FITT

 

FITT Model: Impact on Adult Intimate Relationships

  • Summaryt
  • Assessment Measures
  • Interventions
  • References

 

Summary

Within a family, the effects of chronic trauma and poverty can be seen at the individual level, as well as at the subsystem level, which means that the intimate partnership or couple relationship may be impacted when one a family member experiences trauma. Though some research points out that supportive adult intimate relationships can be a source of strength in helping an individual recover from a traumatic experience or deal with the stress of poverty, the majority of research in this area focuses on the difficulties faced by couples who have experienced trauma. Difficulties include problems with communication, difficulty expressing emotion, struggles with sexual intimacy, dissatisfaction with the relationship and higher rates of hostility, aggression and interpersonal violence. Little research has been done to identify the risk and protective factors that make intimate partners more vulnerable or more resilient in the face of traumatic experiences, though some authors have attempted to apply the general trauma literature to couples and identify the following predisposing factors: multiple traumatic experiences, mental illness, poor coping responses and severe trauma. The protective factors or resources identified in the research as potential buffers to the couple relationship from the impact of trauma include: positive coping strategies, high self-esteem, social support, good physical and mental health, and couple level resources such as cohesion, adaptability and shared power. The most frequently used assessment instrument measuring the impact of trauma within adult intimate relationships is the Dyadic Adjustment Scale (DAS), while the Family Assessment Form (FAF) is also used to measure interactions between adult caregivers. The Conflicts Tactics Scale is often used to assess intimate partner violence. Two models of couple level interventions addressing trauma have demonstrated some empirical support, including cognitive behavioral couples therapy (CBCT) and directed therapeutic exposure (DTE) for couples, while the following couples interventions have clinical support: emotionally focused couple therapy with trauma survivors, relational couple therapy for child survivors of trauma, and critical interaction therapy.

 

Assessment Measures

Name of Instrument Author(s) Domains Assessed Age Range Source/Form (self report, lab, observation, other) # of items Time Cost Training Required Where to obtain Psychometric Properties Other comments:
Dyadic Adjustment Scale (DAS) Spanier, 1976 Measure of intimate partner relationships. It assesses four areas: Dyadic consensus, Dyadic satisfaction, Dyadic cohesion, and Affectional expression. Adult Self-report 32 5-10 minutes $35 (manual); $2.25 per Quikscore form (pkgs of 20). Computer scoring also available for $3 per profile report.  Familiarity w/administration, scoring guidelines, and interpretation Multi-Health Systems Well validated  Applicable to both unmarried and married couples. Shorter versions are also available including a 14-item Revised Dyadic Adjustment Scale (RDAS) (Busby, Crane, Larson, & Christensen, 1995) which retains three of the original subscales and a 7-item Abbreviated Dyadic Adjustment Scale (ADAS or DAS-7) (Sharpley & Cross, 1982; Hunsley, Best, Lefebvre, & Vito, 2001) which includes a single factor.
Revised Conflict Tactics Scales (CTS2) Strauss, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B., 1996 Scales measuring the physical and psychological attacks on a partner in a marital, cohabiting, or dating relationship. Also looks at use of reasoning or negotiation to deal with conflicts. Scales include: physical assault, psychological aggression, negotiation, and injury & sexual coercion. Adult Self-report 78 10 minutes $54.50 for the handbook; $1.70 per form (pkgs of 25)  Familiarity w/administration, scoring guidelines, and interpretation Western Psychological Services Strong evidence for reliability and validity  Respondents rate their and their partner's behavior on an 8-point scale. Half of the items relate to respondent's behavior, half relate to their partner's behavior. Also, the CTS2-CA is an adolescent-report version of the Conflict Tactic Scales. Used as a child report of their parents behavior towards one another.
Family Assessment Form (FAF) McCroskey, Nishimoto, & Subramanian, 1991 Assesses 6 domains: living conditions, financial conditions, interactions between adult caregivers, interactions between caregivers & children, support available to family, and developmental stimulation available to children  Adult  Observation, clinical assessment, & self-report 102 Less than an hour for trained clinicians, following at least 3-4 face-to-face contacts with family  $14.95 for paper booklet (unlimited copies permitted). $495 computer administered program w/50 assessments; $4 per additional assessment. Recommended: 6 hours training for measure, 2 hours additional training if using computer software version.  CWLA website: Click Here Some evidence for reliability and validity  Scale utilizes an ecological perspective and was designed as a "practice-based instrument" for use in child welfare home-based services.
Partner Violence Inventory (PVI)  Bernstein, D.P., 1998 Assesses physical, sexual, & emotional assault, partner drug & alcohol abuse, mutual physical fights, warmth & affection, and minimization of problems Adult Self-report  37 5 minutes Unable to locate  Familiarity w/administration, scoring guidelines, and interpretation Unable to locate New or promising measure   

 

References

Bernstein, D. P. (1998). A new screening measure for detecting 'hidden' domestic violence. Psychiatric Times, 15.

McCroskey, J., Nishimoto, R., & Subramanian. K. (1991). Assessment in family support programs: Initial reliability and validity testing of the Family Assessment Form. Child Welfare, 70, 19-33.

McCroskey, J., Sladen, S. & Meezan, W. (1997). Family Assessment Form: A Practice Based Approach to Assessing Family Functioning. Washington DC: CWLA Press.

Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage & the Family, 38, 15–28.

Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The Revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283-316.

 

Interventions

Treatment Name

Developer

Essential Elements

Research Evidence & Outcomes

URL for Additional Information

A framework for couples therapy developed for use with Vietnam veterans guided by the three clusters of PTSD symptoms: re-experiencing, avoidance and arousal

Sherman et al. (2005)

Describes how each cluster of PTSD impacts the relationships and then offers guidelines for intervention. Re-experiencing: to assist the veteran in teaching his partner how to support him during episodes, teach the couple a debriefing process to help deescalate the situation, and promote learning from the episode.
Avoidance: to empower the couple to risk trust and openness with each other and negotiate how much of the trauma is shared in the relationship; encourage the pursuit of enjoyable activities, teaching interpersonal problem-solving skills.

Increased arousal:  to assist the couple in coping effectively with irritability and/or expressions of anger, teach conflict disengagement strategies, and educate the couple about anxiety management strategies and sleep hygiene tips.

Case studies demonstrated reduction of traumatic stress symptoms and improved relationship quality.

http://careforthetroops.org/articles/Article-20040224%20working_with_families_and_vets.pdf

Cognitive Behavioral Couples Therapy (CBCT)

Monson et al. (2004)

CBCT for PTSD includes 15 sessions with 3 phases of treatment: (1) treatment orientation and psychoeducation about PTSD and its related intimate relationship problems; (2) behavioral communication skills training; and (3) cognitive interventions.

Clinician and partner reports showed significant improvements in PTSD symptoms, while veterans denied reduction in PTSD symptoms but reported decreased depression and anxiety. Partners reported improved relationship satisfaction, while veteran reports remained the same.

http://www.coupletherapyforptsd.com/therapy/

Critical Interaction Therapy

Johnson, 

Feldman,  & Lubin (1995)

Nine-step therapy process: (1) free discussion; (2) emergence of the critical interaction; (3) identifying the traumatic memory; (4) establishing the physical connection; (5) reporting the traumatic story; (6) linking trauma with current conflict; (7) checking in with spouse; (8) reviewing the critical interaction sequence; and (9) offering directives.

Developed for use with Vietnam veterans, case studies demonstrated reduction of traumatic stress symptoms and improved relationship quality.

http://www.ncbi.nlm.nih.gov/pubmed/8674521

Directed Therapeutic Exposure (DTE) for couples

Boudewyns & Shipley (1983)

18 twice-weekly sessions in 3 stages: (1) introduction and data gathering (2 sessions); re-exposure-cognitive restructuring (13-14 sessions); and (3) generalization training and termination (1-2 sessions).

Sample included 42 Vietnam veterans with PTSD and a family member (89% participated with their spouse or an intimate partner). DTE resulted in improvement of positive symptoms (such as hypersensitivity and hyperarousal), but no significant change in negative symptoms (such as avoidance and numbing).

http://www.springerlink.com/content/v1686671x4508078/

Emotionally Focused Couple Therapy (EFT)

Johnson & Greenberg (1988)

EFT for trauma survivors follows 3 stages: (1) creation of stability and de-escalation of trauma symptoms and relationship distress; (2) restructuring of interactions to create the secure bonding that fosters relationship healing; and (3) integration of these changes into the life of the couple.

Meta-analysis of studies of EFT with “maritally distressed couples” (not necessarily trauma survivors) showed an effect size of 1.3, meaning that almost 90% of treated couples rated themselves better than controls following this intervention (Johnson et al., 1999). Although case studies indicate success with trauma survivors, no empirical studies reported.

http://www.iceeft.com/index.php?option=com_content&view=article&id=47&Itemid=79

Relational Couple Therapy

Mazor, 2004

Based upon object relations theory, designed for use with couples with one partner who survived the Holocaust. Three phases of intervention: (1) developing a “containing therapeutic environment” to establish a sense of trust and secure relations with the therapist and, later on, within the couple bond; (2) relating each partner’s life/trauma story, increasing empathy, reducing automatic projections and fears of each other; (3) creating new responses and behaviors in the couple “that may extend the couple’s emotional system.”

Qualitative case studies indicate potential success of this intervention, but no empirical research has been reported.

http://www.springerlink.com/content/lq3144r003370761/