,  2022 ; Fischer et al.,  2016 ; Goger & Weersing,  2022 ; Hogue et al.,  2022 ; Lamson et al.,  2022 ; Stith et al.,  2022 ). For example, there is evidence in support of couple‐based interventions for depression or anxiety (Wittenborn et al.,  2022 ), posttraumatic stress (Monson et al.,  2012 ), and alcohol problems (McCrady et al.,  2016 ) of an adult partner. Couple‐based interventions for physical health problems comprise an expanding application—with evidence beginning to emerge supporting the benefits of couple therapy across a broad spectrum of conditions including couples in whom one partner has cancer, chronic pain, cardiovascular disease, anorexia nervosa, or type‐2 diabetes (Fischer et al.,  2016 ; Lamson et al.,  2022 ; Rohrbaugh et al.,  2012 ; Shields et al.,  2012 ; Woods et al.,  2020 ). Typical components of couple‐based interventions for individual mental and physical health problems emphasize partner support, improved communication, and increased attention to the disorder's adverse impact on the couple relationship. The extension of couple‐based treatments to individual disorders reflects one of the most important developments of couple therapy in this century.

FOUNDATION IN RELATIONAL SCIENCE

An important aspect of contemporary couple therapy is its strong foundation in relational science. Consider that couple therapy began as a method of practice before there was a field of relational science. Indeed, at the time of its origin, there were only the most primitive beginnings of social psychology. The infusion of relational science into practice has been steady and evolving.

The first widely recognized connections to science came in the form of bringing outcome and efficacy assessments to couple therapies (Gurman & Kniskern,  1981 ). To no great surprise, those efforts initially instigated considerable reactivity from those who eschewed a focus on measurable outcomes and who practiced therapies less frequently represented in the research literature (Gurman & Kniskern,  1978 ). In historical context, it is ironic that Alan Gurman, who espoused a nuanced view of the therapy process and outcome, was the primary mover of this initial emphasis on outcomes (Gurman & Kniskern,  1978 ), yet even his nuanced view led to a strong negative reaction. Today, the crucial role of evidence in relation to the impact of various couple therapies is widely accepted. Most couple therapy begins with the clear purpose of reducing relationship distress and promoting couple well‐being, measurable outcomes that readily can be compared to the limited changes in relational satisfaction typical of those couples in no‐treatment control conditions (Baucom et al.,  2003 ; Roddy et al.,  2020 ).

To some extent, couple therapy has become more firmly established because both meta‐analytic data and systematic reviews of the literature affirm the considerable broad impact of couple therapy (Bradbury & Bodenmann,  2020 ; Doss et al.,  2022 ; Roddy et al.,  2020 ; Shadish & Baldwin,  2003 , 2005 ) and of several of its specific approaches (Fischer et al.,  2016 ; Roddy et al.,  2016 ; Wiebe & Johnson,  2016 ). Research also highlights the impact of couple therapy on individual functioning even when relational functioning is the primary focus of couple therapy. Moreover, unlike the spontaneous remission of some problems that occur in the absence of treatment, research demonstrates little improvement in relationship satisfaction among distressed couples who do not receive therapy (Baucom et al.,  2003 ; Roddy et al.,  2020 ). Mental health and other healthcare delivery systems find links of couple‐based treatments to such clear and measurable outcomes essential.

Even more marked has been the influence of basic relational science research on couple therapy. Whereas the early forms of couple therapy only drew occasionally on the emerging field of relational science, most approaches now cite basic research about relationships as part of the foundation for their methods. Included here are such threads as research about attachment, communication processes, behavior exchanges, and emotional resonance, as well as characteristics of couples with specific problems or from specific populations. The linkages between basic research and practice articulated by Gottman ( 1999 ) in the late 20th century modeled for others the incorporation of such basic science research into practice. After the emergence of science‐based couple therapies, those who promoted their ideas about relationships without spelling out the empirical basis of those concepts and methods came to have less credibility (even if remaining fashionable at times in the popular media). Moreover, with the empirical investigation also came the ability to disconfirm theories and even identify the potentially harmful effects of certain untested ideas.

LINKS TO NEUROSCIENCE

Closely connected to the incorporation of relational science in practice has been the rapid advance in the last decade in the integration of relational neuroscience into contemporary approaches. Most models of couple therapy developed before the technology was available to assess brain function in relational life. Nonetheless, with the explosion in the information available from neuroscience in relation to couple functioning, couple therapies have begun to incorporate this emerging and exciting new knowledge base. Most especially, Fishbane's ( 2015 ) translation of neurobiology to the couple context has had considerable influence, providing a bridge to couple therapists directly being able to invoke working with neural pathways as a part of their repertoire. Other applications of neuroscience have become an essential part of emotionally focused couple therapy (Greenman et al.,  2019 ) and Gottman method therapy (Gottman & Gottman,  2015 ) as well as many other specific approaches (Tatkin,  2011 ).

Yet, here there is a caveat. Relational neuroscience is in its infancy. Studies are complex with endless possible neurotransmitters and brain structures that may be simultaneously influencing and influenced by couple processes. Methodologies range from those employing simple, readily available instruments such as pulse oximeters (an inexpensive instrument that many bought to monitor the effects of Covid‐19 that has utility here) to very expensive fMRI scanners. In exploring the literature and evaluating claims made of the implications of findings for clinical practice, it is vital to understand that specific findings that support one approach might also support another, that some findings come from a single study yet all research findings require replication and testing across diverse contexts before they can be seen as broadly applicable, that sometimes claims are made that inappropriately extend correlations to infer causation, and that the body of findings from neuroscience is only just beginning to produce an evidence‐based set of knowledge that is widely accepted.

CONVERGING METHODS

One of the most prominent trends in couple therapy is an emerging and substantial convergence of specific intervention methods across different theoretical approaches.

Couple therapy is both pluralistic and integrative

Contemporary couple therapies often cross the boundaries of schools of therapy and theoretical constructs that typically have been identified in individual therapy and earlier iterations of couple therapy. Thus, for example, cognitive‐behavioral couple approaches today transcend simply focusing on cognitions and behavioral sequences, instead also tapping emotion, meaning, and early experience (Baucom et al.,  2019 ; Epstein et al.,  2016 ). Similarly, while psychoanalytic individual therapy almost exclusively focuses on such factors as transference, the impact of early experience, and inner experience, the couple therapy variations of these approaches have come to include many other elements such as communication skills building (Nielsen,  2017 ). Such integration results from cross‐pollination across the couple therapies (wise ideas become assimilated into other models) along with the powerful pragmatic issues which every couple therapist faces regardless of orientation such as how to manage spiraling angry interactions, engage the less invested partner in therapy, promote positive connection, or deal with comorbid individual emotional or physical health concerns.

Most approaches build from a biopsychosocial foundation that includes diverse aspects such as the influence of family history, cognition, emotion, and inner psychological processes. Thus, they tap into multiple levels of human experience (Lebow,  2014 ). For example, emotionally focused couple therapy (Greenman et al.,  2019 ) addresses underlying primary and derivative emotions but also attachment. Enhanced cognitive behavioral therapy (Epstein & Baucom,  2002 ) addresses behavioral patterns but also relational schemas and emotions. Gottman method therapy (Gottman & Gottman,  2015 , 2017 ) addresses the direct behavioral level of exchanges and a far deeper level of meaning. Integrative systemic therapy (Pinsof et al.,  2018 ) addresses the many levels of human experience from behavioral exchange to inner experience.

Approaches certainly have differences in how much they emphasize each component (something we address later in this paper), but the overlap is considerable. Sometimes, authors explicitly speak of their approaches as integrative, while others do not; but regardless of whether they do so explicitly or not, integrative elements frequently permeate.

How should couple therapists think about and make use of these trends toward an expansion of both the specific phenomena to which contemporary approaches attend, as well as the broadening of various theoretical frameworks from which these phenomena are conceptualized? One approach that emerged during the 1970s was eclecticism—defined as the borrowing of specific techniques or constructs without allegiance (or even regard) for the theoretical framework in which those techniques or constructs were originally embedded (Lazarus,  1989 ). However, there are risks in eclecticism—most prominently the unsystematic or even contradictory use of specific interventions, as well as the possibility of dismantling interventions that rely on the synergistic effects of specific components implemented in combination for their effectiveness.

An alternative to eclecticism is pluralism—an approach that recognizes the validity and usefulness of multiple theoretical perspectives and draws on constructs and intervention strategies from across theoretical models by tailoring intervention strategies to a given case at any given moment based on their clinical relevance and potential utility. Pluralism differs from eclecticism in that interventions are always conceptualized from within a theoretical framework. Snyder ( 1999 ) advocated a pluralistic approach to couple therapy involving six levels progressing from a foundation of the collaborative alliance and managing initial crises, through strengthening the couple dyad and promoting relevant relationship skills, to addressing cognitive components and developmental sources of relationship distress. The therapeutic palette method of couple therapy presented by Fraenkel ( 2019 ) articulates a particularly elegant approach to pluralistic practice.

By the 1990s, the majority of therapists came to self‐identify as “integrative” rather than “eclectic” (even if their understanding of the difference might have been limited). Integration extends beyond pluralism via its blending of theoretical constructs or therapeutic techniques into one unified system or framework. Two threads of integration involve the identification of common factors and shared strategies, each of which we consider further here.

Common factors

A set of common factors lies at the base of couple therapy (Sprenkle et al.,  2009 ). These include common factors shared with individual therapy such as the therapeutic alliance, the instillation of hope, and attending to feedback. There also is a second set of common factors unique to relational therapies that include maintaining a relational frame, an active therapy style, disrupting dysfunctional relationship patterns and supporting functional ones, and some effort to create a relational therapeutic alliance. Although not all models speak explicitly of common factors, most do attend to them. For example, it is rare to find an approach that does not include a discussion of creating a therapeutic alliance and attending to its complexities.

Shared strategies

Beyond common factors lies a wide array of strategies that either originated within one approach and migrated to other therapies or have emerged as important intervention pathways in different approaches (Lebow,  2014 ). For example, most approaches strive to promote some form of mutual empathy and understanding, some form of negotiation between partners, some engagement and focus on the strengths of the relationship, some affective reengagement of positive connection, some understanding of individual contributions to the conjoint problem, and some form of mindfulness or affect regulation to render conflict‐based interactions more constructive. Frequently shared strategies include tracking patterns, listening, witnessing, psychoeducation promoting mentalizing, promoting softening, and creating experiences that enhance attachment.

Notably, the naming of these shared strategies can often be a constraint in the recognition of shared ground. Terms such as cognitive restructuring, reframing, and restorying exemplify different jargon for similar interventions across approaches. Ironically, although apt and grounded in relational science, words that have come to be identified with specific theories such as attachment and differentiation often come to divide. Jargon readily invites a Tower of Babel in which similarities across approaches are not recognized and small differences in methods are accentuated over common ground (Miller et al.,  1997 ). (Notable exceptions exist—for example, the use of the word “softening” in emotionally focused couple therapy has been enormously helpful in providing the perfect word for a broadly recognized intervention across diverse approaches.)

Structure of sessions and other arrangements

Given the many different approaches to couple therapy and the varying problems and purposes for which it is employed, the extent of shared arrangements is quite remarkable. Couple therapy today is primarily done conjointly with a clear set of specified rules for separate communication with individual partners. Sessions are most commonly conducted for 1 hour per week, and most methods include some carryover of the process (e.g., homework) between sessions. Couple therapy may continue for only a few sessions or last years, but most models envision a process lasting between 3 and 12 months. It is striking that even though there have been innumerable methods developed that are aimed to be conducted over either briefer or longer timeframes (and even in the wake of randomized controlled trial protocols that often necessarily limit the number of sessions), and with shorter or lengthier sessions, the standard remains mostly the standard. Whether this is driven by custom, by cost considerations such as insurance reimbursement, or by some shared notion that this is most effective remains an open question.

Couple therapies have evolved from their origins

Couple therapy models emerged out of various theoretical traditions, each anchored in its own time of development. However, it is in the nature of psychotherapies that, whereas theories and concepts often last over time, specific approaches do not. For example, behavioral marital therapy was initially a distinct, singular approach. That original treatment has been largely supplanted by the considerably expanded cognitive‐behavioral couple therapy (Epstein & Baucom,  2002 ) and integrative behavioral couple therapy (Christensen et al.,  2020 ). Similarly, emotion‐focused therapy has been succeeded by emotionally focused couple therapy (Johnson,  2015 ) and emotion‐focused couple therapy (Goldman & Greenberg,  2015 ). In a like manner, early psychoanalytic therapies have been superseded by object relations couple therapy (Scharff & Scharff,  2005 ; Siegel,  2015 ) and mentalization‐based couple therapy (Bleiberg et al.,  2023 ). And Bowen therapy (Bowen,  1972 ) and contextual therapy (Boszormenyi‐Nagy,  1987 ) have been largely supplanted by a broader more attachment‐oriented version of intergenerational therapy (Fishbane,  2019 ). Other early therapies, such as structural, experiential, and strategic couple therapy, have now declined in their prominence although they still have a cadre of devoted followers and their critical influence can be seen in various contemporary approaches. In tandem, the practice of some forms of couple therapy, such as narrative therapy (Freedman & Combs,  2015 ), has vastly expanded and evolved. And newer forms of couple therapy have emerged, such as socioculturally attuned couple therapy (McDowell et al.,  2018 ) and acceptance and commitment couple therapy (Lawrence et al.,  2023 ), as well as numerous specific therapies targeting specific issues or populations.

A central role for culture and gender

Couple therapy began as “marital” therapy—that is, with a fixed set of ideas about who comprised the couple (a man and a woman), their legal status as a couple (married), and often with a stereotypic set of expectations having to do with roles and other aspects of the relationship. And from this perspective, marital therapy without much self‐reflection often spoke primarily to the experience of white, middle‐ and upper‐class Americans and Europeans. Feminist, queer, and multicultural perspectives, as well as the dissemination of couple therapy around the world, have very much changed this perspective (Addison & Coolhart,  2015 ; Kelly et al.,  2019 ). Couple therapy is now a vehicle for helping with intimate relationships across gender, sexual preference, class, culture, race, ethnicity, and other facets of social location.

Understanding couples in the context of culture, race, ethnicity, gender, sexual orientation, and other aspects of social location that afford persons greater or less privilege (and greater or lesser experiences of marginalization and oppression) has become an essential aspect of couple therapy. Further, couple therapies are most helpful when adapted to specific kinds of couples—for example, adaptations for LGBTQ couples (Coolhart,  2023 ; Green & Mitchell,  2015 ) and stepfamily couples (Papernow,  2018a ), or description of the special considerations in therapy with Black American couples (Kelly et al.,  2019 ) or Latinx couples (Falicov,  2014 ). These insights and practices do not require clinicians to relinquish their favored theoretical approach to couple therapy but do present crucial additional considerations in the context of working with couples in a sensitive and effective manner.

COMMON ELEMENTS OF COUPLE THERAPY

Assessing multiple domains (e.g., emotions, cognitions, and behaviors) across multiple system levels (e.g., individual partners, their relationships, and broader family and cultural contexts) is essential for selecting, tailoring, and sequencing couple therapy interventions in a planful and effective manner. Whether implicitly or explicitly, the different approaches universally recognize the importance of attending to individual differences in conducting relevant interventions. Similarly, nearly all speak to the importance of monitoring both the process and progress of therapy in evaluating the impact of specific interventions, and revising the clinical formulation (whether explicit or implicit) and plan of therapy accordingly.

That said, both theoretical models and specific applications of couple therapy vary in their philosophical stance toward normative versus idiographic approaches, their advocacy of specific content or methods, and their views on whether formal assessment necessarily precedes intervention or, instead, evolves organically throughout therapy. Some approaches advocate meticulous assessment and the generation of an explicit case formulation and treatment plan (Christensen et al.,  2020 ), whereas some others do not. Some approaches such as narrative therapy explicitly eschew specific assessment methods (Freedman & Combs,  2015 ). And among those approaches that purposely incorporate methods of assessment, there may be a formal stage of assessment (e.g., a four‐session protocol combining individual and conjoint meetings; Chambers,  2012 ) or not; similarly, the various approaches or specific applications may prescribe standardized questionnaires or a set of observational tasks (Gottman,  1999 ; Gottman & Gottman,  2015 ) or not.

Related to assessment is the specification of specific inclusionary or (more usually) exclusionary criteria for couple therapy. Most models of couple therapy consider moderate to severe partner aggression, active alcohol or other substance abuse, continuing infidelity, or psychotic symptoms as contraindications for conjoint couple therapy. Yet, paradoxically, there are specific couple‐based treatments for these issues such as treatments for couples that include a person with a substance use disorder (McCrady et al.,  2016 ) or infidelity (Baucom et al.,  2009 ; Scheinkman & Werneck,  2010 ). A careful assessment facilitates informed decisions as to whether any of these or similar problems can be addressed within the more general theoretical models of couple therapy or require the more specialized intervention protocols, or whether any couple therapy is likely to be unhelpful in a particular case.

A myriad of strategies of intervention and techniques

One marvels at the rich and distinct body of intervention methods that have been developed. Clearly, some of the most creative and astute clinicians have developed this wonderful array of methods. The various models for helping couples bubble over with a panoply of active ingredients couple therapists can incorporate into treatment. That said, effective therapists often come up with very similar ways of working in couple therapy across whatever divides exist among theories. Clearly, there also has been cross‐pollination.

The systemic view: Sequences and vulnerability cycles

One important shared emphasis of almost all couple therapies lies in tracing the interpersonal sequences that unfold in the process of developing relational difficulties. This speaks to the influence of shared systemic understandings. Although certain processes may lie within individuals, the inevitable mutual influences between partners define the crucial understanding that is foundational to treating couples. It is in the nature of intimate relationships that the thoughts, feelings, and behaviors of partners inevitably affect one another and their relationship in an ongoing, recursive manner.

These cycles are named in a variety of ways across approaches, and what is seen as the specific internal component of the greatest moment in these cycles varies from approach to approach. Thus, Scheinkman and Fishbane ( 2004 ) speak of the vulnerability cycle, whereas Johnson and colleagues refer in their discussion of emotionally focused therapy to mutual attachment injuries (Johnson,  2015 ). In describing integrative systemic therapy, Pinsof et al. ( 2018 ) refer to sequences. Regardless of how these processes are named, the core sequence being referenced here involves a multilevel interpersonal process in which distressed partners turn away from one another or aggressively vie for control as opposed to engaging compassionately. The various general models of couple therapy articulate how these processes, like rust corroding the foundation of bridges, can erode the positive connection between partners. These models of couple therapy describe both how couples can develop and maintain a vital loving connection as well as the processes by which such connections diminish. Similarly, couple therapies targeted at specific problems and issues (e.g., post‐traumatic stress disorder or sexuality) emphasize how those issues come to be interwoven in the broader fabric of individual and relational functioning.

Pragmatic focus on relationship satisfaction

Another clear point of overlap lies in a dual focus on reducing couple distress and promoting relationship satisfaction. Almost all couple therapies emphasize specific interventions targeting these two complementary outcomes. That said, models vary in their relative emphasis on one versus the other. By definition, couple‐based applications for specific relationship issues (e.g., partner aggression or infidelity) or individual problems (e.g., depression or anxiety disorders, alcohol problems, and acute medical issues) target reduction in these difficulties, with improvement in relationship satisfaction often being viewed as one of the mediating pathways. Historically, many couple therapies have focused more on reducing conflict than on promoting intimacy—although more recently such positive aspects of relationships as encouraging emotional connection and shared meaning have moved into greater focus. Theories of couple functioning and related models of intervention play a pivotal role through their differential emphasis on specific aspects of relationships such as attachment, mentalization, mutual acceptance, problem‐solving and communication, narratives, and gender or sociocultural consciousness.

Ethical considerations

Couple therapists across orientations recognize a shared set of ethical considerations. Although couple therapies may disagree about what is the optimal ethical decision in a specific circumstance (e.g., whether to hold certain secrets—most especially about past behavior), there is almost total agreement on where the ethical issues lie and how to think about those issues. Thus, discussions about ethics in couple therapy speak to almost all couple therapies regardless of the specific application or underlying theoretical model (Barnett & Jacobson,  2019 ; Gottlieb et al.,  2008 ; Margolin et al.,  2023 ). Couple therapists struggle with the same complex set of dilemmas and questions, and most often come up with similar answers about such issues as confidentiality about private communication with one partner during couple therapy; about identifying who the client is in therapy, and how to respond to one partner's desire to leave the relationship; or about how to deal with the risk of intimate partner violence. Sometimes, there are differences about what is to be done in a specific circumstance; however, it is rare for an idea about these issues to be presented without recognizing that others may hold different positions and an awareness of the complexities involved in holding particular positions. Nonetheless, we must remember that in the practice of such a complex endeavor as couple therapy, there always will be those who are exceptions in their beliefs about some debatable standards of good practice.

Relation to individual and family therapy

Even as couple therapy has differentiated itself from individual and family therapy, it also has found a place to incorporate these modalities. In relation to individual therapy, most of the methods co‐exist and often actively look to be enhanced through collateral work with an individual partner. Although in some models that “individual” work may be done within the couple format, many suggest a complementary role for concurrent individual therapy with a different therapist.

Ironically, given its systemic roots, concurrent family therapy is less frequently spoken of in expositions about couple therapy than is individual therapy. Some approaches do retain the fluidity between couple and family therapy (at least in the unit of focus in therapy). Intergenerational approaches include a considerable focus on the family of origin and some still bring the family of origin into couple therapy sessions (Fishbane,  2019 ). Family systems considerations focused on children also become a center of attention in considering couple distress in the special circumstance of working with couples in which one partner leans toward ending the relationship while the other wants to continue with it before making a decision to enter couple therapy, where the impact on children typically arises as an important factor (Doherty & Harris,  2017 ). Additionally, Wymbs et al. ( 2023 ) speak to the role of working with couples as part of a multiformat approach with families of youth with attention deficit hyperactivity disorder or disruptive behavior disorders. Similarly, in their discussion of therapy with couples with medical issues, Rolland ( 2019 ) and Ruddy and McDaniel ( 2015 ) describe how that approach derives from broader medical family therapy. Notably, some of the most popular forms of couple therapy such as emotionally focused couple therapy have recently spawned related forms of individual and family therapy (Furrow et al.,  2019 ).

Stages of couple therapy

Although there are exceptions, most couple therapies envision beginning therapy with a stage of assessment and building of the therapeutic alliance, followed by a stage of promoting change (e.g., reducing couple distress and fostering positive connection), and then a concluding stage of termination and maintenance of gains. In the initial stage, many approaches include an explicit sharing or co‐creation of the clinical formulation and tentative treatment plan, reflecting emerging emphases in the field on collaboration and transparency in all phases of couple therapy.

FACETS OF DIFFERENCES ACROSS APPROACHES

Despite the underlying pragmatism and integration evident in many contemporary couple therapies, theories do matter. In his seminal 1978 analysis, Alan Gurman spelled out the essential tenets of what then were the major schools of couple therapy: behavioral, psychoanalytic, and systemic approaches (Gurman,  1978 ). In this classic deconstruction of couple therapies, Gurman differentiated couple therapies along four dimensions: (1) the role of the past and of the unconscious; (2) the nature and meaning of presenting problems and the role of assessment; (3) the relative importance of mediating versus ultimate treatment goals; and (4) the nature of the therapist's roles and functions. Fraenkel ( 2009 ), following a similar analysis, highlighted that approaches differ in (1) time frame (present, past, or future), (2) change entry point (thoughts, emotion, or behavior), and (3) degree of directiveness. It is striking (although perhaps not surprising) that now, decades later, these key facets of differences still apply today.

Earlier, we noted multiple sources of commonality across couple therapies—including shared systemic understandings, integration of specific techniques across approaches (even if reconceptualized within an alternative theoretical framework), the broadening of therapeutic focus (i.e., the near‐universal consideration of thoughts, feelings, and behaviors), and common arrangements (e.g., the emphasis on conjoint sessions). That said, while sharing considerable foundational elements, couple therapies in the 21st century can be differentiated along multiple dimensions—including (but extending beyond) those cited in previous analyses—both in terms of unique components as well as their relative emphasis on various shared components. Below, we summarize some of the most important, differentiating facets of various couple therapies.

The defining elements of a successful relationship

What are the most essential features that define a successful couple relationship? What are the typical individual elements, relationship patterns, or broader systemic characteristics that differentiate healthy or well‐functioning couples from those challenged by distress or dysfunction? Relatedly, what implicit or explicit theory of love and connection underlies a particular therapeutic model? For some, the answer lies in growing the couple friendship; for others, in attachment; for others, in how partners think and feel about their relationship; for others, the broader historical or cultural context; for some, sexuality; and, for still others, deep intrapsychic needs and capacities to connect. For some, peak experiences (and intensity of connection) are stressed (Perel,  2006 ); for others, steadiness and order. Although it is now typical for various models to speak to multiple levels of experience, the therapeutic approaches to couple therapy tend to emphasize one predominant lens in their theory of love, connection, and health.

Whom to include in the couple therapy

As noted earlier, contemporary approaches typically operationalize couple therapy as uniquely involving conjoint sessions with two relationship partners. That said, there are important exceptions. For example, many theoretical models and specific applications advocate for the inclusion of individual interviews during the initial assessment—particularly as opportunities for partners to discuss topics they may not yet feel comfortable discussing in the presence of their partner (e.g., infidelity, intimate partner violence, or considerations of divorce). Specific policies for handling confidential communication in such individual meetings may also vary across approaches (Scheinkman,  2019 ; Scheinkman & Werneck,  2010 ). Some suggest infusing individual sessions during the couple therapy as a means for disrupting unremitting, escalating negative exchanges until better self‐regulation can be achieved with the individual partners and then incorporating that individual work into resumed conjoint sessions. Some models have more flexible boundaries about whom to include, based on whomever the therapist or partners regard as potentially helpful in the process of improving the relationship. For example, members of the extended family may be included occasionally in integrative systemic therapy (Pinsof et al.,  2018 ) and intergenerational couple therapy (Fishbane,  2019 ). Papernow ( 2018a ) notes that ex‐spouses are a permanent part of the family; hence, couple therapists may need to incorporate time‐limited intervention with ex‐spouses to promote more collaborative coparenting across households. In approaches to polyamorous relationships there may be little or no hierarchy, and all relationships may be treated as equally important (Coolhart,  2023 ); within that context, discussions of interpartner conflict, attachment, security, jealousy, or relationship roles and boundaries easily require reconfiguration of couple therapy from a dyadic to a broader multipartner context.

Separate from issues of “whom to include” is the setting for the couple work. At the pragmatic level, where to conduct the therapy may be influenced by medical issues, mobility, systemic constraints (e.g., access to childcare or transportation), and a host of related concerns. Telehealth has recently emerged as a primary mode for the delivery of couple therapy (see below) (Fraenkel & Cho,  2020 ; Hardy et al.,  2021 ). Telehealth may reduce but not eliminate constraints in access, depending on access to, and proficiency with, relevant technology. Approaches to couple therapy also vary in how much they consider the couple “work” to extend outside of sessions to between‐session (e.g., at‐home) prescribed exercises or enactments and the use of such materials as worksheets or ancillary texts.

The role of the therapist

The role of the couple therapist represents an aspect of therapy about which there is considerable debate. Certainly, all acknowledge the therapist as a vital part of a system with the couple, and all accentuate the importance of alliance and collaboration. That said, the various models differ in how they regard the therapist's position in relation to both partners and the roles they ideally fulfill.

Influences on the therapeutic process

Although the various approaches to couple therapy universally recognize the importance of the therapeutic alliance as a common factor (Sprenkle et al.,  2009 ), they differ considerably in how they envision the therapist influencing (and being influenced by) the therapeutic process. There was a time when couple therapy largely consisted of therapists assuming the role of an expert in teaching partners about how to pursue a more functional relationship. Although this instructional role of the therapist remains a thread in the work of several approaches (such as cognitive‐behavioral couple therapy and Gottman method therapy) as well as in the applications of couple therapy to specific relational issues or individual problems, more broadly the field has moved from hierarchical therapist–couple relationships toward a much more collaborative stance. For example, some couple therapy models such as solution‐focused, narrative, and the therapeutic palette emphasize the therapist's and couple's collaborative co‐construction of the treatment goals and strategies, during which the therapist participates as a “fellow traveler” who facilitates the partners' realization of their own unique goals and pathways toward attaining these (Freedman & Combs,  2015 ). Most approaches locate themselves somewhere midway along the continuum between expert guide and fellow sojourner.

Attention to self of the therapist

Couple therapies also vary in how much they attend to the “self of the therapist” as an integral component of the therapy process. From this perspective, therapists need to pursue mindfulness of their own thoughts and emotions, memories, values, and implicit assumptions or biases to draw on both their past and present experiences in relating and intervening with couples (Aponte & Kissil,  2016 ). Some models emphasize such self‐awareness as an essential core component of effective therapy—for example, socioculturally attuned couple therapy (McDowell et al.,  2018 ) and object relations couple therapy (Scharff & Scharff,  2005 ; Siegel,  2015 ), as well as couple therapies tailored to populations where issues of identity are often central such as LBGTQ couples (Coolhart,  2023 ), and couples from specific ethnic or racial cultural contexts (Falicov,  2014 ; Kelly et al.,  2019 ).

Notably, approaches that once most centrally emphasized the self of the therapist and therapist self‐disclosure (e.g., Whitaker's symbolic‐experiential therapy; Whitaker,  1958 ; Whitaker & Keith,  1981 ) now play a less prominent role in couple therapy. It is also notable that whereas many early models explicitly called on therapists in training to participate themselves in couple therapy, we have been unable to locate recent writing specifically about couple therapy that does so, despite its obvious potential value.

Some approaches encourage therapist self‐disclosure, whereas many others do not. Most models leave open the possibility without being explicit about guidelines for self‐disclosure. Yet, transcending these differences, most approaches encourage therapists to recognize and draw upon their own subjective experiences during the therapy process (e.g., feelings of empathy, irritation, or boredom) as important information regarding the content and process of interactions with the couple or between partners themselves.

Levels and focus of interventions

By definition, couple therapies focus on the couple dyad and, for the most part, on the aggregate subjective balance of couple distress versus well‐being. However, within that general framework, approaches vary considerably in their consideration of multiple system levels including individual partner characteristics, aspects of the extended family, and the broader socioecological context. Approaches also vary in their relative emphasis on emotions, cognitions, and behaviors—and the explanatory or conceptual lens through which each of these are understood. And there are marked differences in the order of intervention even when there is a shared base of strategies. For example, integrative systemic therapy suggests first dealing with action‐oriented aspects of the relationship whereas integrative behavior couple therapy (Christensen et al.,  2020 ) first accentuates acceptance and Nielsen's integrative approach (Nielsen,  2017 ) prioritizes understanding underlying issues in the relationship.

Levels of intervention

Contemporary approaches to couple therapy all share a systemic perspective, but with varying points of emphasis. For some, there is a greater focus on individual processes. For example, in object relations therapy (Scharff & Scharff,  2005 ; Siegel,  2015 ) and intergenerational approaches to couple therapy (Fishbane,  2019 ) the enduring and predisposing vulnerabilities of the individual partners, rooted in their respective family and prior relationship histories, comprise the foundational substrate from which interactive vulnerabilities, self‐ and partner perceptions, and exaggerated response dispositions evolve. By contrast, other therapies focus less on the individual partners, and more on sequences of interaction (Hoyt,  2015 ). Still, others place greater emphasis on contextual factors as contributing or perpetuating influences on couple distress or dysfunction. From this perspective, such influences as systemic poverty, racism, or heterosexist and cisgender bias not only moderate the development or treatment of couple distress—they directly contribute to it (Hardy & Bobes,  2017 ; Knudson‐Martin & Kim,  2023 ) and, hence, comprise a central focus of treatment.

Moreover, the various approaches may target individual problems, relational problems, broader systemic influences, or any combination of these—either in their underlying theoretical formulation or in their specific application (as in the application of cognitive–behavioral couple therapy to individual disorders).

Focus of intervention

Similarly, contemporary couple therapies vary in their relative focus on specific areas of content, regardless of the system level of intervention. Most all recognize the interactions among thoughts, feelings, and behaviors, but their emphases on one or another of these domains differ considerably. Even the labeling of the approaches reflects these differences—for example, the naming of cognitive‐behavioral versus emotionally focused couple therapy. Further, there is an argument even across approaches that target multiple dimensions of experience about how the optimal sequence for addressing these should proceed. For example, some suggest behavior should be addressed first (e.g., integrative systemic therapy) whereas others initially emphasize such processes as attachment (e.g., as in emotionally focused couple therapy) or acceptance (e.g., as in integrative‐behavioral couple therapy). Moreover, partners may be encouraged to attend primarily to the subjective experiences of the other (e.g., to promote empathic awareness and joining) or, instead, to pursue mindfulness of their own thoughts and feelings as these influence relational exchanges (e.g., as in acceptance and commitment couple therapy).

Also influencing the content of interventions are approaches' differential attention to levels of awareness related to subjective thoughts and feelings. For example, partners' expectations of themselves and each other may reside well within conscious awareness, may lie outside immediate awareness but prove accessible with modest guidance from a cognitive framework, or may rely upon techniques more typical of various psychodynamic approaches for uncovering latent internal processes and explicating their influence in the current relationship. Sager's ( 1976 ) work on such “hidden forces” in couple relationships, and their impact on both implicit and explicit contracts (and their degrees of congruence or discordance), offered an influential explication of levels of consciousness as related to different approaches to intervention and provides a useful lens to inform such considerations.

The various approaches to couple therapy also differ considerably in their relative emphases on overt change (e.g., cognitive‐behavioral and solution‐focused couple therapy) versus acceptance (e.g., integrative behavioral couple therapy). Notably, even among those therapies that emphasize acceptance, approaches vary in how they conceptualize and promote this outcome. For example, in integrative behavioral couple therapy, acceptance is pursued through specific interventions promoting empathic joining (emotional change) and unified detachment (cognitive change) as an alternative (or precursor) to interventions targeting behavioral change. In acceptance and commitment therapy (Lawrence et al.,  2023 ), partners are encouraged to experience uncomfortable internal experiences and to tolerate their presence rather than trying to control them, so that they can allocate their time, energy, and attention in more fulfilling ways. In the various psychodynamic and multigenerational approaches, partners' acceptance evolves from changes in understandings of their own and each other's developmental histories and associated vulnerabilities—that is, through partners' more compassionate interpretations or meanings (and hence, related feelings) connected to specific behaviors or interaction sequences.

Presumed mechanisms of change

Closely related to levels and focus of interventions are the various approaches' underlying theoretical tenets regarding mechanisms of change. Separate from their shared emphasis on the therapeutic alliance, most approaches first prioritize attending to disabling individual or relationship crises. Beyond such shared initial “stabilization” interventions, however, the various approaches' theoretical precepts guide the selection, sequencing, and even pacing of specific interventions. Some models, for example, prioritize behavior change (or problem solutions) as the mediating pathway for promoting partners' positive thoughts and feelings for one another. Others prioritize interventions aimed at altering partners' thoughts toward one another—including the interpretations or meaning they give to relational events (whether explicit or implicit) as the mediating pathway for reducing negative affect derived from the subjective meaning and, by reducing subjective negativity, thereby fostering more positive exchanges. And still other approaches prioritize interventions aimed at promoting emotional connection (e.g., via vulnerable emotional expression and empathic responding) or acceptance (e.g., tolerance of inevitable differences). From any of the pluralistic or integrative approaches, the therapist could select specific interventions from across theoretical models, based on their presumed mechanism of change and in congruence with the case formulation.

The temporal framework of interventions

How important is the exploration of partners' individual and shared histories? Some approaches, such as intergenerational ones are fully anchored in the past and may begin with genograms as both an assessment and intervention method. Others, such as solution‐focused therapy (Hoyt,  2015 ) are almost exclusively present focused. Most contemporary couple therapies incorporate attention to both distal (historical) and more proximal (recent or current) influences, although often to different degrees or in different sequences. For example, in Snyder's ( 1999 ) pluralistic approach, developmental influences are pursued only after more structural or cognitive‐behavioral interventions fail to achieve desired outcomes. Moreover, in various integrative approaches or specific theoretical models that assimilate particular techniques from alternative approaches, the labeling of techniques or their interpretation through a particular theoretical lens may obscure similarities in their application (e.g., identifying projective identifications in object relations therapy, attachment injuries in emotionally focused therapy, or acquired perceptual and behavioral response dispositions in cognitive‐behavioral couple therapy).

Manualized versus improvisational approaches

Contemporary couple therapies vary in their level of structure. Some therapies are highly improvisational; Fraenkel ( 2019 ), for example, even names improvisation as a core aspect of the therapy. Others are much more prescriptive regarding the sequence and general content of interventions—e.g., couple therapy for partner aggression (Epstein et al.,  2015 ) or infidelity (Baucom et al.,  2009 ). Some approaches—e.g., Gottman method therapy (Gottman & Gottman,  2015 , 2017 ) and Papernow's therapy for stepfamily couples (Papernow,  2018b ) propose specific goals of intervention and methods of accomplishing those goals, although the sequence and number of sessions devoted to each goal may be tailored to aspects of the individual partners and their relationship. Applications of couple therapy to individual problems such as posttraumatic stress disorder or alcohol abuse, similar to their cognitive‐behavioral counterparts in individual therapy, tend to be more highly structured or manualized—often with a specific sequence and prescribed “curriculum” detailing specific sessions.

Length of therapy and intermediate versus ultimate goals

Couple therapy can be open‐ended or time‐limited. Solution‐focused couple therapy (Hoyt,  2015 ) anchors this continuum through its explicit focus on brief interventions targeting circumscribed problems. Other couple therapies of all varieties may segue into ongoing meetings over many years, potentially reflecting a transition from initial interventions promoting specific relationship skills to a subsequent emphasis on partners' individual growth within a conjoint framework. Most contemporary couple therapies terminate after sufficient progress toward initial goals has been achieved. Longer durations can be anticipated, regardless of approach, with couples for whom individual, relational, or broader systemic dysfunctions are more severe, more complex or pervasive across multiple domains, or more entrenched across time.

Gurman's ( 1978 ) distinction between mediating versus ultimate treatment goals also provides a useful heuristic for viewing shorter‐ versus longer‐term approaches. For example, when situational stressors compromise partners' functioning and couple well‐being, initial goals may involve resolving those stressors to achieve a direct (and potentially sufficient) effect on reducing couple distress (Bodenmann & Randall,  2020 ). However, if in the course of that work the therapist determined that traumatic individual developmental experiences mediated the impact of current stressors on individual and relational functioning, then stress‐reduction might shift to being an intermediate goal and the “ultimate” goal might be reconceptualized as emotional or cognitive reprocessing of traumatic experiences to reduce or resolve their contribution to recurrent patterns of vulnerability or exaggerated reactivity. In the final analysis, the formulation of treatment goals and related decisions about termination inevitably reflect an evolving interaction between the therapeutic approach and couples' own values, aspirations, and resources.

EMERGING ELEMENTS

There also are emerging an exciting array of novel elements in contemporary couple therapies.

The Covid‐19 pandemic potentiated a trend already developing in couple therapy toward telehealth and using electronic media as extensions of therapy. Much of couple therapy delivered during the pandemic shifted to videoconferencing and it appears that videoconferencing will remain a major format for couple therapy. Therapists needed to augment and adapt their methods to a context during which in‐person meetings were not possible. Fairly quickly, several useful sets of guidelines for relational teletherapy were offered (Burgoyne & Cohn,  2020 ; Drieves,  2021 ; Hardy et al.,  2021 ; Hertlein et al.,  2021 ). Couple therapists mostly report that virtual therapy appears to work as well as in‐person therapy (de Boer et al.,  2021 ). 1 Additionally, video‐conference couple therapy sometimes may be the sole viable alternative to in‐person sessions (e.g., when partners are geographically separated by work, deployment, or other factors). Videoconferencing solves one of the major constraints of couple therapy that historically had caused so many who could benefit from couple therapy not to seek it—namely, individual control over the time and place of meeting. For many persons, meeting virtually from their homes or from work is easier, and therapists can often be more flexible with the scheduling of sessions in this format. It can be relatively easy to assemble a couple in virtual space, and often much harder to do so in person. (It must also be added that for some, such as many older and economically disadvantaged potential clients, videconferencing makes for an additional constraint in accessibility.)

Many recent writings about couple therapy refer to these now ubiquitous methods of videoconferencing. There has yet to be much written about special issues that arise in couple video therapy such as special methods for working with conflict at a distance, guidelines for working with intimate partner violence, and privacy issues. As to the outcomes of video‐conference couple therapy compared to in‐person couple therapy, we must await the data, not only for the global question of impact but also for whether there are differences in impact across types of couples (e.g., by problem area or demographics), as well as for process data such as the quality of the therapeutic alliance across these formats.

Beyond using videoconferencing services for couple therapy, there is considerable growing excitement regarding the application of web‐based resources as adjuncts to treatment (Hatch et al.,  2021 ; Roddy et al.,  2016 , 2021 ) or in relationship education (Bradbury & Bodenmann,  2020 ; Markman et al.,  2022 ; Rohrbaugh,  2021 ; Spencer & Anderson,  2021 ). Models on the technological cutting edge such as Gottman method therapy now regularly augment couple therapy with online psychoeducational materials, reminders to engage in prescribed behaviors, and even physiological measures of partners' autonomic arousal.

Couple therapy and social media

Couple therapy is increasingly an evidence‐based practice. Yet, in tandem, couple therapy now is frequently identified by lay consumers not by its evidence‐based variations but through its dissemination through popular media. The extent to which those representations of couple therapy are grounded in the state‐of‐the‐art practice of couple therapy varies. For example, Perel ( 2006 ) builds from well‐known traditions from psychoanalytic couple therapy and systemic practice. Real ( 2008 ) similarly builds on the traditions of feminist couple therapy and treatment of relational trauma. And Gottman and Gottman ( 2015 ) and Johnson ( 2015 ), developers of major forms of couple therapy, have crossed over into providing highly accessible aspects of couple therapy in podcasts and other new media. Similarly, Solomon et al. ( 2021 ) has adapted and popularized a version of integrative systemic therapy in her approach to young people in relationships. Still, one cannot help but note that there are innumerable examples of well‐known persons and internet personalities suddenly turning into relationship coaches offering advice, based on their personal notion of how to live a relational life (not surprisingly, most of these lean toward the dramatic). Similarly, some of the best‐selling guides for couples (e.g., Gray's  1992 “Men Are from Mars, Women Are from Venus” and Chapman's  1992 “The Five Love Languages”) are inconsistent with research from relational science. It is a time of much attention to couple therapy, and a time in which having informed consumers is essential to helping potential clients separate what is grounded and what is performance.

Specific treatments for specific problems and populations

Couple therapy has traditionally been mostly envisioned as a process targeted at improving relationship satisfaction or, at least, as deciphering the viability of committed relationships. However, over the last 20 years, couple therapies have been developed and widely disseminated focusing on problems traditionally viewed as residing within individuals. Baucom et al. ( 2014 ) provide a useful distinction between partner‐assisted and disorder‐focused interventions targeted at individual problems. In partner‐assisted interventions, the partner is enlisted to help in the process of reinforcing and supporting the active treatment of the individual problem. In contrast, in disorder‐specific treatment, the treatment itself is couple therapy tailored to the particular kinds of couple dynamics likely to occur in the context of the partner's individual problem.

Today, given the predominance of cognitive behavioral therapies for the treatment of individual disorders, couple treatments of individual problems are also mostly cognitive‐behavioral in their approach. However, other models, such as emotionally focused couple therapy, have begun to speak to such uses of couple therapy across several specific disorders (Slootmaeckers & Migerode,  2020 ) and one could anticipate that such applications of other theoretical models of couple therapy to treat individual emotional or physical‐health problems will continue to proliferate.

Couples often present for therapy to receive assistance with issues around parenting of their children or adolescents. Traditional parenting programs, while promoting positivity in parent–child interactions, give only limited attention to the relationship between parents. Many family therapy models for parents and adolescents with various disorders (e.g., conduct disorder or substance misuse) also under‐attend to the couple relationship itself and its recursive influences upon and from the adolescent's behaviors. It is inevitable that parents will experience occasions of disagreement or other challenges when rearing children together. Couple challenges associated with children's behaviors become more frequent, severe, and difficult to resolve when offspring have their own individual problems—whether these take the form of internalizing, externalizing, or neurodevelopmental disorders. Expositions of couple therapy with parents of youth with emotional or behavioral disorders have been notably rare, and there is a need for a general framework for tailoring interventions to couples struggling with these common concerns.

Reaching out to a wider range of couples

As culture and gender have become more central considerations in couple therapy, approaches explicitly addressing issues of diversity have also emerged and gained broader traction. Exemplars include the discussions of therapy with LGBTQ couples (Coolhart,  2023 ; Green & Mitchell,  2015 ), interventions involving sexuality (Hall & Watter,  2023 ), and therapy targeted to couples from specific ethnic groups (Boyd‐Franklin et al.,  2008 ; Chambers,  2019 ; Falicov,  2014 ; Kelly et al.,  2020 ). One cannot underestimate the sea change that has been involved. 2 Generalizations about couples and about the most helpful interventions with them are now enhanced with a far greater appreciation of differences among couples and how those can best be attended to.

Old formulations of relationships or guidelines for therapy must now be viewed through new lenses. The evolution in the breadth of couples embraced by the field of couple therapy has been enormous. For example, today, nearly all theoretical approaches to couple therapy explicitly address issues of applicability to LGBTQ couples and most have begun to stretch to include the emerging broader world of sexuality in couples. This broadening of the vision of who is involved in couple therapy has also unearthed culture‐bound assumptions and led to adaptations and advances in the core models of couple therapy in both their development and delivery.

The Interface with relationship education

Relationship education has a long and distinguished history as it developed in parallel with couple therapy (Bradbury & Bodenmann,  2020 ; Markman et al.,  2022 ). Relationship education and enrichment programs of late have become ubiquitous. This has promoted lively conversations about which couples (or individual partners) are most appropriate for which activity, about the fuzzy boundaries between education and treatment, and how to manage or optimize the interface between them. Whereas at one time it was clear that couple therapy was targeted at distressed couples and relationship education aimed at preparation and enrichment of better functioning relationships, this boundary has become much more fluid (Bradford et al.,  2015 ). Further, several models of couple therapy —e.g., integrative behavioral couple therapy (Roddy et al.,  2017 ) and emotionally focused couple therapy (Conradi et al.,  2018 )— describe adaptations of those models intended for either in‐person, videoconference, or self‐directed online psychoeducational relationship education programs. And there is a growing movement toward relationship education involving individuals not presently in relationships so that they might develop healthier relationships (Carlson et al.,  2023 ).

The growing emphasis on acceptance

Acceptance has moved into a much more prominent place in several methods of couple therapy, including integrative‐behavioral couple therapy, Gottman method therapy, acceptance and commitment couple therapy, and mentalization‐based couple therapy. At one time, change was the focus of every couple therapy; now, many seek primarily to promote mutual acceptance while also facilitating a framework for change.

Collaborative therapists

Overall, the field has moved from implicit views of a somewhat hierarchical therapist–couple relationship toward a much more collaborative stance. A collaborative stance goes well beyond elements of promoting a therapeutic alliance initially identified in client‐centered individual therapy (i.e., genuineness, warmth, and noncontingent positive regard). Rather, collaboration extends to co‐constructing therapeutic goals that incorporate partners' own views of individual and relationship health, their values rooted in their unique developmental histories and broader cultural contexts, and their own priorities regarding the balancing of individual with relationship interests in determining how to select and sequence treatment objectives and methods.

Addressing sexuality

Sexuality is clearly a central aspect of relational life, both in itself and in its association with attachment. Hence, it is somewhat bewildering why, in most models of couple therapy, it is so tangentially addressed. Notably, this core component of relationships is principally addressed in specific discussions of sexuality (Hall & Watter,  2023 ; McCarthy & McCarthy,  2012 ; Perel,  2006 ) and often about LGBTQ couples (Coolhart,  2023 ). Despite the limited attention to sexuality in many treatment models, there has been a revolution in the consideration of sexuality when working with couples. Couple therapists need to challenge their own implicit attitudes or assumptions, and expand their knowledge base and skill sets, when addressing sexuality in working with sexual‐ and gender‐minoritized couples. Similarly, therapists need to become familiar with and comfortable in discussing aspects of sexuality that may vary in specific populations—such as older adults, couples confronting specific medical problems, or couples who engage in less frequently encountered forms of sexuality. Couple therapy around issues of sexuality has evolved beyond addressing specific sexual dysfunctions and, instead, now embraces broader goals of promoting greater sexual awareness, improving sexual responsiveness, and enhancing sexual intimacy and enjoyment that might benefit any couple.

Attending to the life cycle

Both the challenges and benefits of being a couple vary across the life cycle. Most models of couple therapy have implicitly centered on mid‐life couples, and the specific issues and intervention strategies they emphasize do not always generalize to younger couples early in their individual and relational development, nor to older couples for whom individual and relational challenges and resources often change. The good news here is that many models have now evolved to incorporate couple development over time as a part of their vision. Beyond this, there is an emerging increased focus on specific stages of development and the typical issues in couples related to those life stages (see, e.g., Solomon et al.,  2021 on emerging adults; and Knight,  2023 on older adults). These include attention to special issues in older couples, the unique issues and challenges that confront stepfamily couples, and younger couples—particularly around decisions to formalize a committed relationship or transition to parenthood. Specific couple interventions have been developed for working with couples in specific stages of the life cycle (Gottman et al.,  2010 ). From a broader perspective, the question of how to keep relationships vital and connected over a lifetime underlies most couple therapy.

Whither divorce in couple therapy? Long regarded as a disastrous negative outcome, divorce is now re‐envisioned as a potential positive pathway for couples, yet one fraught with challenges. New versions of intervention have recently been developed to help couples who face the possibility of divorce. For example, Doherty and Harris ( 2017 ) offer discernment counseling targeted to those not yet ready for couple therapy who are ambivalent or have mixed agendas about whether they want to divorce, to help the partners decide on whether working on their relationship further in couple therapy is indicated. How to work with those considering divorce, with the therapist finding a balanced position toward couples remaining together or parting, has become an essential aspect of couple therapy. So too has helping those who decide to divorce to pursue the best outcomes for themselves and for the children who may be impacted (Lebow,  2019 ). Couples often envision couple therapy ending if they decide to divorce, but “divorce therapy” is paradoxically an essential part of the repertoire of the skilled couple therapist.

Closely related are therapies focused on what Fraenkel ( 2019 ) calls “last chance” couples. These couples are already on the verge of divorce and, if therapy is to reinvent the relationship, a more radical process may be needed than in typical couple therapy.

ADDITIONAL CHALLENGES

Contemporary couple therapies face numerous challenges—some enduring since the inception of the field (e.g., attention to individual differences and issues of diversity; balancing interventions to address intrapersonal, dyadic, and broader systemic sources of distress)—and others more recent (e.g., integrating technology; securing recognition across private and public healthcare systems). Some challenges are either explicit or implicit in earlier parts of this paper (e.g., decisions regarding whom to include in the couple therapy; the balancing of acceptance versus change; or specific ethical dilemmas). Beyond these, two additional challenges warrant consideration.

Maintenance of gains

One crucial challenge for couple therapy is the maintenance of therapeutic gains. Research has shown couple therapy to be highly effective in improving relationship satisfaction in most couples in the short term (Bradbury & Bodenmann,  2020 ; Roddy et al.,  2020 ), but vulnerable to problems returning over the long term (i.e., at 2 years or longer after termination). From the few controlled clinical trials of couple therapy and one uncontrolled evaluation examining couple outcomes 4–5 years after posttreatment, the evidence shows deterioration or divorce occurring for roughly 35%–50% of couples (Snyder & Balderrama‐Durbin,  2020 ). Exceptions to this general finding, such as Snyder et al.'s ( 1991 ) controlled trial of insight‐oriented therapy yielding a deterioration/divorce rate of 20% at 4 years posttreatment, have not been replicated.

Moreover, couple relationships evolve and different stages of the life cycle begat different problems. Thus, it would not be unexpected for a couple who has worked through problems at one stage of life to have prior problems return or different ones develop as time passes, events occur, and new circumstances arise. For this reason, most contemporary couple therapies include some specific interventions prior to termination aimed at dealing with issues that may arise in the future. However, despite their obvious intuitive appeal, the efficacy of those interventions in forestalling or reducing future deterioration or divorce remains unknown.

Client values

Couples exist within a broader socioecological as well as historical context. So, too, do the various models of couple therapy intended to treat couple distress and promote individual and relationship well‐being. That said, the contexts in which various couple‐based interventions were developed, and in which couple therapists are trained, may not mirror the diverse and emerging contexts shaping the set of values that each partner brings to therapy. How can couple therapists conduct effective therapy in a world in which values differ so mightily within and across couples?

For example, what processes are seen as essential for successful relationships? How much closeness or distance is viewed as optimal or acceptable? What to do when one aspect of relational life is problematic whereas others are satisfactory? How much to strive for what Finkel ( 2017 ) describes as the “all or nothing marriage” in which relationships are seen as needing to meet all individual needs? At what point is divorce viewed as a well‐considered option? How much might expectations for successful relationships vary with cultural context? At what point does good therapy entail challenging cultural expectations around such issues as gender inequality and relational violence?

Doherty ( 2022 ) and Lebow ( 2014 ) have written extensively about the crucial role of client and therapist values in couple therapy and about the complex and often unarticulated ways in which therapist values influence practice. LGBTQ therapists and those from various cultural contexts have added diverse vantage points to such discussion (Addison & Coolhart,  2015 ; Kelly et al.,  2019 ). Couple therapy and, more importantly, couple therapists must remain aware, flexible, and responsive to the ways that values impact therapy—most especially in a world in which both conceptual models and related interventions are applied across diverse populations and cultures with dramatically different core beliefs and customs.

Pandemic and postpandemic life

It is difficult to specify precisely how the Covid‐19 pandemic has affected couples and couple therapy beyond such simple observations as the increased use of teletherapy. Yet, there clearly have been profound effects (Stanley & Markman,  2020 ). Many of the standard interventions have needed to be adapted in response to dramatic increases in levels of both individual and relational stress and constraints driven by the pandemic. Although reports regarding couple satisfaction and divorce rates during the first 2 years of the pandemic are mixed, there is no doubt that for vulnerable couples both coping strategies and outside resources became more restricted and less sufficient. This necessitated an expanded vision of couple therapy during the pandemic and its aftermath. The conceptual scheme may remain largely the same—the therapeutic palette adapted to the times, but couple therapy is adapting. Specifically, observation suggests that themes once identified with existential therapy seem to be on the rise as they have in other turbulent times (Fraenkel & Cho,  2020 ).

Inclusion in healthcare coverage

Couple therapy has succeeded in becoming widely disseminated as the preferred treatment for those encountering relational difficulties in the United States and much of the world. This accomplishment is especially remarkable given that there is little attention paid to couple therapy in most insurance and healthcare systems. For example, there is presently no separate Current Procedural Terminology (CPT) code for couple therapy (leaving the service coded as “family therapy”). Better procedures for coding couple therapy and couple relationship problems are sorely needed in healthcare systems, as well as a formal recognition of the cost‐effectiveness and therapeutic benefits of couple therapy for a broad spectrum of individual physical and mental health concerns of both partners and their offspring (Bradbury & Bodenmann,  2020 ; Ruddy & McDaniel,  2015 ). One estimate found couple therapy to be cost‐effective when paid for by the government to reduce public costs of divorce or when reimbursed by insurers to offset the increased healthcare expenses associated with divorce (Caldwell et al.,  2007 ). Further arguments in favor of healthcare coverage for couple therapy include direct medical cost offsets and the fact that insurance companies already find it cost‐effective to reimburse for the prevention of other health and psychological problems (Clawson et al.,  2018 ).

CONCLUDING COMMENTS

This is an exciting time in the evolution of couple therapy! Collectively, there is remarkable depth and variety in today's approaches to couple therapy. Numerous approaches offer integration of evidence‐informed principles with clinical wisdom in the best of the scientist‐practitioner tradition. With an increasing foundation in relational science and evidence for their efficacy, such approaches continue to mature in their development. There is both a diversity in the most prominent approaches, but also an emerging and shared understanding of couple processes and core principles underlying couple‐based interventions. Both established clinicians and those in training may benefit from expanding their own theoretical lenses to examine the relative strengths, as well as limitations, of respective approaches to allow their own clinical repertoire to evolve as well—enhancing their skill sets for addressing the complexities of couples' challenges in a potentially more differentiated and effective manner.

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1 It is important to note here that ultimately the relative impact of in‐person vs. tele‐couple‐therapy is an empirical question that will require multiple studies to assess.

2 The historical trend to focus on white middle class couples is reflected in studies of clients in couple therapy research (Tseng et al.,  2021 ).

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Home > Colleges, Schools, and Departments > Falk College > Marriage and Family Therapy > Marriage and Family Therapy Dissertations

Marriage and Family Therapy - Dissertations

Twice as good: A constructivist grounded theory study on the socialization process of black middle-class families and how this shapes the parent-child relationship , Dominique Nicole Walker

Traumatization Resulting from Interpersonal Disclosure: Developing a Measure of Disclosure-Induced Neo-Trauma , Sarah D. Wolf-Gramzow

The Impact of Poverty and Neighborhood Characterstics on the Mental Health and Parent-Child Closeness in the Black Community: The Protective Role of Black Cultural Strengths , Brandon Davis Hollie

The Impact Of Poverty And Neighborhood Characterstics On The Mental Health And Parent-child Closeness In The Black Community: The Protective Role Of Black Cultural Strengths , Brandon Davis Hollie

Immigrant and U.S. Born Early Head Start Families: Exploring the Relationship Between Parenting Stress, Attachment Behaviors, Primary Caregiver Depressive Symptoms, and Parent-child Attachment in a Nationally-representative Sample , Shaelise Marie Tor

Transgender Congruence and Sexual Satisfaction in Trans Masculine Adults: The Role of Affirmative Sexual Partners , Tristan Karel Martin

Revolutionships: Experiences of Queer Women of Color Maintaining Romantic Relationships while Engaging in Contemporary Movements for Liberation , Montinique DeNice McEachern

EMOTIONAL BONDS AND FAIRNESS EXPERIENCES BETWEEN TRANSGENDER WOMEN AND THEIR CISGENDER PARTNERS: AN INTERPRETATIVE PHENOMENOLOGICAL EXPLORATION , Jennifer Coppola

Therapists' Experiences of Trauma, Compassion Fatigue, and Compassion Satisfaction: The Role of Post Traumatic Growth , Tracey Reichert Schimpff

“IN OUR OWN WORDS”: THE PHENOMENOLOGICAL EXPLORATION INTO THE AFRICAN AMERICAN EXPERIENCE OF RELATIONAL THERAPY WITH WHITE THERAPISTS , Melody Michele Brown

Disparities in Student of Color Education and Resulting Racial Microaggressions: Can MFT Training Programs Do More? , Sarah R. Cort

Child sexual abuse, interpersonal difficulties, and staying in relationships with intimate partner violence: a preliminary study , En-Ting Hsu

Intuition: A Silver Lining for Clinicians with Complex Trauma , Sarah Dyanne Stanton

AN EXAMINATION OF THE RELATIONSHIP BETWEEN ATTACHMENT STYLE AND BODY IMAGE IN ADOLESCENT GIRLS: A FOCUS ON THE MOTHER-DAUGHTER RELATIONSHIP , Jaclyn Bex

The Relationships Between Stress, Social Support, Maternal Self-Efficacy, Maternal Depression, Maternal Reports of Child Demandingness and Maternal Reports of Child Social and Emotional Quality of Life in a Sample of Overweight and Obese Women Two Years Post Childbirth , Elizabeth Banks Feldhousen

Lesbians and Their Mothers: A Taiwanese Experience , Meng-ning Wang

Waiting for Your Return: A Phenomenlogical Study on Parental Deportation and the Impact of the Family and the Parent-Child Attachment Bond , Erika Beckles Flores

Growing Up Gay in Black America: An Exploration of the Coming Out Process of Queer African American Youth , DeMarquis Clarke

Co-Creating Collaborative Health Care in a Federally Qualified Health Center: Exploring Clients' Experiences of Behavioral Health Services , Ginny-Lea Tonore

Fibromyalgia Syndrome: The Relationship between Alexithymia and Attachment Style on Couple Relationship , Ileana Ungureanu

The meaning of Ataxia: How do families experience it? , Maria del Pilar Castaneda

Raising her daughter: A phenomenological study of the African American stepfather's perception of his relationship with his stepdaughter , Akwete Cleveland Noble

Breaking the silence: The impact of political violence in Sikh diaspora , Kiran Shahreen Kaur Arora

Parenting economically disadvantaged adolescent children through pervasive loss in the inner city , Timothy Ronald Baima

The experiences of marriage and family therapists of Asian descent and their perception of the practice and profession , Liang-Ying Chou

Having a child with cancer: The impact on couple relationships, belief systems and values , Todd H. Marshall

Autonomy, father's role, and eating disorders: A daughter's perspective , Karen Fernandez-Cosgrove

The African American experience of overcoming barriers and participating in therapy , Cadmona Alexandra Hall

The role of social support in bereaved families with dependent children , Heather Lynn Hay

A phenomenological study of the use and experience of intuition in marriage and family therapy by those who claim it , Aaron Joseph Jeffrey

Childhood sexual abuse: Are marriage and family therapists less likely to hypothesize sexual abuse in men as compared to women? , Todd Christopher Workman Jesness

The role of MS patient and partner reports of couple relationship quality and depression in the physical functioning of MS patients , Justin Kade McPheters

The male adolescent's perception of family dynamics and the impact on the development of sex offense behavior: A qualitative study , Michelle Kathleen Murray

Family of origin functioning and the likelihood of seeking romantic partners over the Internet , Michael Evan Sude

A retrospective exploration of overweight adolescent girls' relationships with self, others, and cultural context , Amy Zavada

Queering the discussion: A Delphi study of the effects of GLBT identity and queer theory on marriage and family therapy , Sheila Marie Addison

Dyspareunia due to endometriosis: A qualitative study of its effect on the couple relationship , Kristina Schelbert Brown

The intersection of feminism and the narrative metaphor in the practice and profession of family therapy: A Delphi study , Nina Maria Castronova

Experiences of oppression among Middle-Eastern couples living in Denmark: Implications for marriage and family therapy , Birgitte Bonning Espitia

The experience of disclosure of queer identity within sibling dyads , Rebecca Grace Harvey

Emotion and family therapy: Male clinician's attitudes and use of emotion as a main component in therapeutic intervention and theory , Matthew M. Suarez Pace

Sexual minority women: Exploring familial relationship development after coming out at home , Deborah Anne Coolhart

The early therapeutic relationship with MFT trainees: Race, gender, confidence and relationship satisfaction , Loree Anitra Johnson

"I just want a normal life!": A phenomenological inquiry into children's perspectives on parental addiction and the effects of the addiction in the parent-child relationship , Maria Andrea Reinking

The role of parent-adolescent attachment in the glycemic control of adolescents with type-1 diabetes , Tziporah Esther Rosenberg

Critical relational model: A normative and meta-theoretical analysis of family therapy theories , Anibal Torres Bernal

A survey of the attitudes and behaviors of medical family therapists regarding complementary and alternative medicine: An exploration of collaboration , Miyoung Christine Yoon Hammer

An ecological view of the risk discourse in African-American adolescent identity development , Roxanne L. Hill

Supervision and clinical competency evaluations: The influence of the supervisor's gender , Jason James Platt

Missionary ministry satisfaction predictors: How spiritual attribution influences the effects of stress on family communication and satisfaction , Joy E. Corby

The inner workings of foster families: Implications for family therapy , Kimberly L. Sumner-Mayer

Narrative means to research ends: Learning about therapy from clients' descriptions , Stephen R. Gaddis

The relationship between family resilience and the successful management of fibromyalgia , John Cameron Preece

The relationship between marital attachment and caregiver depression in older couples facing major medical illness , Clark David Christensen

Contextual therapy and relational ethics: A dynamic ethical perspective , Susan Victoria Compton

Jewish identity, family cohesion, and child well-being , Maureen Patricia Semans

Crossing borders: The negotiation of difference and formation of couple identity in interracial , Kyle D. Killian

An exploratory study of family therapists working as consultants to address the interaction between race and education in an elementary school , Tracey Ann Laszloffy

When the monsters under your bed are real: The social construction of incest , Janet L. Osborn

Insights and perspectives on relationships and friendships: Views from adults who are labeled as mentally retarded , Guy Anthony Caruso

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Evidence Base Update on the Efficacy and Effectiveness of Couple and Family Interventions, 2010-2019

Based on: Wittenborn, A. K., & Holtrop, K. (2022). Introduction to the special issue on the efficacy and effectiveness of couple and family interventions: Evidence base update 2010-2019. Journal of Marital and Family Therapy, 48 (1).   https://doi.org/10.1111/jmft.12576

Since 1995, the Journal of Marital and Family Therapy (JMFT) has published decade reviews to provide clinicians and other stakeholders an update on the evidence base for couple and family interventions for mental and behavioral disorders and health conditions (Pinsof & Wynne, 1995; Sprenkle, 2003; Sprenkle, 2012; Wittenborn & Holtrop, 2022). The most recent JMFT decade review was published in January 2022 (Wittenborn & Holtrop, 2022). This exciting issue reviewed the empirical evidence published from 2010 to 2019 on couple and family interventions for a range of mental and behavioral disorders and health conditions relevant to our work as couple and family therapists.

The JMFT special issue includes 11 articles that review the evidence base on couple and family interventions for common mental and behavioral disorders and one article focused on high mortality health conditions; the final article (Dwanyen, Holtrop, & Parra-Cardona, 2022) describes the past decade of intervention research on racially and ethnically diverse populations. Findings from these reviews add to the cumulative body of evidence that has consistently shown the positive short- and long-term effects of couple and family interventions (e.g., Carr, 2019a; 2019b). The authors of each article in the special issue reviewed the empirical evidence published in the past decade, in combination with the cumulative body of literature, and constructed categories of the interventions they identified. The interventions were grouped into categories based on mechanism of action, underlying theory, or other meaningful characteristics. The authors then used a set of criteria (Southam-Gerow & Prinstein, 2014) to classify the level of evidence that existed for each intervention category into one of five levels of evidence.

Level 1: Well-Established Interventions require two or more rigorous studies, led by two or more independent research teams in independent settings, showing the intervention to be either: (a) statistically superior to another intervention, or (b) equivalent or not significantly different from an already established intervention in a study with adequate statistical power. The studies were required to meet the following methodological criteria: (a) a randomized controlled trial (RCT) design, (b) use of intervention manual or equivalent, (c) clear inclusion criteria applied to the target population, (d) psychometrically sound assessment of outcomes, and (e) appropriate data analyses. Level 2: Probably Efficacious Interventions must show either: (a) two or more rigorous studies demonstrating significantly better outcomes than a waitlist control group, or (b) at least one study meeting Level 1 criteria; they must also meet the same methodological criteria as Level 1 . Level 3: Possibly Efficacious Interventions are supported by either: (a) at least one rigorous study showing the intervention to be superior to a waitlist or no treatment control group with the same five methodological criteria as Level 1 and Level 2, or (b) at least two studies showing the intervention to be efficacious but without meeting the RCT method requirement. Level 4: Experimental Interventions have positive findings from at least one study but are not rigorous enough to meet the Level 3 criteria. Finally, Level 5: Treatments of Questionable Efficacy , have been tested against a comparison group and found inferior.  

Brief overview of the JMFT special issue

The special issue articles report evidence-based classifications on interventions for the following conditions: (1) infant and early childhood mental health (Kaminski, Robinson, Hutchins, Newsome, & Barry, 2022), (2) disruptive behavior problems (Sheidow, McCart, & Drazdowski, 2022), (3) attention-deficit/hyperactivity disorder (Babinski & Sibley, 2022), (4) anxiety disorders (Goger & Weersing, 2022), (5) mood disorders (Wittenborn et al., 2022), (6) suicidal ideation and behavior (Frey, Hunt, Russon, & Diamond, 2022), (7) substance use disorders (Hogue, Schumm, MacLean, & Bobek, 2022), (8) traumatic event exposure (McWey, 2022), (9) violence (Stith et al., 2022), (10) couple relationship education (Markman, Hawkins, Stanley, Halford, & Rhoades 2022), (11) couple relationship distress (Doss, Roddy, Wiebe, & Johnson, 2022), and (12) health conditions (Lamson et al., 2022). Table 1 summarizes the classifications of couple and family interventions for each condition. The classification summary is designed to guide clinical decision-making by compiling the most efficacious practices for each condition. Detailed descriptions of the intervention categories listed in Table 1 can be located in the special issue article associated with each condition.

Note. The intervention categories were developed by the authors of each article to best represent the research on that condition and, therefore, the categories are not consistent across conditions. For health interventions, brackets were used to indicate age categories (e.g., [0-24] indicates 0 to 24 years of age).

a Two intervention categories for IECMH could not be classified (i.e., curriculum-based INTs for at-risk parents and families, INTs to promote positive parenting through shared reading and play).    

Source: Wittenborn, A. K., & Holtrop, K. (2022). Introduction to the special issue on the efficacy and effectiveness of couple and family interventions: Evidence base update 2010-2019. Journal of Marital and Family Therapy, 48(1). https://doi.org/10.1111/jmft.12576

Couple and family interventions are based on the well-established science that close relationships are involved in the development, maintenance, and treatment of mental and behavioral disorders. The evidence base for couple and family interventions has flourished since the first JMFT efficacy and effectiveness special issue was published (Pinsof & Wynne, 1995). When implemented in the community, these efficacious interventions can make a significant difference in the lives of couples and families. We encourage future research on couple and family interventions for diverse racial and ethnic groups, gender and sexual identities, ages, and mental health conditions to strive toward mental health equity for diverse and marginalized populations. Together, we can commit to continued research and clinical practice efforts to ensure that all families can receive the most efficacious and culturally appropriate care.

This article is offered free by AAMFT. If you are interested in accessing other members-only content, join today!

Andrea K. Wittenborn, PhD , is an AAMFT Professional Member holding the Clinical Fellow and Approved Supervisor designations, a professor in the Department of Human Development and Family Studies at Michigan State University, and the program director of the Couple and Family Therapy doctoral program. She also holds an appointment in the College of Medicine’s Division of Psychiatry and Behavioral Medicine. Her research evaluates the process and outcomes of couple interventions for depression, including methods for personalizing care. Her research has been continuously funded since 2008 by federal agencies such as the National Institute of Mental Health, private foundations, and intramural awards. Wittenborn is a member of the AAMFT Board of Directors and Journal of Marital and Family Therap y Advisory Board. She has also served as a Governor-appointed member of the Michigan Board of Marriage and Family Therapy and mentor for the AAMFT Minority Fellowship Program and AAMFT Leadership Certificate Program. Wittenborn is a licensed marriage and family therapist and has won several awards for excellence in research and mentoring graduate students.

Kendal Holtrop, PhD , is an AAMFT Professional Member holding the Clinical Fellow and Approved Supervisor designations and is an associate professor in the Department of Human Development and Family Studies at Michigan State University. She is also currently serving as the acting program director of the Couple and Family Therapy (CFT) doctoral program. Her program of research focuses on parenting and parenting interventions, with the goal of addressing mental health disparities by expanding the reach of evidence-based parenting interventions among underserved populations. Holtrop has recently completed grants from the National Institutes of Health (NIH) to determine the functional components of the evidence-based GenerationPMTO parenting intervention and from the Michigan Health Endowment Fund to develop and pilot test an online parenting intervention. Holtrop is an editorial board member for the Journal of Marital and Family Therapy , an advisory editor for Family Process , and a mentor for the AAMFT Minority Fellowship Program. She also serves as a Governor-appointed member of the Michigan Board of Marriage and Family Therapy. Holtrop is a licensed marriage and family therapist.

Babinski, D., & Sibley, M. (2022). Therapy for attention-deficit/hyperactivity disorder in families: A review of randomized controlled trials from 2010 to 2019. Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12572

Carr, A. (2019a). Family therapy and systemic interventions for child-focused problems: The current evidence base. Journal of Family Therapy, 41 (2), 153-213. https://doi.org/10.1111/1467-6427.12226

Carr, A. (2019b). Couple therapy, family therapy and systemic interventions for adult-focused problems: The current evidence base. Journal of Family Therapy, 41 (4), 492-536. https://doi.org/10.1111/1467-6427.12225

Doss, B., Roddy, M., Wiebe, S., & Johnson, S. (2022). A review of the research (2010-2019) for evidence-based treatments for couple relationship distress. Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12552  

Dwanyen, L., Holtrop, K., & Parra-Cardona, R. (2022). Reducing mental health disparities among racially and ethnically diverse populations: A review of couple and family intervention research methods (2010-2019). Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12573  

Frey, L., Hunt, Q., Russon, J., & Diamond, G. (2022). Review of family-based treatments from 2010 to 2019 for suicidal ideation and behavior. Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12568

Goger, P., & Weersing, V. R. (2022). Family based treatment of anxiety disorders: A review of the literature (2010-2019). Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12548

Hogue, A., Schumm, J., MacLean, A., & Bobek, M. (2022). Couple and family therapy for substance use disorders: Evidence-based update 2010-2019. Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12546

Kaminski, J., Robinson, L., Hutchins, H., Newsome, K., & Barry, C. (2022). Evidence base review of couple and family-based psychosocial interventions to promote infant and early childhood mental health, 2010–2019. Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12570  

Lamson, A., Hodgson, J., Pratt, K., Mendenhall, T., Wong, A., Sesemann, E., Brown, B., Taylor, E., Williams-Reade, J., Blocker, D., Caspari, J. H., Zubatsky, M., & Martin, M. (2022). Couple and family interventions for high mortality health conditions: A strategic review (2010-2019). Journal of Marital and Family Therapy, 48( 1). https://doi.org/10.1111/jmft.12564

Markman, H., Hawkins, A., Stanley, S., Halford, K., & Rhoades, G. (2022). Helping couples achieve relationship success: A decade of progress in couple relationship education research and practice, 2010-2019. Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12565

McWey, L. (2022). Systemic interventions for traumatic event exposure: A 2010-2019 decade review. Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12547

Pinsof, W. M., & Wynne, L. C. (1995). The efficacy of marital and family therapy: An empirical overview, conclusions, and recommendations. Journal of Marital and Family Therapy, 21 (4), 585-613. https://doi.org/10.1111/j.1752-0606.1995.tb00179.x  

Sheidow, A., McCart, M., & Drazdowski, T. (2022). Family-based treatments for disruptive behavior problems in children and adolescents: An updated review of rigorous studies (2014-April 2020). Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12567

Southam-Gerow, M. A., & Prinstein, M. J. (2014). Evidence base updates: The evolution of the evaluation of psychological treatments for children and adolescents. Journal of Clinical Child & Adolescent Psychology, 43 (1), 1-6. doi: 10.1080/15374416.2013.855128  

Sprenkle, D. H. (2012). Intervention research in couple and family therapy: A methodological and substantive review and an introduction to the special issue. Journal of Marital and Family Therapy, 38 (1), 3-29. https://doi.org/10.1111/j.1752-0606.2011.00271x  

Sprenkle, D. H. (2003). Effectiveness research in marriage and family therapy: Introduction. Journal of Marital and Family Therapy, 29 , 85-96. https://doi.org/10.1111/j.1752-0606.2003.tb00385.x  

Stith, S., Topham, G., Spencer, C., Jones, B., Coburn, K., Kelly, L., & Langson, Z. (2022). Using systemic interventions to reduce intimate partner violence or child maltreatment: A systematic review of publications between 2010 and 2019. Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12566

Wittenborn, A. K., & Holtrop, K. (2022). Introduction to the special issue on the efficacy and effectiveness of couple and family interventions: Evidence base update 2010-2019. Journal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12576

Wittenborn, A. K., Woods, S., Priest, J., Morgan, P., Tseng, C.-F., Huerta, P., & Edwards, C. (2022). Treating depressive and bipolar disorders with couple and family therapy: Systematic review of the evidence from 2010 to 2019. J ournal of Marital and Family Therapy, 48 (1). https://doi.org/10.1111/jmft.12569

Other articles

Evidence in Support of Couple and Family Interventions for Depressive and Bipolar Disorders: What Does the Research Say?

Among those who experience depressive or bipolar disorders, too few get the treatment they need to experience relief. When people do seek treatment, it’s commonly in the form of medication, individual therapy, or both. Given the impact of close relationships on the course of depressive and bipolar disorders, targeting clients’ relationships may be a key mechanism to promoting symptom improvement. Sarah B. Woods, PhD

Couple and Family Interventions for High Mortality Health Conditions

The authors discuss their findings as MedFTs who see health, wellness, illness, trauma, and death in the context of families as they interface with larger systems such as healthcare, schools, and military systems. An interview with Angela Lamson, PhD, Jennifer Hodgson, PhD, Keeley Pratt, PhD, Tai Mendenhall, PhD, Alison Wong, PhD, Erin Sesemann, PhD, Braden Brown, PhD, Erika Taylor, MS, Jacqueline Williams-Reade, PhD, Daniel Blocker, PhD, Jennifer Caspari, PhD, Max Zubatsky, PhD, and Matthew Martin, PhD

Couple and Family Therapy for Substance Use Disorders

Substance use disorders can contribute to a variety of couple- and family-related problems. Fortunately, there are couple- and family-based interventions for adults and adolescents. The authors reviewed the past decade of research to provide an up-to-date picture of effective couple and family treatments. Aaron Hogue, PhD, Jeremiah Schumm, PhD, Alexandra MacLean, MA, and Molly Bobek, MSW

Privacy Overview

In 2018, we (LLC and MP) met in person for the first time in the lobby outside a large conference room at the United Nations Office in Vienna. Although we had collaborated previously (Palit & Levin, 2016; Charlés & Samarasinghe, 2016), we had never met face-to-face. In Vienna, we were invited participants in a United Nations Office on Drugs and Crime (UNODC) technical consultation: “Elements of Family-based Treatments for Adolescents with Drug Use Disorders: Creating Societies Resilient to Drugs and Crime. ” This consultation meeting included 25 experts across the fields of family therapy, staff from the UNODC PTRS unit, and the World Health Organization, and subject matter experts in substance use disorders and countering violent extremism. The meeting was convened for a memorable week in Vienna, with participants from over 13 countries. The goal of the meeting was “to identify key elements of effective approaches to the treatment of adolescents with drug use disorders and to provide guidance for the development of a UN training package on family therapy.” A key aspect of the “effective approaches” and “guidance” asked of us as a group of technical experts was that we had to consider FT adaptation and implementation in low and middle income countries. The challenge is clear; while research studies in many contexts illustrate how systemic family therapy practices are part of the evidence base, Busse et al. (2021) noted that:

…almost all these studies were conducted in high-income countries and almost all of them were conducted within a research context in university setting. As such, the findings might not be generalisable to studies conducted in LMICs …. Furthermore, adolescents with SUDs and their families in LMICs do not have or very little access to effective treatment such as family-based therapy. To address this accessibility gap as well as to increase quality and diversity of treatment options for adolescents with drug and other SUDs, the Treatnet Family (TF) was developed by the United Nations Office on Drugs and Crime (UNODC; 2020). (p. 2)

That package that was begun in 2018 in Vienna is now called Treatnet Family (see below for an example of some of the concepts addressed in the package). Treatnet Family has been a part of feasibility studies, has been implemented in many countries and regions, and involved hundreds of practitioners across the globe. The package is openly accessible at no cost, and as of this writing, has been translated into four languages, with more on the way. We need more multilateral efforts and collaborations like this one, and family therapy as an established field needs to hear much more and much more often about the ways practice must be adapted to meet country contexts across the globe.

A recent publication by Busse et al. (2021) described Treatnet Family (TF) as:

containing elements of evidence-based family therapy which has been developed specifically for adolescents with SUDs and their families in low resource settings. TF focuses on family interactions and uses elements of family therapy to interrupt ineffective communication within the family. It contains the key components of family therapy, such as:

• positive reframing (i.e., positive labeling of a negative behavior without necessarily accepting it as fine. It involves emphasizing the possible positive intent behind a seemingly negative behavior),
• positive relational reframing (i.e., positive labeling of a negative behavior in relationship to the family without necessarily accepting it as okay. Even when the behavior is self-destructive, the intent behind it can be understood and appreciated, yet not necessarily condoned).
• perspective taking (i.e., developing empathy and the ability to take another person’s viewpoint into account).
• relational questions (i.e., to support perspective taking, relational questions are asked [e.g., “When Narendra gets into trouble, who feels most sorry for him?”] in order to encourage perspective taking and relational thinking).
• going with resistance (i.e., helping family members feel heard and understood, which reduces defensiveness and makes more productive conversations possible).

TF has six sessions, with each session lasting between 90 and 120 minutes. Each session is to be attended by the adolescent with SUDs and his/her family members because the primary focus of the sessions is on the relationships among family members. The practitioner’s role is to interrupt problematic cycles, ineffective communication, and harmful behaviors family members currently use to meet their emotional and interpersonal needs. As change in family interaction can influence each family member’s behavior, family members are encouraged to be part of the solution. ” (p. 2)

For more on Treatnet Family: https://www.unodc.org/documents/southeasterneurope/UNODC_Treatnet_Family_brochure_190320.pdf

The following are definitions for terms commonly used pertaining to becoming licensed in other states or practicing in other states. The definitions below represent how these terms are used in this article and may not represent how these terms are defined by others:

Portability: Portability or license portability is the general ability to take an individual’s qualifications for a license in one state and apply them for licensure in another state. The term “portability” is used to describe the various methods to allow a licensee in one state to be able to legally provide services to clients in other states, including through model laws, reciprocity, endorsement, or compacts.

Model Laws: Model laws, also referred to as model portability laws, are laws included as provisions within existing state licensure statutes that allow out-of-state licensees to obtain a license in a state in an expedited fashion without having to meet all of the requirements that an associate clinician applying for initial licensure would have to meet. Most MFT state licensure laws contact such model laws allowing an MFT licensed in another state to obtain licensure if they meet certain requirements or have been licensed for several years. Model laws are far more common than licensure compacts. Unlike compacts, the language in model laws can differ from state to state.

Endorsement: Endorsement generally describes laws that allow a state board to recognize or endorse a person’s license granted in another state, allowing that person to become licensed in the endorsing state. The terms “portability” and “endorsement” are commonly used interchangeably.

Reciprocity: Licensure reciprocity is when a state honors and recognizes licensees from certain other states through mutual agreements in other states. However, in the healthcare field, these agreements, which must be approved by officials in each state, are not found in most states pertaining to mental health licensure as states are reluctant to grant reciprocity.

I (LLC) interviewed Alexandra “Xan” Weber, International Institute for New England’s (IINE) Senior Vice President for Advancement. IINE was founded in 1918, and is a non-profit social service organization that serves refugees and immigrants through resettlement, education, livelihood/career advancement and support for the journey toward citizenship. Responsible for resource development, advocacy, and strategic initiatives, Xan oversees the organization’s fundraising, institutional partnerships, advocacy initiatives, and strategic planning. She began her career at IINE in 2008 as IINE’s Director of Community Services, managing the Boston site’s refugee resettlement program, various victim services projects, and behavioral health services. IINE is an affiliate of the United States Committee for Refugees and Immigrants, and one of the nine national networks contracted with the U.S. Department of State to resettle Afghan evacuees. In 12 weeks, IINE resettled over 450 Afghan evacuees throughout New England.

Laurie: What are the most important things that clinicians need to know about this group?  

Xan: In my presentations to the community, I often list everything that refugees usually go through—statelessness and forced migration, violence, war. This population faced an additional challenge—evacuation, an additional trauma. At IINE, we’re not used to receiving evacuated populations who have had no time to prepare and process their resettlement. Afghan evacuees did not prepare for resettlement and I think that that in itself has created another layer of suffering. We are meeting many Afghans who do not have a sense of refugee identity. Evacuees made a life or death decision to evacuate—a lot to process in just a short amount of time. And we’ve heard the actual evacuation itself was horrible and traumatic. People rushing the airports and tarmacs and getting trampled, getting pulled over barbed wire fencing to reach an airplane, some people making it onboard and others not and families separated.

Afghan evacuees were air evac’ed from Afghanistan to a third country, and this step added to the complexity of their resettlement process. From overseas bases, evacuees were flown to Dulles Airport in Virginia and then dispersed to military bases in the U.S. A shuffling between U.S. bases in multiple countries is not the typical refugee experience, and when they arrived at U.S. bases, most lacked processing documentation. Lack of documentation impacted evacuees’ sense of security—they did not enter the country with traditional refugee documentation, work authorization, etc. The U.S. government didn’t really know who they were and they had to go through months of processing on U.S. bases to generate critical documents. On the U.S. military bases, families struggled. Even if they had shelter, heat, and food that they could eat, for some there was so much dust in the air, their children had asthma attacks.  

Laurie: Can you say a bit more about the term used for the evacuees? “Humanitarian parole”?

Xan: Most Afghan evacuees were offered Humanitarian Parole by the U.S., and they entered as parolees. Humanitarian Parole is a rare authorization—it’s an opportunity offered to people ineligible for admission to the U.S. to enter temporarily due to a compelling emergency. This designation is outside of refugee processing, and it doesn’t confer the same benefits. Afghans who have humanitarian parole have been authorized to stay in the U.S. for two years, and within that time, they have to adjust their legal status or they will become unlawfully present. Afghan evacuee status presents, therefore, an additional significant concern—without a broad status adjustment of the 100,000 Afghans who are here now, every single one of them will need an attorney to adjust their legal status in the U.S. The adjustment process is extraordinarily time consuming and expensive.  

Laurie: How would you say your organization looks at mental health and psychosocial support needs of the families you serve, in particular the Afghan families?  

Xan: I think it’s our mission to consider clients’ health, mental health, and well-being. The logistical support offered by resettlement is not enough. Refugees by definition have been through persecution, for many physical and emotional violence, and upon resettlement need time to adjust. Ideally, IINE would have clinically-trained case workers who could enhance client health, even providing practical and logistical support alone. We don’t have many clinically-trained case workers on staff, but we are lucky because we work with amazing community health center partners, and over the summer we moved offices in Lowell and are now co-located with the Lowell Community Health Center. In considering our move, we asked ourselves, what’s the most important support that our clients need that we don’t provide? We don’t provide healthcare [at IINE]. In combining skill sets with partners, we can achieve holistic support.

Laurie: What have you seen that’s on the minds of these families? What’s the thing that they’re telling you or telling your caseworkers?

Xan: I’ve worked with a few Afghan families myself, and our staff have shared lots of different stories about their experiences resettling Afghan evacuees. Honestly, I think our staff, on the whole, are very challenged by many of the Afghan families that they’ve met. The evacuees’ expectations are so high, and many seem so dissatisfied with what we can offer through the resettlement program. The U.S. resettlement program is one-size-fits all: every refugee receives the same services and support, right down to the the number of forks, spoons, and knives per family…it’s very, very proscribed.  

At IINE, we’ve been doing this a long time—we try to assess each family’s needs and we give as much individualized support as we can. Because of an incredible outpouring of support from community members and funders, the Afghan evacuee population is receiving about five times the amount of funding and resources than any other resettling refugee population. But many evacuees are upset because they expect to resettle into a middle-class American life, and the U.S. refugee program doesn’t provide resources to begin life in the U.S. at that economic level.   Most families we have met are completely focused on their children, and they are here for their children. They’re also really focused on working; they want to get a job. They want to know where their paperwork is. They want to know where the grocery store is. They want to know how to get work authorization. They want to know where things are, they want to do things. They want a bank account, they want to finally move into the driver’s seat in their life after having a huge, disruptive time of feeling out of control.  

After the evacuation experience, it hard to know how so many function so well. Most are simultaneously experiencing deep grief, because most of their family is still in Afghanistan.  

Laurie: Have you noticed things that have worked that have been helpful to reduce the worry for the families you work with, or that caseworkers work with?

Xan: I think when evacuees get their questions answered, that’s the most helpful, moving away from complete uncertainty about everything and toward control. Even if it’s just receiving a food card to go and buy their own groceries. These are practical things that I think have helped people start making their decisions, and feeling more in control.  

Laurie: You mention the deep grief for families, who are separated from each other, with many still in Afghanistan. Can you say more about what is happening regarding reuniting families?

Xan: Most evacuees left most of their family in Afghanistan when they were evacuated. We refer evacuees to our attorneys to explore legal reunification options. But we haven’t had success in helping Afghan families in country to get out. An IINE case worker is an Afghan refugee whose family resettled in Canada, and she and her husband were admitted to the U.S. Her entire family fled Afghanistan through Pakistan, and just barely escaped. They recently   joined her sister in Canada. The CTV W5 Channel broadcasting station did an entire video series on her—with graphic footage of the Afghan evacuation. Watching it, I realized it is hard to put into context what people endured. People had to decide who in their family was going to try to evacuate and who would be left behind.

But those who fled have not left their connections behind. Many Afghans are motivated to resettle and work because they want to be able to send money home, to those now struggling in an Afghanistan on the verge of famine. I was just talking to someone who worked in Afghanistan for years, and he said all of the money wire channels are still open, and people can still send money through Western Union to family in Afghanistan. At the end of the day, what you learn as a resettlement provider is that those offered a chance to resettle in a new country and rebuild their lives are not just here for themselves. They try desperately to share even the most basic, modest support they are given with others still in hell.

Afghan Family Evacuees: “Not just here for themselves.”

Laurie: What are the most important things that clinicians need to know about this group?

Afghan evacuees were air evac’ed from Afghanistan to a third country, and this step added to the complexity of their resettlement process. From overseas bases, evacuees were flown to Dulles Airport in Virginia and then dispersed to military bases in the U.S. A shuffling between U.S. bases in multiple countries is not the typical refugee experience, and when they arrived at U.S. bases, most lacked processing documentation. Lack of documentation impacted evacuees’ sense of

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250 Outstanding Marriage and Family Research Topics

Looking for the best marriage and family research topics for your sociology paper? With the changing dynamics of family and marriage, there is always scope for more research. This leaves you with endless options for a suitable title for your paper. To make the process simpler, here is a list of the best topics on marriage and family to help you narrow down the choices. It is good to remember that some of these topics may evoke conflicting emotions and opinions. therefore, they are best handled with sensitivity and objectivity. They present ample scope for classroom discussion and debates. However, pick a topic that also presents sufficient scope for research to showcase your understanding of the subject and writing skills as well. 

Trending Marriage and Family Research Topics

Here is a list of some of the most commonly used topics on marriage and family that will help you get ample supporting data and content.

• The evolution of the concept of marriage
• The changing role of spouses in a modern marriage
• Changes in the values around marriage and family over the last decade.
• The effect of social media on marriages
• Types of marriages in Nigeria
• Cultural differences and its effect on the sociology of marriages
• The influence of media on marriage and family
• Change in marriages in your country
• Does gen X think that marriage is an outdated concept
• The sociology of inter-racial marriages
• A traditional role that men could perform better than women and vice versa.
• The social benefits of a marriage
• The financial benefits of a marriage
• How does mental health affect marriages?
• The important role of stress in modern marriages.
• Getting married but not choosing to have children. The benefits and risks.
• How long should a couple know each other before getting married?
• Should gender roles within a marriage be maintained strictly? What are the benefits and risks?
• Does society benefit from prioritizing marriage
• Living with an unmarried partner or marriage. Which has a higher level of relationship satisfaction?
• Your thoughts on an egalitarian marriage
• Marriage is a public performance in the age of social media. Your understanding of this statement.
• Is financial instability one of the most common reasons for not getting married.
• The steady decline in marriage among individuals without a college degree.
• Marriage rate for women with good education is higher.
• People who want children should get married. Your thoughts on this.
• The common causes for decline in marriage rate in modern society
• The concept of arranged marriages across the world.
• The role of matrimonial sites in modern marriages.
• Are dating apps a reliable option to meet a suitable partner for marriage?
• Is marriage rate affected by ethnicity?
• The effect of substance abuse on a marriage
• Physical acts of aggression in a marriage. When does one go too far?
• Financial independence of women and its effects on marriage.
• Increasing rate of infidelity in marriages. What are the common causes?

Best Research Topics on Family

Here is a list of some of the best family research topics that explore the changing dynamics on family structures in the recent times.

• How can you define the term ‘family’?
• Family background determines your rate of success in career and life. Comment.
• What are the consequences of divorce on children?
• Overcoming trauma of a dysfunctional family
• Is it possible to always live up to family expectations?
• The effects of parental neglect on children.
• How to minimize negative effect of divorce on a family
• War veterans and their families. Do they really need help?
• Family and its impact on teenage delinquency
• Stages of grief in children after the loss of a family member
• Stages of grief in an adult after the loss of a family member
• How should families cope with the loss of a family member?
• The increasing problem of work-life balance and its impact on families
• Joint family versus a nuclear family
• Family members who should have a say in the upbringing of a child
• Fostering children and the issues that arise
• Substance abuse within a family. How to save yourself and the rest of your family?
• Sexual abuse within a family. Strategies to escape it.
• Family violence in the last decade. Has it increased?
• The effect of setting very high expectations for members of the family.
• Family values: Should they be strict or flexible?
• Different types of relationships within a family.
• Putting life together after a natural disaster.
• Accepting children from a previous marriage into your family.
• How to meet a crisis as a family
• The issue of gender discrimination within a family.
• Gender roles and expectations of the family
• Coping with unpleasant secrets of your family
• The pressure of inheriting a family business and the impact on children and younger members of the family.
• Balancing between family support and allowing young adults to live their lives on their own.
• How involved should the family be in one’s career?
• The absence of love within a family
• Helping a family member in distress.
• Unwanted activities that modern families engage in
• Accepting the transition of children into adult lives.

Family Life Education Topics for Research

Among the many family and marriage topics for discussion, family life education is an important concept that presents a huge scope for research.

• The objectives of family life education
• The importance of family life education
• The primary principles of family life education
• The practices of family life education and their importance in effective outreach.
• How family life education can improve moral codes in young adults
• The importance of family life education in developing a good personality in adolescents
• Complementing parent education with family life education.
• How family life education can fill the gap when parents abdicate responsibilities.
• The three behavioural needs for family planning.
• Importance of setting priorities when planning a family.
• Resources that teen parents need for effective parenting.
• Tools to build resilience in teen parents
• Family life education and psychology
• Family life education and social work.
• The 10 contents of family life education.
• Family life education is one of the most flexible fields of sociology. Your comments.
• Family life education to help problem teens cope in college or school.
• The role of family life education in decision making among family members.
• Write in detail about a decision making model that youth can benefit from when it comes to family planning decisions.
• Skill application in family planning.
• Parenting classes: A modern trend or a necessity for new parents?
• Identifying personal attitude and belief in teen parenting.
• How family life education contributes to overall well being and growth of a family.
• Assessing knowledge levels of adolescent girls with respect to issues in family life education.
• The key areas of study of family life education.
• Differences in rural and urban approach to family life education.
• How to set up an effective intervention plan when dealing with family life education crisis
• The challenges of parents with adolescent parents.
• Using family life education to teach teens about balancing between responsibility and freedom.
• Critical interests of preschool children
• Stimulating growth and development of preschool children.
• The right time to plan for a second child.
• Adjusting to the ‘Empty Nest Syndrome’.
• Importance of family life education in reproductive health.
• Population education versus family life education.

Sociology of Family Research Topics

Family structures are an important part of studying sociology. Here are trending sociology research topics on family to help you ace your papers.

• Unconventional family structures in the modern world.
• Child behaviour and the impact of parents on it.
• Child abuse and its long term effects
• The impact of cross-racial adoption
• The challenges of cross-racial adoption
• Differences in family structures across ethnic groups and races
• How single parenting impacts the life of children.
• The impact on children when couples live apart.
• The impact on family structure when couples live apart.
• Family and its involvement in community
• The role of the community in changing family structures.
• Different household structures within families
• The earner-carer family model
• The need for dual earner couples
• The evolution of household structures within families
• The importance of dividing household labour within a family.
• What is family demography?
• Effective ways of dealing with family conflicts
• What is maternalism?
• The changing approach to filial responsibility
• Effective family migration planning
• The challenges faced by immigrant families.
• Examples of matriarchal family structures across the globe.
• The changing roles of a woman in a family.
• The changing roles of a man in a family.
• Effective ways to manage money within a family
• The important parental roles in deciding the outcomes for children.
• Sibling relationships at different ages.
• Dealing with stepfamilies.
• Challenges faced by stepmothers and how to overcome them?
• Challenges faced by stepfathers and how to overcome them?
• The concept of sibling ties.
• Causes for increase in female householders
• Deteriorating economic circumstances of men and the impact on family structures.
• Cohabitation and a decline in marriage.

Popular Research Topics on Gay Marriage

With the legalization of same sex marriage in many countries while some still remain in conflict, there are several gay marriage topics that you can write about.

• Should the government have a say in marital decisions?
• Why is gay marriage illegal in some countries?
• The importance of legalizing same sex marriages.
• The social challenges faced by same sex couples.
• How to help a member of the family who has come out of the closet.
• Accepting same sex marriage with a family.
• How to support family members who belong the LGBTQ community?
• The effect of same gender parents on the social life of a child.
• Challenges faced by gay couples with adoption.
• Can gay couples provide the same parenting structure as straight couples?
• Common marriage and family issues for gay people.
• Differences between a heterosexual marriage and same sex marriage.
• Do same gender couples make fit partners? The common consensus.
• The limitations imposed by the law on same sex couples.
• The importance of marriage for gay couples
• Divorce among gay couples. Is it harder to get professional assistance?
• Legalising same sex marriage and the impact on psychological well-being.
• Impact of same sex marriage on the society.
• Are changing contours of family making it easier to accept gay and lesbian marriages?
• Legal decisions affecting children of same sex parents.
• Anticipatory minority as a stressor among same sex couples.
• Civil Union versus same sex marriage.
• Defining household structures in same sex homes.
• Potential differences in the political attitude between heterosexual and homosexual couples.
• Child development and homosexual parenthood.
• The differences in social challenges of a gay marriage and lesbian marriage.
• Emotion work in gay, lesbian and heterosexual relationships.
• Same sex civil partnership and its impact of health.
• How same sex marriage impacts the understanding of same sex relationship.
• A sociological perspective on the legal recognition of same sex marriages.
• Perspectives of gay and lesbian marriages across the globe.
• Czech lesbian activism. Explain some of the significant events.
• Safety concerns for same sex couples in the society.
• The psychology of children of same sex couples.
• Domestic violence in same sex marriages.

Marriage and Family Therapy Research Topics

Whether it is research paper on relationships, marriage or family structure, therapy and counselling plays an important role in today’s world. Here are some topics that are trending and relevant.

• Stress and its impact on family or marriage counselling.
• Qualities of a good family therapist.
• The role of pre-marriage counselling in strengthening relationships.
• Techniques of family therapy
• The key concepts of family therapy
• Objectives of marriage and family therapy
• Living with a family member who has mental health issues
• Providing family support to members with mental health issues.
• Importance of family therapy in the sociology of family.
• The emergence of family therapy as an identifiable field of psychology.
• Family therapy and its importance in social work.
• Child guidance and mental health
• Family systems model of therapy.
• Improving communication patterns within family through counselling.
• The concept of function and purpose of symptoms.
• The circular causation model of family therapy.
• Recognizing structural characteristics of families through therapy
• The increasing need for family and marriage therapy.
• How family therapy can help cope with members who are addicted to substances.
• Family therapy and child sexual abuse.
• Family therapy versus marriage counselling.
• Non systemic postmodernist models of family therapy.
• The challenges faced by family therapists.
• Factors that limit the scope of family therapy.
• History of professional marriage and family therapy.
• The evolving treatment of gender in family therapy.
• The evolving treatment of sexual orientation in family therapy.
• The perspective of family and marriage therapy among various ethnic groups.
• The need for counselling for children of divorce.
• Family therapy to help deal with loss of family members.
• Family therapy to cope with terminally ill family members.
• Significant models of family therapy in the modern world.
• Important research papers on family therapy.
• The pioneers of family and marriage counselling.
• Changes in psychiatry and its role in the development of family therapy.
• The contributions of Harry Stack Sullivan to family therapy.
• Factors that contribute the positive mental health among family members.
• The impact of cultural systems on the understanding of family dynamics.
• Family therapy and its integration into family medicine.
• Common treatment protocols in family therapy.

Divorce Topics For Research Paper

Because of the social and emotional impact that it has, divorce is among the most important marriage topics for discussion.

• Study of abusive and toxic relationships within a family.
• The causes for increasing divorce rates.
• Perception of divorce among different ethnicities.
• The impact of culture on the perception of divorce.
• Marriage counselling as an effective way of preventing divorce
• The trauma of child custody battles
• The impact of child custody battles on the child.
• The social perspective of divorced couples.
• Raising children as a divorced couple.
• A study on family violence
• The changing perspective of marriage among children of divorce.
• The impact of divorce on the social lives of children.
• Sociological consequences of divorce.
• Changing patterns and trends of divorce
• Is divorce a social problem?
• The negative consequences of divorce
• The positive consequences of divorce
• The economical consequences of divorce
• How divorce impacts your social circle.
• The impact of increasing divorce rates on society.
• Ideological considerations of divorce
• The process of marital breakdown.

Family Law Topics for Research

Here is a list of family law topics that have a good scope for data collection so that you can present an impressive paper.

• Shared residence orders versus single residence orders.
• The need for reform and alteration in family laws in your country.
• Relationships, family and the law
• Reform in the cohabitation law.
• The Children Act of 1989 and its importance in Family Law.
• Extending civil marriage availability to same sex couples. Write your views for and against this topic.
• Laws regarding non-conjugal relationships.
• The role of family law in determining the boundaries of marriage.
• Child relocation and the laws associated with it
• Divorce decisions based on the Principles of Fairness
• The matrimonial cause act of 1973. Discuss its importance and the evolution.
• Discuss three family laws that may be irrelevant in the modern world.
• Why is it necessary to establish family laws?
• The Piglowska versus Piglowski case of 1999 and its impact on divorce law decisions.
• The role of religion on divorce laws.
• Providing legal support to make victims of domestic abuse.
• Why are child protection laws important?
• The legal aspects of family welfare and social work.
• Intervention of the State or authorities in families where children are abused or neglected.
• Termination of parental rights in case of neglect or abuse. Is it the right approach?
• Family laws about inheritance.
• The changing laws of adoption.
• A comparison of family laws in the West and the East.
• Are family laws more liberal in the West?
• Is the concept of alimony redundant in today’s world?
• The need for legal validation of relationships.
• Should women receive child support even if they are financially stable?
• Is it correct for one parent to withhold visitation rights of the other?
• Challenges faced by family lawyers.

Family Bible Study Topics of Research

Religion is a primary construct in the family structure. Here are some best rated family bible study topics that you can choose from:

• Family bible study and its role in establishing values with a family.
• How to use family bible study to improve the personality of adolescents.
• The role of family bible study in increasing bonding between family members.
• Is family bible study necessary in the modern world?
• How the church positively influences the family structure.
• Some family theories and concepts from the bible that are relevant even today?
• Some outdated concepts of family that are mentioned in the bible that do not fit into modern society.
• How family bible study impacts marriages and relationships.
• Family bible study and why it is important for children to start young.
• Family bible study and its role in improving behaviour of family members.
• Interesting ideas to make family bible study relevant and interesting.

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The byu mft programs strive to be an international leader in process research that informs how change occurs and extend our healing influence beyond our programs. explore current research projects that our students have the opportunity to be involved in., mft-prn: marriage and family therapy practice research network, healthy and unhealthy intimate relationship practices: a grounded theory, champs: changing hearts and minds in relationships & champs+, cad: couples and disaster, sexuality, sex therapy, sexual education projects, what what happens after therapy, in-session predictors of dropout in couple therapy, pandemic and couples: understanding the relational consequences of mass trauma, more: minority-oriented research evaluation project, flourishing families project, effects study.

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Qualitative research in family therapy: a substantive and methodological review

Affiliation.

• 1 Department of Counseling and Special Education, California State University, 5005 N. Maple ED 3, Fresno, CA 93740, USA. [email protected]
• PMID: 11314558
• DOI: 10.1111/j.1752-0606.2001.tb01162.x

Over the last decade, marriage and family therapy (MFT) researchers have developed a growing interest in qualitative research. In this article, we review substantive and methodological trends in the published qualitative studies within the MFT field. The research is compared and contrasted in the following areas: General topic, epistemological theory, methodological theory, sampling and sample, data collection, data analysis procedure, and approach to reliability and validity. We also provide recommendations for future research.

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• Dyadic research in marriage and family therapy: methodological considerations. Wittenborn AK, Dolbin-MacNab ML, Keiley MK. Wittenborn AK, et al. J Marital Fam Ther. 2013 Jan;39(1):5-16. doi: 10.1111/j.1752-0606.2012.00306.x. Epub 2012 May 9. J Marital Fam Ther. 2013. PMID: 25073839
• Challenges of an outcome-based perspective for marriage and family therapy education. Nelson TS, Smock SA. Nelson TS, et al. Fam Process. 2005 Sep;44(3):355-62. doi: 10.1111/j.1545-5300.2005.00064.x. Fam Process. 2005. PMID: 16206635
• Common factors across theories of marriage and family therapy: a modified Delphi study. Blow AJ, Sprenkle DH. Blow AJ, et al. J Marital Fam Ther. 2001 Jul;27(3):385-401. doi: 10.1111/j.1752-0606.2001.tb00333.x. J Marital Fam Ther. 2001. PMID: 11436430
• Integrating qualitative and quantitative research methods: a research model. Sells SP, Smith TE, Sprenkle DH. Sells SP, et al. Fam Process. 1995 Jun;34(2):199-218. doi: 10.1111/j.1545-5300.1995.00199.x. Fam Process. 1995. PMID: 7589418 Review.
• Marital and family therapy in alcoholism treatment. O'Farrell TJ. O'Farrell TJ. J Subst Abuse Treat. 1989;6(1):23-9. doi: 10.1016/0740-5472(89)90016-0. J Subst Abuse Treat. 1989. PMID: 2651683 Review.
• "It's splendid once you grow into it:" Client experiences of relational teletherapy in the era of COVID-19. Maier CA, Riger D, Morgan-Sowada H. Maier CA, et al. J Marital Fam Ther. 2021 Apr;47(2):304-319. doi: 10.1111/jmft.12508. Epub 2021 Mar 15. J Marital Fam Ther. 2021. PMID: 33721348 Free PMC article.
• Expectations and Experiences of Couples Receiving Therapy Through Videoconferencing: A Qualitative Study. Kysely A, Bishop B, Kane R, Cheng M, De Palma M, Rooney R. Kysely A, et al. Front Psychol. 2020 Jan 21;10:2992. doi: 10.3389/fpsyg.2019.02992. eCollection 2019. Front Psychol. 2020. PMID: 32038380 Free PMC article.
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