Selected topics from the book will be explored in this presentation Katherine Helm, PhD Program Director, Clinical Mental Health Counseling Lewis University  1st edition foundational text in couples treatment for couples with a psychological disorder  2nd edition, aligned with DSM 5; incorporated empirically validated couples treatment; incorporated cultural lens for diverse couples; added several areas of focus (e.g. domestic violence, social media & technology, stage of life issues, etc.)  Continued using case studies to integrate each chapter’s main points  Explores the changing landscape of couples therapy then & now Kimberly Duris, Ed.D. Lewis University Exploration of Discussion of positive/negative internet infidelity impact technology and technology has on romantic addiction relationships

Assessment of internet-related Treatment problems in a implications relationship How much information do we share with others?

What should be kept private in a relationship?

Cybersex engagement- is it cheating?

Decrease in autonomy of partners Assist with Aide for long- managing Greater sexual distance multiple life intimacy relationships tasks  Multitheoretical Model – Katherine Hertlein ◦ Integrates 3 perspectives:  Ecology  Structural- functional perspective  Interaction- constructionist perspective

 Seven Ecological Vulnerabilities Couples Face as a Result of Technology: ◦ Accessibility, affordability, anonymity, acceptability, approximation, ambiguity, accommodation Ecological Elements Questionnaire (EEQ)

Technological Genogram (TG)

TIRA

Technology and Intimate Relationship Assessment Seven Therapeutic Tasks: 1. Development of physical boundaries regarding the use of technology 2. Development of psychological boundaries 3. Holding the partner who cheated accountable (if applicable) 4. Developing an awareness regarding the etiology of the problem 5. Assessing the couple’s context and readiness for change 6. Assessing the presence of unique circumstances 7. Work toward forgiveness Lisa Brown, MA, LCPC Clinical Coordinator, Lewis University Doctoral Candidate, Governors State University  Physical ◦ Pushing, grabbing, slapping, Biting, choking, burning, intimidation, coercion  Sexual ◦ Unwanted, unsafe, degrading acts ◦ Dress, watch or participate, name calling, STIs, Reproductive coercion  Emotional ◦ Isolation, minimization, blaming, using children and using privilege  Economic ◦ Amassing debt, stealing, job interference, omitting name from joint assets

Photo Credit: The Duluth Model  Current Abusive behaviors or patterns ◦ Cannot treat when physical abuse is current  Hx of DV in family of origin/previous Tension- Relationships Honeymoon  Reenactment of the cycle of violence building  Abandonment  Boundaries  Expectations and views of gender roles  Dissociation  Guilt and Shame Explosion  Restless, suspicious, secretive, dependent, submissive Cycle of Violence, Lenore Walker (1979) 1. Establish Safety  Coping skills  Assertiveness skills training 2. Develop understanding of  Psychoeducation effects of DV  Identify triggers  Witnessing effects of abuse 3. Foster healthy relationship  Individual counseling patterns Emily Petkus, MA, LCPC (IL), LPC (VA) Doctoral Candidate Governors State University Relational functioning Increased deteriorates after withdrawal traumatic events

Reduced Overwhelming relationship negative affects satisfaction  Both partners experience  Decision making during the distress and dissatisfaction treatment process in the relationship  Shared couple’s narrative  Both partners developed  Processing symptoms maladaptive coping  Self-regulation strategies  Establishing connections  Need positive social support  Posttraumatic growth Restore hope between partners •Strong therapeutic relationship •Successfully navigate challenging issues Reprocess emotional responses to each partner

Change interaction between partners

Create a more secure attachment STAGES: Treatment goals within each stage:

 Create and maintain safe therapeutic 1. Stabilization alliance

2. Building self and  Restore hope and healthy relationship relationship capacities dynamics

 Integrate new interactional patterns 3. Integration within relationship Emily Petkus, MA, LCPC (IL), LPC (VA) Lisa Brown, MA, LCPC Sexual addiction Pornography  Uncontrolled or excessive  Differentiate between sexual behavior addictions to/on the  Destructive internet  Loss of power of choice  Who/what is accessed  Warning signs online  Anxiety and stress  Tolerance, inability to stop, irritability, risk of losing  Shame and isolation relationship, lying about use, escaping difficult emotions  Thorough sexual history  Secretive behavior  Negative self-talk and core beliefs  Dissociation/depersonalization  Distress in relationship disrupts attachment  Negative messages of sexuality in childhood  Loss of trust, anger, constrained communication, ego-centric attitudes, negative impact on sexual relationship between partners  History of abuse Addict Coaddict

•Thorough sexual history •Assess for PTSD •Assess for tolerance/withdrawal •Codependency •Honesty & accountability •Emotions and coping •Comorbid disorders •Suspicion, ”need to know” •Paraphilic behaviors •Detective behaviors •Motivation for treatment •Rebuild trust/communication •12 step program •Painful emotions among •Safe sex practices partners •Behavior change •Interpersonal and FOO dynamics •Relationship needs Kenneth Oliver, PhD Program Director, Clinical Mental Health Counseling Quincy University  General Issues of Transition  “Sandwich”-ing  Spousal Bereavement  Cognitive, Behavioral, Affective Concerns  “Functional Impasse”  Common Disorders ◦ All: Adjustment Disorders, Generalized Anxiety, Major Depression ◦ Aging Parents: Dementia, Cognitive Decline/Impairment, other Neurocognitive Disorders ◦ Children/Adolescents: ADHD, ODD, Conduct Disorder, other Behavioral and Learning Disorders ◦ Bereavement: Uncomplicated Bereavement and Complex Bereavement Disorder  Case: Lucinda and Ron (Sandwiched Couple)  Instruments: ◦ Sandwich Couples:  The Perceived Stress Scale (Cohen, Kamerck, & Mermeistein, 1983)  The Couples Satisfaction Index (Funk & Rogge, 2007)  The Perceived Support Scale (Krause & Markides, 1990) ◦ Spousal Bereavement:  Inventory of Traumatic Grief  Grief Experience Inventory  Continuing Bonds Scale  Bonds in Coping Scale  Tx Recommendations ◦ Multipronged Approaches (i.e., Preventative & Responsive, Individual, Couples (when applicable), and Family Therapy) ◦ Anticipatory Exploration and Psychoeducation  May help to assess fit for additional caretaking roles  Exploration of Existential, Cognitive, and Behavioral issues Shift from communication focus to emotional connectivity & attachment Understanding impact of culture, social media & technology, stage of life issues, etc. Couples treatment as the treatment of choice Changes in training models to include empirically validated treatments Please see authors for references