Psychosocial distress can exacerbate marital conflict, maladjustment, and mental health vulnerability. This pilot randomized clinical trial examined cognitive-behavioral couple therapy (CBCT) integrated with mindfulness in low-income Brazilian couples (per-capita household income up to one minimum wage). Thirty-four participants (17 heterosexual couples) were randomized (independent computer-generated sequence) to an experimental (n = 16) or waitlist control group (n = 18). We assessed dyadic adjustment, mindful attention, marital social skills, and depressive symptoms (R-DAS, MAAS, IHSC, BDI-II) at baseline, post-treatment, and 3-month follow-up. The intervention was eight 80-min conjoint sessions plus daily home exercises. Time × group effects favored the experimental group for dyadic adjustment, mindful attention, and depressive symptoms (all p < 0.001, η p 2 = 0.20-0.37), but not marital social skills (p = 0.14). Because two outcomes differed at baseline, effects were confirmed with baseline- and dependence-adjusted sensitivity analyses. These findings provide preliminary evidence that CBCT with mindfulness may benefit disadvantaged couples.
Large language model agents such as ChatGPT are increasingly used for relationship advice and mental health support, with many users describing these interactions as therapeutic. This study assessed the clinical and cultural competence of a GPT-based model trained to provide systemic interventions aligned with the AAMFT Code of Ethics and core skills. A volunteer client discussed a relational concern with the model, and the resulting transcript was evaluated by 12 experienced supervisors using standardized measures. Supervisors, unaware of the study's purpose and the therapist being an AI, rated the model as moderately competent in maintaining a systemic perspective and delivering systemic interventions. Supervisors identified weaknesses in pacing, joining, and attending to cultural and contextual factors, and inferred that the therapist resembled an early-career clinician with less than 500 h of experience. Findings indicate limitations of AI therapy and underscore the value of human judgment, attunement, and intuition in clinical practice.
This study investigates "mixed-agenda" couples characterized by significant discrepancies in commitment and therapy goals, using both clinical and non-clinical data sets. While theoretical frameworks suggest these couples present unique challenges for treatment planning and therapy outcomes, empirical data on their prevalence have remained limited. We analyzed data from the National Couples' Health and Time Study (NCHAT) and the Marriage and Family Therapy Practice Research Network (MFT-PRN) to identify groups of couples that might practically be classified as mixed-agenda couples. Findings reveal that mixed-agenda dynamics are prevalent, occurring in approximately 10% of the non-clinical sample and nearly 40% of the clinical sample. This exceeds prior clinical estimates and confirms that a substantial portion of couples seeking therapy do so with conflicting motivations. These results validate the mixed-agenda construct beyond anecdotal evidence, suggesting a need for tailored clinical interventions that address dyadic ambivalence to improve therapeutic efficacy and relationship stability.
An estimated 600,000 individuals returning home after incarceration each year face significant challenges that constrain their reentry and reintegration into society. A scoping review was conducted on how relational therapy is discussed in the literature on post-incarceration. Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, 19 out of 304 articles met the inclusion criteria for full review. Our findings highlight the limited empirical evidence on relational therapy interventions for post-incarceration. The review also emphasizes that there is a lack of evidence-based therapeutic models or interventions that marriage and family therapists can utilize when working with this population. The paper sheds light on this issue and calls for more research on relational therapy geared towards those post- carceral release in the United States.
This systematic review examined the characteristics, cultural adaptations, and effectiveness of multi-family therapy in studies conducted in the Chinese Mainland, Hong Kong, and Singapore. Eighteen reports from 17 studies were included, covering quantitative, qualitative, and mixed-methods designs. Quantitative findings showed that multi-family therapy was more consistently associated with improvements in individual-level outcomes (e.g., symptom severity, psychological distress, functioning), whereas effects on family-system outcomes were more mixed. Thematic synthesis of qualitative and mixed-methods studies identified four interrelated themes: multi-family therapy creates a non-problem-saturated space for families to come together; engages them in fun activities; fosters inter- and intra-family connection; and supports relational understanding. Overall, individual-level benefits are more readily captured by quantitative measures, while relational and process-level changes may be less well-reflected. Future research should strengthen methodological rigor and extend multi-family therapy to presenting problems, such as eating disorders, to better evaluate its family-system mechanisms and effects.
This systematic review replicated and updated Baucom and colleagues' (1998) evaluation of empirically supported treatments (ESTs) for couple relationship distress using the Chambless criteria, the primary framework used by the American Psychological Association to classify ESTs. Applying these criteria to 40 eligible studies, we found that, in contrast to Baucom and colleagues, no couple therapy models met the standards for strong empirical support; insufficient sample size and lack of independent replication were the most frequent limitations. Seven models demonstrated modest support: behavioral, cognitive-behavioral, emotionally focused, Gottman, integrative behavioral, insight-oriented, and strategic couple therapies. Findings highlight the need for rigorous large-scale studies with more diverse couples to strengthen the empirical foundation and generalizability of couple therapies. Limitations of the Chambless criteria underscore the importance of evaluating couple therapy models with the recently adopted Tolin criteria, which synthesize a broader base of evidence via meta‑analysis and emphasize clinical significance to improve treatment recommendations.
Artificial intelligence (AI) is increasingly used as a source of emotional support, reflection, and perceived companionship. Despite growing public and clinical interest in AI companionship, little research has examined how individuals construct these experiences within broader relational systems. Drawing on systemic, attachment, and social constructionist perspectives, this study examines AI companionship using anonymized data from Psyhelp, an AI-assisted mental health platform. A qualitative-dominant mixed methods design integrated thematic analysis of user narratives with engagement patterns and self-reported emotional indicators. Findings suggest that users primarily experienced AI companionship as a relational supplement characterized by availability, responsiveness, and psychological safety. Four themes emerged: AI as a relational supplement, a transitional emotional regulator, a psychologically safe disclosure space, and a facilitator of human relationships. Findings suggest that AI companionship reflects broader relational needs and has implications for systemic assessment, case conceptualization, and clinical training.
The Person-of-the-Therapist Training approach is a relational framework that supports therapists in intentionally integrating personal experience into clinical work. Despite its growing presence in couple/marriage and family therapy training, no comprehensive synthesis has traced POTT's historical development, empirical foundations, and contemporary relevance. This narrative review employed a structured literature search and thematic synthesis of 30 sources published between 1987 and 2024. Three developmental periods are described: philosophical foundations emphasizing therapist personhood, institutionalized training with emerging qualitative evidence, and recent global, sociocultural, and supervisory expansions. Across three periods, the literature reflects increasing conceptual clarity, pedagogical structure, and attention to ethical and embodied therapeutic presence. Implications include the need for increasing the transportability of POTT, expanding its empirical base, and employing it in diverse supervision contexts. In an era of technological mediation and artificial relationality, POTT clarifies the importance of the embodied, ethical, and human-centered psychotherapy dimensions.
Mindfulness is beneficial for mental health and romantic relationships. Recently, there has been a novel application of mindfulness to romantic relationships called "mindful partnering" (MP). Emerging evidence from interpersonal mindfulness frameworks suggests that relational forms of mindfulness may provide unique benefits for individuals and their relationships beyond those associated with partners' individual intrapersonal mindfulness. However, interpersonal mindfulness in relationships (MP) is multifaceted, and previous examinations of interpersonal mindfulness in couples have been limited by focusing on a small number of isolated features. In the current study, we applied actor-partner interdependence models in two samples (Ns = 168;170) to test how MP (including self-reports and observations) predicts mental and relational health outcomes. Results indicated that greater MP predicts fewer mental health symptoms and greater relationship health. Alongside literature supporting mindfulness as beneficial for couples, these results suggest that MP may be a strong target for couple-focused interventions.
Cumulative childhood trauma (CCT) can lead to long-lasting consequences, such as difficulties in emotion regulation, which, in turn, can affect romantic relationships. While problems with emotion regulation are associated with poorer relationship outcomes, few studies have examined these associations among couples seeking relationship psychotherapy, despite an estimated 80% of individuals in such psychotherapy having experienced CCT. The present study investigated the intermediary role of emotion regulation difficulties in the association between CCT and relationship distress in 199 couples seeking relationship psychotherapy. Path analysis revealed both a direct and an indirect association between one's CCT and one's relationship distress, through difficulties in emotion regulation. This study highlights the need for further investigation into the mechanisms underlying the consequences of CCT on romantic partnerships.
Equality in marriage is an important element of healthy relationships. Religious marriages differ from those of non-religious or religiously ambiguous individuals. How religious couples experience equality in marriage is an understudied process. A grounded theory design was used to understand how Latter-day Saint couples experience marital power sharing. Thirty-one participants (fifteen opposite sex couples and one wife) participated in 46 interviews where they discussed their marital dynamics, especially surrounding their perceived influence of The Church of Jesus Christ of Latter-day Saints and power sharing. Four interrelated processes surfaced from these interviews: interacting influences (one's family of origin, the Church, and culture), self-in-relationship (including one's self-concept, self-awareness, examination of beliefs, and healing and reconciliation), relational processes (including taking relational responsibility, balancing relational influence, attuning to one's partner, and engaging in emotional exposure), and identity formation ("we" vs. "me"). Implications and applications for clinical practice are discussed.
Military couples face unique relational challenges, including deployments, relocations, and extended separations, which can negatively impact relationship well-being. The Adventures in Marriage (AIM) program aims to enhance relationship functioning by focusing on couple interactions through a structured, skills-based curriculum in a time-efficient and accessible format that addresses the challenges faced by military couples. The purpose of the current study was to examine military couples' relationship functioning and relationship deployment readiness after attending the AIM program. A total of 302 different-sex military couples completed pre- and post-program surveys. Using Latent Change Score Modeling (LCSM), the results indicated significant increases in both wives' and husbands' relationship functioning and relationship deployment readiness following participation in the AIM program. Improvements in relationship functioning were associated with improvements in relationship deployment readiness at both individual and dyadic levels. The implications underscore the importance of integrating programs like AIM into military family services.
Attachment-based family therapy (ABFT) is an evidence-based systemic treatment for adolescent depression and suicidality. The first session focuses on shifting therapy goals from behavior management to relational repair. This study explores whether making this shift is associated with adolescent treatment outcomes. First-session recordings from an ABFT randomized controlled trial were coded for shifts in content (from an individual to a relational understanding of symptoms) and affect (from defensive to vulnerable emotions or hopefulness). Greater maternal responsivity to the relational reframe and stronger maternal acceptance of the relational contract were associated with greater reductions in adolescents' depressive symptoms. In contrast, adolescent scores on these measures were not associated with depressive symptom change, and although suicidal ideation decreased in the overall study, neither adolescent nor maternal scores on these measures predicted changes in suicidal ideation. Findings suggest that early maternal engagement with the relational focus of ABFT may be an indicator of subsequent improvement in adolescent depression.
This study focuses on marital satisfaction, a key concept often used to assess happiness and stability in a marriage. The main goal of this study was to explore the mediating processes linking experiences in the family of origin to marital satisfaction. A total of 357 married individuals participated in the research. Participants completed self-report questionnaires assessing marital satisfaction, family-of-origin experiences, and dysfunctional relational beliefs. The study's model was analyzed using structural equation modeling. The mediation analysis suggests that experiences in the family of origin may play a role in shaping marital satisfaction through dysfunctional relationship beliefs. The results indicated that married individuals who experienced dysfunctional family-of-origin experiences reported lower marital satisfaction if they also held dysfunctional relationship beliefs. This highlights the importance of addressing dysfunctional relationship beliefs in married couples to minimize the influence of negative family experiences on their marital relationships.
Research has yet to clarify the relational mechanisms through which communicated perspective-taking (CPT) during conflict relates to overall relationship satisfaction, and prior studies have largely overlooked its dynamic and interactive nature, often examining partners' contributions separately. To address these gaps, this study employed an observational dyadic design to examine, in a sample of 178 young adult couples, the unique and joint contributions of partners' CPT during conflict to their relationship satisfaction, as well as the role of positive relational experience during conflict in these associations. Results showed that an individual's CPT was positively associated with their own and their partner's relationship satisfaction, through both their own and their partner's greater positive relational experience during the conflict discussion. Partners' CPT also interacted in association with relational experience and relationship satisfaction. Findings underscore the potential role of positive relational experience and the inherently dyadic and interactive nature of CPT within couple interactions.
The Satir Model (SM) is an experiential and systemic approach increasingly used across clinical and community contexts. Although research shows benefits for emotional resilience, self‑esteem, communication, and family functioning, no synthesis has examined how SM is described as a transformational systemic therapy. This review followed PRISMA 2020 guidelines and identified 21 eligible studies from 5923 records. Using thematic synthesis, four interconnected domains of change were identified: intrapersonal processes (emotional regulation, self‑worth, coherence), relational and systemic processes (communication, attunement, boundary reorganization), experiential somatic mechanisms (sculpting, imagery, movement), and meaning‑ and identity‑level transformation (narrative reframing, existential clarity, cultural meaning). Together, these findings position SM as a holistic and culturally adaptable approach that facilitates multilayered change beyond symptom reduction. Future research should strengthen methodological rigor, operationalize core constructs, and examine long‑term and cross‑cultural outcomes.
This special issue brings together 11 theoretical, quantitative, and qualitative articles that apply a strength-based, liberatory framework to systemic therapy with people of color. Collectively, the authors reconceptualize the meaning and treatment of a range of presenting problems, critically interrogate selected ethical and legal mandates, broaden the application of systemic thinking, and offer guidance for training the next generation of systemic professionals.
Effective couple interventions, such as Integrative Behavioral Couple Therapy and the Relationship Checkup, include the labeling of common relationship patterns. This study hypothesized that a micro-intervention using nature metaphors, such as "Porcupine-Turtle," would produce greater improvements in relationship health relative to descriptive labels such as "Approach-Withdraw." Twenty-five couples were presented with nature metaphor patterns, while 24 couples were presented with descriptive patterns. Several measures of relationship health showed significant improvements across both groups, while other measures showed significant improvements for descriptive patterns only. Generally, nature metaphor patterns were initially rated as more novel and more resonant. Broadly, these results add support for the effectiveness of relationship pattern labeling. The effectiveness of nature metaphor patterns may be improved if introduced with more guidance to help couples capitalize on initial, stronger senses of resonance.
Mindfulness has well-documented benefits for mental, physical, and relational health. However, research about the role of mindfulness in health has scarcely explored interpersonal mindfulness, a distinct type of mindfulness expressed externally and relationally in interpersonal interactions. Mindfulness is known to be beneficial in romantic relationships but has been underexplored to date. A new interpersonal mindfulness construct known as "mindful partnering" (MP) presents a comprehensive application of interpersonal mindfulness to romantic relationships. This study advances research on MP by providing an improved conceptualization of the construct and an observational coding scheme, the Ratings of Observed Mindful Partnering (ROMP) system. Results showed that the ROMP has strong interrater reliability at the level of suggested analysis, supporting the idea that interpersonal mindfulness is observable, and initial tests of validity indicated convergent validity of this measurement tool for the MP construct. We suggest that this tool is potentially useful for clinicians and future research.
