"I think it's communication and trust and sharing everything": Qualitative evidence for a model of healthy intimate relationships in Black women living with HIV and men in KwaZulu-Natal, South Africa

In South Africa, couple-based interventions (CBIs) have been used to increase HIV testing, reduce HIV transmission, and shift relationship dynamics. To understand local definitions of healthy relationships, this study sought to collect qualitative data on a model of healthy relationships in a semi-rural area of KwaZulu-Natal, South Africa. We conducted semi-structured qualitative interviews with HIV-positive women (n = 15) and men of mixed HIV status (n = 15) who were in heterosexual, monogamous relationships (not with each other). Thematic analyses guided coding. Three primary healthy relationship behaviour themes emerged, labelled open communication, couple-level problem-solving, and active relationship building, which were related to various relationship facets (trust, support, respect, commitment, and connection). We purposively explored contextual themes, namely the role of HIV, positive community involvement, and power dynamics, to better situate the healthy relationship behaviour themes. HIV was not central to relationship conceptualisations and three different power structures (shared power/flexible gender norms, shared power/traditional gender norms, male-dominated power/traditional gender norms) were described as being healthy. This model of healthy relationships is similar to observed definitions in other African countries and in high-income settings. Findings can inform HIV programming content for couples in KwaZulu-Natal, particularly the active relationship building component.

Posttraumatic stress symptoms and interpersonal processes in burn survivors and their partners

Background: A burn event can elicit symptoms of posttraumatic stress disorder (PTSD) in survivors and their partners and may impact the way these couple members interact with each other. They may try to protect each other from further emotional distress by avoiding talking about the burn event, but they may also show concern towards each other.Objective: The aim of this study was to investigate bidirectional relationships between survivor's and partner's PTSD symptoms and two interpersonal processes: partner-oriented 'self-regulation', which is avoidance-oriented, and 'expressed concern', which is approach-oriented.Method: In this longitudinal multi-centre study, 119 burn survivors and their partners participated. Measures of PTSD symptoms, self-regulation, and expressed concern were administered in the acute phase following the burns, and follow-ups took place up to 18 months postburn. Intra- and interpersonal effects were examined in a random intercept cross-lagged panel model. Exploratory effects of burn severity were also investigated.Results: Within individuals, survivor's expressed concern predicted later higher levels of survivor's PTSD symptoms. In their partners, self-regulation and PTSD symptoms reinforced each other in the early phase postburn. Between the two couple members, partner's expressed concern predicted later lower levels of survivor's PTSD symptoms. Exploratory regression analyses showed that burn severity moderated the effect of survivor's self-regulation on survivor's PTSD symptoms, indicating that self-regulation was continuously related to higher levels of PTSD symptoms over time within more severely burned survivors, but not in less severely burned survivors.Conclusion: PTSD symptoms and self-regulation reinforced each other in partners and possibly also in more severely burned survivors. Partner's expressed concern was related to lower levels of survivor's PTSD symptoms, whereas survivor's expressed concern was related to higher levels of survivor's PTSD symptoms. These findings emphasize the importance of screening for and monitoring PTSD symptoms in burn survivors and their partner and of encouraging couple's self-disclosure.

Concurrent randomized control trials of the 1-year efficacy of two couple relationship education programs: ELEVATE and Couples Connecting Mindfully

A long-standing university-community partnership used a longitudinal randomized control trial to implement and evaluate two couple relationship education (CRE) curricula, ELEVATE and Couples Connecting Mindfully (CCM), among an economically and racially diverse population of adult couples. Married and non-married couples (n = 929 couples) completed baseline surveys and were randomly assigned to either one of the two program groups or to the control group by implementation site. Follow-up surveys were collected at 2 months, 6 months, and 1 year after baseline. Using an intent-to-treat approach, growth curve modeling comparisons of trajectories indicated program effects at 1 year post-baseline in key outcome areas. Both the ELEVATE and the CCM group reported significant gains in couple relationship skills, couple quality, and family harmony over time compared to the control group that experienced either no change or declines. Further, the ELEVATE group also demonstrated positive program effects on measures of mental health and sleep quality. An assessment of the central premise of CRE indicated that the immediate post-program improvements in couple relationship skills predicted later couple quality for both program groups. This study indicates that both ELEVATE and CCM can be considered evidence-based CRE programs for use with a broad population of couples.

The Couple Therapist as Moral Agent

Partners in intimate relationships rely on each other to meet essential emotional needs. This mutual dependence creates reciprocal obligations, engendering a moral dimension to intimate relationships. This moral dimension involves questions of fairness, equity, and justice which are often central to couples' presenting complaints in treatment. This paper proposes that moral considerations in couple therapy are not only inevitable, but potentially beneficial, and illustrates how they can inform the therapist's case conceptualizations and interventions. This paper will also explore the therapist's responsible use of her moral influence through an examination of personal values. This paper utilizes concepts from psychodynamic and family systems theory to illustrate key points, but the ideas presented apply to therapists with diverse theoretical orientations.

Self-compassion mediates the link between attachment security and intimate relationship quality for couples navigating pregnancy

Millions of couples navigate the transition from pregnancy to postpartum in a given year, and this period of change and adjustment in the family is associated with elevated risk for intimate relationship dysfunction. Self-compassion has the potential to promote skills that are essential for healthy adaptation (e.g., emotion regulation, greater openness and flexibility, and more awareness of the needs of oneself and one's partner). The overarching goal of the present study was to investigate the role of self-compassion in intimate relationship quality during pregnancy. A sample of 159 couples completed semi-structured interviews and questionnaires. Parents engaging in more compassionate self-responding during pregnancy have higher-quality intimate relationships as measured across multiple facets-the degree of emotional intimacy and closeness in the relationship, adaptive conflict management and resolution, high-quality support in response to stress, and a high degree of respect and acceptance directed toward each other. Furthermore, compassionate self-responding emerged as a mediator of the link between attachment security and intimate relationship quality. Specifically, mothers who were higher in attachment anxiety reported lower levels of compassionate self-responding, which in turn undermined multiple dimensions of the intimate relationship. Furthermore, fathers who were higher in attachment avoidance practiced less self-compassion, which have deleterious consequences for the couple. These results provide implications that can inform conceptual frameworks of intimate relationship quality and clinical implications for interventions targeting the transition into parenthood.

Using Intent-to-Attend to Predict Attendance in Community-Based Relationship Education

Government-supported relationship education has provided resources for inclusion of economically vulnerable and ethnically diverse participants; however, many grantees and programs struggled to retain couples in longitudinal studies, which has likely influenced study effects and threatened internal validity. In the present study, we assessed 1,056 couples' baseline relationship satisfaction and intent-to-attend their next scheduled visit while participating in a randomized controlled trial of relationship education and evaluated the predictive ability of their responses to remain in the six-month study. We conducted actor-partner interdependence models for couples, using a probit cross-lagged regression with a structural equation modeling framework, to test the dyadic influence of intent-to-attend on future couple attendance. We also examined the influence of higher or lower baseline relationship satisfaction between partners and group assignment (treatment or wait-list control) on attendance. Intent-to-attend scores were associated with attendance for couples at the one-month follow-up, and early attendance was the biggest predictor of later attendance. Additionally, baseline intent-to-attend scores predicted later intent-to-attend scores for all follow-up time points. However, we found no partner effects, and no effects for the influence of baseline relationship satisfaction or group assignment. We discuss practical suggestions for including intent-to-attend in future studies, relationship education programming, and general therapy practice.

Implementing Behavioral Couples Therapy for Substance Use Disorders in Real-World Clinical Practice

Behavioral couple therapy (BCT) is an evidence-based, manualized treatment that has been primarily developed to treat alcohol use disorder. The treatment model leverages the intimate partner relationship to support recovery. Although the efficacy of BCT is well-supported in randomized controlled trials, little attention has been given to the translation of BCT to everyday practice settings. This article presents recommendations for implementing BCT in such settings. We describe a stepwise approach for getting a couple into BCT and determining whether it is an appropriate treatment for the couple. In addition, we provide recommendations for broadening inclusion criteria for everyday practice settings, including the use of BCT with couples who have drug use disorders with couples where both members exhibit substance use disorders and with couples who choose controlled drinking or drug use versus abstinence. Whereas BCT has mostly been researched in speciality substance use disorder settings, we provide recommendations for its use in general couple therapy settings. Based upon the extant research, we suggest implementing BCT as a standalone treatment or as an add-on to individual counseling for substance use disorders. We provide guidance for delivering BCT through telehealth and encourage future research to investigate this delivery modality. Future research should prioritize investigating the effectiveness of various BCT dissemination strategies and seek to determine what dosage and components of BCT will result in the best outcomes.

"Don't you care about the well-being of your race?": African American couples discuss racial differences involving criticisms of other Black people

African American couples have unique racial stress and high relationship instability, although few studies have examined the role of racial stressors in their relationships. This qualitative study used grounded theory to examine 10 African American couples' disagreements about criticisms of other Black people. Each couple completed a standard couple problem-solving task modified to focus solely on racial differences between the partners. Two models of couple relationships framed the approach; the general vulnerability-stress-adaptation model (Karney & Bradbury, Psychol. Bull., 118, 1995, 3) was combined with a comprehensive race-focused model (Bryant et al., J. Fam. Theory Rev., 2, 2010, 157). The goal was to understand racial stress faced by African Americans, including its context, how and why it is stressful, how they cope, and its consequences in their relationship. A tentative model emerged, suggesting that some African Americans have early race-related experiences that make them vulnerable to concerns about how Black people are seen by others. This may result in a unique minority status stressor that appears indicative of internalized stereotypes and may often include gendered criticisms of their partners. Partners seem to adapt by looking to other African Americans to take personal responsibility for their behavior and defending their racial group. Black male-female gender role issues appear to emerge as a consequence of racial stress that also seems salient across all aspects of the model. Future studies can further examine culturally specific models involving African Americans' criticisms of other Black people and identify successful couple-level strategies to overcome internalized oppression.

Love in the time of COVID-19: A brief report on relationship and individual functioning among committed couples in the United States while under shelter-in-place orders

The COVID-19 pandemic in the United States has changed many aspects of people's daily life, including increased time at home in response to shelter-in-place orders, heightened stress about health effects of COVID-19, and shifts in other domains of life (e.g., employment). These lifestyle changes are likely to impact the well-being of individuals and their romantic relationships. This investigation examined how COVID-19 influenced couple and individual well-being in real-time during the early phase of the pandemic. Data were collected in early May 2020 during shelter-in-place orders in the United States. Participants in committed relationships (n = 332) completed an online survey assessing their experiences currently and before the pandemic. Results suggested that while couple functioning overall maintained or even improved, individual well-being was more negatively impacted by the pandemic. Moreover, some groups who are at higher risk of a poor health outcome from COVID-19 or experience unique challenges as a result of COVID-19 reported worse outcomes (e.g., those whose employment changed) while others did not decline in their psychological and couple functioning (e.g., Black individuals and older individuals). These findings suggest that the pandemic has had varied impacts on couples and individuals, as well as across different virus-related risk factors. Further research is needed to understand the nuanced effects of this pandemic on couples and individuals across time.

A Closer Examination of Relational Outcomes from a Pilot Study of Abbreviated, Intensive, Multi-Couple Group Cognitive-Behavioral Conjoint Therapy for PTSD with Military Dyads

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD) is associated with improvements in patients' PTSD symptoms, partners' psychological distress, and relationship satisfaction. However, little is known about whether CBCT for PTSD is associated with changes in other relationship domains that have theoretical and clinical relevance to the relational context of PTSD. The current study is a secondary analysis of relational outcomes from an uncontrolled, within-group trial designed to examine whether an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered in a retreat during a single weekend was associated with improvements in PTSD symptoms and relationship satisfaction. In this investigation, we examined whether AIM-CBCT for PTSD is also associated with improvements in ineffective arguing, supportive dyadic coping by partner, joint dyadic coping, and partners' accommodation of patients' PTSD symptoms. Participants were 24 couples who included a post-9/11 U.S. service member or veteran with PTSD. At 1- and 3-month follow-up, patients reported significant reductions in couples' ineffective arguing (ds = -.71 and -.78, respectively) and increases in supportive dyadic coping by partners relative to baseline (ds = .50 and .44, respectively). By 3-month follow-up, patients also reported significant increases in couples' joint dyadic coping (d = .57), and partners reported significant reductions in their accommodation of patients' PTSD symptoms (d = -.44). Findings suggest that AIM-CBCT for PTSD is associated with improvements in multiple relationship domains beyond relationship satisfaction but that these may be differentially salient for patients and partners.

Understanding the Early Years of Socioeconomically Disadvantaged Couples' Marriages

Recent research has identified significant differences in how satisfaction in newlywed relationships progress, with the majority of spouses reporting relatively high marital satisfaction. However, most studies have focused on white, middle class, childless couples, and it is not clear whether these findings hold for socioeconomically disadvantaged couples (those with low educational attainment or income). Further, previous work has largely ignored differences between spouses within the same marriage and the circumstances under which interpersonal processes between spouses are influential to prospective marital satisfaction. Using dyadic growth-mixture modeling and three waves of data from 530 newlywed couples in the Supporting Healthy Marriages study, we simultaneously modeled husbands' and wives' marital satisfaction and identified two classes of couples, labeled the Relatively satisfied class and Husbands' moderate intercept, wives' low, and increasing satisfaction class. Husbands consistently reported better marital satisfaction than their wives regardless of class membership. Wives' perceptions of interpersonal processes during experiences of financial stress predicted class membership. Dissolution rates also differed between classes. We conclude by providing practical implications for working with socioeconomically disadvantaged families.

Mindfulness-Based Couple Interventions: A Systematic Literature Review

Over the past decades, mindfulness-based interventions have been shown to improve individual health and well-being in clinical and nonclinical settings. More recently, secular contemplative trainings were adapted to the couple context as research showed satisfying couple relationships to be one of the strongest predictors of physical and mental health. Mindfulness-based interventions hence seem to be a promising treatment in couple counseling and therapy in both clinical and nonclinical settings. Therefore, we conducted a systematic review to provide an overview of the emerging literature in the field of mindfulness-based interventions for couples and other dyads. Overall, sixteen studies met the inclusion criteria. To summarize the heterogeneous quantitative literature regarding individual outcomes, mindfulness interventions for couples seem to increase mindfulness, self-compassion, well-being, and quality of life. Additionally, we found initial evidence of beneficial effects on relieving psychopathological symptoms and psychobiological stress measures. Measures of relationship quality were the predominant dyadic outcome. Based on these studies, we cautiously conclude that mindfulness trainings can enhance relationship quality. Practitioners should be aware that mindfulness-based interventions for couples can potentially improve the perceived relationship quality between partners and the individual burden. Future studies should expand the field, particularly with regard to other contemplative practices for couples such as compassion interventions.

A Systematic Review of Respiratory Sinus Arrhythmia in Romantic Relationships

Respiratory sinus arrhythmia (RSA), an index of the parasympathetic nervous system, has recently gained attention as a physiological component of regulatory processes, social connectedness, and health. Within the context of romantic relationships, studies have operationalized and conceptualized RSA in disparate ways, obscuring a clear pattern of findings. This systematic review synthesizes the rapidly developing literature and clarifies the role of RSA in romantic relationships. We evaluate support for three conceptual hypotheses: (1) resting baseline RSA is associated with better quality relationships; (2) phasic RSA is reflective of changes in threat and connection during couple interactions; and (3) physiological linkage in RSA between romantic partners relates to positive or negative relationship functioning depending on the nature of the linkage (e.g., in-phase vs. antiphase). We identified 26 empirical studies that tested associations between RSA and an index of romantic relationships (i.e., relationship satisfaction). Our findings show that higher RSA is not uniformly "good" for relationships. Higher resting baseline RSA was contemporaneously associated with better quality relationships, yet higher baseline RSA was also unexpectedly associated with relationship violence. Short-term decreases in RSA were found during relationship conflict, though the opposite-phasic increases in RSA during positive romantic partner interactions-was not found due to mixed empirical support. As expected, evidence for RSA linkage was found, though the connection between linkage and relationship functioning depends on the context in which it was measured. We discuss methodological limitations and directions for future research.

Cooperation or Tension? Dyadic Coping in Cystic Fibrosis

Following a rise in the life expectancy of cystic fibrosis (CF) patients, many adults with CF form couple relationships. Yet, dyadic coping has not been previously examined in people with CF. This study examined how adults with CF and their partners cope as a couple with the illness, and what meanings each partner and the couple as a unit attribute to the experience. Seventeen adult CF patients and their partners participated in separate semi-structured in-depth interviews. Two main patterns of dyadic coping with CF were identified as follows: cooperation and tension. For couples in cooperation, the marital relationship served as a resource for adaptive coping. These couples were characterized by similarities in their perception of the place of CF in their lives and of their roles in the marital relationship. Couples in tension described the couple relationship as strained by difficulty of accepting the disease, proliferation of negative emotions, and a sense of burden and loneliness in the process of coping. Findings point to the importance of mutual empathy, clear and accepted division of roles between the partners, and open communication for facilitating coping as a couple.

Escalation and Regulation of Emotional Arousal in Couples Predicts Relationship Satisfaction Concurrently and 25 Years Later

Relationship distress and divorce are major risk factors for the development or exacerbation of psychopathology and psychosocial impairments. Given that heightened negative emotions within couples' interactions may portend negative relationship outcomes, it is critical to understand how emotions unfold across a conversation and how partners may influence each other's immediate emotional experiences. This study examined whether these regulatory dynamics within one interaction predicted relationship satisfaction concurrently and 25 years later. Vocally-encoded emotional arousal (f₀ ) was measured during couples' (N = 25 couples) conversations about a relationship issue. Across different analytical strategies, results demonstrate that one partner's f₀ dynamics had immediate and long-term associations with the other partner's satisfaction. Partners were less satisfied if the other partner (a) expressed higher f₀ overall and (b) escalated more in f₀ across the conversation. Yet, partners were more satisfied when their f₀ escalated across the conversation. Also, women specifically were more satisfied if their f₀ remained elevated longer before regulating back to their emotional baseline. Thus, higher f₀ was associated with higher satisfaction in the same partner, but associated with less satisfaction in the other partner-particularly when these emotions come from women. It may be that partners have to decide whether to prioritize expressing their emotions fully or limit expression in the service of their partner's happiness. These findings challenge us to think of ways to address this "win-lose" scenario so that couples can balance both partners' emotional needs and preserve relationship quality across the life span.

Exploration of a Marital Typology: Implications for Marital Functioning in a Multi-Ethnic Sample

Marital conflict is associated with multiple negative outcomes for couples, including marital dissatisfaction and divorce. Little research, however, has examined conflict in Hispanic/Latino couples or its association with marital satisfaction, which creates an unfortunate knowledge gap for clinicians working with diverse client groups. The present study sought to examine both marital conflict and satisfaction using a sample of 231 European American (EA; n = 108) and Hispanic/Latino (H/L; n = 123) couples. Through observational coding, couples were placed into four groups based on their type of conflict management strategies: Harmonious, Withdrawn, Conflictual-Expressive, or Conflictual-Hostile. For both ethnic groups, couples in the Harmonious group were nondistressed and couples in the Conflictual-Hostile group were in the distressed range of marital satisfaction. Cross-ethnic differences emerged. EA couples experienced distress when both hostile (Conflictual-Hostile) and nonhostile conflict (Conflictual-Expressive) communication types were observed, while only hostile conflict was associated with distress for the H/L group. H/L couples reported similar levels of satisfaction in both the Harmonious and Conflictual-Expressive groups. H/L couples also fell within the distressed range when withdrawn communication patterns were observed; however, this was not the case for EA couples. These differences suggest that both types of conflict are associated with marital distress for EA couples, whereas hostile conflict and withdrawn behavior appear to be more negatively associated with marital satisfaction in H/L couples. Results provide support for the use of an observational coding system with H/L and EA couples and also suggest the importance of understanding how differences in expressions of conflict across ethnicities may relate to marital satisfaction.

Perceptions of War Trauma and Healing of Marital Relations Among Torture-surviving Congolese Couples Participating in Multicouple Therapy

Citizens of the Democratic Republic of Congo (DRC) experienced widespread torture during national wars between 1998 and 2003. Couples who survived and stayed intact suffered tremendous relationship stress. This study used a critical ethnography framework to explore the prewar, wartime, and postwar experiences of 13 torture-surviving couples who participated in a 10-session Torture-Surviving Couple Group in 2008 in the DRC. The group was designed to address the relational effects of torture and war trauma. Participants reported profound negative effects of the war on their relationships; mostly positive experiences during the group, including marital and peer connection and relationship growth; and a number of improvements in their relationship after the group. Implications include support for the use of relational interventions informed by both treatments for traumatic stress and couple approaches to promote trauma healing. Future directions call for increased funding, research, training, and clinical action to treat the effects of traumatic stress on relational family dynamics.

A Multifaceted and Dyadic Examination of Intimate Relationship Quality during Pregnancy: Implications for Global Relationship Satisfaction

Understanding how couples navigate and negotiate the challenges and demands of pregnancy has important implications for family health. The aim of this study was to apply a multidimensional model of intimate relationship quality in a sample of 154 pregnant, cohabitating couples, to investigate the association between a range of intimate relationship processes (i.e., emotional intimacy, conflict management, sexual quality, received respect and acceptance, and received support) and the global relationship satisfaction of each partner. Semistructured clinical interviews were administered to each partner assessing multiple qualities of the relationship, and participants completed home surveys of global relationship satisfaction each day for 14 days. Results demonstrated that multiple dimensions of the intimate relationship were associated with greater relationship satisfaction. Some processes (e.g., degree of emotional intimacy and closeness, conflict management) had larger effects on relationship satisfaction than others (e.g., quality of the sexual relationship). Furthermore, some processes were more important for maternal than paternal satisfaction (e.g., emotional intimacy, support, respect). Finally, results varied, to some degree, as a function of whether parents were transitioning to parenthood for the first time. We discuss the implications of adopting a multidimensional approach to studying the specific relationship processes associated with global relationship satisfaction and present implications for clinicians working with couples navigating the transition into parenthood.

Protective Buffering by Service Members During Military Deployments: Associations with Psychological Distress and Relationship Functioning

To shield a romantic partner from potential distress due to stressors occurring during deployment, service members (SMs) may engage in protective buffering, or withholding information or concerns from a romantic partner. This study utilized data from 54 couples collected before, during, and after a military deployment to assess whether SMs engaged in protective buffering while deployed and the possible associations between buffering and psychological, relationship, and contextual factors. Only 2% of SMs indicated never engaging in protective buffering during a deployment. In bivariate analyses, only partners' psychological distress prior to deployment was significantly associated (negatively) with protective buffering. In multilevel models with time nested within individuals, and individuals nested within couples, higher buffering was associated with less partner distress during deployment, but was also associated with higher SM distress both during and after deployment. In these multilevel models, protective buffering was not significantly associated with SM or partner marital satisfaction.

Romantic Conflict Narratives in Emerging Adult Couples: Viewpoint and Gender Matter

Healthy romantic relationships entail understanding the needs of the self and other when interpreting conflict events. Yet how couples make meaning around specific conflicts and their capacity to reflect on their own and their partners' unmet needs is understudied. Using narratives, we examined destructive (e.g., extreme anger and break-up anxiety) and constructive (e.g., perspective taking) interpretations of past romantic conflicts in 80 emerging adult heterosexual couples and the extent to which such interpretations varied by viewpoint and gender. Couple members were interviewed separately about two conflict episodes in which their partner did not meet their needs (victim viewpoint) and two episodes in which they did not meet their partners' needs (perpetrator viewpoint). As anticipated, destructive interpretations were more evident in the victim viewpoint and for female couple members. In contrast, within constructive interpretations, the use of insight was greater in the perpetrator than the victim viewpoint. Although perspective taking was expected to be more common in the perpetrator viewpoint and in female narratives, this was not the case, as this type of constructive interpretation was infrequent in narratives about conflict. The findings revealed aspects of meaning making that might be useful to mental health professionals concerned with building skills to improve romantic competence in emerging adult couples.

The Association between Symptom Accommodation and Emotional Coregulation in Couples with Binge Eating Disorder

Intense negative emotions and maladaptive behavioral strategies to reduce emotional distress occur not only in patients with various forms of psychopathology but also in their committed partners. One common strategy to reduce distress is for partners to accommodate to the symptoms of the disorder, which reduces distress short term but maintains symptoms long term. Accommodation is believed to be motivated by the partner reacting behaviorally to the patient's emotions, but the emotions of the partner in this context have yet to be examined. This pilot study examined how partner accommodation related to specific patterns of emotional coregulation between patients with binge eating disorder (BED) and their partners, before and after a couple-based intervention for BED. Vocally encoded emotional arousal was measured during couples' (n = 11) conversations about BED. As predicted, partners' emotional reactivity to patients' emotional arousal was associated with high accommodation before treatment. Thus, partners may use accommodation as a strategy to reduce both the patients' and their own distress. After treatment, partners' arousal was no longer associated with the patients' emotional arousal; instead, partners showed greater emotional stability over time, specifically when accommodation was low. Additionally, patients were less emotionally aroused after treatment. Therefore, treatment may have decreased overall emotionality of patients and altered the association between accommodation and partners' emotional reactivity. If replicated, this understanding of the emotional context associated with accommodation in BED can inform couple-based treatment by targeting specific emotional precipitants of behaviors that maintain symptoms.

Sexual Passion in Committed Relationships: Measurement and Conceptual Issues

The purpose of this study is to discuss the need for a new triadic model of sexual passion in relationships and to present the preliminary psychometric properties of a scale designed to measure these three approaches to passion (harmonious, obsessive, and inhibited) for use in clinical and scholarly work. Existing theory and measures of general passion are based on a dualistic model of passion that includes the harmonious and obsessive approaches to passion. We added the inhibited approach to passion from the sexuality research and develop measures for assessing sexual passion in relationships. We utilized an Amazon Mechanical Turk sample of 1,421 individuals in committed relationships to test this measure. Reliability analyses and confirmatory factory analyses evinced that these three approaches to sexual passion were unique constructs and distinct from sexual satisfaction. Sexual passion showed predictive validity above and beyond relationship length, sexual desire toward a partner, and a broader variable of sexual drive. Harmonious sexual passion robustly predicted higher sexual satisfaction and relationship satisfaction, and inhibited sexual passion moderately predicted lower sexual satisfaction and relationship satisfaction. Obsessive sexual passion had minimal associations with either outcome. These new constructs, especially harmonious and inhibited sexual passion, may help scholars and practitioners improve their understanding of sexual satisfaction and overall relationship satisfaction.

When the "U" is not Inverted: Trajectories of Expressed Emotional Arousal Predict Relationship Satisfaction

Maladaptive emotional reactivity and dysfunctional communication during couple conflict are both destructive to couple functioning, and observational research has elucidated how conflict escalates. However, much of the evidence is based on measures that combine content (i.e., what was said) and the emotion with which it was said, which are then examined using sequential analyses. Despite the general presumptions about underlying emotional reactivity and escalation in negative emotions as part of relationship distress and deterioration, little empirical data are available that directly examine these continuous shifts in emotions. The current study examined concurrent and longitudinal associations between relationship satisfaction and trajectories of change in vocally expressed emotional arousal during couple conflict in 62 couples who participated in a relationship education program. Contrary to expectations and patterns found in distressed couples, trajectories followed a U-shape rather than an inverted U-shape curve, with steeper and more persistent decreases in emotional arousal predicting more stable relationship satisfaction over time. In addition, there were within-couple effects. These results suggest that early signs for relationship deterioration may be less in the form of overt escalation as would be seen in distressed couples. Instead, couples who subsequently deteriorate more are less effective in calming emotional arousal. They also are less able to remain at lower emotional arousal. It is possible that the more pronounced escalation toward the end of the conversation in more at-risk couples is a precursor of the greater escalation patterns seen in distressed couples; this should be examined empirically. Limitations and implications are discussed.

Depressive Symptoms, Criticism, and Counter-Criticism in Marital Interactions

Although people with depressive symptoms face criticism, hostility, and rejection in their close relationships, we do not know how they respond. Following interpersonal theories of depression, it might be expected that depressive symptoms would be associated with a tendency to receive and also to express criticism toward one's spouse, and that at least some of this criticism would be a contingent response to criticism received (i.e., "counter-criticism"). However, other research has determined that depressive symptoms/behaviors suppress partner criticism, suggesting that depressed people might respond to partner criticism similarly, by subsequently expressing less criticism. In a sample of 112 married couples, partial correlations, regressions, and Actor-Partner Interdependence Modeling indicated that lower criticism and counter-criticism expression during a laboratory marital interaction task was associated with higher depressive symptoms, especially when such individuals were clinically depressed. Furthermore, during a separate and private Five-Minute Speech Sample, lower criticism by partners was associated with higher depressive symptoms, especially when those who chose the interaction topic were also clinically depressed. All analyses controlled for relationship adjustment. These results suggest that spouses with higher depressive symptoms and clinical depression diagnoses may be suppressing otherwise ordinary criticism expression toward their nondepressed partners; furthermore, nondepressed partners of depressed people are especially likely to display less criticism toward their spouse in a private task.

Out Drinking the Joneses: Neighborhood Factors Moderating the Effects of Drinking on Relationship Quality over the First Four Years of Marriage

Neighborhood quality has been cross-sectionally linked to both relationship behaviors and relationship well-being. Consistent with the Vulnerability Stress-Adaptation model of relationship functioning (Karney & Bradbury, 1995), we hypothesized that associations between social behaviors (e.g., drinking) and relationship quality could be moderated by neighborhood factors. Specifically, we characterized neighborhoods along multiple dimensions using multiple methods (self-report, census) to investigate how neighborhood factors might clarify ambiguous effects of alcohol use on marital functioning. A nationally recruited sample of 303 newlywed couples completed a baseline assessment around the time of marriage and was then assessed yearly across the first 4 years of marriage (94% retention). Three level HLM slope-intercept models were used to model changes in relationship satisfaction across the first 4 years of marriage. Results suggested that, for couples living in highly disordered neighborhoods, positive shifts in overall levels of drinking within specific waves of assessment were associated with corresponding negative shifts in satisfaction whereas in neighborhoods without perceived disorder, this effect was reversed. For couples living in neighborhoods with low levels of domestic structures (high census rates of single renters without children), within-couple discrepancies favoring higher rates of husband drinking in specific waves predicted poorer relationship quality for both partners in those same waves whereas those same discrepancies predicted higher satisfaction in high domesticity neighborhoods (high census rates of married homeowners with children). The findings provide insight into the different roles of alcohol use in relationship maintenance and highlight the importance of using external context to understand intradyadic processes.

Testing a Military Family Stress Model

The current study examines a military family stress model, evaluating associations between deployment-related stressors (i.e., deployment length/number, posttraumatic stress disorder [PTSD] symptoms) and parent, child, parenting, and dyadic adjustment among families in which a parent had previously deployed to Iraq or Afghanistan in the recent conflicts. Married families (N = 293) with at least one child between the ages of 4 and 12 were recruited from a Midwestern state. Service members were from the Reserve Component (National Guard or Reserves); fathers (N = 253) and/or mothers had deployed (N = 45) to the recent conflicts in the Middle East. Multiple-method (observations of parenting and couple interactions; questionnaires) and multiple informant measures were gathered online and in the homes of participants, from parents, children, and teachers. Findings demonstrated associations between mothers' and fathers' PTSD symptoms and a latent variable of child adjustment comprising teacher, parent, and child report. Mothers' but not fathers' PTSD symptoms were also associated with dyadic adjustment and parenting practices; parenting practices were in turn associated with child adjustment. The results are discussed in terms of their implications for military family stress research and interventions to support and strengthen parents and families after deployment.

Trauma Symptoms, Communication, and Relationship Satisfaction in Military Couples

Trauma symptoms are negatively correlated with couple relationship satisfaction, which is of particular importance in the relationships of military personnel who are often exposed to trauma whilst on overseas deployment. This study tested a model in which communication mediated an association between trauma symptoms and low relationship satisfaction. Thirty-one Australian military couples were observationally assessed during a communication task, and assessed on their relationship satisfaction and individual functioning. As expected, trauma symptoms in the male military spouse were associated with low satisfaction in both spouses. Females' low positive communication fully mediated the relationship between males' trauma symptoms and low female satisfaction, but not male relationship satisfaction. Unexpectedly, males' negative communication behaviors were associated with high male relationship satisfaction, and partially mediated the association between trauma symptoms and male satisfaction. Discussion focused on how some communication usually thought of as negative might be associated with relationship satisfaction in military couples.

Relationship Quality with Parents: Implications for Own and Partner Well-Being in Middle-Aged Couples

Relationships with parents have significant implications for well-being throughout the lifespan. At midlife, these ties are situated within both developmental and family contexts that often involve the adult offspring's spouse. Yet, it is not known how ties with aging parents are related to psychological well-being within middle-aged couples. This study examined how middle-aged wives' and husbands' views of the current quality of relationships with their own parents (positive and negative) are linked to their own and their partner's psychological well-being. Using a sample of 132 middle-aged couples from Wave 1 of the Family Exchanges Study, we estimated actor-partner interdependence models to evaluate these dyadic associations while controlling for each spouse's marital satisfaction. Both actor and partner effects were observed. With respect to actor effects, wives who reported more negative relationship quality with their own parents had elevated depressive symptoms and lower life satisfaction. Husbands who reported more negative relationship quality with their own parents had lower life satisfaction. In terms of partner effects, husbands had lower depressive symptoms and greater life satisfaction when wives reported more positive relationship quality with their own parents. Finally, the link between wives' positive ties with parents and husbands' lower depressive symptoms was intensified when husbands had less positive relationships with their own parents. Findings suggest that relationship quality with wives' aging parents has implications for both spouses' well-being and may serve as a critical social resource for husbands.

Deployment-Related Benefit Finding and Postdeployment Marital Satisfaction in Military Couples

Extensive research has evaluated potential negative effects of military deployments on romantic relationships. Comparatively few studies have examined potential positive effects of such deployments. In stressful situations, benefit finding (BF) has been found to be linked with better functioning on both individual and interpersonal levels. This study reports on deployment-related BF in a sample of 67 male service members (SMs) who deployed at least once since 9/11/2001 and their wives. Couples completed measures of marital satisfaction at baseline (an average of 1 year postdeployment) and follow-up 4-6 months later. At follow-up, SMs also provided data on symptoms of posttraumatic stress, and both partners provided reports of deployment-related BF. Multivariate path analysis controlling for SMs' PTSD symptom severity revealed that wives' BF was positively associated with increases in SMs' relationship satisfaction. These findings suggest that wives' responses to deployment may be more influential than SMs' responses to deployment on military couples' relationships. This pattern indicates that support for spouses during deployments is essential; furthermore, such support should include an emphasis on trying to facilitate personal growth in spouses.

Relationship Education for Military Couples: Recommendations for Best Practice

Military couples have a number of distinctive strengths and challenges that are likely to influence their relationship adjustment. Military couples' strengths include stable employment, financial security, and subsidized health and counseling services. At the same time, military couples often experience long periods of separation and associated difficulties with emotional disconnect, trauma symptoms, and reintegrating the family. This paper describes best practice recommendations for working with military couples, including: addressing the distinctive challenges of the military lifestyle, ensuring program delivery is seen as relevant by military couples, and providing relationship education in formats that enhance the accessibility of programs.

Informative Disagreements: Associations Between Relationship Distress, Depression, and Discrepancy in Interpersonal Perception Within Couples

This study evaluated the associations between relationship distress, depression symptoms, and discrepancy in interpersonal perception within couples. After completing a series of discussion tasks, couples (N = 88) rated their behavior using the circumplex-based Structural Analysis of Social Behavior Model (SASB; Benjamin, 1979, 1987, 2000). Overall, couple members were strikingly similar in their interpersonal perceptions, and tended to see themselves as friendly, reciprocal in their focus, and balanced between connection and separateness. As hypothesized, however, perceptual discrepancy was related to relationship distress and depression. Relationship distress was associated with discrepancy regarding transitive behavior focused on the partner, while depression was associated with disagreement about intransitive, self-focused behavior. Analysis of affiliation and autonomy revealed that relationship distress was associated with seeing oneself as reacting with more hostility than the partner sees, and perceiving one's partner as more hostile, more controlling, and less submissive than he or she does. Partners of depressed individuals viewed themselves as more controlling than their mate did. Men's depression was associated with disagreement between partners regarding men's self-focused behavior. Results underscore the importance of considering interpersonal perception when conceptualizing relationship distress and depression within intimate relationships.

Worried About us: Evaluating an Intervention for Relationship-Based Anxiety

Although romantic relationships are commonly a source of pleasure and comfort, for some individuals they can be a source of persistent anxiety. The aim of the current investigation was to explore the construct of relationship-based anxiety and to evaluate the effectiveness of a brief couple-based psychoeducational session for this issue. Common behavioral patterns and cognitive tendencies seen among individuals with relationship-based anxiety were examined, including excessive reassurance-seeking, self-silencing, and partner accommodation. In the current investigation, a single psychoeducational session was developed to address these maladaptive interactive patterns of behavior specifically. The session was administered to a sample of 21 couples and was found to decrease levels of reassurance-seeking and self-silencing significantly among individuals with relationship anxiety, and to decrease levels of maladaptive accommodation behaviors significantly in their partners.

Proxemics in Couple Interactions: Rekindling an Old Optic

Utilizing as a lens the interpersonal implications of physical interpersonal distances in social contexts (a set of variables present during the professional discourse during the 1960s and 1970s, to then fade away), this article explores interactive process displayed by the protagonic couple in Bela Bartok's opera "Bluebeard Castle," an exercise aimed at underlining the value of maintaining proxemics as an explicit level of observation for clinical practice and interpersonal research.

More than One Way to Get There: Pathways of Change in Coparenting Conflict after a Preventive Intervention

This study explored pathways of change in the levels of conflict couples experienced after Supporting Father Involvement, an evidence-based, prevention-oriented couples and parenting intervention that included a diverse low-income and working class group of participants. Pathways of change were examined for couples with baseline conflict scores that were initially low, medium, and high. The growth mixture model analysis found that the best-fitting model for change in couples' conflict was represented by three distinctly different change patterns. The intervention was most successful for High-Conflict couples. This finding contributes to a growing literature examining variations in how relationships change over time and the process of change, especially for couples in distress. This study supports further investigation into the impact and costs associated with universal interventions versus those that target specific groups of higher risk families.

If We Build It, They Will Come: Exploring Policy and Practice Implications of Public Support for Couple and Relationship Education for Lower Income and Relationally Distressed Couples

Over the past decade, public funding for Couple and Relationship Education programs has expanded. As program administrators have been able to extend their reach to low-income individuals and couples using this support, it has become apparent that greater numbers of relationally distressed couples are attending classes than previously anticipated. Because psychoeducational programs for couples have traditionally served less distressed couples, this dynamic highlights the need to examine the policy and practice implications of more distressed couples accessing these services. This paper reviews some of the most immediate issues, including screening for domestic violence and couple needs, pedagogical considerations, and the potential integration of therapy and education services. We also make suggestions for future research that can inform policy and practice efforts.

The Effectiveness of the Within Our Reach Relationship Education Program for Couples: Findings from a Federal Randomized Trial

This study examined the effectiveness of a couple-based relationship education program, Within Our Reach. Secondary data (n = 3,609) were analyzed from the federal Supporting Healthy Marriage project. Couples were randomly assigned to receive Within Our Reach and associated services or to a no-treatment (treatment-as-usual) control group. Those assigned to Within Our Reach reported better couple and individual outcomes on 8 of 12 outcomes measured (M ES = .15) at the 12-month follow-up and 6 of 10 outcomes measured at the 30-month follow-up (M ES = .14), including higher relationship happiness, more warmth and support, more positive communication, less negative behavior and emotion, less psychological abuse, less physical assault (for men), lower psychological distress (for women), and less infidelity. They were also less likely to report that their marriage was in trouble. These effects were generally small in size and many were replicated across the two follow-ups. There were no significant differences between those assigned to Within Our Reach versus control on cooperative parenting, severe psychological assault, or percent married. Implications for future research, programming, and policy are discussed.

Couples Relationship Education and Couples Therapy: Healthy Marriage or Strange Bedfellows?

This paper focuses on issues sparked by the Couples Relationship Education (CRE) field moving toward a more clinical model to meet the needs of an increasing number of distressed couples coming to CRE programs. We review the concerns raised and recommendations made by Bradford, Hawkins, and Acker (2015), most of which push CRE toward a more clinical model. We address these recommendations and make suggestions for best practices that preserve the prevention/education model underlying research-based CRE. The three main issues are couple screening, leader training, and service delivery models. Our suggested best practices include: conducting minimal screening including the assessment of dangerous levels of couple violence, training leaders with key skills to handle issues raised by distressed couples as well as other couples who may place additional burdens on leaders, providing referrals and choices of programs available to participants at intake and throughout the CRE program, and adding (rather than integrating) clinical services to CRE services for couples who desire additional intervention. Finally, throughout the paper, we review other key issues in the CRE field and make recommendations made for future research and practice.

Is committed desire intentional? A qualitative exploration of sexual desire and differentiation of self in couples

The question of what heightens or diminishes sexual desire has long been a passionate theme across cultures in literature, arts, media, and medicine. Yet, little research has been conducted to determine what affects level of desire within couples. The degree of differentiation of self has been suggested as an important variable in shaping partners' level of desire. Through a qualitative analysis of dyadic couple interviews, this study provides an account of characteristics, processes, and trajectories of sexual desire and differentiation in 33 heterosexual couples of varying ages and relationship duration. Factors associated with high desire were change and autonomy, whereas conflict and children were reported to be desire-diminishing factors. Innovation, sharing, autonomy, and effort emerged as desire-promoting strategies, while fostering personal interests, investing in a positive connection, and enhancing personal integrity were identified as couples' strategies to promote and preserve differentiation of self. The results also shed light on couples' perceptions of whether and how sexual desire changes over the course of the relationship and challenge common cultural assumptions about desire in committed relationships-namely the myth that the only authentic expression of desire is that which occurs spontaneously and without intention and planning. Implications for couple therapy are discussed.

Gender and the construction of intimacy among committed couples with children

This study began with curiosity regarding how long-term couples with children manage their relationships in view of changing societal demands and ideals. Couples interviewed for this study described the intersection of time and intimacy as a core issue. Thus, this analysis focused on how couples construct intimacy in shared time. The diverse sample included 17 heterosexual working and professional class couples in the United States who had been committed for at least 10 years and whose oldest child was aged 6-16. Analysis identified four types of shared time experiences: gender divided, elusive, growing, and emotionally connected. Four factors influenced these types: (a) negotiated gendered differences, (b) intentionality, (c) mutual attending, and (d) dyadic friendship. The most emotionally connected couples reported that time together reinforced satisfaction and pleasure from their relationships. Results help explain different ways couples successfully negotiate changing expectations for heterosexual relationships and why some couples struggle. Findings suggest that therapists help couples intentionally develop habits of friendship and mutual attending.

Location, location, location: applying spatial statistics to the relationship landscape

The desire to understand relationships is a passion shared by professionals in research, clinical, and educational settings. Questionnaires are frequently used in each of these settings for a multitude of purposes-such as screening, assessment, program evaluation, or establishing therapeutic effectiveness. However, clinical issues arise when a couple's answers on questionnaires do not match clinical judgment or lack clinical utility, while statistical problems arise when data from both partners are put into analyses. This article introduces the use of geospatial statistics to analyze couple data plotted on a two-dimensional "relational map." Relationship maps can increase assessment sensitivity, track treatment progress, and remove statistical issues typically associated with couple data. This article briefly introduces core assumptions of spatial models, illustrates the use of spatial models in creating a relational landscape of divorce, offers suggestions for the use of relational maps in a clinical setting, and explores future research ideas.

An actor-partner interdependence analysis of associations between affect and parenting behavior among couples

Prior studies evaluating associations between parental affect and parenting behavior have typically focused on either mothers or fathers despite evidence suggesting that affect and parenting behavior may be interdependent among couples. This study addressed this gap in the literature by evaluating associations between self-reported affect and parenting behavior using an actor-partner interdependence analysis among a sample of 53 mother-father dyads of 3- to 5-year-old children. Results suggested that mothers' and fathers' negative affect, as well as mothers' and fathers' positive affect, were positively associated. Both mothers' and fathers' negative affect were negatively associated with fathers' positive affect. Mothers' and fathers' harsh/negative parenting behavior, and supportive/engaged parenting behavior, were positively associated. Furthermore, mothers' negative affect was positively associated with mothers' and fathers' harsh/negative parenting behavior while mothers' positive affect was negatively associated with mothers' harsh/negative behavior and positively associated with mothers' supportive/engaged behavior. Fathers' negative affect was positively associated with fathers' supportive/engaged parenting behavior, while fathers' positive affect was positively associated with mothers' and fathers' supportive/engaged behavior. Results highlight the importance of conceptualizing and measuring characteristics of both mothers and fathers, if applicable, when researching the dynamics of interpersonal relationships within families.

The partners for life program: a couples approach to cardiac risk reduction

Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses. What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness. Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise, nutrition, and medication adherence. Ninety-three patients and their spouses/partners consented to participate (26% of those eligible) and were randomized into either the individual or couples condition. However, only 80 couples, distributed across conditions, contributed data to the analyses, due to missing data and missing data points. For exercise, there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time. In addition, there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment, while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment. In terms of medication adherence, patients in the couples treatment exhibited virtually no change in medication adherence over time, while patients in the individuals treatment showed a 9% relative decrease across time. There were no condition or time effects for nutritional outcomes. Finally, there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction, while non satisfied patients in the couples treatment showed improvement over time.