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Purpose There is a critical need to explore bariatric patients’ perceptions of existing neighborhood and built environment resources and supports to assist with postoperative behavior change and weight loss maintenance. The objective of this study was to survey postoperative patients to determine neighborhood food retail, fitness facility, and options for outdoor activity access, utilization, satisfaction, and perceptions of resources. Materials and Methods A convenience sample of postoperative patients from a single academic surgical center in the USA (N = 44) completed an online survey about access, utilization, satisfaction, and safety for food retail, fitness facility, and outdoor activity options in their neighborhoods. Analysis included descriptives (frequency, percent, Chi-square), and independent samples t tests and ANOVA determined differences based on race, insurance status, geographic location, and receipt of governmental assistance programs. Open-ended questions were analyzed using summative content analysis. Results Patients reported the highest access to lower-cost national food retailers and fitness facilities. The most prevalent challenge in finding food products to meet patients’ goals was financial (39%). Patients’ top suggestions for fitness facilities included training staff/facilities (59%) and trainers (35%) in postoperative patient care and exercise. The highest access for outdoor activity options was for walking/running trails, city/metro parks, and sidewalks. Significant differences in access, utilization, and safety were found based on geographic location, receipt of at least one assistant program, and race. Conclusion The development of targeted resources may benefit patients in non-suburban areas and who receive governmental assistant programs to increase safety of outdoor options and access to lower-cost food retailers and to increase utilization of lower-cost fitness facilities. Graphical abstract

Premature termination is significantly understudied in couple and family therapy research yet is a prevalent issue for therapists and has a significant impact on therapeutic outcomes. While therapeutic alliance has been consistently linked to premature termination and other treatment outcomes, little is known about other factors, particularly couple factors, that may influence premature termination in couple therapy. Utilizing dyadic data combined from two different samples of couples seeking therapy, this study examines the influence of relationship satisfaction and therapeutic alliance on premature termination using an Actor Partner Independence Model. Additionally, a chi-square difference test was used to determine differences in therapeutic outcomes among termination-status type groups. Results showed that alliance was not predictive of termination status. Couple factors, particularly relationship satisfaction, were found to be associated with premature termination. That is, couples with lower relationship satisfaction were more likely to terminate therapy prematurely without agreement with their therapist. Findings suggest that couple influences showed stronger associations to premature termination than did therapeutic alliance alone. This highlights a need for therapists to assess how initial relationship satisfaction influences alliance and how each partner’s satisfaction and alliance influence that of the other partner.

While it is likely that Couple and Family Therapists will treat clients with interpersonal trauma history, not much is known about how interpersonal trauma history associates with the therapy process in couple and family therapy settings. The aims of this study were twofold: (1) describe the types of interpersonal trauma that couples, seeking treatment for relationship issues, have experienced, and (2) investigate how this history of interpersonal trauma was associated with the process of treatment, including therapeutic alliance, number of sessions attended, and termination status. Data were collected through a survey distributed upon consent at an on-campus couple and family therapy clinic. Participants included 73 couples who were assessed for physical abuse, sexual abuse, and experiences of abandonment using Carlson et al.’s (Psychol Assessment 23(2):463, Carlson et al., Psychological assessment 23:463, 2011) Trauma History Screen. Using content analysis, responses were categorized into three groups: both partners, only one partner, and no partners reported having experienced an interpersonal trauma. Results revealed that just under 50% of individuals had experienced some type of interpersonal trauma, affecting 71.2% of couples. Quantitative analyses were conducted to assess for significant differences, and effect sizes, among trauma categories in terms of number of sessions attended, termination status, and therapeutic alliance. Results suggested that couples who had previously experienced interpersonal trauma, particularly when both partners reported interpersonal trauma, may be more likely to terminate without agreement or no-show. Future researchers should continue to investigate how the presence of interpersonal trauma in dyads associates with the therapeutic process and clinical outcomes to better inform couples’ therapy treatment.