Relationship distress and divorce often have profound effects on couples and their children. Relationship science has long sought to prevent and alleviate relationship distress; this chapter is a summary of many important recent developments in the field. Ongoing challenges in studying and assisting intimate relationships are also discussed

Lawrence, Erika E.

Sullivan, Kieran T.

English

Scholar Commons - Santa Clara University

Santa Clara UniversityScholar CommonsPsychology College of Arts & Sciences8-12-2016Relationship science and interventions: Where weare and where we are goingKieran T. SullivanSanta Clara University, ksullivan@scu.eduErika E. LawrenceFollow this and additional works at: http://scholarcommons.scu.edu/psychPart of the Clinical Psychology Commons, Counseling Commons, Counseling PsychologyCommons, Marriage and Family Therapy and Counseling Commons, and the Psychiatry CommonsView the book in our Faculty Book Gallery.This Book Chapter is brought to you for free and open access by the College of Arts & Sciences at Scholar Commons. It has been accepted for inclusionin Psychology by an authorized administrator of Scholar Commons. For more information, please contact rscroggin@scu.edu.Recommended CitationSullivan, K.T. & Lawrence, E.E. (2016). Relationship science and interventions: Where we are and where we are going. In K.T. Sullivanand E.E. Lawrence (Eds) The Oxford Handbook of Relationship Science and Couple Interventions. Oxford Press.CHAPTER 18 Relationship Science and Couple Interventions: Where We Are and Where We Are Going Kieran T. Sullivan and Erika Lawrence Abstract Relationship distress and divorce often have profound effects on couples and their children. Relationship science has long sought to prevent and alleviate relationship distress; this chapter is a summary of many important recent developments in the field. Ongoing challenges in studying and assisting intimate relationships are also discussed. Key Words: long-term relationship, intimate relationship, couple intervention, marriage, relationship distress, divorce, distressed marriage, marital distress The purpose of this book is to describe and inre-grate cutting edge research in the basic and applied study of relationship development, maintenance, and dysfunction. We hope you, the reader, will gain a sense of the critical importance of srudying rela-tionship functioning, the current state of the field of relationship science, and what top research sci-entists view as the crucial next steps to understand-ing intimate relationships in all their complexity in order to effectively assist couples who experience distress and dysfunction. In this final chapter, we summarize the key developments and future chal-lenges for relationship scientists and practitioners described in this book. Summary of Key Developments in Couple Research and Interventions Defining and Classifying Couple Dysfunction Perhaps the most fundamental contribution for scientists and practitioners has been the develop-ment of reliable and precise standard definitions of key relational processes to guide assessment, diag-nosis, and research, which have taken place in the context of the recent DSM and !CD revisions. 'l11e increased focus of these classifications systems on relational processes and efforts to base the descrip-tion of such processes on empirical evidence mark a substantial move forward for the field. Experts call for continued improvement, particularly in devel-oping greater precision in the conceptualization of relational processes, which will facilitate meaning-ful inquiry into rhe causes of couple dysfunction, encourage innovation in applied research, and result in better empirical data on which to base policy decisions (Beach et al., Chapter 2). A focus on the dissemination of current definitions and assessment instruments and related training across counrries and settings is also needed to maximize the poten-tial of the new, more precise definitions (Foran et al., Chapter 3). Causes and Con·elates of Couple Dysfunction Perhaps the most innovative and leading edge of recent relationship research is the integration of genetics and epigenetics. Al1 emerging body of work provides compelling evidence that understanding molecular generics and epigenetic processes that affect gene expression and activity is essential for understanding relationship functioning and out-comes. Furthermore, examining the interactions 259 among genetics, epigenetics, and key family pro-cesses will assist in t he development of more precise models that will better capture the transac-tio nal processes between family and genetic faccors (Beach, Brody, & Kogan, Chapter 4) and how these processes affect individual health and well-being. Recent rapid improvements in the technology for genotyping has spurred on research in this area and the continued development of such technology, and associated reduced costs, is expected co encourage the inclusion of genetic and epigenetic variables in couple and family research. Several o ther key areas of research into couple dysfunction that are described in this book are the associations between physical and mental health and relationships, the connections between sex-ual and relationship functioning, and the effects of parmer aggression and infidelity. Decades of resea rch on health and couple functioning have provided abundant evidence of the strong link between physical health and rela tionship satisfac-tion . Recent research has elucidated the complex-ity of the relations between physical health and relationship processes, which is best conceptual-ized as a reciprocal, longitudinal feedback loop, wherein relationship factors influence health processes and health issues influence relation-ship processes. Longitudinal designs that include multiple assessments of couple functioning-from prediagnosis th rough recovery- are needed in o rder ro understand the complexity of the relatio nship between health and relationship funct ioning (Piecqnski et al. , C hapter 5). Such research will help practi tioners maximize the effectiveness of interventions before, during, and after illness, and to attenuate couple expectations regarding relationship functioning throughout this process. Research on relationship factors and men tal health has examined the complexity of associa-rions between psychopathology and relationship functioning by controlling for third variables (e.g., personali ty variables) and employing twin studies to test whether genetic and/or shared environment selection effects can account for these associations. Research in this field has also expanded to include mental disorders that have not been examined pre-viously (e.g., binge eating disorder), and to iden-tify speci fic aspects of relationship functioning that contribute to the development and mainte-nance of psychopathology, such as expressed emo-tion and perceived criticism . Future research is needed to explore interactions between o ther risk factors for mental illnesses and relationship pro-cesses (Whisman & Robustelli, Chapter 6). Research on the associarion between sexual functioning and relationship functioning remains limited. Basic research on sexual functioning and relationships is scarce and there are currently no randomized clinical trials of sex therapy, in part due ro the medicalization of sexual dysfunction. C linical researchers have argued for a psychobioso-cial approach to treatment and cognitive-behavioral therapy for sexual dysfunction has been developed and implemented in recent years. McCarthy and Wald (Chapter 7) call for an empirical study of models of sexual functioning and its association with relationships functioning, as well as efficacy trials for sex therapy. Regarding partner aggression, recent research has highlighted the importance of psychological aggres-sion and its relationship co physical aggression. fndeed, evidence from treatment research indicates that reducing psychological aggression is the key to reducing physical aggression. There are a number of treatments that have been shown to reduce partner aggression, such as behavioral couple therapy, treat-ment for substance dependence, and couple therapy designed to specifically treat partner aggression, as well as individual services for men and women fol-lowed by dyadic interventions. Ir remains critical for practitioners to identify couples who can ben-efit from dyadic interventions, particularly because there is litrle evidence that mandated individual services for males arc effective (Salis & O 'Leary, C hapter 8). Recent research o n infidelity indicates that atti-tudes about infidelity, marital satisfaction, and sexual satisfaction are important predictors of engaging in infidelity. These findings have important treatment implications and suggest optimal targets when help-ing couples understand why the extramarital infi-delity occurred and helping couples prevent fu ture occurrences. The good news regarding treatment is that though it is difficult, there is evidence that sug-gests that it can be successful; empirically validated treatment approaches include the forgiveness-based approach developed by Gordon and colleagues (H owell, G ilberr, & Gordon, C hapter 9), behav-ioral couple therapy, integrarive behavioral couple therapy, and emotionally focused couple therapy (see also C hapter 13). Assessment, D esign, and Data Analysis A series of recommendations for best prac-tices in the assessment of couple distress have been 260 I RE LAT I ONS HIP SC I ENCE AND COU P LE I NTE RV ENT I ONS developed based on empirical findings regarding couple distress (Balderrama-Durbin, Fisserte, & Snyder, Chapter 1 0). Key elements of optimal assess-ment include an initial screening of couple and indi-vidual functioning, a tailored in-depth assessmen t based on the couple and the psychometric charac-teristics of each assessment technique, and assessing communication, aggression, substance use, affective disorders, and emotional or physical involvement with someone other than the relationship partner. Multiple assessment methods (e.g., self-reports and partner reports, interviews, behavioral observations) should be used whenever possible and the assess-ment of couple distress should be ongoing. The ubiquity and ongoing rapid development of information technology have dramatically improved our ability to design and analyze research on couple dysfunction. Relationship researchers are now eval-uating and improving measurements using Item Response Theory (e.g.,' relationship satisfaction, Funk, Rogge, & Ronald, 2007). There are many new options for collecting data in more naturalistic settings, such as the use of mobile devices to assess in-the-moment behaviors, feel ings, and thoughts, direct observation outside the laboratory using voice- and video-streaming (e.g., Skype), and pas-sive monitoring for collecting naturalistic behavior samples that requires little or no effort on the part of participants. Automated coding programs based on acoustic speech features and video are being devel-oped and show great promise for coding behavior in a fraction of the rime it currently takes. Finally, new statistical techniques, such as multilevel model-ing and actor-partner interdependence models, are allowing researchers to analyze the ongoing mutual influence of intimate partners (Atkins & Baucom, Chapter 11). Treating Couple Dysfunction and Distress There are a n umber of empirically validated approaches to treating (Benson & Christensen, Chapter 13) and preven ting couple distress (H alford, Perch , & Bate, Chapter 1 4) that have the potential to increase the effectiveness of couple interventions. Two challenges, however, limit actualizing their potencial in clinical settings. The first is the lack of research on treating diverse couples (e.g., people of color, gay and lesbian couples). Adcfitional research that focuses on whether empirically supported t reatments (ESTs) are effective for couples from diverse cultural backgrounds and whether cultural adaptations of ESTs do, in fact, improve outcomes for diverse groups is sorely needed (Sevier, Brew, & Yi, Chapter 16). When working with stigmatized or marginalized groups, such as lesbian, gay, bisexual, and transgender (LGBT ) couples, couples with low socioeconomic status (SES), or couples who belong to a disadvantaged minority group, it is critical to address the unique challenges faced by these couples (Mitchell, Chapter 1 7). Another challenge to actualizing the promise of ESTs is dissemination to practitioners. The APA, among other organizations, is attempting to meet th is challenge by developing specific processes for establishing treatment guidelines based on empiri-cal findings and clinical experiences (Sexton & LaFollette, Chapter 12). There are also exciting new approaches to intervening with couples, such as the Marriage Checkup and web-based programs such as Power of Two and Our Relationship, that show promise for improving our efforts to prevent and treat couple distress (Fleming & Cordova, Chapter 15). Suggestions for Moving the Field Forward Our first recommendation for the field is to actu-alize the promise of empil'icalo/ sttppol'ted tl'eatments. Researchers have already taken steps to address the challenge of dissemination of efficacious interven-tions. An excellent model is the training ofVeteran's Administration therapists to implement Integrative Behavioral Couple Therapy (IBCT) to assist veter-ans who are suffering from posttraumatic stress d is-order (PTSD ). Evidence indicates that IBCT is an effective treatment for PTSD, especially for those suffering from comorbid couple distress (Monson, Macdonald, Fredman, Schumm, & Taft, 2014). This is a great example of how researchers and gov-ernment can work together to get interventions out and assess their effectiveness in community settings. Our second recommendation is to expand the sys-tem for specialization in couple and fomio/ psychology. Couple distress is the most common complaint of those who seek therapy, bur most couples do not receive empirically supported treatments and/or do not work with a trained couple therapist. Ineffective couple therapy is costly for those who receive it and contribute to the myth that couple therapy is largely ineffective. Stanton and Welsh's (2011) seminal text on Specialty Competencies in Couple and Famio/ Psychology "provides a comprehensive explanation of the competencies involved in the specialty and illustrates how complexity, reciprocity, interdepen-dence, adaptation, and self-organization are impor-tant aspects of rhe epistemology of a couples and family approach." Indeed, the American Board SULLiVAN, LAWRENCE 261 of Couple and Family Psychology, which admin-isters the examinations that allow professionals to become Board Certified as Couple and Family Psychologists, evaluates individuals based on this set of competencies. These certification processes and established, operationalized competencies are the key to determining which professionals are truly qualified to provide couple or family therapy and will allow potential clients to make better informed decisions about where to seek couple therapy. Third, we call for efforts to clearly establish the cost effectiveness of couple interventions. Government research and funding emphasize the need for cost-effective interventions; thus there has been great interest in funding for the prevention of marital distress through implementation of empirically sup-ported premarital education programs. Mal<ing the cost effectiveness of couple therapy clear (e.g., sav-ing the costs of distress-related depression and anxi-ery, improving child outcomes, and reducing missed days of work) would help to fund and implement tertiary interventions. Finally, we encourage training programs to more folly integrate couple and family psychology into clini-cal and cou.nseling psychology training. Couple and family psychology encompasses a broad orienta-tion to human behavior that occurs in the context of relationships as well as larger macrosystemic dynamics (Stanton & Welsh, 2011). Research clearly demonstrates that the couple and family context is bidirectionally related to individual adult and child well-being. Assessing the effectiveness of integrated care, for example, relationship and health outcomes when family interventions are merged with primary health care, or when interventions for physical aggression are merged with public health efforts, is critical for optimizing outcomes and minimizing cost. References Funk, j. L., Rogge, & Ronald D. (2007). Testing the ruler with item response theory: Increasing precision of measuremenc for relationship satisfaction with the Couples Satisfaction Index. journal of Family Psychology, 21, 572- 583. Monson, C. M., Macdonald, A., Fredman, S. J ., Schumm, J. A., & Tafr, C. (2014) . Empirically supported couple and family therapies for PTSD. In M. J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice (2nd ed., pp. 451-465). New York, NY: Guilford Press. Stancon, M., & Welsh, R. (2011). Specialty competencies in couple and fomily psychology. New York, NY: Oxford Universiry Press. RELATI ONSH I P SCIENCE AND COUP LE INTERVENTIONS 

Relationship science and interventions: Where we are and where we are going

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Relationship science and interventions: Where we are and where we are going

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