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Polyamory, meaning "many loves," can be defined as the practice of having or pursuing multiple romantic relationships with the knowledge and consent of all involved. Falling into the category of ethical nonmonogamy, polyamory is becoming increasingly recognized as a relationship style, although monogamy is still the norm in many cultures. Polyamory is distinguished from polygamy in that polygamous people are married to more than one person, whereas polyamorous people may or may not be married to one other person.

Many of those who pursue polyamorous relationships find them fulfilling, and when challenges arise, a therapist or other mental health professional may be able to help partners navigate polyamory and other nonmonogamous relationship styles.

Understanding Ethical Nonmonogamy

In many cultures, monogamy is still upheld as the ideal structure for committed relationships, but nonmonogamous relationship styles are increasingly being recognized as a valid choice. Monogamous cultures tend to support the ideas of "soul mates," "true love," and marriage as the goals of committed relationships. In an idealized version of this model, people generally engage in romantic relationships in order to find one person to spend their future with, believing once that person is found, they will no longer desire other relationships.

However, people pursue relationships in a variety of ways. Some people find a monogamous relationship style works for them. They may choose a partner and spend life committed to that one partner. Others move through a series of monogamous relationships, seeking out a new partner when they experience waning attraction or lack fulfillment. Still others find monogamy does not work for them and choose to pursue some form of nonmonogamy.

Ethical nonmonogamy is an informed choice, not something a person pursues only at the request of a partner. While people become aware of their desire for or tendency toward nonmonogamy in a variety of ways, it is generally considered unhealthy when people enter a nonmonogamous relationship without choosing it for themselves.

Some pursue an open relationship or choose to share partners out of the desire to experience casual intimacy with multiple people. Others find they experience love and affection for multiple people at the same time, and they may feel unhappy or stifled when in a monogamous relationship. For many, polyamory may be an unalterable aspect of identity, not a phase or a temporary lifestyle while waiting for "the right one" to come along.

Infidelity is not considered to be a form of polyamory. Though some polyamorous or open relationships may have different rules or standards regarding the information shared between partners about their other relationships, most exist on the basis that some information about each relationship will be shared for reasons of safety, consent, and trust.

Polyamory in Popular Culture

Polyamory has recently received significant attention in the media. Showtime's One such book, Polyamory: Married and Dating highlights the lives of a polyamorous triad and two married couples who move in together as a polyamorous foursome. A number of books offer advice on polyamory. The Ethical Slut, is considered by many to be a helpful guide and a good starting place for those who choose to pursue polyamorous relationships.

Due to the recognition of polyamory as a legitimate relationship style, people may be increasingly likely to identify as polyamorous. People in polyamorous relationships may raise children together, and married people may make additional long-term commitments to lovers to whom they are not married. Some dating sites feature selective filters for nonmonogamous relationships, and many people use these sites to find friends and potential partners.

Although polyamory is becoming more accepted, one challenge to the way it is viewed is the lack of inclusion of people of color, whether in the media, research studies, or in events and groups. People of color often report feeling "othered" or fetishized at polyamory events or in groups, and this marginalization may lead some to be reluctant to join communities that do not seem diverse or welcoming. Thus, people may feel excluded from a lifestyle natural to them.

Because plural marriage is not legal in the United States, polyamory has an ambiguous legal standing-even for those who do not wish to marry more than one partner. Laws generally do not specifically prohibit sexual relationships with more than one person; however, adultery is still grounds for divorce in many states. Thus, married people who are polyamorous may be violating their state's terms of marriage even if they have chosen different terms, leading to potential complications. Other complications and conflicts may arise when partners in a polyamorous relationship raise children together but not all partners have legal rights to the child or children, or when multiple people attempt to buy real estate together.

Polyamory Terms

There are as many ways to carry out polyamorous relationships as there are polyamorous people. There are some identities within polyamory, as well as more common types of relationship structures that emerge. While the following is not an exhaustive list, it represents many people who are polyamorous.

Hierarchical polyamory: This describes when one of a person's relationships takes precedence or priority over others. Typically, this is seen when married partners have other relationships outside of their marriage but do not intend to marry or cohabitate with others. The marriage becomes the primary relationship; another partnership is secondary; a third is tertiary, etc.

Couples privilege: Couples privilege typically applies to partners in a primary relationship who practice hierarchical polyamory, though this may not always be the case. Partners may demonstrate couples privilege by having "veto power" over the other partner's dates, dictating rules about other partnerships, or simply maintaining a hierarchical relationship dynamic. Because not all people are "out" as polyamorous, couples privilege can mean the couple's relationship is public, while all other partnerships remain closeted from friends, family, and social media.

Metamour: A partner's partner is a metamour. Some metamours may never meet, while others get acquainted or even develop deep friendships.

Unicorn: A unicorn is typically a bisexual woman who is interested in being in a relationship with a couple-usually a heterosexual man and an LGBTQ+ woman. Named for their rarity, unicorns may be expected to be equally devoted to each party and not date outside of the triad relationship. Couples looking for this dynamic, especially on dating sites, are sometimes called unicorn hunters.

Polycule: A group of people with partners in common is called a polycule. A polycule might be small-for instance, a husband, wife, and the husband's boyfriend-or can be many partners and partners of partners.

Relationship escalator: Romantic relationships tend to have a trajectory or progression of milestones that are viewed as deepening the relationship. Examples of this might include traveling together, meeting family, moving in together, or having a bonding ceremony such as marriage. These milestones, and the mind-set of wanting or needing to achieve them, is known as the relationship escalator.

Solo polyamory: This describes when someone has relationships and dates, but is committed to maintaining an independent life and does not intend to marry or move in with any partner(s). People who practice solo polyamory generally eschew the relationship escalator.

Relationship anarchy: Those who believe in relationship anarchy strive for fluidity in all types of relationships. They may not label relationship types or distinguish between friendships and partnerships. Personal freedom and spontaneity take priority in the philosophy of relationship anarchy.

Don't ask, don't tell (DADT): Not all people are comfortable talking to a partner about a different partnership, or hearing about their partner's other relationships. A "don't ask, don't tell" policy means each partner is free to date or seek other relationships, but they agree not to discuss those pursuits with one another. This works for many people; however, because communication is known as a primary tenet of polyamory, a DADT policy is sometimes seen as a red flag by others in the community.

One-penis policy (OPP): Seen almost exclusively in relationships between a heterosexual man and a LGBTQ+ woman, a one-penis policy is a type of contract in which the woman agrees she will date or have sex only with people who do not have penises. The inverse-a one-vagina policy-is rarer. Like DADT, the one-penis policy is often seen as a red flag.

Kitchen table polyamory: Frequently regarded as an idyllic polyamory dynamic, kitchen table poly is a scenario in which a polycule cohabitates. It's named for the idea of all partners being able to gather around the kitchen table for breakfast.

Comet: A comet is a long-distance polyamorous partner.

Compersion: Compersion is when a nonmonogamous person feels contentment, elation, or warmth when a partner experiences joy with a different partner or potential partner. Not all people who practice polyamory experience compersion, and for some it is cultivated over time.

Polyamory Flag

The polyamory flag has three stripes-blue, red, and black from top to bottom. In the center of the flag is a gold Greek lowercase pi symbol. Pi represents the first letter of polyamory, as well as the concept of infinite love.

The blue stripe of the flag symbolizes communication and honesty with all partners; red represents passion and love; and black is a reference to the closeted nature of many polyamorous relationships that are hidden because of intolerance or possible rejection.

Polyamorous Celebrities

Few celebrity couples have revealed they have an open or polyamorous relationship dynamic, though it's common for tabloids and fans to speculate about celebrities' personal lives-especially after anything resembling a scandal. Celebrity couples who have made murky remarks about the openness of their relationships include:

Will Smith and Jada Pinkett-Smith

Brad Pitt and Angelina Jolie

Robin Thicke and Paula Patton

Ethan Hawke and Ryan Shawhughes

Other celebrities who have more explicitly talked about nonmonogamy or polyamory, or who have documented consensual relationships with multiple people concurrently, include:

Mo'Nique

Margaret Cho

William Marston, Elizabeth Marston, and Olive Byrne, co-creators of Wonder Woman

Scarlett Johansson

Therapy for Nonmonogamous Partnerships

A couples counselor may be able to help a person navigate the beginnings of a nonmonogamous relationship, and therapy may be a safe place for many to discuss their goals for and concerns regarding a nonmonogamous relationship. An increasing number of mental health professionals specialize in addressing the challenges of polyamorous relationships.

Partners who remain committed to each other but also wish to explore intimacy or relationships with others may find therapy a supportive space to discuss the topic. Issues that may affect nonmonogamous partnerships include:

Some people may find that, despite their interest, a polyamorous lifestyle is not for them. Therapy can help one arrive at and clarify this realization and may also provide a safe environment to discuss this with a partner.

Case Examples of Therapy for Polyamory

Interest in polyamorous lifestyle threatens partnership: Eliza, 29, and Morton, 28, seek a couples counselor who specializes in nonmonogamous relationships. Both Eliza and Morton are interested in opening their partnership, but they have different ideas about how to pursue an open relationship. Eliza is heterosexual, while Morton is pansexual, and he states his desire to pursue casual or friendly sexual encounters with anyone to whom he is attracted. Eliza is supportive of Morton's orientation and encourages this. However, she tells the therapist she is not interested in casual sexual encounters. Based on her relationship history, she knows she has the capacity to love more than one person at the same time, and she wishes to pursue men in the hopes of making other romantic connections while remaining committed to Morton. Morton expresses his frustration and discomfort with this, telling the therapist he does not believe he has the capacity to care for other people in the same way he cares for Eliza. He thought Eliza was satisfied with his role in their partnership and he feels threatened by her professed interest in other men. In therapy, the two work to set up boundaries for their relationship as they begin to pursue other intimate connections and, with the help of the therapist, explore ways to show and reinforce their commitment to each other and their relationship. They each make goals for themselves: Eliza, to communicate her feelings about others clearly and share with Morton her attraction or interest in another, and Morton, to trust Eliza's commitment to him and the life they have built. They decide to continue in therapy as needed to address and work through any concerns-such as jealousy, resentment, or miscommunication-as they arise.

Addressing the challenges of parenting while in a polyamorous relationship: Joni, 32, and Hallie, 38, enter family therapy with their mutual partner, Oscar, 35, and their son Marcus, 9. They report no issues affecting the family dynamic but express the desire to talk through issues that may arise as they continue to raise a child as a polyamorous triad. Joni is Marcus' biological mother, and Oscar is his father. Joni and Hallie are legally married, and the three consider Marcus to be equally parented by all three adults. One issue they bring to therapy is how Marcus will explain the relationship in school and to his friends, if doing so becomes necessary. Marcus tells the therapist that he thinks his parents' relationship is "fine" because "they all love each other, and they love me," but the adults worry that in a few years his views will change, and they want him to grow up accepting of relationships that exist outside social norms. Although Joni, Hallie, and Oscar express mutual happiness and satisfaction with the relationship, they also discuss what might happen if one or more of them wishes to leave the partnership, exploring ways to prevent any negative impact on Marcus. The therapist helps them address these issues and gives each of them a chance to voice their thoughts and concerns, and they decide to continue periodically in therapy in order to prevent possible conflicts.

References:

1. Alt.polyamory. (n.d.). Retrieved from http://www.polyamory.org

2. Brown, G. (2014, April 7). So You Want to Try Polyamory. Retrieved from http://everydayfeminism.com/2014/04/so-you-want-to-try-polyamory

3. Edwards, B. (n.d.). The real list of celebs who have open relationships. Retrieved from https://www.nickiswift.com/2274/celebrities-admitted-open-marriages/

4. Grinberg, E. (2013, October 26). Polyamory: When three isn't a crowd. Retrieved from http://www.cnn.com/2013/10/26/living/relationships-polyamory

5. Hergenrader, J. (2017). 5 Celebrities Share What They Really Think About Monogamy. Retrieved from https://www.womenshealthmag.com/relationships/a19993534/celebrities-in-open-relationships/

6. Kacere, L. (2013, October 15). More Than Two: Examining the Myths and Facts of Polyamory. Retrieved from http://everydayfeminism.com/2013/10/myths-and-facts-of-polyamory

7. The Man Behind Wonder Woman Was Inspired By Both Suffragists And Centerfolds. (2014). Retrieved from https://www.npr.org/2014/10/27/359078315/the-man-behind-wonder-woman-was-inspired-by-both-suffragists-and-centerfolds

8. Mitchell, K. (2015, February 4). There's a Big Problem With Polyamory That Nobody's Talking About. Retrieved from http://mic.com/articles/109616/there-s-a-big-problem-with-polyamory-that-nobody-s-talking-about

9. Polyamory. (n.d.). Retrieved from http://www.unmarried.org/polyamory.html

10. Romano, T. (2013). The Rise of Polyamory: So What If Celebrities Have an Open Marriage? Retrieved from https://www.thedailybeast.com/the-rise-of-polyamory-so-what-if-celebrities-have-an-open-marriage

11. Thomas, E. (2014, April 9). In Mainstream Media, Polyamory is Getting Attention. Retrieved from https://bitchmedia.org/post/mainstream-media-has-discovered-polyamorous-relationships

12. Veaux, F. (2015, August 25). Polyamory FAQ. Retrieved from https://www.morethantwo.com/polyamory.html

13. Veaux, F. (2015, August 25). Glossary of Poly Terms. Retrieved from https://www.morethantwo.com/polyglossary.html

14. X, G. (2015, April 15). 6 Varieties of Ethical Non-Monogamy. Retrieved from http://www.huffingtonpost.com/gracie-x/6-varieties-of-ethical-non-monogamy_b_7066490.html

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Polyamory is becoming more widely recognized as a valid relationship style, and those wishing to pursue polyamory may find the support of a therapist he...

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Family Process - 2023 - Edwards - The use of emotionally focused therapy with polyamorous relationships

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What is Polyamory?  - Esther Perel & Margie Nichols

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By Stephanie M. Sullivan, MS, LLMFT

Polyamory is the combination of the Greek word for "many" and the Latin word for "love." Combined, polyamory means "many loves" or "more than one love" (Anapol, 2010; Klesse 2006). To be more specific, polyamory is a relationship style centered on the belief that it is possible to love more than one person. Polyamorous relationships often involve having more than one romantic relationship simultaneously, with full knowledge and consent of all the partners involved. Polyamory is not cheating, and should not be confused with affairs or infidelity. It also differs from polygamy, which is a religious-based form of non-monogamy. It is estimated that there are somewhere between 1.2 to 9.8 million polyamorous people living in the United States (Sheff, 2014).

Every polyamorous relationship has different structures, as there are often more than two people involved in a romantic relationship. However, there are some basic labels to categorize the different kinds of relationships that polyamorous people form.

Vee: A vee relationship is made up of three partners and gets its name from the letter "V," in which one person acts as the "hinge" or "pivot" partner dating two people. The other two people are not romantically or sexually involved with each other. These two people are known as "metamours" to one another (metamours are two people who are dating the same person, but are not actively dating each other). Metamours in a vee relationship may not know one another, may be vague acquaintances, or may be very good friends. In some cases, metamours may even live with one another, with or without their partner.

Triad: A triad is also made up of three partners, but is a relationship in which all three partners are romantically and/or sexually involved with each other. Triads may be formed when an existing couple opens their relationship and finds a third partner who is interested in them both, and whom they are both also interested in. They may also be formed when two metamours in a vee relationship begin to date, changing the form of the relationship from a vee to a triad. A triad may also form when three very close friends begin dating each other at the same time.

Quad: A quad is made up of four partners who are intimately connected in some way, whether romantically or sexually. A quad can be formed in a multitude of ways, such as a triad adding another partner. However, quads are often formed when two swinging couples connect and begin dating, forming the quad.

While these labels are descriptive of some of the kinds of relationships that can form, this list is by no means exhaustive. Every person's relationship landscape will look different. Someone who is part of a vee relationship may also be part of a different, separate triad. They may also simply be dating one other person, or no one at all. The people involved in these relationship structures may be referred to as an individual's polycule, which is a term used to discuss collectively all of the people who are in a relationship with one or more members of a polyamorous group. This term was created by combining the words "polyamory" and "molecule."

There are also added layers to the way people in polyamorous relationships experience their relationships. A popular notion in the polyamorous community is "You can have unlimited love, but you do not have unlimited time." Therefore, each individual has to make a choice about how they prioritize their time and emotional energy, and how to define the importance of each relationship.

Hierarchical Polyamory: Individuals who practice hierarchical polyamory place more importance on one relationship above other relationships (Easton & Hardy, 2009). The partner that this person shares finances with, lives with, or co-parents with will likely be considered the primary partner. This person may be prioritized above other relationships in regards to time commitments, vacations and holidays, going to family functions, and other important events as well. Other partners may be considered secondary or tertiary. Secondary or tertiary partners may not be taken into account when big decisions are being made, and if the individual is not "out" as polyamorous, could even be kept hidden from friends and family.

Non-Hierarchical Polyamory: In non-hierarchical polyamory, individuals within the relationship do not prioritize one relationship above all others. This does not necessarily mean that time is split equally between two or more partners, nor does it mean that all the partners live together. It does mean that every partner is considered when making big decisions. It may also mean that each partner has the ability to go on vacations with the individual. Within non-hierarchical polyamory, there is generally a belief that one partner does not hold importance over another, and each relationship is important in its own way.

Solo Polyamory (also referred to as "sopo"): A solo polyamorist is someone who does not have any desire to be considered part of a "coupled" relationship. In solo polyamory, an individual may not live with or share finances with anyone else, and does not have the desire to work toward those things. Some solo polyamorists may live with different partners throughout the year and prefer a nomadic lifestyle. They often consider their partners when making big decisions, but do not allow their partners to dictate their choices. For some people, solo polyamory is an option to pursue for a limited time, perhaps while raising their children or when an individual is focused on their career and has no desire to build a home with another person. For others, solo polyamory is a lifelong pursuit, and often consider themselves their own primary relationship (Winston, 2017). This can allow the solo polyamorist to make decisions based on what makes themselves and their relationships strong and happy. Although solo polyamorists usually do not live with their partner(s), this does not mean that they do not have one or more deeply committed and intimate relationships.

Relationship Anarchy: A person who practices relationship anarchy may differ a bit from other polyamorists, but they still often fall within the spectrum of polyamory. Relationship anarchy is a relatively new term to refer to individuals who believe that all interpersonal relationships are equally important (Winston, 2017). A relationship anarchist might have multiple romantic relationships simultaneously, but may also avoid making special distinctions between relationships that are romantic, sexual, platonic, or familial. They often avoid putting relationships into categories or having expectations in their relationships. Instead, they allow their relationships to take any form and have any level of commitment that the participants decide to have. For example, a relationship anarchist may choose to buy a house with their best friend, rather than their romantic partner of ten years.

Again, this list is not exhaustive by any means. Every individual navigating a polyamorous relationship will structure their relationships differently, and may identify with certain aspects of these polyamorous structures but not with others. This list is merely intended as an introduction to understanding how many polyamorous relationships form and develop. Any of these relationship structures can be done in a healthy way or in an unhealthy way; it is up to the participants to ensure they are practicing the different forms of polyamory ethically.

In any relationship, whether it is monogamous or a consensual non-monogamous relationship, there is the possibility that someone with get their feelings hurt, experience jealousy, and experience arguments and disagreements. Therefore, it is imperative for an individual in any relationship to consider the needs of each of their partners, their boundaries, and their expectations for the relationship. It is also important to consider your own needs, boundaries, and expectations within relationships, and to learn to communicate these things safely and considerately. Educating yourself about the polyamorous community, ethical and non-ethical relationships, and healthy communication techniques can all help you navigate happy and healthy relationships with your partners.

References

Anapol, D. (2010). Polyamory in the 21st century: Love and intimacy with multiple partners. Lanham, MD:
Rowman & Littlefield Publishers, Inc.

Easton, D., & Hardy, J. W. (2009). T he ethical slut: A practical guide to polyamory, open relationship, &
other adventures (2nd ed.). Berkley, CA: Celestial Arts.

Sheff, E. (2014). The polyamorists next door: Inside multiple-partner relationships and families. Lanham,
MD: Rowman & Littlefield.

Winston, D. (2017). The smart girl's guide to polyamory: Everything you need to know about open relationships, non-monogamy, and alternative love. New York, NY: Skyhorse Publishing.

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Polyamory is the combination of the Greek word for "many" and the Latin word for "love." Combined, polyamory means "many loves" or "more than one love" (Anapol, 2010; Klesse 2006).

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Working with Poly Couples: What to do and not to do

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Working with Poly Couples: What to do and not to do

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Working with Polyamorous & Non-Monogamous Clients | Therapist Thrival Guide Episode 45

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As more people explore and embrace having multiple romantic and sexual partners simultaneously, the demand for specialized relationship counselling services has also increased.

Relationship counselling provides valuable support to individuals in open relationships, addressing the unique challenges and complexities of maintaining multiple loving connections.

In this article, we will discuss the importance of polyamory relationship counselling, its benefits, and how to find a poly-friendly therapist.

The Need for Polyamory Relationship Counselling

While polyamory offers a more expansive and inclusive approach to love and relationships, it isn't without its challenges.

The complexities of managing multiple relationships, navigating jealousy, and establishing clear boundaries and agreements can be overwhelming for some individuals. In addition, societal misconceptions and stigmas surrounding polyamory can lead to feelings of isolation and internalized shame.

Polyamory relationship counselling provides a safe and supportive space for individuals and couples to explore their feelings, address concerns, and develop effective communication and conflict-resolution skills.

By seeking professional guidance, those in polyamorous relationships can better understand their emotional needs, identify areas of growth, and foster healthier, more fulfilling connections.

Benefits of Polyamory Relationship Counselling

1. Improved Communication

Effective communication is crucial in any relationship but is especially important in polyamorous connections. A poly-friendly therapist can help clients develop better communication skills, allowing them to express their needs, set boundaries, and navigate difficult conversations with partners.

2. Conflict Resolution

Conflicts are inevitable in any relationship, and polyamorous relationships are no exception. Relationship counselling can help clients learn healthy ways to address and resolve conflicts, promoting a more harmonious and balanced dynamic among partners.

3. Overcoming Jealousy and Insecurity

Jealousy and insecurity can be incredibly challenging in polyamorous relationships. A therapist can provide tools and techniques for managing these emotions, helping clients build trust and confidence in their relationships.

4. Establishing Boundaries and Agreements

Clear boundaries and agreements are essential in polyamorous relationships to ensure all parties feel respected and valued. A poly-friendly therapist can guide clients in creating and maintaining these agreements, fostering a more stable and secure relationship foundation.

5. Emotional Support and Validation

For those who may feel isolated due to societal misconceptions and stigmas surrounding polyamory, relationship counselling can offer much-needed emotional support and validation. A poly-friendly therapist will understand and validate the complexities and challenges unique to polyamorous relationships, helping clients feel seen and heard.

Finding a Poly-Friendly Therapist

While many therapists may have experience working with couples and relationship issues, it's essential to find a professional knowledgeable about and supportive of polyamory. Here are some tips for finding a poly-friendly therapist:

1. Research Online

Search online directories and therapists' websites to find professionals specializing in polyamory relationship counselling. Look for indications of experience or training in working with non-monogamous clients.

2. Ask for Recommendations

Reach out to local polyamory support groups and communities for therapist recommendations. Other clients' experiences can provide valuable insight into a therapist's expertise and approach.

3. Interview Potential Therapists

Once you have a list of potential therapists, contact them to discuss their experience and approach to polyamory relationship counselling. Ask about their familiarity with polyamory, views on non-monogamous relationships, and any specialized training they have received.

4. Trust Your Instincts

Choosing a therapist with whom you feel comfortable and supported is essential. Trust your instincts when evaluating whether a therapist fits your unique relationship needs.

Conclusion

Polyamory relationship counselling is an invaluable resource for individuals and couples navigating the complexities of open love. By seeking professional support, those in polyamorous relationships can develop the skills and tools necessary to foster healthy, fulfilling connections.

As societal attitudes towards non-monogamy continue to evolve, it's crucial to have access to specialized counselling services. It's important that they understand and validate the unique challenges faced by those in polyamorous relationships.

If you're looking for relationship counselling in Calgary , we'd love to help you. Virtuous Circle Counselling is committed to helping people, starting with non-judgment and self-compassion. Change starts with a single step, and we would like to help you. Get started today. Let's talk!

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In this article, we will discuss the importance of polyamory relationship counselling, its benefits, and how to find a poly-friendly therapist. Read on!

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https://youtu.be/xQCg-jC25fo

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Circle of Willis: Susan Johnson, Part 1 on Apple Podcasts

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We Can Do Hard Things with Glennon Doyle: REAL, JOYFUL SEX with Emily Nagoski on Apple Podcasts

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Eichenberg, C., Huss, J., & Küsel, C. (2017). From online dating to online divorce: An overview of couple and family relationships shaped through digital media. Contemporary Family Therapy, 39(4), 249-260. https://doi.org/10.1007/s10591-017-9434-xLink

Bouffard, S., Giglio, D., & Zheng, Z. (2022). Social media and romantic relationship: Excessive social media use leads to relationship conflicts, negative outcomes, and addiction via mediated pathways. Social Science Computer Review, 40(6), 1523-1541. https://doi.org/10.1177/08944393211013566Link

Abbasi, I. S., & Alghamdi, N. G. (2017). When flirting turns into infidelity: The facebook dilemma. The American Journal of Family Therapy, 45(1), 1-14. https://doi.org/10.1080/01926187.2016.1277804Link

Carter, Z. A. (2018). Emotional and sexual facebook communication habits of married men with the opposite sex: The damaging marital effects of facebook cyberinfidelity. The Journal of Psychology and Christianity, 37(2), 153-161.Link

Pickens, J. C., & Whiting, J. B. (2020). Tech talk: Analyzing the negotiations and rules around technology use in intimate relationships. Contemporary Family Therapy, 42(2), 175-189. https://doi.org/10.1007/s10591-019-09522-9Link

Vaterlaus, J. M., Stinson, R., & McEwen, M. (2020). Technology use in young adult marital relationships: A case study approach. Contemporary Family Therapy, 42(4), 394-407. https://doi.org/10.1007/s10591-020-09538-6Link

Hertlein, K. M., Chang, J., VanYperen, A., Fatkin, K., & Nakamura, S. (2022). Experiences after infidelity via internet communication: Surveillance, ambivalence, and termination. Sexual and Relationship Therapy, 37(4), 537-556. https://doi.org/10.1080/14681994.2021.1907568Link

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Small Things Often - The Gottman Institute

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Sex is a normal part of life that affects and interacts with other parts of your life, including your sexual identity, physical health, relationships, family planning, and mental health. Consensual, healthy sex can have both physical and mental benefits.

Sex and consent

When we talk about sex, we're also talking about consent -freely and willingly agreeing to engage in sexual activity. Consent is the key to a healthy sexual experience. Your choice to have or abstain from sex should be entirely yours.

What is consent?

Consent is often defined as an "enthusiastic yes" to any type of sexual activity. This means verbally agreeing to sexual activity as well as using nonverbal cues (like body language) that match this agreement. Nonverbal cues alone aren't enough to show consent; explicit verbal communication is also important.

Someone who seems to show interest with their body language hasn't given consent until they also say they want to engage in a sexual activity. Similarly, someone who feels pressured or coerced into having sex-and who doesn't explicitly say no, but clearly communicates through their body language that they don't want to have sex-has not given consent.

Consent isn't a one-time event. Consenting to sex once with someone doesn't mean you agree to have sex with them forever. Similarly, consenting to one kind of sexual activity doesn't mean you're saying yes to all sexual activities. Consent can also be taken back at any time before or during sex.

Shame, pressure, expectation, or threats should play no part in influencing your decision to engage in a sexual activity. Similarly, you should never use these tactics to try and convince someone to engage in sexual activity with you.

Who can consent to sex?

Only adults can consent to sex. Minors categorically can't. People of any age who are incapacitated or overly intoxicated by alcohol or drugs also can't give consent, and neither can people who are cognitively impaired due to injury, illness, or certain disabilities.

Masturbation, abstinence, and asexuality

The rule of consent also applies to sex by yourself. Private self-exploration through masturbation is normal and healthy, but no one should ever feel pressured into any sexual activity, including masturbation. People can live full, healthy lives without sex, whether they identify as asexual or freely choose to be abstinent or celibate.

What is sex positivity?

Sex positivity is the attitude that healthy, safe, consensual sex between adults is generally a good thing. It rejects the idea that sex (particularly "too much" sex or certain kinds of sex acts) is unhealthy, morally bad, or "dirty." It also avoids the idea that some types of sex-such as heterosexual intercourse, sex for reproductive purposes, or sex that always ends with orgasm-are superior to others.

Many mental health experts take a sex-positive approach in their work. Using a sex-positive framework, mental health professionals can help people of all sexualities and identities learn to have a healthy relationship with sex, their sexual identity, and their potential or committed sexual partners. They can also help people protect and prioritize their physical and mental health around engaging in sexual activity.

Is sex healthy?

Healthy, consensual sex protects and prioritizes the physical and mental health of all participants. Sex can have many physical benefits, including:

The mental health benefits of having sex can include:

Stress relief: Having sex can lower stress hormones like cortisol.⁶

Happiness: Sex can release hormones that make us feel good, including dopamine, endorphins, and oxytocin. This may temporarily boost your mood, reducing symptoms of anxiety or depression.⁷

Increased self-esteem: Sex and masturbation can allow us to explore our bodies in ways that increase self-confidence.

Better communication: Communication is important during sex to ensure everyone feels safe and enjoys the experience. Sex can help you learn how to communicate better with your partner(s), inside and outside the bedroom.

Increased intimacy: Sex can be an intimate experience, especially if you have it regularly with the same partner(s). It can make people feel physically and emotionally closer to each other.

Healthy sexual activity is motivated by pleasure, curiosity, and/or experimentation. It's unhealthy, though, to engage in sexual behavior as a way to avoid difficult emotions or to intentionally harm yourself or others.

Is it unhealthy to have multiple sexual partners?

It's not inherently unhealthy, bad, or wrong to have multiple sexual partners. No matter how many you partners you have, you'll need to take intentional steps to protect your sexual health and your mental health. (See our tips below.)

How sexual health affects mental health

Protecting and promoting your sexual health, as well as your mental health, requires safety. If your sexual life lacks physical, mental, or emotional safety, you may face negative mental health outcomes, such as:

Increased anxiety: Engaging in unsafe or obsessive sexual behavior increases your risk for sexually transmitted infections or diseases. This risk to your physical health can increase your anxiety.

Emotional distress: Excessive preoccupation with sex can affect both your physical and mental health. If you're diagnosed with hypersexual disorder (sometimes called "sex addiction"), a seemingly uncontrollable desire for sex may cause you distress, threaten your health, and inhibit your daily functioning. If you think your sexual behavior may be compulsive or you feel out of control, seek help from a sex therapist.

Guilt, shame, or depression: If you're LGBTQIA+ or exploring or questioning your sexuality, you may struggle with guilt, shame, or depression due to societal discrimination, lack of family or community support, or your own internalized homophobia or transphobia. Your identity isn't the cause of these feelings, but society's bigotry may put you at risk.

How mental health affects sex

Just as sex can affect your mental health, your mental health can affect your relationship to sex. Certain conditions (and their treatments, including some medications) can affect your sexual desire and performance. These include anxiety, depression, insomnia, stress, grief, and some antidepressants.

Unresolved or untreated trauma-particularly trauma rooted in sexual abuse or assault-can have a huge impact on your experiences with sex. Posttraumatic stress disorder (PTSD) symptoms can be triggered by sexual activity, especially if you've experienced sexual trauma. Traumatic birthing experiences can also affect your sexual desire.

If you have mental health challenges related to sex, a sex therapist, trauma-informed therapist, and/or a couples counselor can help you start your journey toward healing. Browse our directory to find a licensed mental health professional near you.

Intimacy and mental health

"Intimacy" refers to closeness, and it's another part of life that intersects with sex and mental health. Intimacy often characterizes committed sexual relationships; however, not all sex is intimate, and not all intimacy is sexual. Examples of intimacy include:

Physical intimacy: Holding hands, hugging, sharing physical space, sitting close

Emotional intimacy: Confiding in someone, asking for advice, offering encouragement, expressing feelings verbally

Sexual intimacy: Being naked with a sexual partner, holding each other, massaging one another, engaging in sexual activity

Both sexual and nonsexual intimacy are associated with various mental health benefits, including decreased stress, a stronger sense of belonging, and the joy of connecting with another person. Making time for nonsexual intimacy can also increase your enjoyment of sexual intimacy.

Tips for navigating sex, intimacy, and mental health

Sex, intimacy, and mental health are intersecting aspects of the human experience. Your relationship with one can affect or change your experience of another. Here are some tips for navigating these complex parts of your life in ways that prioritize and protect your health and safety.

Explore your own body

Self-exploration is one of the best ways to learn about sex, your own sexual preferences, and your sexual identity. Masturbation is a safe, healthy part of sexual development. Age-appropriate sex education and self-exploration destigmatize sex and protect both minors and adults from sexual abuse or exploitation.

Resist comparisons

Having sex can be a vulnerable experience. You may feel a strong desire to do it "correctly," and movies, TV shows, statistics, porn, and friends' anecdotes can all promote certain sexual ideals that may feel impossible to achieve.

Real healthy sex, however, is all about learning, making mistakes, and trying new things. Sex is rarely "perfect." More often than not, it's silly, funny, vulnerable, confusing, intimate, creative, and enjoyable. Instead of comparing yourself to others, trying to impress your partner, or striving to meet to certain ideas about sex, try to simply be present instead. You and your partner will likely have a more enjoyable experience if you can focus on what's actually happening, rather than what you imagine should be happening.

Reject simple definitions of sex

Some people believe that sex only "counts" if it ends in orgasm or involves penile-vaginal intercourse. Such strict definitions can limit your sexual experiences and make you feel pressured to perform in a particular way. Instead of defining sex so narrowly, embrace a broader definition that includes different types of intimacy.

Ask yourself what you want

Some people choose to pursue sex and intimacy together, often in the form of a committed relationship to a single sexual partner. Others choose to pursue sex and intimacy separately. It's important to ask yourself whether you want to pursue them together or in different ways.

There's no right answer, and your answer may change over time. What's important is knowing what you're looking for in a sexual partner or an intimate relationship, so you have the best chance of finding it.

Practice safe sex

The best way to protect your sexual health is to practice safe (or "safer") sex. Safe sex means:

Waiting to have sex until you're of legal age

Having the freedom to say no or stop at any time

Having sex only with other consenting adults

Using contraceptives to prevent unwanted pregnancy and/or sexually transmitted infections

Knowing and understanding your options if contraceptives fail

Having regular sexual health checkups with a medical professional

Communicating openly with your partner(s) about sexual health

Prioritize your mental health

Your relationship with sex and intimacy is informed and affected by your mental health. Therapy can help you learn how to set boundaries, communicate more effectively, trust those closest to you, challenge unhelpful thoughts and emotions, and be fully present.

Prioritizing your mental health benefits you physically, mentally, emotionally, spiritually-and yes, even sexually. Browse our directory to find a therapist near you.

About the author

The editorial team at therapist.com works with the world's leading clinical experts to bring you accessible, insightful information about mental health topics and trends.

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Safe, consensual sex between adults is a normal, healthy part of life. Learn more about approaching sex and intimacy with your mental health in mind.

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Therapists can assist patients to identify relationships worth salvaging or help heal the pain of detachment

Cite This Article

Fairbank, R. (2024, April 1). Estrangement is never easy or straightforward. Psychologists can help. Monitor on Psychology, 55(3). https://www.apa.org/monitor/2024/04/healing-pain-estrangement

A number of recent high-profile estrangements have brought attention to a deeply complex, often painful topic. Whether it is Prince Harry's high-profile exit from the royal family, Jennette McCurdy's detachment from the suffocating mother/daughter bond detailed in her best-selling I'm Glad My Mom Died, or Britney Spears's severing of the relationship with her overbearing father, familial estrangement is never an easy or straightforward situation to navigate.

Estrangement has always been a taboo topic, one that runs directly opposite to societal ideals about what family can and should be. As a result, many people who are estranged from one or more relatives report feeling deeply ashamed and even afraid to speak about their experiences because of the stigma and assumptions surrounding estrangement.

Research on estrangement is relatively new but shows that estrangement is far more common than people may think. One nationally representative study showed that 27% of Americans are actively estranged from at least one family member. While there is no conclusive data on whether estrangements are increasing or decreasing, it may be that, with celebrities sharing about their experiences, others may feel more comfortable divulging their own family struggles. "Families have always been complicated, and now we're talking about it more," said Lucy Blake, PhD, a senior lecturer in psychology at the University of the West of England in Bristol and author of the book No Family Is Perfect: A Guide to Embracing the Messy Reality.

Patients dealing with estrangement have been found to benefit from therapy in specific ways, including receiving warmth, validation, and safety, which may have been missing in their previous relationships; addressing the causes and resulting fallout from their estrangement; and also working on their relationship skills ( Blake, L., et al., Counselling & Psychotherapy Research, Vol. 23, No. 1, 2023).

"That therapeutic relationship is really important, especially feeling safe and feeling validated," said Blake, one of the authors of the study. "If you are in a family where there are abusive dynamics-and many people who have been estranged know what that family feels like-it's going to be hard to feel safe with a therapist." Though it may take time to establish trust, it is through the therapeutic relationship-perhaps the first or currently the only safe and validating relationship-that patients can explore their own family estrangement and learn strategies for establishing stronger relationships with themselves and with others.

Prevalence of parent and adult-child estrangement

In a 2023 study of parent and adult child estrangement published in the Journal of Marriage and Family, researchers looked at a nationally representative sample of parents, which included 8,495 mothers and 8,119 fathers, to determine estrangement rates according to gender, race, and sexuality. The study found that 6% of respondents reported an estrangement from their mother, while 26% reported an estrangement from their father. The average age at estrangement was 26 for an estrangement with a mother and 23 for an estrangement with a father.

These rates of estrangement also varied according to race, gender, and sexuality. This included the finding that White adult sons were more likely to be estranged from their mothers than were daughters, and that Black sons and daughters were both more likely to be estranged from their fathers but less likely to be estranged from their mothers than White adult children. Members of the LGBTQ+ community were also more likely to be estranged from their fathers than their heterosexual peers, with 32% of gay or lesbian adult children and 36% of bisexual adult children reporting estrangement from their fathers compared with 22% of their heterosexual peers.

Of the adult children with a history of estrangement, 81% reported reconciling with their mother, while 69% reported reconciling with their father. "Estrangement isn't necessarily lifelong," said Rin Reczek, PhD, a professor of sociology at The Ohio State University, coauthor of the book Families We Keep: LGBTQ People and Their Enduring Bonds with Parents, and one of the authors of the paper.

Another study, published in the book Fault Lines: Fractured Families and How to Mend Them, surveyed a nationally representative sample of 1,340 Americans over age 18 and found that 27% were currently estranged from a relative, with 10% reporting an active estrangement from either a parent or a child. In terms of parent-child estrangements, 4% reported being actively estranged from their father, while 2.5% were actively estranged from their mother.

Researchers also found either no significant difference or only very minor differences in rates of estrangement when accounting for race, education level, and gender. "The only notable difference was a substantially higher rate of estrangement in middle age," said Karl Pillemer, PhD, a professor of human development at Cornell University and author of Fault Lines, whose research focuses on estrangement. This increase in prevalence during middle age is thought to be due to the higher number of living relatives, as middle-aged people may have both adult children and parents.

The continuum

"Estrangement is pretty varied in terms of what it can look like," said Kristina Scharp, PhD, a professor of communication at Rutgers University-New Brunswick who studies estrangement. As Scharp's research suggests, there are different aspects to estrangement that set it apart from other factors that can create emotional or physical distance between people. These aspects include communication quantity and quality, physical and emotional distance, and something she calls role reciprocity, which refers to the different roles people take on within a family, such as that of a caregiver or that of a dependent child.

"The expectations we have for each other also vary quite a bit," Scharp said. "Some people feel they don't need to enact these roles anymore, and some people aren't enacting those roles, which is part of the problem." For example, tension can arise in a parent-child relationship when an adult child feels their parents did not care for them in the way they should have or when an aging parent feels uncomfortable with boundary violations by their adult child.

The final straw

As Scharp notes, in the research she has done the most common reasons for estrangement tend to be cited as abuse, whether emotional, physical, or sexual; neglect; substance use; mental health; or major ideological differences, such as an LGBTQ+ child coming out to their very religious parents. Divorce also seems to play a big role, with an online survey of 1,360 parents experiencing estrangement from an adult child showing that one of the major risk factors was whether the parent was divorced from their estranged child's biological parent ( Coleman, J., et al., Journal of Social and Personal Relationships, Vol. 39, No. 3, 2022).

As Scharp's research has shown, when an estrangement happens, many people report a "final straw" moment, one that is often preceded by a very long, very difficult relationship. Other times, estrangement can be the result of a relationship that slowly erodes over time, with no one moment that marks its final dissolution. "You can have what they call fading away or sudden death," Scharp said. "It can happen either way."

As psychologists reported, these "final straw" moments are very common, and often exemplify the long-running tensions in the relationship. "It's important to recognize that while family estrangements often have a discrete triggering event, they are rarely a short-term, overnight phenomenon," said Dan Neuharth, PsyD, a licensed family and marriage therapist who specializes in working with high-conflict families. "It's usually been something that's been brewing for a long time."

As Samantha Rodman Whiten, PhD, a psychologist who specializes in working with estranged families, described it, this final straw can be considered an "empathic rupture," a moment in time that spells out all the ways in which the family member will never change or never be able to fulfill a person's expectations. It could be an adult child giving birth to their first child, with the expectation that their parent will step in to help during those stressful first few weeks, only for their parent to leave for a cruise instead, or it could be something very small but meaningful, such as an adult child failing yet again to follow through on a promise. "It's a representative sort of action that makes you think they're never going to change," Rodman Whiten said.

When patients are navigating a dissolution, it is crucial that practitioners guide their patients to fully own their decision about how to proceed, whether that is a short- or long-term estrangement, active counseling with their family member, or an attempted reconciliation. It is not uncommon for the cutoff family member to assign blame to a perceived source of influence. For example, parents whose children have cut off contact are more likely to cite a significant other or clinician playing a role in the estrangement, said Joshua Coleman, PhD, a psychologist and author of the book Rules of Estrangement: Why Adult Children Cut Ties and How to Heal the Conflict.

Coleman usually sees patients at critical points of estrangement (such as exploring reconciliation or whether to sever ties) over the course of two to five sessions, bringing in the estranged family members-if the patient agrees-to get a full sense of the family dynamics. "With families, whether you are seeing the parent or the adult children, you're only getting part of the picture," Coleman said.

Stigma and loneliness

The difference between societal ideals around what family should be and the reality of messy family behavior can often trigger shame and a hesitancy to speak about the estrangement, while even well-meaning clinicians may inadvertently contribute to the pain of the estranged patient by encouraging them to reconcile when it may not actually be safe to do so. "These societal messages can be very disempowering if the family is emotionally dangerous," Neuharth said.

In these cases, the practitioner's role is to help the patient recognize that although estrangement can be a deeply painful choice, it can also be necessary to protect their physical, emotional, and mental well-being. "One of the things that is helpful, and sometimes difficult, is to try and understand the reasons for why this is happening," Neuharth said. As Neuharth noted, an estrangement over issues such as abuse or substance misuse is very different from an estrangement over differences in values or expectations, such as a parent wanting their child to follow in the family business.

Research shows that group therapy can help people dealing with estrangement feel less alone, Blake said. In a 2022 study coauthored by Blake and published in Evaluation and Program Planning (Vol. 95, 2022), people who were experiencing family estrangement reported feeling less alone and less ashamed after attending a six-session support group intervention where they met with others who were going through similar experiences. After they completed all six sessions, participants reported less psychological distress, with their average distress scores falling from moderate to mild.

Reconciliation

As research suggests, very few estrangements are permanent, with several studies showing that many people will report periods of estrangement that are often followed by a period of reconciliation. "It's often not a permanent state, but something people move in and out of," Blake said. In Pillemer's book, of the 300 estranged sets interviewed, 100 had attempted reconciliation. Of these 100 sets, many underwent reconciliation with the help of professional counseling, which they generally credited as being integral to a successful and productive reconciliation.

"My methodology is all around helping the parent to take responsibility, to find the kernel, if not the bushel of truth," Coleman said. Coleman, who often works with parents who have reached out to him in the hopes of attempting a reconciliation with their estranged child, will often start by having them write a letter of amends to that child. "I always have them start with, 'I know you wouldn't do this unless you felt like it was the healthiest thing for you to do,'" Coleman said.

For parents who do not know or understand the reason for the estrangement, Coleman will often recommend that they write something along the lines of, "It's clear I have some significant blind spots as a person and a parent, and that I don't have a better understanding of what caused this, but I would like to know." Coleman finds that when adult children are willing to respond to the letter, and to attend counseling sessions mediated by him, there is generally a good chance of a parent and an estranged child finding common ground where they can start to repair things.

However, there will always be times when reconciliations just cannot or will not happen. "On one hand, people should not be made to feel guilty or ashamed because it is critical for their mental health to exclude a family member from their life," Pillemer said. "On the other hand, there are a large number of people for whom reconciliation is possible and has very beneficial outcomes."

Further reading

Attachment security, divorce, parental estrangement, and reconciliation
Coleman, J., et al., Journal of Social and Personal Relationships, 2022

Fault lines: Fractured families and how to mend them
Pillemer, K., Penguin Random House, 2020

"It was the straw that broke the camel's back": Exploring the distancing processes communicatively constructed in parent-child estrangement backstories
Scharp, K. M., et al., Journal of Family Communication, 2015

No family is perfect: A guide to embracing the messy reality
Blake, L., Welbeck Publishing, 2022

Parent-adult child estrangement in the United States by gender, race/ethnicity, and sexuality
Reczek, R., et al., Journal of Marriage and Family, 2023

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Estrangement is never easy or straightforward. Psychologists can help

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Therapists can assist patients to identify relationships worth salvaging or help heal the pain of detachment.

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How Do You Know If You Were Sexually Coerced?

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Sexual trauma can happen in many ways, and it doesn’t always involve physical force.

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If you have a child with psychiatric or behavior problems, there's a good chance you've heard of mindfulness and cognitive behavioral therapy (CBT), two different approaches to helping kids with everything from test anxiety to depression. But there's another very promising therapy that combines elements of both. DBT, or dialectical behavior therapy, is an intensive, highly structured program that's been adapted specifically for adolescents with extreme emotional instability, including self-harm and suicidal ideation.

The "dialectical" in DBT means the therapy works by dealing with two things at once that might seem contradictory: acceptance of feelings (mindfulness) and learning to use thinking to change feelings (CBT). It's basically "'I'm doing the best I can' on the one hand," notes Dr. Alec Miller, professor in the Department of Psychiatry and Behavioral Sciences at the Albert Einstein College of Medicine " and 'I need to do better.' That's a dialectical truth."

A brief history of DBT

Dialectical behavior therapy was developed by Dr. Marsha Linehan in the 1970s to treat adult borderline personality disorder - a mental illness with symptoms ranging from chronic suicidal thoughts and/or self-harming behaviors to anxiety and depression. These patients were typically thought of as "difficult," if not impossible, to treat. Dr. Linehan redefined the disorder, reframing it as a specific problem of the emotion regulation system that can be addressed with a structured intervention.

People with borderline personality disorder have trouble regulating their moods, which leads to impulsivity and conflict in interpersonal relationships. That, in turn, often leaves them feeling misunderstood by others around them. First, Dr. Linehan tried traditional CBT, which emphasizes using conscious thoughts to confront and change problematic emotions. She was unsuccessful with her patients. So she then tried a much more acceptance-based approach that came out of her meditation and mindfulness practice. This, too, failed.

"So then she had this brilliant epiphany," says Dr. Miller. "Blending the acceptance strategies of mindfulness with the change technologies of CBT to create this dialectical behavior therapy."

How Does DBT Work?

DBT treatment is designed to help with extreme emotional instability, which clinicians call "dysregulation" - the inability to manage intense emotions. Dysregulation leads to impulsive, self-destructive, or self-harming behaviors. The goal of DBT is to teach adolescents techniques to help them understand their emotions without judgment - the mindfulness component - and also to give them skills and techniques to manage those emotions and change behaviors in ways that will make their lives better. But it takes work and commitment.

Related: What Drives Self-Injury and How to Treat It

DBT for adolescents involves individual therapy and group skills training, where parents and teenagers learn together. The feedback from parents, says Dr. Jill Emanuele, a clinical psychologist at the Child Mind Institute, is, "Where have these skills been all my life? I need these skills too." Other components include telephone consultation (patients are encouraged to call their therapists when they feel the urge to self-harm), family therapy, and weekly consultation team meetings where the therapist checks in with other professionals to consult on the case.

What skills does DBT teach?

DBT skills training is very structured; for adolescents, it consists of five modules:

Mindfulness skills: Being present in the moment and understanding the signs of unregulated emotions

Emotion regulation skills: Coping with difficult situations by building pleasant, self-soothing experiences to protect from emotional extremes. "Especially with teenagers," says Dr. Emanuele, "there's a big focus on the physical body: eating properly, getting enough sleep, taking their medicine and avoiding drug use."

Interpersonal effectiveness skills: "It's often interactions with others that are the negative triggers for impulsive behaviors," Dr. Emanuele says. The purpose is to teach adolescents how to interact more effectively with others, and enable them to feel more supported by others.

Distress tolerance skills: "It's being able to recognize urges to do things that would be ineffective, such as hurting themselves or trying to kill themselves" and consciously controlling them, says Dr. Emanuele.

Walking the middle path skill: Kids and parents learn how to validate one another, how to compromise and negotiate, and how to see the other person's side of things. "It has to do with acknowledging multiple truths in the teenagers' and the parents' worldview as opposed to 'I'm right and you're wrong,' " explains Dr. Miller.

What is DBT used to treat in adolescents?

Borderline personality disorder was historically considered something that could not be diagnosed in a person under the age of 18. But many clinicians, including Dr. Emanuele and Dr. Miller, now feel that symptoms of the disorder do develop in some adolescents, and the debilitating roller coaster of extreme emotions that they experience can be effectively treated with DBT.

DBT has also proved effective in treating the emotional instability and severe behavioral symptoms - self-harm and suicidal thoughts or attempts - seen in adolescents with other diagnoses, including:

"DBT," says Dr. Emanuele, "is used to treat adolescents with multiple problems that often include suicidality or self-harming behaviors. The keyword here is multiple."

DBT: An adolescent's perspective

Rachel Monasch did not have it easy as a kid. When she was little her mother's chronic illness kept her in the hospital for long stretches of time. She developed severe anxiety early on in life and had trouble making friends at school. Eventually she developed an eating disorder and at 13 she began to hurt herself. At 15, Rachel says, "I had I guess what you'd call a breakdown. I spent most of the year out of school." Rachel had been in therapy for a long time but it was mostly unstructured talk therapy along with medication. When she began struggling with suicidal thoughts she was hospitalized in an adolescent unit at a hospital that she describes as horrifying and traumatic. "I was assaulted by another patient and they didn't do anything." Rachel says she came out more depressed than when she went in.

Related: Teen Suicides: What Are the Risk Factors?

But then she switched to a therapist who specialized in DBT. That clinician got her enrolled in a 28-day DBT "boot camp" for adolescents that also had an eating disorders program. "We learned and practiced DBT all day, every day, for 28 days," she says. Now, a year later, Rachel is doing very well. She finds some of the tools she learned in DBT more helpful than others, so that's where she focuses her energy. "Distress tolerance, mindfulness, and emotional regulation skills are the big ones for me," she says. "I don't fight with people or even really my parents so the interpersonal effectiveness skills aren't all that helpful to me."

Rachel relies heavily on diary cards - daily logs that track her moods and emotions, what triggered them, how she reacted to them both positively and negatively-and the collection of skills she has come up with to deal with uncomfortable emotions. She has 19 so far. She also does a lot of breathing to center herself.

According to Rachel's dad, "DBT saved her life." But Rachel says it's not quite that simple. "I would say lithium plus DBT and a great therapist saved my life."

Read More:

What to Do if You're Worried About Suicide
What Are the Symptoms of Depression in Teenagers?

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DBT: What Is Dialectical Behavior Therapy?

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If you have a child with psychiatric or behavior problems, there's a good chance you've heard of mindfulness and cognitive behavioral therapy (CBT), two different approaches to helping kids with everything from test anxiety to depression. But there's another very promising therapy that combines elements of both.

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Teach Kids to Manage Big Feelings Through Effective Social Emotional Learning

Over 80% of U.S. public schools reported in 2022 on the negative impact of the pandemic on child well-being and self-regulation. Kids are:

Struggling to manage their feelings and mental health

More disruptive in the classroom

Needing additional social, emotional, and behavioral support

(source: National Center for Education Statistics)

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Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial

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Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial

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Affiliations

¹ Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen.

² Clinical Psychology, KU Leuven.

³ Affiliated staff, Developmental Psychology, University of Amsterdam.

⁴ Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam.

⁵ Department of Pediatrics, Amsterdam Reproduction & Development, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group.

⁶ Specialist in youth and family care, Levvel.

⁷ Department of Clinical Psychology and Experimental Psychopathology, University of Groningen.

Randomized Controlled Trial

Affiliations

¹ Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen.

² Clinical Psychology, KU Leuven.

³ Affiliated staff, Developmental Psychology, University of Amsterdam.

⁴ Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam.

⁵ Department of Pediatrics, Amsterdam Reproduction & Development, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group.

⁶ Specialist in youth and family care, Levvel.

⁷ Department of Clinical Psychology and Experimental Psychopathology, University of Groningen.

Abstract

Objective: Behavioral parent training (BPT) is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD), but little is known about the effects of separate techniques parents learn in BPT.

Method: In a three-armed randomized controlled microtrial including parents of 92 children (4-12 years) with ADHD, we examined the efficacy of two sessions parent training involving either stimulus control techniques (antecedent-based condition (AC)) or contingency management techniques (consequent-based condition (CC)), compared to a waitlist. Primary outcome was daily parent-rated problem behaviors, secondary outcomes were parent-rated symptoms of ADHD and oppositional defiant disorder (ODD), and mental health-care consumption. Measures were completed at baseline (T0), immediately after the training (T1), at two weeks (T2) and three months (T3) follow-up. We also explored whether child and parent characteristics moderated treatment effects.

Results: Compared to the waitlist, in the AC, daily rated problem behaviors improved at T1 ( d= .56) and T2 ( d= .65); in the CC, these behaviors only improved at T2 ( d= .53). Daily rated problem behaviors within both conditions remained stable between T2 and T3. In the AC compared to the other conditions, inattention symptoms decreased at T1 and T2. For both active conditions compared to waitlist, hyperactivity-impulsivity symptoms decreased only at T2 and ODD symptoms did not decrease. No moderators were identified. Mental health-care consumption after training was low and did not differ between the active conditions.

Conclusions: Brief training of parents in antecedent- or consequent-based techniques improves problem behaviors of children with ADHD. Antecedent-based techniques appear to be especially important to target inattention.

Similar articles

Review: Which components of behavioral parent and teacher training work for children with ADHD? - a metaregression analysis on child behavioral outcomes.

Hornstra R, Groenman AP, van der Oord S, Luman M, Dekkers TJ, van der Veen-Mulders L, Hoekstra PJ, van den Hoofdakker BJ. Hornstra R, et al. Child Adolesc Ment Health. 2023 May;28(2):258-268. doi: 10.1111/camh.12561. Epub 2022 Apr 13. Child Adolesc Ment Health. 2023. PMID: 35417075 Review.

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attention deficit disorder with hyperactivity* / therapy

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national center for biotechnology information

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Which Techniques Work in Behavioral Parent Training for Children with ADHD? A Randomized Controlled Microtrial - PubMed

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Brief training of parents in antecedent- or consequent-based techniques improves problem behaviors of children with ADHD. Antecedent-based techniques appear to be especially important to target inattention.

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ADHD Weekly 2017-06-29

There is a growing emphasis on behavioral parent training an as intervention when their child has ADHD, especially for young children and families with a recent diagnosis. But what is parent training, and how should you choose a program?

Behavioral intervention is an important tool for managing ADHD symptoms, particularly for children. Behavioral modification training focuses on using positive reinforcement, structure, and consistent discipline to improve children's behavior. Parents and teachers learn skills to help guide children affected by ADHD, and to support children in their relationships and at school.

The American Academy of Pediatrics recommends behavior therapy as the first mode of treatment for young children, and parent training has the most evidence of being effective.

Let's explore what behavioral parent training is and look at some of the programs that have scientific studies to validate their effectiveness.
Behavioral Parent Training
Behavioral parent training, often referred to as BPT, is perhaps the most studied psychosocial intervention, and is one of the three most evidence-based treatments for ADHD along with medication and school accommodations and interventions.

Anil Chacko and colleagues state in the chapter "Training Parents of Youth with ADHD," of Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment by Russell Barkley, PhD, that when BPT is used along with medication, it can boost the effectiveness of medication. Behavioral parent training is often necessary for learning more effective ways to cope with and manage the symptoms of a child's ADHD. There are typically high levels of stress associated with ADHD in children, which also affects their parents and families.

There are a variety of BPT programs and manuals; most share a common set of principles and methods. The most effective BPT programs consistently produce an increase in positive parent-child interactions and emotional communication skills, teach strategies to improve parenting consistency, and require parents to practice during the training sessions.

It is important to work with your child's healthcare provider to determine the best approach for your child. To have this conversation, it is helpful to learn more about evidence-based BPT programs.

Triple P Positive Parenting Program

Triple P programs draw on research, social learning, cognitive behavioral therapy and developmental theory. The programs focus on teaching parents the skills they need to address and prevent behavioral and emotional problems in their children. It includes a range of interventions, with increasing intensity, depending on your child's age, and the ability to choose your own parenting goals based on your beliefs and values.

Started more than 30 years ago, the program now has more than 690 published papers and more than 240 clinical trials, studies, and evaluations. Triple P offers online and in-person options, and a guide to help you find the best program for you and your child. Learn more about Triple P programs for parents on the program website.

Teen Triple P
Based on the same research as the program for young children, Teen Triple P focuses on "tweens" and teens. Using the five principles found in all their programs, Teen Triple P helps parents learn to:

Create a safe, interesting environment

Have a positive learning environment

Use assertive discipline

Have realistic expectations

Take care of yourself as a parent

For more information, visit the Teen Triple P website to learn more about online or in-person training.

Incredible Years Parenting Program
Incredible Years is a set of three developmentally based curricula for parents, teachers, and children. Designed for children ages 2-12, it has been shown to improve behaviors for up to 80 percent of participating children.

The parent program emphasizes skills known to promote children's social skills and reduce behavioral problems, while building parents' interpersonal skills. With 14 programs designed for specific ages, parents, teachers, and children learn skills and strategies for helping children regulate their emotions, improve their social skills and academic performance. For more information, visit Incredible Years.

Parent-Child Interaction Therapy
Parent-Child Interaction Therapy (PCIT) is an in-person therapy that focuses on improving the quality of the parent-child relationship and changing parent-child interaction patterns to promote a healthy family relationship. Using evidence-based protocols, PCIT International certifies trainers to provide expert training and consultation in their protocol.

The program uses two treatment phases:

The first focuses on helping children feel calm and secure in their relationships, and feeling good about themselves.

The second focuses on building the parenting skills to manage challenging behaviors while remaining calm, confident and consistent in your approach to discipline.

Visit PCIT for more information.

New Forest Parenting Programme
Developed in the United Kingdom by the Early Intervention Foundation (EIF), this program has been implemented in the United States and internationally. Developed for parents with a child affected by ADHD ages 3-11, New Forest Parenting Programme (NFPP) takes place in the family home during eight weekly visits, and teaches strategies for managing difficult behavior and attention challenges.

During sessions, parents learn about the nature of ADHD, how to manage their child's behavior through games that engage attention, encourage patience, and increase concentration. Practitioners observe parent-child interactions while playing together and provide feedback and guidance.

For more information:

STAR Parenting
The STAR curriculum helps parents of young children focus on responding rather than reacting, and is based on developmental and cognitive-behavioral theories and drawing from authoritative parenting. Experimental outcomes show a reduction in parent stress, anger and aggression, and a decrease in harsh verbal or corporal punishment.

STAR Parenting teaches a problem-solving process, and strategies and tools for providing child guidance for managing emotions, behavior and conflict. Visit the STAR website for more information, including online and in-person class options.

Strengthening Families Program
The Strengthening Families Program is a 14-session program designed to develop parenting, children's social and family life skills. Parents and children participate in sessions separately and together. Implemented in over 35 countries, SFP is culturally sensitive rather than culturally specific.

Outcomes include greater family strength and resilience, and reduced risk factors for problem behaviors. With curriculum for preschool, elementary age, early teens, and high school age children, SFP is widely used in homes, schools, churches, and community settings.

For more information, visit Strengthening Families Program.

Community Parent Education (COPE)
Community Parent Education, known as COPE, is focused on large group, school-based workshops that encourage groups of parents to work together to develop solutions for common problems. It was developed by Charles Cunningham, PhD.

COPE integrates techniques and principles from social learning, social and cognitive psychology, and family systems theory. It helps parents develop specific strategies to more successfully cope with their child's behavioral challenges, including self-regulation and social interactions. Studies have shown decreased child management problems, improved parent problem-solving skills, and better maintenance 6-months post intervention.

For more information, visit COPE.

Parent Management Training
Parent Management Training (PMT) is designed for children ages 2-17 and focused primarily on their parents, though children may participate in some sessions. Parents are taught skills to more effectively manage challenging behaviors through modeling and role-playing. Between sessions, parents practice at home with their children. Training programs typically include at least 10 sessions.

PMT has been shown to be effective in decreasing oppositional, aggressive and antisocial behavior, with strong post-intervention results. For more information, visit the Parent Management Training Institute.

Parental Friendship Coaching and Making Socially Accepting Inclusive Classrooms (MOSAIC Project)

A common symptom of ADHD is difficulty with social interactions and making friends. According to the Michael Smith Foundation for Health Research, more than half of children diagnosed with ADHD are severely disliked by their peers or do not have a single friend.

Amori Mikami, PhD, an associate professor in the Department of Psychology at the University of British Columbia, has developed programs to address the challenges children face in peer relationships. Her interventions focus on the factors that affect whether a peer group chooses to like or dislike a child, and strategies parents and teachers can use to help peer groups be more welcoming.

Parental Friendship Coaching focuses on training parents to improve the peer relationships of their children with ADHD. For guidelines for coaching your child, read How You Can Be a Friendship Coach for Your Child with ADHD in CHADD's Attention magazine by Dr. Mikami.

The MOSAIC Project focuses on helping children be more inclusive, socially accepting, patient and tolerant of classmates through altering the behaviors of the peer group and impacted children to improve peer relationships and academic functioning. First tested in a small, short-term pilot program, MOSAIC demonstrated improvement in children's peer relationships, and is now being tested in elementary schools (grades 1‑3) in the United States and Canada.

For more information about both programs and Dr. Mikami, visit the website for the University of British Columbia's Peer Relationships in Childhood Lab.

Systematic Training for Effective Parenting (STEP)
The STEP program was launched in 1976 and offers three programs focused on different age groups and a Spanish-language version for parents of children 6-12. Studies related to the program conducted from 1976 to 1999 indicate significant positive change in attitudes toward parenting, empathy toward children, family functioning and stress levels, and behavior.

Which program meets your family's needs?

Behavioral parenting training programs have been shown to be highly effective in helping parents and children manage symptoms of ADHD. When choosing a program for your child and family, focus on evidence-based programs to increase the effectiveness and impact of training, and match the program to best address your child's symptoms and needs.

For more information:

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12 Behavioral Programs for Managing ADHD - CHADD

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There is a growing emphasis on behavioral parent training an as intervention when their child has ADHD, especially for young children and families with a recent diagnosis. But what is parent training, and how should you choose a program? Behavioral intervention is an important tool for managing ADHD symptoms, particularly for children.

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How many parents have found themselves thinking: I can't believe I just said to my child the very thing my parents used to say to me! Am I just destined to repeat the mistakes of my parents? In Parenting from the Inside Out, child psychiatrist Daniel J. Siegel, M.D., and early childhood expert Mary Hartzell, M.Ed., explore the extent to which our childhood experiences actually do shape the way we parent. Drawing upon stunning new findings in neurobiology and attachment research, they explain how interpersonal relationships directly impact the development of the brain, and offer parents a step-by-step approach to forming a deeper understanding of their own life stories, which will help them raise compassionate and resilient children.

Born out of a series of parents' workshops that combined Siegel's cutting-edge research on how communication impacts brain development with Hartzell's thirty years of experience as a child-development specialist and parent educator, Parenting from the Inside Out guides parents through creating the necessary foundations for loving and secure relationships with their children.

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Parenting from the Inside Out - Dr. Dan Siegel

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Share on facebook Share on twitter Share on email How A Deeper Self-Understanding Can Help You Raise Children Who Thrive by Daniel J. Siegel, M.D., and Mary Hartzell, M.Ed. DR. DAN SIEGEL order books here: This book uniquely pairs the clinical experience of a psychiatrist with the deep wisdom of a nursery school teacher.

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How to Support Clients Becoming New Parents

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How to Support Clients Becoming New Parents

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How to Support Clients Becoming New Parents - SimplePractice

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As practitioners we can unwittingly cause harm by minimizing the challenges of new parents. Here’s how we can support new parents.

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Transition to Parenthood and Marital Satisfaction: A Meta-Analysis

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Transition to Parenthood and Marital Satisfaction: A Meta-Analysis

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Front Psychol. 2022; 13: 901362.

Abstract

The transition to parenthood is a major life event characterized by profound changes for a considerable number of people. Previous meta-analyses summarized the results obtained by various researchers in the first year and, respectively, in the first 2 years postpartum, globally. The current study adds to the literature by testing the changes from 12 to 24 months, the cross-partner associations and the analysis of different moderators. The aims of this present meta-analysis are to investigate the decrease in marital satisfaction during the first and second year postpartum, to examine cross-partner associations of the decline in postpartum marital satisfaction, and to investigate the potential moderating variables of this decrease. Forty-nine studies (97 samples of parents and 9 samples of non-parents) that fit our criteria are included in the meta-analysis. The data analysis was performed using meta-analytic techniques. Marital satisfaction has a medium decrease between pregnancy and 12 months postpartum, and a small decline between 12 and 24 months postpartum for both genders. In a similar period with first year postpartum, non-parents present a small decline in marital satisfaction. Moreover, the analysis of the dyadic studies data shows cross-partner associations, confirming that one partner's satisfaction has a steeper decline when the other partner's satisfaction presents a steep decrease. The decrease in marital satisfaction does not stop after the first postpartum year, and the coss-partners associations are present. Theoretical and therapeutic implications are also discussed.

Keywords: marital satisfaction, transition to parenthood, meta-analysis, cross-partners associations, moderators

Introduction

Married people are generally happier than unmarried or cohabiting people ( Vanassche et al., 2013). Although the protective role of marriage has been well-established over time ( Waite and Lehrer, 2003; Rendall et al., 2011), it has also been proven that those who have an unhappy marriage suffer from more medical conditions, and their life expectancy is lower than that of unmarried, divorced or widowed individuals ( Lawrence et al., 2019). Moreover, marital satisfaction is not stable over time, White and Edwards (1990) describe a "U"-shaped marital satisfaction trajectory. The research of the early decline of marital satisfaction presents different results. The two existing meta-analyses on this topic have indicated small ( Mitnick et al., 2009) vs. moderate ( Twenge et al., 2003) decreasesin marital satisfaction after the first child's birth. Moreover, in one meta-analysis, similar trajectories were found for parents and non-parents ( Mitnick et al., 2009), while in the other, less marital satisfaction of parents was found compared to non-parents ( Twenge et al., 2003).

Building on these findings, we first aimed to deepen the trajectory of marital satisfaction in men and women during the transition to parenthood. Thus, we investigated the decrease in marital satisfaction in the first and in the second year postpartum using a sample of longitudinal studies with two or three marital satisfaction measurements: during the late pregnancy, at the end of the first year and at the end of the second year postpartum. The previous meta-analyses presented the decrease in marital satisfaction in the first year, respectively, in the first 2 years postpartum globally. This is the first attempt to analyze the trajectory of marital satisfaction in the first year, and in the second year separately, to see if the decrease in the second year is similar or not to than in the first one. Furthermore, we include in our analysis non-parent samples in order to test if the couples without children have the same marital satisfaction trajectory in a similar period of their marriage.

Although empirical studies highlight cross-partner associations, none of the existing meta-analyzes have analyzed this aspect. Therefore, our second aim was to investigate whether one partner's satisfaction has a steeper decline when the other partner's satisfaction also has a more pronounced decrease. Moreover, there is little evidence of how marital satisfaction changes during the transition to parenthood depending on the participants' demographic characteristics. Subsequently, our third aim was to investigate the possible moderators of the satisfaction's trajectory during this period.

Transition to Parenthood and Marital Satisfaction

The transition to parenthood is a major life event characterized by profound changes for a considerable number of newlyweds. Even though the arrival of a baby is often a joyful event, it can affect interpersonal resources. The transition to parenthood is a transformative experience that changes the self-concept, social roles and daily routines ( Saxbe et al., 2018). Therefore, it is associated with more stress and decreases both partners' marital satisfaction ( Mirowsky and Ross, 2002). The quality of the spouses' relationship depends on their adaptation to this new status. The process of intense adjustment to parenthood begins when the woman becomes pregnant and ends when the child reaches the age of two ( Doss et al., 2009).

A growing number of studies had looked at different characteristics of couples during the early transition to parenthood, drawing some conclusions regarding the trajectory of marital satisfaction. Moreover, the two previous meta-analyses allowed us to test and to build upon their results ( Twenge et al., 2003; Mitnick et al., 2009). As mentioned, Mitnick et al. (2009) found a small decrease in marital satisfaction during the first 11 months postpartum. Treating globally the first 2 years after the first child's birth, Twenge et al. (2003) indicated that marital satisfaction substantially decrease. Their conclusions were also different when comparing parents with non-parents.

The empirical research over the last decades has also reached some different results. While several studies illustrate that transition to parenthood brings a decrease in marital satisfaction (e.g., Doss et al., 2009; Simonelli et al., 2016; Bäckström et al., 2018), other research shows that a decrease in marital satisfaction is common in newlyweds with or without children ( Lawrence et al., 2008). Moreover, more recent studies on marital satisfaction of newlyweds highlight that trajectories depend on the initial level of marital satisfaction. Therefore, people who report a low initial level of marital satisfaction suffer from a more significant decrease in the first years of marriage, while people who indicate a medium or high level of marital satisfaction remain at their initial level of their marital satisfaction ( Birditt et al., 2012; Williamson and Lavner, 2020). However, the research on newlyweds contains no information on whether the participants became parents during the study. Furthermore, a review that includes 14 empirical studies on newlyweds concludes that a decrease in marital satisfaction is due to a low initial level of marital satisfaction or essential experiences like the transition to parenthood ( Proulx et al., 2017).

Based on previous research findings, Lawrence et al. (2008) identified two perpectives of the fundamental nature of marital satisfaction change during the transition to parenthood. The first assumes that the partners experience a qualitative change in their relationship. Their marital satisfaction decrease and the decline is sudden, significant and persistent in time. The second refers to the minor, temporary and quantitative character of the decline in marital satisfaction. The satisfaction decrease depends on the partners' capacity to manage the transition to the new couple's stage ( Lawrence et al., 2008). The attachment theory ( Bowlby, 1988) deepens the explanation of these perspectives. A partner's secure attachment has positive effects on marital satisfaction during postpartum through the high support he/she gives and the optimistic expectations from the partner. This behavior may explain the second perspective. In contrast, an insecure attachment negatively influences couple satisfaction due to partner's demand for attachment and the critical manner he/she ask for it ( Cowan and Cowan, 2000; Velotti et al., 2011). When both partners have an insecure attachment, the decrease in marital satisfaction is considerably higher than in couples in which both partners have a secure attachment or one of them has a secure attachment ( Velotti et al., 2011). Furthermore, in threatening and stressful periods, the attachment system is activated, and anxiety and avoidance increase. This may explain the findings within the first perspective of sudden changes of marital satisfaction.

Thus, building on the previous studies and on their slightly different results, we aim to investigate whether the decrease in marital satisfaction characterizes only the first-time parents, and how large it is. According to our fist aim, based on previous research results and to addressed the gap in the literature we hypothesized that: (H1) Marital satisfaction suffers a decrease from pregnancy up to 12 months postpartum for both men and women; (H2) The decrease in marital satisfaction continues between 12 and 24 months postpartum for both men and women; (H3) The trajectories of marital satisfaction are different in parents and non-parents. The decrease is higher for parents compared to non-parents.

Cross-Partner Associations

The family systems' approach assumes that families are emotional units of interdependent individuals ( Minuchin, 1974). Not surprisingly, previous studies highlighted the need to focus on dyadic data analysis ( Gameiro et al., 2011). The dyadic studies' results underline the partner effects (e.g., Meijer and van den Wittenboer, 2007; Don and Mickelson, 2014), suggesting that some of the husband's characteristics have an essential role in the wife's marital satisfaction, and vice-versa ( Don and Mickelson, 2014). Also, the emotional state of one of the partners influences the marital satisfaction of the other partner. For example, people characterized by low levels of a negative emotional state in the third trimester of pregnancy are those whose partners report higher marital satisfaction levels ( Bower et al., 2013). Moreover, during the transition to parenthood, the partners tend to have a similar marital satisfaction trajectory marital satisfaction ( Don and Mickelson, 2014). Furthermore, none of the existing meta-analyses the cross-partner associations. Therefore, the second aim of this meta-analysis is to test the cross-partner associations: whether a partner's decrease in marital satisfaction has a significant impact on the other partner's decrease in marital satisfaction 12 months after birth. Thus, we formulated the following hypothesis: (H4) The steeper decrease in one partner's satisfaction is associated with the steeper decrease in the other partner's level of satisfaction.

Moderators

Marital satisfaction is influenced by demographic data, like gender ( Elek et al., 2003; Twenge et al., 2003), age ( Trillingsgaard et al., 2014), or length of relationship ( Doss et al., 2009). Therefore, we analyze the extent to which all these variables, described below, moderates the decrease in marital satisfaction separately in the first, and in the second year after the child' birth.

Gender

Research supports the idea that the postpartum marital satisfaction of mothers is more affected than that of fathers ( Twenge et al., 2003). Don and Mickelson (2014) showed that almost 80% of first-time mothers suffer a moderate decrease in marital satisfaction, while 51% of fathers cross a moderate decline, and 49% endure a milder decrease. Other research also indicates a more sudden decrease for women and a gradual decline in men ( Belsky and Hsieh, 1998; Grote and Clark, 2001) or a notable decrease for mothers and an unchanged marital satisfaction for fathers ( Lawrence et al., 2008).

Age

It seems that older women have a more challenging time adapting to their new role immediately after childbirth than the younger ones ( Lederman et al., 1981). After a few months, they recover this difference and present better adaptation ( Robinson et al., 1988). Moreover, at 12 months postpartum, older women are more satisfied with their husband's domestic activities than younger women ( Robinson et al., 1988). Childbirth at a younger age is associated with lower marital satisfaction ( Doss et al., 2009; Trillingsgaard et al., 2014).

Relationship Length

It has been shown that having a child earlier in a marriage predicts more significant decreases in marital satisfaction ( Doss et al., 2009). The birth of the first child in the first 3 years of marriage seems to represent a high risk of couple dissolution ( Belsky and Rovine, 1990).

Measurement

The instruments used in investigations to measure marital satisfaction are generally standardized scales (e.g., Couples Satisfaction Index, Funk and Rogge, 2007; Marital Adjustment Test, Locke and Wallace, 1959; Quality of Marriage Index, Norton, 1983; Relationship Assessment Scale, Hendrick et al., 1998), but by far the most commonly used is the Dyadic Adjustment Scale (DAS; Spanier, 1976). If some decades ago, DAS was applied in over 1,000 studies ( Spanier, 1985), today it can be challenging to precisely determine the number of studies that have used this scale. Nevertheless, due to the high number of studies using DAS, we would like to see if this instrument moderates the decline of marital satisfaction.

According to the third aim of this study we hypothesized that: (H5) The decline in marital satisfaction is moderated by gender, age, relationship length and the instrument used for measuring marital satisfaction. The decrease is higher for women than men, for the younger parents compared to older parents, and for parents having a shorter length of their marital relationship than those having the child later in their marriage. Also, the reported decrease is lower when using the Dyadic Adjustment Scale (DAS; Spanier, 1976) than on other scales.

Method

Literature Search

The meta-analysis was conducted according to the PRISMA 2020 recommendations ( Page et al., 2021). We conducted an electronic search using the following databases: PsycInfo, Proquest, Scopus, Web of Science, DOAJ, and Google Scholar. The keywords used individually or in different combinations were: a. "transition," "parenthood," "parental status," "first childbirth," or "first child," and b. "marital satisfaction," "relationship satisfaction," "marital quality," and "relationship quality." The literature search was conducted in five waves (September 2019, April 2020, September, 2020, April 2021, and December, 2021).

Inclusion and Exclusion Criteria

The inclusion criteria of the current meta-analysis are: (1) the studies of first-time parents included self-reported measures of prepartum marital satisfaction and a similar measure at least one postpartum time, up to 24 months, (2) the studies contained the necessary statistical data allowing us to compute the effect sizes (means and standard deviation for both measurements); (3) the studies were published in peer-reviewed journals; (4) the studies were published in English; (5) for intervention studies targeting marital satisfaction, we eliminated the studies that did not include a control group. Given that we were interested in the mean difference between two dependent measures (the satisfaction level of the same person, at two different time points), the correlation between the two measures was also needed. However, not all studies reported the correlation. To avoid the exclusion of the studies that did not report the correlation, we computed a mean correlation for the whole sample and used it when necessary. Additionally, we included four studies with at least two-time measurements of marital satisfaction in couples without children.

Effect Size Calculation

We computed effect sizes (standardized mean gain scores) from the raw mean scores, standard deviations and correlations between measurement at the two time points. Given that not all the studies offered the necessary correlations when needed, we used the average correlation coefficient from all the included studies. First, we computed the overall effect size (Hedge's g) to show the difference between pregnancy and postpartum marital satisfaction up to 12 months after the first child's birth. Second, we computed the effect size (Hedge's g) to show the difference in marital satisfaction between the first and the second year postpartum. We computed the overall size effects for mothers, fathers and couples (samples that did not differentiate between genders).

Finally, we wanted to verify whether one partner's decrease in satisfaction influences the other partner's decrease in satisfaction. Only the studies that reported data for both partners were included in this analysis. For this, each couple was regarded as a unit of observation, and several steps were necessary. To test this relationship for the wives, we first calculated the effect size for the husbands' satisfaction decrease. Thus, we obtained a separate effect size for each sample included in the analysis. Then, we computed a meta-regression where we included the husband's effect sizes as a supplementary explanatory variable predicting the outcome variable and the wives' decrease in satisfaction. The same method was used when assessing the husbands' decrease in satisfaction.

Meta-Analytic Strategy and Analyses

We conducted the meta-analyses using the Meta-Essentials ( Suurmond et al., 2017). This free tool consists of a set of workbooks designed for Microsoft Excel that, based on the researcher's input, automatically produces all the required statistics, tables and figures ( van Rhee et al., 2015). In terms of usability, it is a simpler tool for conducting meta-analyses because it does not require any coding or programming knowledge and it can handle various effect sizes and most of the common meta−analysis methods. This tool was used in various highly impact studies over the last years ( Kim et al., 2019; Kolte et al., 2019; such as Candel and Turliuc, 2019). In this study, the models were tested for differences among dependent groups with continuous data. We tested random-effects' models, because they allow for wider generalization ( Borenstein et al., 2010). The meta-regression analyses were performed using the free JASP software ( van Doorn et al., 2021). For the heterogeneity analysis (how consistent the results were across the analysis), we used the tau-squared and the Q-tests (which, when significant, indicate heterogeneity in the sample) and I ² percent, which is a better-suited test for larger samples ( Higgins et al., 2003). I ² takes values from 9 to 100%, with 25, 50, and 75%, meaning low, medium and high heterogeneity. For bias detection, we used the Egger t-test, which, when significant ( p < 0.05), indicates bias in the analysis ( Egger et al., 1997). To further analyze the publication bias, we used the trim-and-fill method as well as the Orwin Fail-Safe N ( Orwin, 1983; Duval and Tweedie, 2000).

Transparency and Openness

We describe the way we obtained our sample size, the literature search including all inclusion and exclusion criteria. We calculated effect sizes using the Meta-Essentials ( Suurmond et al., 2017) and JASP software ( van Doorn et al., 2021) for meta-regressions and followed Cohen's (1988) recommendation for the significance of effect sizes. The datasets are publicly available (Open Science Framework) and can be consulted by accessing the following link.1 This investigation was not pre-registered.

Results

We evaluated the identified samples based on the inclusion criteria and excluded samples that failed to meet the inclusion criteria. A flowchart depicting this process is shown in Figure 1 . The list of studies included in this meta-analysis can be consulted in Supplementary Material.

The final sample consisted of 49 studies (45 studies were reporting data for parents only, 1 study for non-parents only and 3 studies for both parents and non-parents), with 106 independent samples (97 samples of parents and 9 samples of non-parents), with a total of 145,139 participants. From these, 4,790 were men and 139,956 were women. The mean age for the whole sample was 29.11 years ( SD = 2.39). The mean age for men was 29.96 years ( SD = 1.74) and for women 28.12 ( SD = 2.21). The mean relationship length was 52.68 months ( SD = 17.36) for the entire sample, 51.15 months ( SD = 16.95) for men, and 53.96 months ( SD = 18.41) for women. In the parent group, 71 samples used dyadic data. Most of the studies were conducted in North America (19 studies) and Europe (14 studies).

Marital Satisfaction in Parents' and Non-parents' Samples (T0-T1)

Firstly, we calculated whether the parents' and non-parents' satisfaction decreased between the prepartum assessment and the postpartum assessment, up to 12 months postpartum (or a similar time frame for non-parents) (see Table 1 for the results).

TABLE 1

Estimates

Measures

K

N

g (SE)

95% CI LL

95% CI UL

τ ²

Q

I ² (%)

First year

Parent sample

Couple satisfaction change

3

291

-0.28* (0.08)

-0.62

-0.06

0.01

4.73

57.71

Non-parent samplea

Women satisfaction change

4

165

-0.12* (0.04)

-0.24

-0.01

0.00

.73

0

Men satisfaction change

4

165

-0.13* (0.04)

-0.24

-0.02

0.00

.71

0

Second year

Parent sample

Fist 2 years

We used Cohen's (1988) recommendation regarding the magnitude of effect sizes, namely 0.2 for a small effect, 0.5 for a medium effect and 0.8 for a large effect. The first hypothesis was supported. Overall, the marital satisfaction of the participants from the parents' sample decreased significantly from T0 to T1 (for mothers: Hedge's g = -0.31, p < 0.001; for fathers: Hedge's g = -0.29, p < 0.001; for couples: Hedge's g = -0.28, p < 0.05). All the effect sizes were medium. The results for mothers and fathers also showed significant heterogeneity in the distribution of effect sizes across the included samples (for mothers: Q = 528.16, p < 0.001, I ² = 90.91%; for fathers: Q = 238.65, p < 0.001, I ² = 81.56%). The participants from the non-parents' sample also showed a significant decrease in marital satisfaction, but the effects sizes for this decrease were small (for mothers: Hedge's g = -0.12, p < 0.05; for fathers: Hedge's g = -0.13, p < 0.05).

Based on the significant heterogeneity of the sample, we computed a series of moderation analyses for the parents' sample.

Gender

For the first of these analyses, we used sub-group analysis to test gender as a potential moderator. The results for mothers and fathers are displayed in Table 1 . By using heterogeneity Q-test significance, determined by the degree to which the confidence intervals for two or more moderator subgroups overlapped, we observed that the difference between men and women was not significant ( Q = 0.20, p = 0.65).

Measurement

We used the type of instrument used for measuring marital satisfaction as a potential moderator for the decrease in marital satisfaction (see Table 2 ). We observed that there are no significant differences ( Q = 0.50, p = 0.47) in the decrease in marital satisfaction from T0 to T1 between the cases when the DAS scale was used and to the cases where marital satisfaction was measured with another instrument.

TABLE 2

Subgroup summary information

Q-test for heterogeneity

First year

Satisfaction's measure

Second year

Satisfaction's measure

Age

To test the moderating effect of the participants' age, we conducted a meta-regression where we introduced age as an independent variable (see Table 3 ). The results show a non-significant effect of age on the decrease in marital satisfaction ( b = -0.002, S.E. = 0.02, p = 0.91).

Relationship Length

We ran a similar analysis for relationship length (see Table 3 ). The effect of relationship length on the decrease in marital satisfaction was also non-significant ( b = 0.003, S.E. = 0.003, p = 0.26).

Marital Satisfaction in the Second Year Postpartum in Parents' Samples (T1 to T2)

For testing the third hypothesis, we calculated whether the parents' satisfaction decreases between the first postpartum assessment and a latter postpartum assessment (between 12 and 24 months postpartum, see Table 1 for details). We found no sufficient data to compute similar analyses in the non-parents' sample.

Overall, the satisfaction decreased from T1 to T2, the results being significant (for mothers: Hedge's g = -0.16, p < 0.001; for fathers: Hedge's g = -0.14, p < 0.05). The effect sizes were small. The samples were heterogeneous (for mothers: Q = 158.47, p < 0.001, I ² = 91.17%; for fathers: Q = 46.19, p < 0.001, I ² = 78.35%). The meta-regression results show that the time difference between T1 and T2 did not influence the decrease in marital satisfaction for men or for women.

Moderator analyses were also conducted for the second year postpartum.

Gender

The results for mothers and fathers are displayed in Table 1 . However, the differences between them were not significant ( Q = 0.12, p = 0.72) (see Table 2 ).

Measurement

The decrease was weaker in the studies that used DAS compared to the studies that used other instruments to assess marital satisfaction ( Q = 6.50, p = 0.01) (see Table 2 ).

Age

Age did not moderate the decrease in marital satisfaction from T1 to T2 ( b = -0.008, S.E. = 0.01, p = 0.56) (see Table 3 ).

Relationship Length

The length of the relationship did not moderate the decrease in marital satisfaction from T1 to T2 ( b = 0.001, S.E. = 0.002, p = 0.58) (see Table 3 ).

Marital Satisfaction Reported by Parents in the First 2 Years Postpartum (T0 to T2)

Additionally, we calculated the effect sizes for the overall satisfaction decrease between prepartum and 24 months postpartum. The satisfaction decreased from T0 to T2, the result being significant (Hedge's g = -0.37, p < 0.001). The effect size was medium (see Table 1 for more information). The sample was heterogeneous ( Q = 367.29, p < 0.001, I ² = 93.19%).

Cross-Partner Associations

We tested the forth hypothesis regarding the interdependence effect in the samples that came from the studies that used dyadic samples for the first year postpartum. For this, we computed a meta-regression where the effect sizes for decrease in one partner's satisfaction were entered as a predictor for the decrease in the other partner's satisfaction. The results were significant for both men ( b = -0.68, S.E. = 0.08, p < 0.001) and women ( b = 0.87, S.E. = 0.10, p < 0.001). The satisfaction of one partner has a steeper decline when the satisfaction of the other partner also has a more pronounced decrease.

Publication Bias

To verify the publication bias, we applied Egger's T-test. We obtained a value of -3.85 ( p < 0.001), which, at first sight, would indicate a significant publication bias. However, using the trim and fill method, we found that by adding four studies, the adjusted value indicates a Hedge's g score of -0.28, which does not differ from the initial result. In addition, after applying the Orwin Fail-safe N method, we noticed that another 367 studies would be needed to indicate a difference of -0.05 for the meta-analytical result to become zero. Thus, we found no significant publication bias.

Discussion

We conducted a meta-analysis on longitudinal studies that investigated marital satisfaction during the transition to parenthood. The 97 samples of parents and 9 samples of non-parents from 49 empirical studies that fit our criteria allowed us to test the proposed hypotheses and achieve the meta-analysis's aims. Our first aim was to deepen the trajectory of marital satisfaction in the first and in the second year postpartum for mothers and fathers, and to compare the parents' trajectory with the non-parents' trajectory of marital satisfaction for a similar period of marriage. The second goal is to examine the cross-partner associations of decline in marital satisfaction, and the third is to investigate the potential moderators of a decrease in postpartum marital satisfaction.

Marital Satisfaction in the First Year Postpartum

Firstly, we verified whether marital satisfaction suffers a decrease from pregnancy up to 12 months postpartum for both men and women (H1). The results of the present meta-analysis indicate a medium decline in marital satisfaction for mothers and fathers in this period, thus our first hypothesis was confirmed. Then, we investigated the decrease of marital satisfaction in non-parents having a similar length of their relationship. For non-parents, the results reveal a small deterioration in marital satisfaction. Thus, our third hypothesis was confirmed: the trajectories of marital satisfaction are different in parents and non-parents. The decrease is higher for parents compared to non-parents (H3). These present results differ from the Mitnick et al. (2009) meta-analysis, which illustrated a small decrease in marital satisfaction for first-time parents and non-parents from pregnancy to the first 11 months after birth, respectively, for a similar duration of their relationship.

A drop in marital satisfaction during the first year of parenthood has been widely reported in the literature ( Doss et al., 2009; Simonelli et al., 2016; Bäckström et al., 2018). This decrease may prove the difficulties that first-time parents go through in the transition to parenthood ( Bäckström et al., 2018). A plethora of factors could determine deterioration in marital satisfaction, such as the change from a system of spouses without children to a system of parents with a child ( Minuchin, 1974; Simonelli et al., 2016), the stress generated by childcare ( Condon et al., 2004), reduced postpartum communication and responsiveness ( Perren et al., 2005) as well as multiple activities performed simultaneously ( Baxter et al., 2008). Once the partners become parents, they experience more marital conflicts and more dissatisfaction toward the marriage stage ( Perren et al., 2005; Bouchard et al., 2006). Our results seem to support the idea that marital satisfaction's decline is significant and quite abrupt for up to 1 year postpartum ( Lawrence et al., 2008).

Concerning the newlyweds without children, our result reflects a middle point between the previous theories. The small decrease in marital satisfaction, identified by our meta-analysis, is interposed between "gradual disillusionment," "the honeymoon is over," or the "honeymoon followed by blandness" models ( Kurdek, 1998; Huston et al., 2001; Aron et al., 2002), and the "enduring dynamics model" ( Huston et al., 2001). The first ones state that the husbands begin their matrimonies with a high level of satisfaction, the relationship satisfaction decreasing over time. The last model supports the idea of marital satisfaction stability over time. Moreover, recent research shows that, in general, couples report a relatively constant level of marital satisfaction during the first years. Exceptions are those who start their marriage with a low level of marital satisfaction, but their number is considerably lower than those who report medium and high satisfaction levels ( Birditt et al., 2012; Proulx et al., 2017; Williamson and Lavner, 2020). Future investigation in newlyweds should more often include samples of parents and non-parents in longitudinal designs in order to draw more reliable causal conclusions.

Marital Satisfaction in the Second Year Postpartum

From the first to the second year postpartum, marital satisfaction has a small decrease for first-time parents, with a similar decline for mothers and fathers, confirming the second hypothesis, that the decrease in marital satisfaction continues between 12 and 24 months postpartum for both men and women (H2). Unfortunately, the studies included in this meta-analysis did not present enough data to allow us to measure the course of marital satisfaction in couples without children for a similar interval of time.

Previous research supports our findings regarding the decline in marital satisfaction for the second year postpartum ( Figueiredo and Conde, 2015). The difficulties that partners face during the transition to parenthood does not stop after the first year postpartum. Some aspects of the transition to parenthood, like the increase in marital conflict ( Christopher et al., 2015), negative communication and problem intensity ( Doss et al., 2009; Figueiredo and Conde, 2015), parental stress ( Eller et al., 2019; Gou et al., 2019) and couple intimacy ( Figueiredo et al., 2018) influence the trajectory of marital satisfaction from first to the second year postpartum.

Marital Satisfaction in the First 2 Years Postpartum Globally

Additionally, our results show that marital satisfaction has a medium decrease from pregnancy to 24 months postpartum. These data converge with those obtained by Twenge et al. (2003) and with several longitudinal studies using multiple waves (e.g., Doss et al., 2009; Hirschberger et al., 2009; Simonelli et al., 2016). First-time parents can show a substantial increase in hostility, disagreement and problem severity several years after the infant's birth. The magnitude of negative post-birth relationship changes is unexpected for parents; the most likely reason is the exacerbation of stressors that are not well controlled during the transition to parenthood ( Doss et al., 2009) which affects marital satisfaction ( Lu, 2006). Referring to directions of change proposed by Lawrence et al. (2008), our results support the first one, consisting in a significant and qualitative decrease in marital satisfaction to the detriment of the temporary decline. According to our meta-analysis, the decrease in marital satisfaction is significant, of medium intensity, and characterizes at least the first 2 years after the birth of the first child. Attachment theory has shown that in difficult times anxiety and avoidance tend to increase, especially affecting couples in which one or both partners are more insecurely attached ( Feeney et al., 2003). Higher insecurity is associated with lower affect regulation, interpersonal functioning, and relationship satisfaction ( Mikulincer and Shaver, 2007). Furthermore, several studies have investigated the course of marital satisfaction many years after the first baby arrives and concluded that the decline of marital satisfaction remains at 4, 8, and 15 years after becoming a parent ( Doss et al., 2009; Simonelli et al., 2016).

Cross-Partner Associations

In order to test our fourth hypothesis, data showed that a steeper decrease in one partner's satisfaction is associated with the steeper decrease in the other partner's level of satisfaction (H4). Thus, there are significant cross-partner association effects between prepartum and postpartum marital satisfaction. Our results represent an extension of previous studies indicating the interdependence effect in couples, that found that couples report similar levels of marital satisfaction during the transition to parenthood ( Elek et al., 2003; Don and Mickelson, 2014), and one partner's marital satisfaction predicted the other partner's relationship quality at a later time ( Lee, 2017). It seems that the two partners go through the same marital satisfaction patterns in the first year postpartum ( Figueiredo and Conde, 2015) and see their couple relationship in related ways ( Elek et al., 2003). This mutual influence can be explained by the couple dynamic. Both parents also experience several changes once the first child is born and becomes more easily influenced by their partner. Birth, confinement, breastfeeding, job suspension, diminishing independence and reduced personal freedom make women more sensitive to their partner's characteristics. A supportive partner's approach helps them get over these changes more easily ( Rauch-Anderegg et al., 2020), while a stressed, unsupportive, depressed or an anxious spouse impacts the individual's marital satisfaction ( Don and Mickelson, 2014) and makes the transition more difficult. Although some data shows that the mother's behavior had no impact on the father's marital satisfaction ( Rauch-Anderegg et al., 2020), it seems that some latent variables of the mothers have a substantial impact. For example, a high level of a mother's daily stress and low self-esteem are related to a decline in the father's marital satisfaction during the transition to parenthood ( Meijer and van den Wittenboer, 2007; Don and Mickelson, 2014).

Moderators of Decrease in Marital Satisfaction

Although some evidence suggests possible moderators of decrease in marital satisfaction in first-time parents, like gender ( Don and Mickelson, 2014), age ( Lederman et al., 1981; Zare et al., 2014), and length of relationship ( O'Brien and Peyton, 2002; Doss et al., 2009; Lavner et al., 2020), our results reveal that only the type of instrument used presents a significant moderation of decline of marital satisfaction in the second postpartum year. So, our last hypothesis, that the decline in marital satisfaction is moderated by gender, age, relationship length, and the instrument used for measuring marital satisfaction (H5), was partially confirmed. The decline was smaller in studies that used the Dyadic Adjustment Scale (DAS, Spanier, 1976) compared to the studies that used other instruments to assess marital satisfaction. The scales measuring marital satisfaction include a conglomerate of items comprising evaluative judgments about marital quality, reports of specific behaviors and general interaction patterns ( Bradbury et al., 2000), the number, scoring and relevance of the items varying greatly from one instrument to another ( Fincham and Beach, 2006). Being one of the first scales built to assess marital satisfaction, it is possible that DAS, which does not include all the negative aspects affecting first-time parents, increases contamination to social desirability / acquiescence response bias in less difficult times compared to other scales. Moreover, this discrepancy concerning the moderating role of the couple satisfaction measure may indicate that after the first year postpartum, the parents are more sensitive to some aspects of their marital relationship, like love, sensuality or sexuality. These aspects of marital satisfaction are included in several marital satisfaction scales (e.g., Quality of Dyadic Relationship; Ahlborg et al., 2009; Relationship Assessment Scale; Hendrick, 1988) but not in DAS.

Concerning gender as a possible moderator, our results show a similar trajectory for men and women across all time points, thus contradicting the idea that the transition to parenthood impacts women's marital satisfaction more than men's ( Twenge et al., 2003). Our results are in line with other research's results indicating that parents do not differ in their trajectory of postpartum marital satisfaction, inferring that husbands have similar perspectives when it comes to their relationship ( Elek et al., 2003; Don and Mickelson, 2014).

Therefore, our meta-analysis confirms the previous line of findings that sustain the marital satisfaction decline once the first child is born. Previously, little was known about the trajectory of marital satisfaction from 12 to 24 months postpartum. Our work covers this gap and reveals a low decrease in first-time parents' marital satisfaction. Also, for the first time, our results offer a global summary of cross-partner associations in the trajectory of postpartum marital satisfaction. Concerning the therapeutical inferences, we want to conclude with three practical implications. First, when delivering parenthood educational training to couples, practitioners should know that pre-pregnancy levels of marital satisfaction will tend to contract spouses' evaluations of the marriage after the baby is born ( Lawrence et al., 2008), but the decline is lower when parents have realistic expectations about parenthood ( Menéndez et al., 2011). Second, professionals should be aware that a medium decrease in marital satisfaction is common in first-time parents. Knowing that transition to parenthood moderately affects marital satisfaction for the average couple and that the couple's satisfaction before the birth of the first child is a strong predictor of how couples manage this transition suggests the need to build dyadic interventions before the baby arrives and a long time after. Third, family counselors should know that marital satisfaction continues to decrease in the second year after childbirth. A realistic view of marital quality during the transition to parenthood should help souses manage this period better.

Limitations and Furture Directions

Several limitations should be considered when interpreting the findings of the present study. The first limitation concern with the number of the included non-parent samples. Also, the some parents' studies reported a common mean of marital satisfaction for married and unmarried participants. Future research should use independent means for the two categories of participants, considering that couples who have a child after marriage report higher marital satisfaction than couples who become parents before marriage ( Lavner et al., 2020). Secondly, not all included studies show averages of marital satisfaction at exactly 12 or 24 months postpartum, which is why we chose the averages reported to the nearest proposed time. Also, even if our study does not suffer from publication bias, it does not contain unpublished data. A prospective investigation should introduce unpublished data, which will lead to an increasing number of studies.

Conclusion

Summarizing our results, the drop in marital satisfaction during the first year of parenthood is medium for both mothers and fathers. In the same period of their marriage, non-parents reported only a small decline. The satisfaction's decline continues in mothers and fathers in the second year postpartum to a lesser extent. Also, the cross-partner associations of marital satisfaction decrease were noticed during the first postartum year. Although we found no publication bias, no moderation effect of the participant's age, gender or of the length of their relationships, the instrument of measurement moderates the marital satisfaction decrease in the second year postpartum.

Data Availability Statement

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: https://osf.io/xp3hk/files/.

Ethics Statement

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

Author Contributions

IB and MT contributed to all phases of the article. OC contributed to the design phase of the manuscript, and collection and analysis of the data. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

Ahlborg T., Lilleengen A.-M., Lönnfjord V., Petersen C. (2009). Quality of dyadic relationship in Swedish men and women living in long-term relationships and in couples in family counselling - Introduction of a new self-report measure, QDR36. [Nordic Psychol. 61 23-46.Google Scholar]

Aron A., Norman C., Aron E., Lewankowski G. (2002). "Shared participation in self-expanding activities," in [Understanding Marriage: Developments in the Study of Couple Interaction, eds Feeney J., Noller P. (New York, NY: Cambridge University Press; ), 177-194. 10.1136/bmjopen-2021-054222 [CrossRef] Google Scholar]

Fincham F. D., Beach S. R. H. (2006). "Relationship satisfaction," in [The Cambridge Handbook of Personal Relationship, eds Vanghelisti A. L., Pearlman D. (Cambridge: Cambridge University Press; ), 579594.Google Scholar]

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Transition to Parenthood and Marital Satisfaction: A Meta-Analysis

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The transition to parenthood is a major life event characterized by profound changes for a considerable number of people. Previous meta-analyses summarized the results obtained by various researchers in the first year and, respectively, in the first 2 ...

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The Transition to Parenthood: Relationship Tips for New Parents

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Strengthen your bond during the transition to parenthood with our research-based relationship tips for new and expecting parents.

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Perfect Love, Imperfect Relationships by John Welwood - Ebook | Scribd

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A nationally known couples therapist reveals the single root cause of all relationship problems—and offers revolutionary advice on what to do about it While most of us have moments of loving freely and openly, it is often hard to sustain this where it matters most—in our intimate relationships.…

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Codependency refers to a psychological construct involving an unhealthy relationship that people might share with those closest to them.

It was originally thought to involve families of substance abuse but has since grown to include other types of dysfunctional relationships.

Read on to learn about what codependency is and how it can affect people, how to recognize signs of codependency, and resources for learning more about and overcoming codependency.

If you wish to learn more, our Positive Relationships Masterclass© is a complete, science-based training template for practitioners and coaches that contains all the materials you'll need to help your clients improve their personal and professional relationships, ultimately enhancing their mental wellbeing.

What Is a Codependent Personality Disorder?

Originally, "the term 'codependent' described persons living with, or in a relationship with an addicted person" (Lampis et al., 2017). Modern understandings of codependency now refer to "a specific relationship addiction characterized by preoccupation and extreme dependence-emotional, social and sometimes physical-on another person."

The concept of codependency does still apply to families with substance abuse issues but is used also to refer to other situations too. The main consequence of codependency is that "[c]odependents, busy taking care of others, forget to take care of themselves, resulting in a disturbance of identity development" (Knudson & Terrell, 2012).

Cermak (1986) argued that codependency should be defined in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), borrowing diagnostic criteria from alcohol dependence, dependent personality disorder (DPD), borderline personality disorder (BPD), histrionic personality disorder, and even post-traumatic stress disorder (PTSD).

This argument was unsuccessful and the DSM-III-R (the next revision) did not include codependency as a personality disorder. The DSM-5, the newest edition of the manual, still only refers to DPD, not codependency.

Codependency does not only overlap with DPD but also with BPD, which is one reason some research has dismissed the idea of codependency making up its own personality disorder. One study found, though, that while codependent people do share some overlap with DPD and BPD symptoms, there are also people who exhibit codependency without exhibiting symptoms of DPD and BPD (Knapek et al., 2017).

Codependency can be distinguished from DPD because codependent people are dependent on a specific person(s), while people with DPD are dependent on others in general. Codependency can be distinguished from BPD; while BPD includes instability in interpersonal relationships, it does not involve dependence on other people.

To sum up, codependency is a psychological concept that refers to people who feel extreme amounts of dependence on certain loved ones in their lives, and who feel responsible for the feelings and actions of those loved ones. Codependency is not recognized as a distinct personality disorder by any version of the DSM, including the DSM-5, the most recent version.

That said, research shows that while codependency does overlap with other personality disorders, it does appear to constitute a distinct psychological construct. The best way to learn about codependency is to review some of the signs of codependency.

20 Signs Of Codependency

What does codependency actually look like? Some of the things that have been found to correlate with codependency include (Marks et al., 2012):

Other signs of codependency include (Lancer, 2016; Mental Health America, n.d.):

Having a hard time saying no;

Having poor boundaries;

Showing emotional reactivity;

Feeling compelled to take care of people;

Having a need for control, especially over others;

Having trouble communicating honestly;

Fixating on mistakes;

Feeling a need to be liked by everyone;

Feeling a need to always be in a relationship;

Denying one's own needs, thoughts, and feelings;

Having intimacy issues;

Confusing love and pity;

Displaying fear of abandonment.

Codependency Quiz & Tests

The simple presence of the above signs does not mean someone is codependent, but a high number of these signs may indicate codependent tendencies.

One way to do this is with codependency tests, like these:

Friel Co-Dependency Assessment Inventory from Mental Health America of Northern Kentucky and Southwest Ohio (1985)

This test consists of 60 true-or-false questions. A score below 20 is little need for concern, a score between 21-30 should be a moderate need for concern, a score between 31-45 is moderate towards a severe need for concern, and a score over 46 indicating a severe need for concern.

Codependency Test from Hamrah

This test consists of 26 simple yes-or-no questions that can get one to start thinking about codependency in their own relationships. Answering yes to five or more questions indicates that the test-taker may be codependent.

This is not a professional diagnosis, but it is a good way to start evaluating codependent behaviors in one's own life.

Are You in a Codependent Relationship?

This article from WebMD serves as a sort of open-ended quiz about whether or not one is in a codependent relationship and suggestions for what to do next. With input from psychologists, it offers up a few signs of codependent relationships to get the reader thinking about whether or not their relationship is codependent.

Characteristics of Codependent People

A checklist by Melody Beattie consisting of over 200 items has been adapted into a shorter version, called the Beattie Codependency Checklist, which has been used in peer-reviewed research on codependency (Wells et al., 1999).

There is no scale at the end which determines the taker's level of codependency, as it is rather meant to contextualize a vast set of behaviors and thoughts into a codependency framework.

5 Books About Codependency

For people who want to learn more about codependency, here are some great books about codependency. These books are particularly helpful for people who fear they are codependent and want to overcome their codependency.

1. Lancer, D. (2015). Codependency For Dummies, 2nd Edition.

This book, from a licensed marriage and family therapist, can be an excellent introduction to codependency for people who do not know a single thing about codependency. The book is aimed at people who think they might be codependent and includes a number of actionable tips one can take to break their codependence.

2. Beattie, M. (1990). The Language of Letting Go: Daily Meditations for Codependents.

This book, by codependency expert Melody Beattie, is a handbook for people who are codependent. This book is full of daily meditations and focuses on self-esteem, acceptance, health, and recovery. This is a good option for anyone who knows they are codependent and wants to do something about it.

3. Weinhold, B.K., Weinhold, J.B. (2008). Breaking Free of the Co-Dependency Trap.

This book, by a married psychologist couple, is all about codependency and how to break out of it. The authors first discuss how codependency develops in people, and how one's childhood can ultimately lead to codependency. The authors then focus on helping the reader out of codependency. This is a good option for anyone who wants to understand their codependency, not just how to fix it.

4. Sowle, J.J. (2014). The Everything Guide to Codependency: Learn to Recognize and Change Codependent Behavior.

This book from a clinical psychologist aims to help people who think they are codependent. In it, the author helps the reader recognize signs of codependency in their own behavior (and the behavior of the people around them), then helps the reader work through their own codependent or enabling behaviors, as well as the codependent or enabling behaviors of their partner.

This is a good option for learning how to recognize codependency in oneself, as well as learning how to identify and avoid codependent behaviors in the future.

5. Menter, J.E. (2012). You're Not Crazy - You're Codependent.

Finally, this book is written by someone who has struggled with codependency in their own life. It aims to help people who have had traumatic experiences in their past figure out if some of their problems stem from codependency. Then, for people who are struggling with codependency, the book offers a variety of ways to overcome it.

Codependency Treatment: 3 Codependency Worksheets

Books can be invaluable resources, but it can take some time to get through them. For people who want to start right away, here are some useful worksheets for learning about codependency, as well as treating and overcoming it.

1. Codependency Questionnaire

This Codependency Questionnaire is a good option for a short overview of common behaviors and feelings linked to codependency. It contains 20 items designed to get people thinking about codependency in their own lives.

While not a substitute for clinical diagnosis, it can be a good starting point.

2. Shifting Codependency Patterns

This worksheet is a helpful way to identify some emotional and behavioral patterns and tendencies that are related to codependency. It contrasts unhealthy ways that people with codependency think about themselves with healthier ways that people think about themselves.

This worksheet is an actionable way to shift thought and action patterns to begin recovering from codependency.

3. Codependent Relationships: Beliefs, Attributes, and Outcomes

Finally, Codependent Relationships - Beliefs, Attributes, and Outcomes is a brief, informal checklist that is broken down into the beliefs, attributes, and outcomes of codependent behaviors in relationships. While not a formal test, it is a good way to evaluate codependent behaviors and thoughts in one's interpersonal interactions, as well more generally in life.

This delves into healthy versus codependent thought patterns and behaviors.

Codependent Parents: Consequences for Children

Codependency was originally thought of as a disorder that affected the children and spouses of alcoholics and substance abusers. Research has shown that codependency is not unique to the children (or spouses) of alcoholics, though, as many types of family difficulties can lead to codependency (Cullen & Carr, 1999).

In fact, having a codependent parent can lead a child to codependency as well.

This is due to the tendency that people who have been "parentified" as children are more likely to be codependent (Wells et al., 1999). The concept of parentification refers to "the reversal of the parent-child role," or when a child is forced to serve in a parental or care-taking role towards their own parent.

This is usually due to the parent not having had their own developmental needs met while they were growing up.

Since these codependent children grow up not having their developmental needs met either, this can create a cycle of codependency passed down from generation to generation.

Being codependent can be particularly harmful for parents of addicted children (Clearview Treatment Programs, n.d.). Codependent parents of addicted children can enable their children's addictions, even when they think they are helping.

This is one of the ways that codependency can be especially tricky - often people with these tendencies believe they are being helpful, or that their actions are necessary for the other person in the relationship.

The most effective treatment for codependency is therapy, whether group or individual, to understand the ways in which someone feels they must care-take for another's emotional state.

This work can be hard to identify in ourselves, so having a supportive professional help us untangle these relationships can be crucial.

A Take-Home Message

For years, the concept of codependency has been criticized for being ill-defined, but over the last few decades, the construct of codependency has become more well-defined and well-researched, as it has been fitted with an empirical base.

Most importantly, codependency has been recognized as a relationship dynamic that affects people with all sorts of childhood trauma, not just the children or spouses of alcoholics or substance abusers.

For people who are codependent, there are plenty of ways to overcome codependency. Aside from seeking professional help, there are all sorts of worksheets and books (such as the ones highlighted above) by people who have overcome codependency. The most important thing to remember is that while everyone has loved ones and feels responsible for those loved ones, it can be unhealthy when one hinges their identity on someone else.

Ultimately, everyone is responsible for their own actions and feelings.

What is your experience with codependency? Are there relationships in your life in which you or the other person tend to exhibit codependent tendencies? Are their relationships from cultural movies or TV shows that provide examples of these kinds of relationships?

We'd love to hear your input in the comments section below.

We hope you found this article useful. If you wish to learn more, don't forget to check out our Positive Relationships Masterclass©.

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Codependency: What Are The Signs & How To Overcome It

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Codependency refers to a psychological construct involving an unhealthy relationship that people might share with those closest to them. It was originally thought to involve families of substance abuse but has since grown to include other types of dysfunctional relationships.

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Codependency in a relationship is when each person involved is mentally, emotionally, physically, and/or spiritually reliant on the other. A codependent relationship can exist between romantic partners, but also with family members and friends, and tends to lead to dysfunctional relationship patterns.

This type of dependence is common in relationships where one of the parties has an addiction, such as to alcohol or other substances. In fact, it is within the field of chemical dependency that the term codependency was born.

"The term was originally coined in the 1950s, in the context of Alcoholics Anonymous" explains Dr. Renee Exelbert, a licensed psychologist and author based in New York, "to support partners of individuals who abused substances, and who were entwined in the toxic lives of those they cared for."

Codependency is not a clinical diagnosis or formally categorized personality disorder on its own. Generally speaking, it incorporates aspects of attachment style patterns developed in early childhood. Codependency can also overlap with other personality disorders, including dependent personality disorder.

Causes of Codependency

What is the root cause of codependency? "Foundationally, it is due to poor concept of self and poor boundaries," says Dr. Mark Mayfield, a licensed professional counselor (LPC), "including an inability to have an opinion or say no."

Research suggests that there may be biological, psychological, and social elements that contribute to codependency:

Biological: The prefrontal cortex part of a codependent person's brain may fail to suppress empathic responses. This would create an overabundance of empathy, making it easier to become codependent.

Psychological: People who are codependent may be psychologically predisposed to care for others. They might also be affected psychologically by negative life experiences, such as growing up with parents who fought a lot or if they are a victim of neglect or emotional abuse.

Social: Codependency may result from changes in how society views women's roles or the increased exposure of substance abuse within family units.

Codependency can come in all shapes and sizes, with varying severity levels. It can also develop in all sorts of relationships, says Dr. Mayfield. It can exist in parent-child, partner-partner, spouse-spouse, and even coworker-boss relations.

Signs of Codependency

Codependency refers to an imbalanced relationship pattern. In this pattern, one person assumes responsibility for meeting another person's needs to the exclusion of acknowledging their own needs or feelings.

Dr. Exelberg

Codependent relationships are thus constructed around an inequity of power that promotes the needs of the taker. This leaves the giver to keep on giving, often at the sacrifice of themselves.

Drs. Mayfield and Exelbert share that there are several signs of codependency. If you experience any of the following, you might be the giver in a codependent relationship:

Having a sense of "walking on eggshells" to avoid conflict with the other person

Feeling the need to check in with the other person and/or ask permission to do daily tasks

Often being the one who apologizes-even if you have done nothing wrong

Feeling sorry for the other person, even when they hurt you

Regularly trying to change or rescue troubled, addicted, or under-functioning people whose problems go beyond one person's ability to fix

Doing anything for the other person, even if it makes you feel uncomfortable

Putting the other person on a pedestal, despite the fact that they don't merit this position

A need for other people to like you in order to feel good about yourself

Struggling to find any time for yourself, especially if your free time consistently goes to the other person

Feeling as if you've lost a sense of yourself within the relationship

Why Codependency Is Unhealthy

While everyone has loved ones and feels responsible for them, it can be unhealthy when your identity is contingent upon someone else. "Codependency does not refer to all caring behavior or feelings," says Dr. Exelbert, "but only those that are excessive to an unhealthy degree. Responsibility for relationships with others needs to coexist with responsibility to self."

Dr. Exelbert goes on to say, "This dynamic has also been referred to as a 'relationship addiction' because people with codependency often form relationships that are one-sided, emotionally destructive, and/or abusive."

In this sense, the inherent issue with codependency is that the giver loses their true sense of self since they're pouring so much into the taker. Even if the giver doesn't feel this way immediately-they likely enjoy giving their love and being relied upon-it can develop to unhealthy degrees as the relationship progresses.

Another issue with codependency is that it becomes difficult for the giver to remove themselves from the relationship since they might feel the other person relies on them so much, even if they know in their gut it is the right thing to do. Conversely, the taker will feel so reliant on the giver that they can have difficulty leaving a toxic relationship as well.

Codependency vs. Healthy Interdependence

How to Overcome Codependency

The first step in overcoming codependent tendencies is to focus on self-awareness. This can be done on your own, of course. But Dr. Mayfield also stresses the importance of therapy to help you really unravel your codependent tendencies.

"Many who struggle with codependency don't seek help until their life begins to fall apart," says Dr. Mayfield. "My advice is to be proactive and seek help."

Once you're on that journey, try your best to do the following:

Become the president of your own fan club. "Learn to speak lovingly and positively to yourself," says. Dr. Exelbert, "and resist the impulse to self-criticize."

Take small steps toward some separation in the relationship. Seek activities outside of the relationship and invest in new friendships. Focus on figuring out the things that make you who you are, then expand upon them.

Actively turn your attention inward when tempted to think or worry about someone else. This takes practice, so be kind to yourself along the way.

"Stand up for yourself if someone criticizes, undermines, or tries to control you," says Dr. Exelbert. By working on building your self-esteem, you'll find more strength in yourself.

Don't be afraid to say "no" to someone when you don't really want to do something.

Consider trying a support group or group psychotherapy if one-on-one therapy doesn't appeal to you, suggests Dr. Exelbert.

There's even an organization called Codependents Anonymous (CoDa) that addresses "needing to be needed" and past relationship dynamics.

Press Play for Advice On Building Confidence

A Word From Verywell

Codependency comes in many forms and levels of intensity. It often leads to an unhealthy relationship dynamic that progressively gets worse over time as the codependent person (the giver) loses a sense of themselves.

Recognizing the signs of codependency is the first step. Then, self-awareness and active redirection are key in reducing your codependent tendencies. Be kind to yourself as you work through the process, undoing years of this learned behavior.

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Codependency refers to a relationship in which one or both of the parties "need" to be with the other person. Learn the signs of codependency and how to overcome it.

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Co-dependency is a learned behavior that can be passed down from one generation to another. It is an emotional and behavioral condition that affects an individual's ability to have a healthy, mutually satisfying relationship. It is also known as "relationship addiction" because people with codependency often form or maintain relationships that are one-sided, emotionally destructive and/or abusive. The disorder was first identified about ten years ago as the result of years of studying interpersonal relationships in families of alcoholics. Co-dependent behavior is learned by watching and imitating other family members who display this type of behavior.

Who Does Co-dependency Affect?

Co-dependency often affects a spouse, a parent, sibling, friend, or co-worker of a person afflicted with alcohol or drug dependence. Originally, co-dependent was a term used to describe partners in chemical dependency, persons living with, or in a relationship with an addicted person. Similar patterns have been seen in people in relationships with chronically or mentally ill individuals. Today, however, the term has broadened to describe any co-dependent person from any dysfunctional family.

What is a Dysfunctional Family and How Does it Lead to Co-dependency?

A dysfunctional family is one in which members suffer from fear, anger, pain, or shame that is ignored or denied. Underlying problems may include any of the following:

An addiction by a family member to drugs, alcohol, relationships, work, food, sex, or gambling.

The existence of physical, emotional, or sexual abuse.

The presence of a family member suffering from a chronic mental or physical illness.

Dysfunctional families do not acknowledge that problems exist. They don't talk about them or confront them. As a result, family members learn to repress emotions and disregard their own needs. They become "survivors." They develop behaviors that help them deny, ignore, or avoid difficult emotions. They detach themselves. They don't talk. They don't touch. They don't confront. They don't feel. They don't trust. The identity and emotional development of the members of a dysfunctional family are often inhibited

Attention and energy focus on the family member who is ill or addicted. The co-dependent person typically sacrifices his or her needs to take care of a person who is sick. When co-dependents place other people's health, welfare and safety before their own, they can lose contact with their own needs, desires, and sense of self.

How Do Co-dependent People Behave?

Co-dependents have low self-esteem and look for anything outside of themselves to make them feel better. They find it hard to "be themselves." Some try to feel better through alcohol, drugs or nicotine - and become addicted. Others may develop compulsive behaviors like workaholism, gambling, or indiscriminate sexual activity.

They have good intentions. They try to take care of a person who is experiencing difficulty, but the caretaking becomes compulsive and defeating. Co-dependents often take on a martyr's role and become "benefactors" to an individual in need. A wife may cover for her alcoholic husband; a mother may make excuses for a truant child; or a father may "pull some strings" to keep his child from suffering the consequences of delinquent behavior.

The problem is that these repeated rescue attempts allow the needy individual to continue on a destructive course and to become even more dependent on the unhealthy caretaking of the "benefactor." As this reliance increases, the co-dependent develops a sense of reward and satisfaction from "being needed." When the caretaking becomes compulsive, the co-dependent feels choiceless and helpless in the relationship, but is unable to break away from the cycle of behavior that causes it. Co-dependents view themselves as victims and are attracted to that same weakness in the love and friendship relationships.

Characteristics of Co-dependent People Are:

An exaggerated sense of responsibility for the actions of others

A tendency to confuse love and pity, with the tendency to "love" people they can pity and rescue

A tendency to do more than their share, all of the time

A tendency to become hurt when people don't recognize their efforts

An unhealthy dependence on relationships. The co-dependent will do anything to hold on to a relationship; to avoid the feeling of abandonment

An extreme need for approval and recognition

A sense of guilt when asserting themselves

A compelling need to control others

Lack of trust in self and/or others

Fear of being abandoned or alone

Difficulty identifying feelings

Rigidity/difficulty adjusting to change

Problems with intimacy/boundaries

Chronic anger

Lying/dishonesty

Poor communications

Difficulty making decisions

Questionnaire To Identify Signs Of Co-dependency

This condition appears to run in different degrees, whereby the intensity of symptoms are on a spectrum of severity, as opposed to an all or nothing scale. Please note that only a qualified professional can make a diagnosis of co-dependency; not everyone experiencing these symptoms suffers from co-dependency.

1. Do you keep quiet to avoid arguments?
2. Are you always worried about others' opinions of you?
3. Have you ever lived with someone with an alcohol or drug problem?
4. Have you ever lived with someone who hits or belittles you?
5. Are the opinions of others more important than your own?
6. Do you have difficulty adjusting to changes at work or home?
7. Do you feel rejected when significant others spend time with friends?
8. Do you doubt your ability to be who you want to be?
9. Are you uncomfortable expressing your true feelings to others?
10. Have you ever felt inadequate?
11. Do you feel like a "bad person" when you make a mistake?
12. Do you have difficulty taking compliments or gifts?
13. Do you feel humiliation when your child or spouse makes a mistake?
14. Do you think people in your life would go downhill without your constant efforts?
15. Do you frequently wish someone could help you get things done?
16. Do you have difficulty talking to people in authority, such as the police or your boss?
17. Are you confused about who you are or where you are going with your life?
18. Do you have trouble saying "no" when asked for help?
19. Do you have trouble asking for help?
20. Do you have so many things going at once that you can't do justice to any of them?

If you identify with several of these symptoms; are dissatisfied with yourself or your relationships; you should consider seeking professional help. Arrange for a diagnostic evaluation with a licensed physician or psychologist experienced in treating co-dependency.

How is Co-dependency Treated?

Because co-dependency is usually rooted in a person's childhood, treatment often involves exploration into early childhood issues and their relationship to current destructive behavior patterns. Treatment includes education, experiential groups, and individual and group therapy through which co-dependents rediscover themselves and identify self-defeating behavior patterns. Treatment also focuses on helping patients getting in touch with feelings that have been buried during childhood and on reconstructing family dynamics. The goal is to allow them to experience their full range of feelings again.

When Co-dependency Hits Home

The first step in changing unhealthy behavior is to understand it. It is important for co-dependents and their family members to educate themselves about the course and cycle of addiction and how it extends into their relationships. Libraries, drug and alcohol abuse treatment centers and mental health centers often offer educational materials and programs to the public.

A lot of change and growth is necessary for the co-dependent and his or her family. Any caretaking behavior that allows or enables abuse to continue in the family needs to be recognized and stopped. The co-dependent must identify and embrace his or her feelings and needs. This may include learning to say "no," to be loving yet tough, and learning to be self-reliant. People find freedom, love, and serenity in their recovery.

Hope lies in learning more. The more you understand co-dependency the better you can cope with its effects. Reaching out for information and assistance can help someone live a healthier, more fulfilling life.

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Co-dependency is a learned behavior that can be passed down from one generation to another. It is an emotional and behavioral condition that affects an individual's ability to have a healthy, mutually satisfying relationship. It is also known as "relationship addiction" because people with codependency often form or maintain relationships that are one-sided, emotionally destructive and/or abusive.

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A new book by the Gottmans focused on 8 Date conversations: trust, conflict, sex, money, family, adventure, spirituality, and dreams.

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John and Julie Gottman: Eight Dates: Essential Conversations for a Lifetime of Love (03/13/19)

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How to write couples notes and termination summary:

How to Write Couples Therapy Notes (icanotes.com)

Couples Counseling Notes: 4 Steps to Simplifying the Process — QA Prep

Couples Therapy Progress Note Template - Mt Home Arts

Termination of Counseling | Syracuse University School of Education

Successful Therapy Termination (Guide) | Therapist Aid

How To Write A Therapy Case Summary — Family Therapy Basics

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Couples counseling differs from individual therapy because instead of dealing with one person's issues or addiction, you're working through two individuals' needs and how those affect their relationship. While the notes and paperwork for couples therapy are not wildly different from individual clinical documentation, there will be more interactions and personal challenges to work on than with one person.

When providing therapy to a couple, remember that each person has their own needs and ways of communicating with you and their partner during the session, which are some of the things you'll need to document. This article discusses how to write couples counseling notes, tips for personalizing them to your specific methods and how to use them to help you achieve your patient's goals.

Table of Contents

Why Couples Go to Therapy

As with individual therapy, couples seek treatment for several reasons. Partners may turn to therapy to deal with a recurring issue in their relationship or to cope with a major event, such as disease, death of a loved one or pregnancy.

Regardless of the reason couples choose to go to therapy, it's often a huge step for each partner to agree they want to work on an individual or relationship issue together. Some of the issues couples may experience that lead them to try therapy include:

Difficulty communicating or expressing feelings

Trauma

Problems with physical intimacy

Infidelity

Abuse or violence

Loss of a child

Lack of trust

Problems with children

Addiction

Anxiety or depression

Irreconcilable differences leading to divorce

Financial struggles

Issues with partners' relatives or friends

Many couples may decide to go to therapy after developing patterns of behavior, leading to circular arguments that continue without any resolution. Some partners may feel constantly blamed or ignored by the other and fail to see their own shortcomings. Couples therapy can help address many difficulties in relationships, from preventing finger-pointing and name-calling to building trust after one or both partners have been unfaithful.

The Goals of Couples Therapy

Because every couple chooses to go to therapy for different reasons, they will all have different hopes and expectations for their sessions. As a therapist, you may want to achieve several goals during their counseling, including:

Repairing their relationship

Identifying the root causes of their disputes

Helping them understand their partner's point of view

Developing trust with each partner without alienating one or the other

Teaching them how their actions contribute to conflicts

Providing them with an understanding of each person's struggles

Setting boundaries in the session to help them feel safe to express their feelings and opinions

Helping them use a more effective communication style

Bringing closure to their past disputes

Offering them ways to balance responsibilities and stress

Finding personalized solutions for their ongoing problems or addictions

It's your job as a therapist to make both partners in the relationship feel equally heard and respected to set an example for the couple, help them achieve their goals and make your couples therapy sessions more productive. One partner may try to gain favor with you by blaming the other or talking over them to make certain you hear their side of the story. Be sure to let both partners know they must respect each other's time and remain neutral when discussing issues.

Both partners should be able to speak freely and without fear of judgment, bias or criticism. It's also a good idea to meet each partner separately as part of their first session to learn about sensitive issues and allow them to warm up to the idea of therapy without feeling judged by their partner. Try to avoid solving the problem for them, as this can cause one or both partners to feel defensive. By sharing new communication methods with them, you give them the resources they need to resolve their own issues during therapy and at home.

The Difference Between Progress Notes and Psychotherapy Notes

As a behavioral healthcare provider, you will know the vital role progress notes play in creating a treatment plan for individuals and couples across many different therapy methods. However, progress notes and psychotherapy notes are not interchangeable. Psychotherapy notes are professional documents containing important information focused exclusively on a patient's or couple's therapy sessions. Unlike progress notes, psychotherapy notes can only be written by therapists, counselors and mental health practitioners who are actively involved in the couples' therapy.

On the other hand, progress notes are professional documents that convey information about a patient's condition through therapy and may transfer between multiple providers.

Let's look at the specific definitions and differences between progress notes and psychotherapy notes.

Progress Notes

The purpose of progress notes is to communicate information about the patient or couple and their treatment plans between behavioral health professionals, including:

Medical history

Session times

Frequency of treatment

Results of clinical assessments and tests

Prescriptions

Past treatments

Current treatment plan information

Current condition

Diagnoses

Progress to date

Major events discussed

Specific interventions provided

Alternative treatments

Homework assigned

You can share progress notes with your clients, insurance companies and billing parties, but they are still protected by privacy laws. You must sign and date every progress note and include your credentials. Keep in mind that progress notes should not include:

Speculation

Hypothesis

Your personal feelings or judgments

Any information, events or experiences that are not relevant to the session or treatment plan

Identifying information about people not involved in the treatment

Psychotherapy Notes

Psychotherapy notes document insights on the patient or couple during therapy and help inform you to make better treatment plan decisions. These notes can include:

Generally, psychotherapy notes are very detailed but should not contain medical or billing information. These notes are for you to reference when you create your progress notes and develop a treatment plan for each individual or the couple as a whole. Your psychotherapy notes should not include diagnoses, either partner's treatment history or individual or couple treatment plans.

Observations

Feelings

Thoughts about the couple or session

Questions

Each patient's demeanor

Personalizing Couples Therapy Notes for Your Practice

As with all therapy notes, you can personalize your couples therapy progress notes to meet your - or their - needs and adjust them to your particular style so it's easier and more effective. After all, every couple is different, and your interactions and experience with them will be unique, so it's a good idea to customize your notes as needed.

Integrate Your Preferred Method

To help personalize your couples therapy progress notes, you can write down your favorite modalities. Whether you usually assign exercises with couples or have them review important principles of their relationship each session, adjusting your notes to your typical methods can make it easier to dive right in and make more efficient notes.

You might like to use the Gottman method, which focuses on managing conflict and negative interactions. Studies have shown that this method effectively handles serious problems in couples, including marital relationships, and helps them develop problem-solving skills.

As you work with more couples and gain more experience managing individual and relationship obstacles, you can modify your notes to a unique system that works for each couple's needs.

Recognize Patterns

If you notice a particular pattern with most couples, identify the steps you typically conduct in your sessions. For instance, what do you usually like to cover within your first three sessions? Do you focus on client confidentiality and honesty? There may be specific factors you like to discuss or ice-breaking exercises you want to conduct to help the couple feel more comfortable about opening up as the sessions progress.

Perhaps you prefer to have a set of constructed techniques during the first phase of treatment, or you put more emphasis on the exercises you assign at the end of your session. Whatever your preferred process, create a timeline of what couples counseling looks like with you and keep it handy for writing your couples therapy and filing notes. This can make the process easier because it allows you to reference important things you may forget during your sessions.

Focus on Interaction

In individual therapy, you only need to focus on the relationship between you and your singular patient. In couples therapy, there are more interactions to consider. You should focus on your interactions with each partner and between your two patients. These interactions are essential to note because they can help you determine if there are trust or boundary issues.

For instance, if you notice a pattern in how one partner speaks to another or how they seem less inclined to open up to you directly, you can write this down in your notes and reference it later to help adjust your treatment plan and tackle these obstacles.

In these notes, you can organize interactions by therapist or client actions and reactions. Note the methods you teach, assignments you make or any insights you give to the couple. Then, write down the couple's responses, the information they provide and how they interact with you and their partner after you speak. Structuring your notes this way can help you develop more effective progress.

Inform the Couple

Though the treatment and note-writing process for couples therapy aren't too different from individual counseling, there is a significant difference in confidentiality and record keeping. It's critical to inform couples of how you prefer to keep patient records. For example, you can keep separate progress notes for couples therapy or create one record if you wish to view the couple together as a single client.

You can choose either option, but be sure to stick to the method once you decide on it. You want to inform couples of how you keep your records in case they should ever ask for copies. This lets them know ahead of time whether your charting, notes and billing process will be done individually or as a couple, so there are no surprises.

Tips for Writing Couples Therapy Notes

Now that you know some general recommendations for personalizing your notes, here are a few helpful tips you can use to ensure your couples therapy notes are accurate, effective and detailed.

Sample Progress Notes for Couples Therapy and Individual Therapy

Remember that individual and couples therapy are different despite having similar goals in mind. In couples therapy, it's important to keep your progress notes organized and detailed enough so you can easily differentiate between each patient and can clearly identify each of their personal obstacles if you keep it all within one record. If you keep the progress notes in separate records for each partner, be sure to make notes in each record about how the couple interacts and what interventions you plan for them as a couple in addition to their individual treatment, if needed.

Refer to your previous notes to ensure appropriate progress and continuity.

Note your specific observations, what they mean and how you and the couple plan to address them.

Write about specific issues or relevant occurrences as soon as possible.

Understand what information you need during the session to create an effective treatment plan.

Avoid using abbreviations, slang or jargon that could confuse you or other providers.

Keep your notes simple and only write the information you can effectively use.

Avoid using terms like "always," "never," "good," "bad," or any words that suggest judgments or absolutes.

Use correct spelling and grammar to make your notes easier to read.

Keep your notes objective, concise, relevant and organized.

Watch out for potential biases or misrepresentations of your patients.

Include the couple's relationship and response to the treatment plan.

In couples therapy, you will likely have to include many other factors and elements compared to when you work with one patient. For instance, in couples counseling, once you receive a description of a problem or an event by partner A, you may also need to ask partner B how they feel about the explanation and if they agree or disagree with the characterization. Aside from the issues each partner may identify with the other, you will also have to discuss any obstacles the couple is facing together, such as financial decisions, family planning or a career change.

A few key components of your couples therapy notes will also include:

To make your notes more detailed, you can use a mental health status checklist to guide you as you organize your observations. A helpful way to keep the different sections and criteria of your notes clear and concise is to utilize software that includes templates and sample progress notes for couples therapy, which include:

Relevant details for each partner

Observations about each partner's mood and body language

Notes about each partner's responses, participation and behavior

Descriptions of significant events or problems between the couple

Goals for each patient individually and as a couple

Interventions you used to help the couple reach their goals

Patient feedback and suggestions about their treatment plan

ICANotes Can Help You Document Your Couples Therapy Notes

Behavior

Content of therapy

Intervention

Diagnoses

Treatment plan details

Keeping your notes relevant, detailed and organized is critical for saving time and energy as you make your notes. Using these effective note strategies during couples therapy can allow you to spend more time with your patients and less time referencing notes to develop your treatment plans. Whether you want to keep your couples therapy records together or separate, using a leading electronic health record software like ICANotes will empower you to take these strategies from idea to implementation.

Our behavioral health platform allows therapists and mental health providers to speed up their clinical documentation processes efficiently and accurately and reduce the frustration associated with long turnaround times. To help take your progress notes to the next level, start your free trial today or schedule a live demo to see how ICANotes can help your private practice. We also invite you to contact us if you have any questions.

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Couples counseling differs from individual therapy because instead of dealing with one person's issues or addiction, you're working through two individuals' needs and how those affect their relationship. While the notes and paperwork for couples therapy are not wildly different from individual clinical documentation, there will be more interactions and personal challenges to work on than with one person.

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Couples conflict and impact on children/Emotion Coaching 

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Couples conflict and impact on children/Emotion Coaching 

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Resources for Emotion Coaching:

Gottman Institute Emotion Coaching

The basics of emotion coaching

https://youtu.be/Cn9bEZ2bRbQ

Resources for buffering children during conflict:

Buffering Children and Conflict

Longitudinal Effects of Parent Conflict

Vagal Tone Protection

Appraisal of Conflict among siblings Interparental Conflict

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Books include Mating In Captivity and The State of Affairs, Where should we begin in Apple Podcast

Videos:
https://youtu.be/sa0RUmGTCYY

https://youtu.be/gOu9Rwl-yxw

Podcasts | Esther Perel

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South Asian American Relationships in US

Cultural Considerations for using EFT with African American Couples

Intercultural Relationships

Arab First Gen in Couples Counseling

Review of Cultural Implications in Couples work with African American Couples

Impact of Racial Trauma in Couples

Racial Trauma in Interracial Couples

How African American romantic partners support each other when faced with racial discrimination can affect mental, physical health, study shows

PopCulture- Interracial Relationships: Diversity And Struggles

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Below are resources on the Book Wired for Love by Stan Tatkin. This book looks at the neurobiology of attachment within couples.

Overview of the Book

Understanding your attachment

Attachment Style Revealed: Are You An Anchor, Island or Wave?

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Relationships Are Hard, But Why? | Stan Tatkin | TEDxKC

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Emily Nagoski Plus Worksheets (Come as You Are)

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Emily Nagoski Plus Worksheets (Come as You Are)

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Videos:
https://youtu.be/WpFIF7DA90A

https://youtu.be/lon25Nc1Vx8

We Can Do Hard Things with Glennon Doyle: REAL, JOYFUL SEX with Emily Nagoski on Apple Podcasts

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In this link, you will find information on working with various types of relationships and LGBTQIA+ individuals:

Handbook of LGBT-affirmative couple and family therapy : Free Download, Borrow, and Streaming : Internet Archive

The Ethical Slut : Dossie Easton : Free Download, Borrow, and Streaming : Internet Archive

'Ethical Slut': Polyamory, Open Relationships, Non-Monogamy - Rolling Stone

Attachment and Queer Realtionships Gay Lesbian R/S Satisfaction Scale

4 Challenges for Lesbian Couples

GLRSS

Intervention w/ Bisexual r/s

When two is too few

Consensual NM Case Study

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Attached is the Narrative Therapy approach to couples: PowerPoint, readings and website.

Narrative Couples Therapy Overview

The Efficacy of the Narrative Therapy Approach

Narrative Lens Child with Autism

Narrative therapy for fertility

Narrative Therapy for CSA

Narrative therapy to expand emotional connection

Narrative Therapy and resilience

Utility of Narrative Couples Therapy

Narrative Couples Therapy

Interventions and treatment plan

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Susan Johnson Emotion Focused Therapy (EFT) Overview

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Susan Johnson Emotion Focused Therapy (EFT) Overview

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Videos:
https://youtu.be/xQCg-jC25fo

https://youtu.be/xQCg-jC25fo

https://youtu.be/UkG0Lobd8s8

Circle of Willis: Susan Johnson, Part 1 on Apple Podcasts

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Lectures include materials from the Marriage Clinic manual by Gottman.

Videos:

https://youtu.be/INo8RSgnviA

https://youtu.be/LUOniBdgdiM

https://youtu.be/xlzKTP9Cexo

Small Things Often - The Gottman Institute