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Objectives Intimate relationships can enhance quality of life and reduce the risk of psychological disorders. Self-disclosure, a fundamental component of intimacy, occurs only when vulnerability is met with acceptance rather than rejection. However, shame disrupts this process by inhibiting vulnerability and promoting defensive strategies, thereby undermining intimacy and relational security. This study aimed to address shame within an Emotionally Focused Couple Therapy framework to enhance intimacy. Method A randomized controlled design was employed. Twenty-six married couples were randomly assigned to either an experimental group or a control group. The Experience of Shame Scale and the Personal Assessment of Intimacy in Relationships were used as assessment tools. Results Compared with the control, EFCT significantly increased intimacy and reduced shame in the experimental group ( p  < 0.05). Conclusion Shame may disrupt both intimacy and the therapeutic relationship and should be addressed during treatment. The discussion outlines possible mechanisms of change. Trial registration This paper has been registered with the Clinical Trial ID (71773). It was registered on 2024/10/04. (Clinical Trial Number IRCT20230801058994N1)

Alcohol use disorder is among the most pervasive substance use disorders in the United States, with a lifetime prevalence of 30%. Recommended treatment options include evidence-based behavioral interventions; smartphone-based interventions confer a number of benefits such as portability, continuous access, and stigma avoidance; and research suggests that interventions involving couples may outperform those for patients only. In this context, a behavioral intervention delivered to couples through smartphones may serve as an effective adjunct to alcohol use disorder treatment. This pilot study aimed to (1) evaluate the feasibility of comparing a patient-only (Addiction version of the Comprehensive Health Enhancement Support System; A-CHESS) versus a couple-focused (Partner version of the Comprehensive Health Enhancement Support System; Partner-CHESS) eHealth app for alcohol misuse delivered by smartphone, (2) assess perceptions about and use of the 2 apps, and (3) examine initial indications of differences in primary clinical outcomes between patient groups using the 2 apps. Broadly, these aims serve to assess the feasibility of the study protocol for a larger randomized controlled trial. A total of 33 romantic couples were randomized to 6 months of A-CHESS app use (active treatment control) or Partner-CHESS app use (experimental). Couples comprised a patient with current alcohol use disorder (25/33, 76% male) and a romantic partner (26/33, 79% female). Patients and partners in both arms completed outcome measure surveys at 0, 2, 4, and 6 months. Primary outcomes were patients' percentage of days with heavy drinking and percentage of days with any drinking, measured by timeline follow back. Secondary outcomes included app use and perceptions, and multiple psychosocial variables. At 6 months, 78% (14/18) of Partner-CHESS patients and 73% (11/15) of A-CHESS patients were still using the intervention. The apps were rated helpful on a 5-point scale (1=not at all helpful, 5=extremely helpful) by 89% (29/33) of both Partner-CHESS patients (mean 3.7, SD 1) and partners (mean 3.6, SD 0.9) and by 87% (13/15) of A-CHESS patients (mean 3.1, SD 0.9). At 6 months, Partner-CHESS patients had a nonsignificantly lower percentage of days with heavy drinking compared with A-CHESS patients (β=-17.4, 95% CI -36.1 to 1.4; P=.07; Hedges g=-0.53), while the percentage of drinking days was relatively equal between patient groups (β=-2.1, 95% CI -24.8 to 20.7; P=.85; Hedges g=-0.12). Initial results support the feasibility of evaluating patient-only and couple-focused, smartphone-based interventions for alcohol misuse. Results suggest that both interventions are perceived as helpful and indicate maintained engagement of most participants for 6 months. A future, fully powered trial is warranted to evaluate the relative effectiveness of both interventions. ClinicalTrials.gov NCT04059549; https://clinicaltrials.gov/ct2/show/NCT04059549.

Most traditional couple therapy models are based on the Eurocentric, middle-class value system and are not effective for today's psychotherapists working in multicultural settings. Multicultural Couple Therapy is the first “hands-on” guide for integrating couple therapy with culture, race, ethnic identity, socioeconomic status, religious beliefs, sexual orientation, and immigration experiences.The editors and a culturally diverse group of contributors follow a common outline of topics across chapters, related to theory, research, practice, and training. They report on the application of major evidence-based models of couple therapy and demonstrate the integral role played by contextually based values involved in relationships, conflict, and resolution.Key FeaturesIntended AudienceThis groundbreaking book provides an in-depth resource for clinicians, supervisors, educators, and students enrolled in courses in couple therapy, marriage and family therapy, and multicultural counseling who are interested in how diverse clients define conflicts and what they consider to be functional solutions.

Background Latino men who have sex with men (MSM) experienced a 13% increase in HIV diagnoses from 2010 to 2014, more than any other racial/ethnic subgroup of MSM in the United States. If current HIV diagnoses rates persist, about one in four Latino MSM in the United States will be diagnosed with HIV during their lifetime. Although some efficacious HIV prevention interventions for Latino MSM exist, none have focused on couples. This paper describes the protocol of a randomized controlled trial (RCT) to test the preliminary efficacy of a couple-based HIV prevention intervention that is culturally tailored for Latino men and their same-sex partners. Methods The RCT will determine the preliminary efficacy of Connecting Latinos en Pareja (CLP) to increase the proportion of anal sex acts that are HIV protected (i.e., anal sex acts in which condoms, pre-exposure prophylaxis (PrEP), treatment as prevention (TasP), or a combination thereof, are used to reduce risk of HIV transmission). CLP builds upon previous couple-based interventions with white and black MSM by incorporating biomedical prevention techniques, such as PrEP and TasP, implementing a framework responsive to the couple’s serostatus, and addressing the socio-cultural factors that influence HIV risk among Latino MSM. We also include input from community stakeholders, members of the target population, and a community advisory board as part of intervention development. Assessments will be conducted at baseline, and 3- and 6-months post-intervention to examine the intervention effects on outcomes (HIV-protected sex acts), and factors potentially mediating or moderating intervention effects. Discussion This paper describes an innovative RCT that incorporates multiple HIV prevention techniques for Latino MSM in couples, regardless of serostatus. The ongoing involvement of community stakeholders, members of the target population, and a community advisory board is emphasized, and plans for widespread dissemination and application of findings into practice are discussed. Trial registration Trial registration: NCT03048838 . Registered on 3 February 2017.

This article reports pre–post intervention results from a randomized controlled trial evaluating the initial efficacy of a couples-based intervention aimed at teaching skills for coping with stress and improving relationship skills in a sample of 173 ethnically diverse low-income co-resident mothers and fathers who were raising at least one child together. Couples were randomly assigned to one of three interventions or to an assessment-only control condition. The Fatherhood, Relationship, and Marriage Education (FRAME) intervention is a 14-h psychoeducation intervention developed specifically to strengthen the ability of low-income mothers and fathers to reduce conflict, cope with stress, and co-parent effectively. Three versions of FRAME were assessed: a men-only group, a women-only group, and a couple’s group. The pre-post intervention analyses revealed reductions in financial stress, disengagement coping, and involuntary disengagement responses, as well as improvements in problem solving. These pre–post changes on stress and coping variables were both statistically significant and reliable as assessed by the Reliable Change Index (Jacobson and Truax 1991 ). Results were particularly strong for the couples’ and women’s groups. In addition, positive pre-post changes on stress and coping variables were associated with pre-post reductions on symptoms of depression for participants assigned to an intervention. The results demonstrate that participants in FRAME acquire some of the key skills taught in the intervention, and skills acquisition appears to translate into symptom reduction. In addition, this study highlights the value of an intervention aiming to improve the capacity of parents with economic hardship to cope effectively with stress.