Eli A. Karam

The impact of the within my reach relationship training on relationship skills and outcomes for low-income individuals.

A federal grant was awarded to provide the Within My Reach healthy relationships curriculum to low-income, at-risk individuals involved with various social service agencies. The effectiveness of this curriculum was evaluated for 202 participants through measures of training and relationship outcomes pre-, immediately post- and 6 months posttraining. Participants experienced high levels of training satisfaction; significant increases in knowledge, communication/conflict resolution skills, and relationship quality; as well as a trend in the reduction of relationship violence. An important implication of this research is that MFTs may broaden their service delivery to at-risk individuals by collaborating with community agencies to adapt established relationship enhancement programs, evidence-based tools, and principles that complement traditional couples therapy.

An Evaluation of Healthy Relationship Education to Reduce Intimate Partner Violence

This research evaluated the impact of the Within My Reach healthy relationship education program on intimate partner violence for 419 high-risk adults in an urban area. Key outcomes such as relationship knowledge, communication/conflict resolution skills, relationship quality, and physical and emotional abuse were evaluated through survey research immediately post- and 6-months postprogram participation. Results suggest that participation in the Within My Reach program is associated with a statistically significant decrease in physical and emotional abuse, as well as isolation behaviors. Differences by participant demographics and the role of communication skills and relationship quality as mediators of these outcomes are also discussed.

Targeting Threats to the Therapeutic Alliance: A Primer for Marriage and Family Therapy Training.

Although theory and research highlight the importance of the client-therapist relationship, marriage and family therapy (MFT) training has historically centered on specific models, consisting of proprietary language and techniques, instead of common factors like the therapeutic alliance. In this article, we begin by making an argument for explicitly focusing on the therapeutic alliance in MFT training programs. Next, we highlight common alliance threats experienced by both faculty members and student therapists. We then integrate research-informed principles with clinical wisdom to outline specific recommendations and concrete skill-building exercises for MFT educators and supervisors to use with their students to address these threats and advance training on the therapeutic alliance.

The Therapist's Role in Effective Marriage and Family Therapy Practice: The Case for Evidence Based Therapists.

In this paper we argue that the therapist is a crucial change variable in psychotherapy as a whole and in couple, marital, and family therapy specifically. Therapists who work with complex systems require more skills to negotiate demanding therapy contexts. Yet, little is known about what differentiates effective couple, marital, and family therapists from those who are less effective, what innate therapy skills they possess, how they learn, and how they operationalize their knowledge in the therapy room. We discuss the need to emphasize evidence based therapists (as opposed to therapies), and implications of the importance of the role therapists for training, practice, research priorities, and policy.

The Marriage of Couple and Relationship Education to the Practice of Marriage and Family Therapy: A Primer for Integrated Training

There is a high degree of overlap in the goals and strategies of couple and relationship education (CRE) and the practice of marriage and family therapy (MFT). Given these similarities, there is great potential benefit for the integration of MRE into the formal training of future MFTs. In this article, the authors focus on how CRE can complement both training in, and the practice of, MFT. In addition to highlighting both the similarities and differences between the disciplines, we explore potential benefits of this type of integration for both therapist and clients. We conclude by outlining a two-phase developmentally appropriate approach for integrating healthy relationship curricula into COAMFTE training programs. In phase one, MFT students get direct experience learning about, observing, and then directly facilitating CRE programs. In phase two, student therapists integrate CRE skills directly into their clinical practice of individual, couple, and family therapy.

Enhancement of Reducing the Risk for the 21st Century: Improvement to a Curriculum Developed to Prevent Teen Pregnancy and STI Transmission

To ensure that Reducing the Risk, a successful teen pregnancy prevention education curriculum, remains relevant for todays youth, covers all information youth need to know in order to make better choices, and is delivered in a standardized way, adaptations were made and enhancements were added. This article describes results of a pilot execution of initial adaptations to Reducing the Risk with 13 youth from impoverished neighborhoods between the ages of 14 and 18. After each pilot day, a focus group was held with these 13 youth and further adaptations and enhancements were added to the curriculum. The full adapted and enhanced version of Reducing the Risk was then tested as part of a larger efficacy study utilizing a three-arm cluster randomized controlled trial comparing the enhanced Reducing the Risk curriculum version with another curriculum that embeds sex education in the context of healthy relationship skill building, Love Notes, and a control condition curriculum. In order for other sites to replicate the work, this article details the findings from focus groups with youth participants in the pilot training that led to changes and additions in the curriculum. All changes and additions are described at length in this article.

The Multisystemic and Multilevel Investigation of the Expanded Therapeutic Alliance-Psychological Functioning Relationship in Individual Therapy

The expanded therapeutic alliance, consisting of multiple interpersonal alliance relationships, is a common factor inherent to the practice of all systemic therapies. The following study has three specific aims: (a) Bring an expanded, multisystemic emphasis to the study of the therapeutic alliance in individual therapy; (b) Understand better the session-by-session relationship between alliance and psychological functioning, including distinguishing within-person from between-person variability by using multilevel modeling techniques; and (c) Explore the role of early attachment relationships and family-of-origin experiences in moderating the alliance-psychological functioning relationship. Instead of taking only one or two alliance measurements throughout treatment like in the majority of previous research, we measured both alliance and psychological functioning continuously at each session for 296 subjects.

Statewide Implementation of Parenting with Love and Limits Among Youth with Co-Existing Internalizing and Externalizing Functional Impairments Reduces Return to Service Rates and Treatment Costs

Many community mental health (CMH) systems contain inefficiencies, contributing to unmet need for services among youth. Using a quasi-experimental research design, we examined the implementation of an adapted structural-strategic family intervention, Parenting with Love and Limits, in a state CMH system to increase efficiency of services to youth with co-existing internalizing and externalizing functional impairments (PLL n = 296; Treatment-As-Usual n = 296; 54% male; 81% Caucasian). Youth receiving PLL experienced shorter treatment durations and returned to CMH services at significantly lower rates than youth receiving treatment-as-usual. They also demonstrated significant decreases in internalizing and externalizing symptoms over time. Findings lay the foundation for further examination of the role of an adapted structural-strategic family treatment in increasing the efficiency of CMH systems.