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Technology as a communication medium now functions as a core way to connect to peers, family members, and romantic partners independent of time and location. These technologies help us to initiate ...

Infidelity is a challenging but prominent issue in couple therapy. In addition to the negative outcomes, clinicians generally report that infidelity is the second most difficult problem to treat af...

Coining the term collaborative pornography viewing, we used a mixed method study to test the perception of individual relationship satisfaction, sexual satisfaction, trust, closeness, and communication after watching pornography together. The purpose of this article is to present the qualitative findings of the study. In the qualitative portion, a subset of couples from the larger sample (8 couples; N = 16) participated in interviews about their experience in the study and, specifically, the collaborative viewing of pornography. The findings indicated that collaborative pornography viewing enabled practice in negotiation, relationship communication, normalized pornography viewing in the relationship, created a boundary around the couple, and increased conversations. These results support the recommendations of previous scholars advising couples that viewing pornography together may improve certain aspects of the relationship.

Intimate partner violence (IPV) is a common public health problem that damages many romantic relationships. It is defined as abuse or aggression that occurs between intimate partners with an estima...

The Internet is a common medium through which people engage in interpersonal electronic surveillance (IES) of one another. We know little empirically about what predicts IES in romantic relationships. The present study expands on factors identified in previous studies (including demographic characteristics, relational characteristics, and other psychosocial variables) to predict surveillance in romantic relationships. Internet users in established romantic relationships (

Working with children can be a difficult and intimidating task for many family counselors, especially when attempting to discuss complex issues of the family structure. Using a construct children a...

The socially constructed genogram allows clients to include individuals to whom they are emotionally close, which may include both biological relatives as well as others. While identifying importan...

The purpose of this qualitative study was to develop understanding of the experience of long-term suicide loss survivors and begin to develop theory of the process of healing. Ten suicide loss survivors were interviewed. Our analyses identified three major categories—one harmful, one helpful, and one that helped to move from harmful to the helpful. Feelings of responsibility was the major harmful category, meaning making the helpful one, and social support the one that appeared to help move from one to the other. Suicide-related thoughts and behaviors were found to be both harmful and helpful at times. Many systemic, family, and interpersonal processes relating to suicide ideation and the perceived responsibility of suicide loss survivors were identified for intervention and future study.

As a response to the COVID-19 global crisis, many in the couple/marital and family therapy (CMFT) professional community quickly met the challenge of providing services to clients via telebehavioral health (TBH) services. As this public health emergency endures, family therapists must continue to engage in TBH practice professionally and ethically. The rapid adoption of TBH with minimal training and experience during this public health emergency can result in crises for both individual therapists as well as for the profession in implementing electronic record-keeping, conducting virtual sessions, and communicating online with various clinical populations. The risk of insufficient training and supervision create a challenge to new and experienced family therapists. This article summarizes the work done by the profession thus far to respond to this public health emergency and presents a roadmap of recommendations for navigating those challenges into the future and offers ideas about how to sustain quality TBH practice.

During the coronavirus pandemic, many behavioral health professionals providing psychotherapeutic services, including couple/marriage and family therapists (C/MFTs), quickly changed from providing in-person services to telebehavioral health (TBH) services, with specific reliance on teleconferencing. Many therapists were thrust into telehealth with minimal or no prior telebehavioral health experience, education, or training. Although TBH services have been shown to be effective and efficient with mental health and substance abuse problems, the teaching and learning of telebehavioral competencies have generally not been included in the formal education and training received by C/MFTs. This article presents an existing interprofessional telebehavioral health competencies framework not before published in C/MFT journals. This article will also demonstrate how those competencies are applicable to the education, training, and practice of telebehavioral health by C/MFTs. Implications for educational, service, and regulatory organizations are presented.

The purpose of this paper is to present strategies to assist LDS (Mormon) sex therapists-in-training as they work through the anxiety and value conflict of doing sex therapy. This paper outlines th...

Telebehavioral health (TBH) in the form of synchronous video is effective, well received and a standard way to practice. Current guidelines and policies discuss the importance of good clinical, technical, and administrative components to care. A review of the TBH evidence-based literature across psychiatry/medicine, psychology, social work, counseling, marriage/family, behavioral analysis, and other behavioral sciences found no common TBH competencies across disciplines. The scope of professional guidelines and standards about technology are broad (e.g., practice of telepsychology; Internet and social media use in social work practice), to mid-range (e.g., American Telemedicine (ATA), American Counseling Association (ACA)), to narrow (e.g., preliminary “guidelines” for asynchronous communication such as e-mail and texts). There is only one set of competencies for telepsychiatry, which discusses skills, training and evaluation. These competencies suggested (1) novice/advanced beginner, competent/proficient, and expert levels; (2) domains of patient care, communications, system-based practice, professionalism, practice-based improvement, knowledge and technological know-how; and (3) pedagogical methods to teach and evaluate skills. Revisions to this framework and technology-specific competencies with additional domains may be needed. A challenge to competencies across disciplines may be finding consensus, due to varying scopes of practice, training differences and faculty development priorities. Disciplines and organizations involved with TBH need to consider certification/accreditation and ensure quality care.

The Coalition for Technology in Behavioral Science (CTiBS) has developed an interprofessional, evidence-based, measurable framework for telebehavioral health (TBH) competencies. The paper presents the development of the CTiBS TBH framework, identifies the theoretical rationale and need for such competencies, outlines methods used, provides two detailed discussions of applications, presents a tabulized form of the framework, and then discusses limitations and future research. In the CTiBS TBH competency framework, the term telebehavioral health is meant to include telemental health and e-therapy. The TBH competency framework is offered as an initial working document to identify and organize discreet, measurable telebehavioral practices derived from a review of the literature, technological advances, and day-to-day clinical practice. It reflects core knowledge, skills, and attitudes needed for competent telebehavioral health practice. The competency framework is directly applicable to psychiatry/medicine, psychology, social work, counseling, marriage/family, behavior analysis, and other behavioral sciences. The CTiBS TBH framework organizes seven topic domains and five subdomains according to competency level, i.e., Novice, Proficient, or Authority. In turn, each competency level is categorized into 51 discrete telebehavioral objectives, which are then distinguished by 149 cumulative and measurable telebehavioral practices. The seven TBH competency domains identified by CTiBS include (1) Clinical Evaluation and Care, with three subdomains addressing Assessment and Treatment, Cultural Competence and Diversity, and Documentation and Administrative Procedures; (2) Virtual Environment and Telepresence; (3) Technology; (4) Legal and Regulatory Issues; (5) Evidence-Based and Ethical Practice, with two subdomains addressing Standards and Guidelines and Social Media; (6) Mobile Health and Apps; and (7) Telepractice Development.

One issue that has risen to prominence in couple work is the development of a relationship via technology and new media with people outside of the primary couple relationship. As this issue becomes more prevalent, couples struggle with the development of rebuilding trust. Despite the previous instances of infidelity, the development of trust is also compromised by the ability to trust what is presently occurring in the relationship. The partner who has been betrayed often continues to check the involved partner's devices for evidence of a continuation of the affair. Such checking and surveillance often result in obsessive checking of such devices and the assertion that the involved partner can no longer be trusted, reasoning that the involved partner must be deleting evidence. This positioning about surveillance can compromise the ability to move forward with couple therapy. The purpose of this paper is to outline how to work with couples with this level of surveillance after an affair.

The field of couple and family therapy has delineated ways in which technology affects couple and family systems. In general, we have proposed that technology affects both the structure and process...

The popularity of forgiveness in clinical contexts may lead some to believe it is a panacea for all interpersonal problems across a multitude of contexts. Yet some research has found that forgivene...

The purpose of this study was to provide an in-depth analysis of divorce by comparing levels of depression, anxiety, self-esteem, and availability of resources between professional performers who w...

The couple and family technology framework outlines how technology affects couple and family relationships. This framework has been applied to understanding the impact of technology on infidelity, contributed to our understanding of online gaming issues in couple relationships, and sexting. The purpose of this paper is to outline how to implement video gaming as a disciplinary tool for youth congruent with the couple and family technology framework. Specifically, we identify the elements of video games that can be applied as an intervention in family treatment with youth in a token economy. This proposed technique focuses on utilizing technology (and specifically video games) as a strategy to improve youth’s behavior. Consistent with the couple and family technology framework, this paper outlines how accessibility, affordability, accommodation, and approximation can be used to improve behavior as well as improve parent–child relationships. Implications are included.

The practice of sexting is becoming increasingly common among college students but has the potential to both initiate productive interactions with others and interfere with relationship development. The purpose of this paper is to report on the findings of a study on sexting among college students and to provide a framework through which practitioners working with this population would be able to effectively intervene. Implications for clinical practice include more specific assessment questions for practitioners, focus on better managing riskier behavior, and guidance toward using technology in relationally responsible and supportive ways.

The role of client’s belief systems in therapy is the central concept in cognitive therapy. In our therapeutic work with clients, we focus on their cognitive schemas surrounding a particular problem. These schemas, however, are embedded in a hierarchy of much larger schemas which strongly influence the content of the particular sub-schemas being investigated. The purpose of this article is to introduce the concept of “meta-schema,” from a theoretical perspective, and then offer clinical case examples to illustrate this concept.

Over the last 20 years, our lives and most notably our communication methods with one another have been taken over by technology. Technology affects our interpersonal relationships through altering the way in which relationships are formed, maintained, and terminated. In its interaction with our sex lives, technology offers certain advantages and certain areas that may make couples vulnerable to specific issues in their relationships. The purpose of this chapter is the review the issues technology may introduce into one’s sex life as well as the contributions technology can make to one’s sexual relationship.

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way-of-being, a relational concept that refers to how the therapist regards a client-either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20-33). Although this case has been made conceptually, there is little empirical research on therapists' way-of-being with clients. The primary purpose of this research is to investigate clients' perceptions of their therapists' way-of-being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists' way-of-being and (b) the influence therapists' way-of-being has on clients' engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi-structured face-to-face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way-of-being as an overarching construct for several well-established therapist factors. Clinical and training implications are discussed.

Individuals who participate in sexual behavior indeed expose themselves to multiple risks, including social, emotional, and physical risks. Outcomes associated with risk behavior can have detrimental consequences on one’s interpersonal relationships, self-esteem, and overall health and well-being. This study examined how four factors (relational, decision-making, sexual variables, and safety) operate in a postmenopausal women’s decision to engage in risky sexual behavior. Data were collected online from 44 women, ranging in age from 34 to 68. Results indicate this model explains 62.6% of the variance in risky decision-making for postmenopausal women. Implications and directions for future research are addressed.

Despite increasing support for lesbian and gay individuals, the same degree of tolerance has not extended to bisexual individuals, and bisexual invisibility and biphobia are continuing problems that affect the mental health and well-being of people who are bisexual. There is evidence that attitudes toward people who are bisexual may vary by one's own sexual orientation or gender. In the present study, the authors examined differences in attitudes toward people who are bisexual by sexual orientation and gender. The authors also asked participants who were bisexual to describe their experiences of being stigmatized. This study found significant effects for sexual orientation but not for gender; specifically, heterosexual participants reported significantly more biphobia and negative bisexual attitudes than participants who were gay, lesbian, or bisexual. Further, participants who were bisexuals reported feeling most stigmatized by individuals who were heterosexual. The results of this study indicate...

The integration of music therapy into marriage and family therapy is an under researched and largely unknown to many clinicians in this field. The understanding of musical integration should be expanded upon for others to utilize in their own therapeutic way. Musical integration in many areas of research shed light upon the improvements it can make to areas of post-operative rehabilitation, biological structures of the mind and body, stress reduction techniques, and therapeutic enhancement. Following a trial integration of music into couples therapy, clients participating in this trial integration found multiple positives effects upon themselves and their relational well-being. Musical integration holds the potential for significant change in the lives of many clients seeking therapeutic help from a marriage and family therapist and the ability to be refined through continued understanding and integration.

Asexuality is an identity held by individuals who have low to no sexual desire or drive which can often be mistaken for hypoactive sexual desire disorder. This article highlights the key diagnostic and clinical differences between hypoactive sexual desire disorder and asexuality. It provides key information about the various typologies of asexuality. We describe the 4 phases of treatment: joining, clarifying definitions, challenging beliefs, and assumptions of socially sanctioned behavior, and developing a common or agreed-upon definition of expression. A case vignette is included.

Interprofessional telebehavioral health (TBH) competencies have been developed to standardize training and improve the quality of TBH care. The seven identified interprofessional TBH competency domains and three levels of expertise (novice, proficient, and authority) are briefly described. More in depth descriptions and examples of several of the competency domains are presented to illustrate what the competencies look like in practice. Some of the challenges faced in using such a competency framework are discussed.

Communication over the Internet is helpful for marginalized individuals in their efforts to feel a part of the collective whole and gain personal empowerment. For individuals who identify as part of the LGB community, the Internet can be seen as a tool to take control of their lives, may promote self-esteem, and foster a sense of belongingness. The purpose of the study was about sexting practices on college campuses in general. It builds on the existing body of knowledge by attending specifically to sexting rather than the previous literature about engagement in sexual behavior online. Participants responded to a survey on sexting and technology use as well as questions from the Sociosexual Orientation Inventory–Revised (SOI-R) and the Lesbian, Gay, Bisexual Identity Scale (LGBIS). Findings indicated that sexting is viewed as more acceptable in same-sex relationships compared with heterosexual relationships. Implications for future research include exploring how greater degrees of perceived acceptability ...

While couples may be holding hands with one another, they are also holding their cell phones in the other hand. Technology is so woven into the fabric of our society that it is hard to separate it from the relationship itself. As such, the role of the marriage and family therapist demands that it attends to technology within the practice of couple therapy. This article describes strategies for couple and family therapists to use in the context of their treatment. The strategies are grounded in both theoretical and empirical knowledge and cover three categories of application: relationship initiation, relationship maintenance, and relationship enhancement.

Sexually transmitted disease and infection rates are continually increasing. Individuals who engage in high-risk sexual behavior (HRSB) expose themselves to multiple risks, including social, emotional, and physical risks. Overall, cultural, intrapsychic, and interpersonal scripts comingle to guide our behavior in sexual situations, yet existing theoretical models that seek to explain an individual's decision to engage in HRSB tend to test specific elements in isolation that affect likelihood of engaging in high-risk sexual behavior rather than examining the combined influence of multiple variables on the decision-making process. In this study, we tested a five-factor model of high-risk sexual decision-making. Results indicated that the model explained approximately 50.5% of the variance in HRSB. Findings and implications for future research are discussed.

The pervasive nature of technology has forced couples and families to rethink the role technology plays in their lives. Several notable areas emerging as challenging areas in couples’ lives include Internet infidelity, Internet pornography usage, and cybersex addiction. The increased prevalence of technology-related issues in therapy has challenged clinicians with the task of understanding the distinct differences and commonalities among each Internet-related issue. Two common Internet sexuality issues reported by clinicians are cybersex and Internet infidelity. The purpose of this article is to provide brief descriptions of the most common Internet sexuality issues, provide an overview of common assessment procedures, and outline the most recent development in treatment of these problems.

With the growing popularity of social networking sites (SNSs) across ages, family issues surrounding SNSs are on the rise. Structural family therapy offers a useful framework for systemic diagnosis and intervention when approaching family issues related to SNSs. The literature on SNSs among adolescent, emerging adult, and adult populations is presented. Research and speculation on how SNSs affect families, as well as how SNSs are discussed and used by families, are also included. Finally, interventions for social networking concerns consistent with a structural and developmental approach are presented, along with a real case example.

The purpose of this investigation was to examine male and female pornography users' and nonusers' attitudes regarding sexual openness and inhibition as well as relational variables both between and within gender. Participants included 846 individuals, 355 men and 491 women, with 239 of the men and 117 of the women being pornography consumers. Results indicate that men are more sexual seeking and less relationally oriented than women. However, men are more sexually conservative than women. When comparing groups by pornography usage, both male and female pornography users are more sexually open and uninhibited and less relationally oriented than nonusers. Interestingly, when comparing female pornography users to male nonusers, pornography-using women are more sexually open and uninhibited than nonusing men and are less sexually conservative than nonusing men. Implications and future directions are discussed.

There are many ways that the use of technology, including gaming, enriches couples’ lives such as allowing partners to interact in a different sphere that enhances their communication. Online role-playing gaming can help couple relationships in the development of social interactions and increased understanding of gender roles and a partner's context and may appropriately increase the use of fantasy within a relationship; on the other hand, online gaming may pose unique challenges for couples. The purpose of this article is to outline the challenges related to massively multiplayer online role-playing games, including individual challenges, challenges to daily life, and threats to intimacy. We also provide specific assessment and treatment strategies that address the challenges based on a multitheoretical model regarding the influence of technology on couple relationships.

We are in an unprecedented age of technology. Few articles in family journals address online behavior, intimacy patterns, and influences on the ways couples and families communicate through technology. The purpose of this article is to use a multitheoretical model to describe the process of how technologies are affecting couple and family life. Suggestions for future research and applications are presented.

This study focused on the effect of a brief CBT-based relaxation/guided visualization intervention on perceived stress, dyadic satisfaction and psychological symptoms. This study also tested the hypothesis that indicators of global orientation including Sense of Coherence and Differentiation of Self would mediate between perceived stress and symptoms of physical, psychological and relational distress. A three session intervention used guided visualization scripts which incorporated relaxation and controlled breathing techniques as well as a CBT approach that focused on stress management and internal locus of control. Results indicated that after the intervention, participants showed lower levels of perceived stress and lower levels of dyadic distress, as well as lower psychological and physical complaints as reported with the Symptom Checklist-90-R. Both Sense of Coherence and Differentiation of Self were mediators for the effect of perceived stress on the number of endorsed symptoms.

Along with the advances and positives the Internet can have for relationships, there are also significant challenges to couples and families, including the potential for Internet addiction, Internet infidelity, cybersex, and other issues. The ambiguity between these concepts in literature creates difficulty in diagnosis and treatment for couple therapists. We propose four dimensions that can assist therapists to appropriately distinguish between an Internet infidelity scenario, a sex addiction facilitated by the Internet, and an Internet addiction.

Recent attention given to environmental concerns has been vaulted to the forefront of American society and the world. This has resulted in an increase in ecologically minded practices known as the ‘go green’ movement. Despite the overlap between environmental sustainability and systemic thought, marriage/couple and family therapists (M/CFTs) have remained relatively silent regarding ecologically friendly practices within training and clinical practice. In this qualitative study (the first one of its kind), we asked 25 M/CFT trainees to describe their perceptions of ecological and family sustainability in general, as well as in the context of applying eco-informed language and practice into their therapy. In general, M/CFT trainees reported that although they believe that ecological practices are important for families, they struggle with what the inclusion of such practices might look like practically. Implications for clinical practice and training are presented as well as suggestions for future research.