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Routine outcome measurement and progress monitoring is well established to enhance quality assurance in clinical psychology service delivery but is not widely used in routine care. A major barrier to more widespread implementation is the lack of public domain, brief, psychometrically sound outcome measures that easily integrate into clinical information systems. The current study assessed a brief 10-item version of the widely used Depression Anxiety Stress (DASS)-42 scale, which we called the Depression Anxiety Stress-10 (DASS-10) scale. In two clinical samples of adults (n = 1036, 445 men, 591 women; and n = 1084, 493 men, 591 women), the DASS-10 had a replicable two-level factor structure, which at the lower level had two factors assessing stress-anxiety and depression, which each loaded onto a superordinate psychological distress scale. The items in the distress score discriminated between a clinical sample (n = 376) and a community sample (n = 379) and were sensitive to clinical change. The measure has the potential to make routine outcome measurement and progress monitoring more cost-effective to implement than existing measures, particularly when integrated with practice management software to make administration, scoring, and use easy.

This invited paper is a review of the significance of couple relationships to the practice of all therapists. The article begins with a summary of the evidence on the centrality of committed couple relationships to the lives and wellbeing of adults, and the association of the quality of the parents’ couple relationship on the wellbeing of children. We argue that the well-established reciprocal association between individual problems and couple relationship problems means that all therapists need to pay attention to how a couple relationship might be influencing a client's functioning, even if the relationship is not the presenting problem. There is an outline the evolution of current approaches to behavioural couple therapy, and the current state of the art and science of couple therapy. We present an analysis of the evidence for couple therapy as a treatment for relationship distress, as well as couple-based treatments for individual problems. This is followed by a description of the distinctive challenges in working with couples and how to address those challenges, and recommendations about how to address the needs of diverse couple relationships. Finally, we propose some core therapist competencies needed to work effectively with couples.

Assessment and feedback of relationship strengths and challenges is a widely used brief approach to couple relationship education (CRE). It can be fully automated through the internet, with couples self-interpreting the feedback. This study assessed whether therapist guidance of couples to interpret the report and develop relationship goals enhanced the benefits of the feedback. Thirty-nine couples seeking CRE were randomly assigned to either self-interpretation of an internet-based relationship assessment report (RELATE), or therapist-guided interpretation of the same report (RELATE+). Participants were assessed on relationship satisfaction and psychological distress pre- and post-CRE, and at 6-month follow-up. RELATE and RELATE+ were not reliably different in outcome. Couples in both conditions sustained high relationship satisfaction and showed an overall decline in psychological distress. However, consumer satisfaction was substantially higher for the RELATE+ condition than the RELATE condition.

The thesis advanced in this essay is that couple relationship interventions are central to effective therapy with many adult clients. I begin by reviewing a body of evidence that demonstrates the significance of couple relationships in the lives of most adults. A range of circumstances are described in which effective therapy with adults needs to address the couple relationship, even when the couple relationship is not mentioned as a presenting issue. It is concluded that individual psychological adjustment often is best understood when conceptualised within the intimate interpersonal context of the couple relationship.

We assessed the effects of the Controlling Alcohol and Relationship Enhancement (CARE) program, an early intervention combining reduction of hazardous alcohol consumption and enhancement of couple relationships. Thirty-seven hazardous drinking couples were randomly allocated to either the CARE program or to a control condition. CARE couples improved their communication more than controls, but couples in both conditions reduced hazardous drinking to a similar extent. CARE is a potentially useful means of promoting positive relationship communication in hazardous drinking couples.

The concept of empirically validated treatments is an attempt to focus psychological training and practice on treatments that work. In this paper, I examine the complexities of defining the concept with reference to the treatment of relationship problems. The key criterion employed to define a treatment as empirically validated is established efficacy within controlled trials. I suggest that the criteria need to be expanded to include assessment of the variability, clinical significance, and durability of treatment effects, the relative efficacy of alternative approaches, and the ease of dissemination of treatments. Whilst few, if any, psychological treatments currently have data on whether they meet all these criteria, I suggest that setting these more ambitious criteria will direct us towards the ultimate goal of offering better psychological treatments.

This brief article introduces a two-part series of special issues ofBehaviour Changeon the cognitive-behavioural treatment of schizophrenia. Two pervasive myths about schizophrenia inhibit effective psychological treatment and rehabilitation: (1) that schizophrenia inevitably has poor outcome, and (2) that drugs are effective in the management of schizophrenia. Neither of these myths is supported by available data. A stress–vulnerability model is described which provides a framework for understanding the variability in outcome of schizophrenia, and for conducting cognitive-behaviour therapy.

A 37-year-old male with a 13-year history of atopic dermatitis (AD) was treated with cognitive behavioural stress management. Self-rated stress and extent of AD rash decreased from baseline to the end of treatment, and gains were maintained at follow-up. A significant correlation between stress and extent of AD rash was observed. Discussion focused on the possible role of stress induced immunosuppression on exacerbations of AD, and the need for controlled trials evaluating the treatment procedures used in the current study.

The Fourth World Congress of Behaviour Therapy, held on the Gold Coast of Queensland, Australia between July 4–8, 1992 was an important event in the professional calendars of many behaviour therapists internationally. It was hosted by the Australian Behaviour Modification Association, in association with the Association for the Advancement of Behavior Therapy, and the European Association of Behavior Therapy. This 3-yearly event provides an important opportunity for behaviour therapists from around the world to meet, socialise, exchange information, perspectives and ideas, and establish or extend colleague networks in a multicultural context. As the first World Congress on Behaviour Therapy to be held in the southern hemisphere, it achieved the same high standard of previous congresses in Israel, Washington, and Edinburgh, producing a balanced and stimulating program addressing most of the major areas of contemporary behaviour therapy research and clinical practice.

Behavioural marital therapy (BMT) is a promising approach to the pervasive concern of lack of marital satisfaction. BMT produces gains in marital satisfaction which are statistically significantly superior to no treatment controls. However when more stringent criteria for success are applied, which are of greater clinical relevance, success rates are moderate. It is argued the limitations of BMT efficacy may be due to three faults in the current conceptualization and practice of BMT. Firstly, while some recognition of the role of cognitions has been made, the salient cognitions of distressed couples have not been clearly described in specific social contexts. Secondly, the cognitive interventions used do not relate clearly to identified maladaptive cognitions. Finally, the generalization of therapeutic effects has been assessed insufficiently, and generalization has not been programmed into therapeutic procedures. Specific suggestions are offered which may help to help overcome these problems.

Behavioural marital therapy (BMT) has developed from the application of social exchange and social learning theories to the understanding and modification of marital interaction. Encouraging high rates of exchange of positive behaviours, and training in communication skills, have been the major focuses of BMT till recently. While these strategies produce therapeutic change, there are still many couples whose marriages do not improve with this sort of therapy. Recent developments have focused on the role of cognitive, affective and situational variables in marital interaction. Outcome research has shown the value of cognitive and affective interventions in their own right, but it is unclear if the addition of these interventions will enhance the efficacy of BMT.

There is a well established relationship between marital discord and individual psychopathology in family members. This paper reviews evidence relating to patterns of marital interaction related to the co-occurrence of marital discord and three common psychological disorders: depression, alcohol abuse, and childhood conduct disorders. The effects of behavioural marital therapy (BMT) on dysfunctional marital interaction in such cases, and the impact of BMT on individuals' psychological disorders, are evaluated. It is concluded that BMT is often a useful component of treatment in each disorder reviewed. Further it is argued that it is important routinely to assess the relationship context in which these disorders occur. Finally, some of the difficulties and limitations of the application of BMT in cases where the presenting problem is an individual psychopathology are considered.

Marital breakdown is common, and often associated with depression. A model is outlined in which such depression may be maintained by avoidance of depression eliciting stimuli. A 27-year-old recently-separated male with severe depression was treated with systematic exposures to depression eliciting stimuli, with cognitive coping self statements being used during exposures. The worst self ratings of depression reported by the client and scores on the Beck Depression Inventory improved greatly from baseline to treatment phases. Gains were maintained at 4 week, 3 and 6 month follow-ups. Further research is warranted to evaluate the efficacy of this potentially useful approach to treating marital breakdown, and possibly other adjustment disorders, which are associated with depressed mood.