Newman Lecture: Current status and future directions in couples therapy by Martiño RodríguezGonzález

0:11Welcome, everyone. My name is doctor Steven Grundman. I teach the integrative courses, philosophy, theology, and psychology in our doctorate in clinical psychology program. I'll be your emcee tonight. The Newman Lecture Series, now in its twenty fourth year, sponsored by Divine Mercy University, aims at building a body of learned discussion that is Catholic both in its breadth of research and in its dialogue with contemporary Catholic Christian thought. We are pleased to offer tonight's lecture both on campus and online, and so a few words to our audiences about submitting questions for our speaker following the lecture. For those joining us online, as questions occur to you, please type them in the chat box or the question and answer box.

1:01For technical reasons, online questions will be taken until the question and answer period begins. For those joining us on campus, we have a microphone for you here in the room. We have two microphones, one on either side in the back. Thank you. And now as father Hsu has been called away suddenly on priestly duties, I've been invited to open us in prayer. Please join me. In the name of the father and of the son and of the holy spirit. Amen. Heavenly father, we thank you for calling us to be living witnesses of your love for each human person. We thank you for inspiring the mission of Divine Mercy University and supporting our studies. We thank you especially for the presence of our distinguished speaker tonight, who will be sharing with us a great deal of research to help further our work.

2:07So we ask you to bless as well all those who are present or are able to watch this presentation with us and all those they touch. We ask all this in Jesus' name. Amen. In the name of the Father and of the Son and of the Holy Spirit. Amen. And now I invite doctor Klowicki, dean of the Institute for the Psychological Sciences, to introduce tonight's distinguished speaker, doctor Klowicki. I have the wonderful pleasure of introducing one of my colleagues and friends. This is doctor Martino Rodriguez Gonzalez. He completed his bachelor's degree in psychology at the University of Santiago de Compostela in Spain. He then obtained a master's in psychology of the family from the John Paul II Institute in Madrid, Spain.

3:00He completed his last degree, which is was his PhD at the Comillas Pontifical University in Spain also. Getting a theme here? Doctor Rodriguez Gonzalez now works as an associate researcher at the Institute for Culture and Society of the University of Navarra in Pamplona, Spain, and he maintains a private practice focusing mainly on work with couples and families. Doctor Rodriguez Gonzales is the principal investigator of three research funding projects, a randomized control trial in emotionally focused couple therapy in Spanish, divine forgiveness, psychological aspects of confession in Spanish speaking Catholics, and mental health in schools. He's also the author of eight book chapters, one book, and over 25 peer reviewed publications, primarily in journals related to family and couples therapy.

3:54He, is a fellowship and has short research visits at the University of Ottawa, University of Comimbra Comimbra. There we go. Sorry. University of Porto, Brigham Young University, Boston University, and Georgetown Family Center for the study of the family. Since 2009, he has had teaching appointments both full time and as an invited professor at the Universidad de Navara, Universidad de Francisco de Victoria, Universidad de Santiago de Compostela, the John Paul II Institute, and the Universidad de de Justo in Spain, Bilbao, Spain. Right? Right. I I I am butchering all of these with my horrible Spanish pronunciation, so I apologize to anybody who did not understand me, actually. He's fully trained in emotionally focused therapy by Sue Johnson's, institute, center for EFT in in Canada.

4:52He has level one, accreditation in emotion focused therapy by Greenberg. He's fully accredited as a family and couple systems therapist by the National Federation of Family Therapy, and he's president of the Spanish Association for the Research and Development of Family Therapy from 2019 to the present. So it's with great honor that I introduce to you doctor Martino Rodriguez Gonzales. Good evening, everyone. Thank you for this opportunity. Thank you to the Divine Mercy. Thank you, doctor Klawicki, for your words and for all all the faculty and students that are here. It's for me a real pleasure to an honor to has been invited to this Newman Lecture, and I expect to be able to share some of my ideas and thoughts and reflections about this very relevant issue, strongly connected with the family and the marriage, with mental health, and with flourishing and with psychotherapy.

6:01Here you can see this the outline, with the I I will follow in the lecture today. I I will start with a brief introduction of the topic, then I'm going to talk a little bit about the main, couple therapy approaches. And after, I'm going to mention some of the research topics, the main research topics and emerging issues in the field. After that, I'm going to talk about some key people and leading research groups and challenges in the in the field. And at the end, I'm going to talk a little bit about my work in in the lab in Navara, related with couples therapy. And at the end, I I'm going to suggest some future studies, some ideas for future studies. My intention is to present a big picture of the state of the of the couples therapy field, and this could be the is is going to be the first part, and we will have another second part of this lecture in October.

7:24More information at the end. Uh-huh. So I would like to start saying that the marriage and the family are in the core of the Catholic church message and its proposal for flourishing in life. Today, my impression is there is a deep discussion in the core of the Catholic church about some specific aspects related with the marriage. Catholic church is the same church for all over the world. Thus, the discussion is not possible to affect only one country. How we can contribute to a real flourishing of the marriage and the family? Moreover, can we contribute to build a better world transforming the couple therapist training, and the view of the person that Catholic couples therapist has? I trust we can.

8:29I think the Catholic psychologists are now more than ever in a relevant position for the Catholic church, and we can contribute to build sometimes a bridge between the church and the society. This bridge is needed particularly for The US of I I think particularly for The US people, there is a temptation of say Rome is very far away. But I think the work EMU is doing with the integration of psychology and Catholic faith is a good job. And it's a big contribution, not only for The USA, but for everyone. But we need to build more bridges, and I hope this lecture can contribute to that. The romantic relationships are a universal aspect of the human existence. It's a relevant topic across cultures with significant implications from several perspectives.

9:43Ethical, biological, for the religion as a also as social construction, studying why we partner, what leads two individuals to stay together, and which are the factors contributing to the flourishing of that union is of great importance. In the past, couple therapy was a variation from individual or family therapy. But nowadays, it stand on its own and it has its own distinct methods. According with Lebow and Snyder, which are two American authors I'm going to mention a lot in this lecture, there are three key factors have rhyme the development of couple therapy as a prominent therapeutic field. First, the couple distress prevalence. In all the occidental countries, a high percentage of marriages and in in divorce.

10:51Second, the negative impact of relationship distress on the emotional and physical well-being of adult partners and their offspring. Partners in distressed relationships are significantly more likely to have a mood disorder, anxiety disorder, or substance use disorder, and to develop more physical health problems. Uncoupled conflict and distress have been related with a long list of negative effects on children including mental health problems and physical health problems. A third factor is the higher expectations for couples relationships. Today, we expect our partner to be the perfect partner. The couple relationship should be should work perfectly. Couples therapy field is highly diverse worldwide.

11:53Research in couple therapy comes predominantly from The USA and from English speaking countries. For example, Canada, Australia, or UK. But for example, in a systematic review of the couple therapy research in greater we Greater China, it is possible to read, couple of or marriage therapy is a western creation designing to address problems arising in intimate and romantic relationships. This shows research in couple therapy from China is pretty new starting mostly in the last fifteen years. It's to take care of coupled relationships, a public health priority. In my opinion, it should. Nevertheless, the investment in research about how to the coupled relationship works is truly inadequate. It doesn't not seem as a priority for the National Institute of Mental Health in The States or the European Commission Research Grants in Europe.

13:17Which are the main couple approaches we can found in the literature? There are hundreds of different couple therapy approaches. I don't know her, but in Spain, for example, you can find a very long list. In the slide, you can check one of the most relevant approaches, in my opinion. But probably if we wait two or three years, new approaches will appear. Everyone create its own approach and try to create a space. There are good news and bad news about the approaches. Let's go first with the bad news. Just pick one couple of examples from the list right now. For example, psychodynamic, psychoanalytic, couple therapy. According with a recent systematic review of the psychodynamic couple therapy field, in the last fifty years, most of research manuscripts published in this field are case studies followed by conceptual theoretical contributions and a very few number of empirical quantitative research contributions.

14:36According with the systematic review published recently, among the 130 studies published under the field psychoanalytic coupled therapy, only two used quantitative approaches. I'm sorry, but this is not good. Case studies and theoretical manuscripts are very important, but we need good quality empirical research in psychology and psychotherapy. Psychotherapy. Another example, cognitive behavioral couple therapy. In Spain, a psychologist, 95% of the schools of psychology trained in a cognitive behavioral approach. Thus, almost any psychologist from Spain, unless he or she be trained in another specific approach, could say, I am a cognitive behavioral coupled therapist. What does it mean and which are the core skills they can show in couple therapy?

15:42It's a mystery. Nobody knows really. This is also a problem because, moreover, I know this is not only a Spanish issue. Do you want to know about the good news? Good news are double therapy is an essential health intervention and different recent systematic reviews and some meta analysis conclude that we cannot be optimistic about couple therapy. Treatment developed for distressed couples are producing large size changes across multiple key domains and relationship function. Moreover, these effects were generally maintained for as much as two years after the end of the right treatment. If we look at the list I have presented previously, we can highlight two models in particular. The integrative cognitive behavioral coupled therapy and the emotionally focused coupled therapy.

17:02These two approaches have been tested through several different RCT, randomized controlled trials, from different cultural frames and research teams. But, and also using another sorry. And also using other research designs, not only the randomized control trials, as a quasi experimental and other types of research. That means that they are two promising approaches to treat coupled distress. There are also health disorders or issues beyond coupled distress for which coupled therapy has also been proven through randomized controlled trials or other research approaches such as to treat post traumatic stress disorder or substance abuse. When we talk about evidence based treatment, we are talking about how much a treatment or approach is based on research.

18:13First, it it's important to know that the number of studies in individual psychotherapy are much higher in their number than the studies for family and couples therapy. And there are different levels of evidence in psychotherapy. In particular, in the field of couple and family therapy, there is a relevant proposal made by Sexton, Lebo, and other colleagues to classify the treatments according with their level of scientific evidence. Here is the the manuscript where is the proposal, and they suggest three levels. Level one, evidence informed treatments clearly based upon psychological research. Second level, treatments which show promising preliminary risk research results. And level three level three evidence based treatments.

19:14To achieve the third level, several conditions must be met. They must be therapy models that have achieved positive results in at least two outcome studies, which we can consider to have been tested in different cultural context and with different research groups. And that the results have been assessed through measures considered reliable. For a therapeutic model to undergo these types of studies, certain conditions must exist such such as a clear treatment model with a manual, a measure of model fidelity to test the utterance or competence of the therapist, and a clear guide about how someone can be trained in the model. Not all the coupled therapy approaches fulfill these requirements. Different and diverse research methods might be needed at different phases in the evolution of a treatment program or a treatment model.

20:32Research approaches do not produce the same type of evidence. A clinical trial is the highest quality level in terms of scientific approach to test the efficacy of a treatment. But other studies with lower internal validity, less control, and more naturalistic research settings can test the treatment model effectiveness. I'm talking here about efficacy and effectiveness, which are two relevant words when we talk about evidence based treatments because efficacy is about the performance of an intervention under ideal or uncontrolled circumstances as the best example is the randomized controlled trial. While effectiveness refers to its performance and the real world conditions. Both types of studies are important in the development of research and to test that couple model to treat sorry.

21:47To to to test that, an approach in couple therapy. Okay. Let's move to the next topic, next point in the outline. What are the main research topics or and after that, some emerging issues in the field. Here, you can see a list of several topics on the field. Many of them are also relevant topics in individual psychotherapy or family therapy. I'm not trying to present a full list of all the topics couples therapy research will address, but to share some examples to help those who are not doing research in this field to know what are the topics. Efficacy and effectiveness, we already talk about that. If there are political alliance, it's a topic itself, dropout, we have a sometimes a high rate of dropout, and this is bad.

22:56Why the couples dropout or keep going in the process? The therapist training is a big issue. The supervision, we can take together these two if we want. The measure of change, LGBT and minority, groups or different kinds of couples is another topic. Cultural competencies and and other topics that you can see in the list. We can take five or twenty hours to talk about each one of the main topics. But I would like to focus briefly in the last one, couple therapy interventions to address individual issue health problems. As Lebo and Seidler are both in a recent manuscript of 2022, couple therapy has traditionally been mostly understood as a treatment to improve relationship satisfaction. Nevertheless, in the last two decades, couple therapies have been focused on problems traditionally viewed as problems of the individuals.

24:11The strong association of couple relationship distress with individual psychological and physical health problems provides a rationale for applying coupled therapy to treat those individual issues. There are two forms of adaptations of coupled therapy for treatment for treatment of individual disorders. Disorder specific coupled interventions, and partner assisted treatment. Couple treatments of individual problems are mostly cognitive behavioral in their approach, But other theoretical models of couple therapy are already working to treat individual emotional or physical health problems. In this slide, you can see some examples of mental and physical health issues where research suggests couple interventions are helpful as substance abuse or intimate partner violence or cancer.

25:15I I want to focus in three of that to talk a little bit more. For example, in substance abuse, there are strong evidence that some of these partner assistant treatments work very well to help them. I'm not alcohol could be a case, but also other substance types of substance abuse. For the post traumatic stress disorder, I have found, more than eight, ten randomized controlled trials from different models, including one, using emotionally focused therapy to try to help couples where one member of the partner has this problem and similar, with intimate partner violence. There are also some emerging issues. They are relatively new issues in couple therapy and in most of the cases, also in individual psychotherapy.

26:25In general, I'm sorry. I'm going to mention three, and most of the ideas I'm going to share or even some sentences come from a recent manuscript by Leboe Leboe and Snyder in family process, where they mentioned a list of around 10 emerging issues in the field of coupled therapy. The technology, one of the the first on the list. The pandemic potentiate a trend toward telehealth and using electronic media as an extension of therapy. During the pandemic, almost all psychotherapy shifted to video conferencing. And in some cases, it remains as a major format for couple therapy in several countries. Couple therapies mostly report that virtual therapy seems to work as well as in person therapy. Video conference solves several constraints about costs, timing, traffic, rush hours.

27:36Nevertheless, there are unsolved questions related with, for example, how to manage couple conflicts in the distance. It's not the same, the individual psychotherapy, at when you have a couple in the screen, and you can't move it to try to somehow take their attention. Is the quality of the interpersonal communication between the therapist and the couples really similar? Is similar the quality of the therapeutic alliance across in person or virtual therapy? What about the efficacy and the effectiveness of couple therapy using teleconference? We don't have a lot of research, on these issues because the teletherapy is although it's not new because it happens since a lot of years, is the research is really new.

28:43It's it's being conducted right now. Mhmm. Another emerging issue is coupled therapy and social media. With the Internet and the globalization of the resources, couple therapy is now frequently identified by live consumers using social media. Anyone can reach for help for their marriage without considering the professional profile. If I say something that doesn't work very well here in The States, considering I live in Spain and I try to I'm very connected with a lot of Latin American countries and other European countries, also with The States where the regulation about who can provide psychotherapy is probably the strongest in the world. Mhmm. In the slide one moment. Mhmm. The people can even choose the couple therapies using.

29:56Mhmm. The channels people choose to seek a couple therapies are changing. Moreover, couple therapy has become a global market. Now we have some couples in Spain and the therapists are in other country. And Spain and these other countries doesn't have any kind of rule that says the you can't do that. It's totally possible and legal. Mhmm. Do people know the difference between a clinical psychologist with a PhD and someone with a two year master program in counseling without a bachelor in psychology? People know that. Does this matter for them? It's a question. What are the criteria people is using to choose their couple therapist? And when we move to the specific field of the Catholic church, this is also a big issue.

31:03My experience in sometimes my experience is that sometimes people rely on the Catholic identity when they look to someone for a professional help without considering the professional training dimension. This is not uncommon, for example, in Spain. I'm sure this does not happen here in The States. A third topic emerging issue is the different and new demands of of health for different types of couples. Traditional formulations of relationships are not now the most frequent. Diverse types of couples with different types of requests and demands are the rule. This this open a long list of questions about the therapies. For example, do I have, as a couple therapist, an adequate knowledge for working with a couple from a different cultural frame?

32:15Couples like to choose therapies they consider they have similar values or cultural frame. In my opinion, this makes sense and it's it has positive aspects As it contributes to promote the idea, couples with a certain religion or cultural background should be able to find a therapist who understands their culture or religion. In this field, I want to highlight the work Jesse Owen from the University of Denver together with several others as Steven Sandidge or Joseph Carrier or Jesse Fox, co editor of Integratos, the journal of the CPA, are doing in the field of psychotherapy, which includes couple and family therapy also to provide research to sustain the relevance of the spiritual competencies of the psychotherapists.

33:19I think they are working in a good direction being able to impact scientific and clinical work through research results where spirituality competencies are part of the skills a therapist needs to conduct couple therapy or individual therapy or family. Okay. Let's talk about a little bit about the key people and leading research groups. I already mentioned it. Research in coupled therapy comes predominate predominate mainly from The USA and the English speaking countries. Mhmm. This is coherent when we look at the key people and the leading research group. First, I would like to mention some senior generation. I call them senior because most of them are retired as you can see in the slide. But they are very relevant people in the, field, and they are still alive.

34:33They publish something, not a lot, but are still present doing different kind of things, and they are important. Gottman, Snyder, Johnson, Christensen, and Balcon. But if we think about research groups working now in making relevant contributions to the field. I should mention probably first, Brigham Young University. Brigham Young University has a very strong group of people, a 12 researchers linked with the school of family life, working in the marital and family therapy program, who are very good researchers, publishing three sheets, eight manuscripts, papers every year in the field of family and couple therapy. And they have very strong funds from their own university to to create a long term program in research in couple therapy and tablets.

35:45I never know how to pronounce the second author. Brian, Brian from the University of Miami is another very relevant person in the field together with Wittenberg, in Michigan State. And the Northwestern University has a very important group of people in the family institute, and, Jai Levoe is from that institution. In Canada, there is a group of researchers from different universities, Quebec, Ottawa, Laval, and others, and they work a lot together. Some sometimes, some of them are PhD students that have become professors, so they have strong relationships and they work a lot in this field. In Florida State, we have also a good group leading by Franz Finchan. And in Denver, we have a group more focused on a couple education than in couple therapy.

36:55But at the end, they they publish also some research in couples therapy. Mark Mann, Stanley. If we look at Europe, the main two are Bodenmann and Barkaliza. Bodenmann is a very relevant author in the in the area of dyadic data approach. Is a person with a very strong focus on methods and steps, but their main contributions came from the area of couple and couple therapy and couple in general. And Eran Bar Khalifa is the leading of a lab in Israel. Israel has a very strong focus as a country in research. Really, in Europe, psychotherapy is one of the stronger countries in in Europe. It's in the limit of Europe, but okay. And Aram has a lab where he studied the nonverbal facial expressions with a very new approaches.

38:12There are other people in Spain, some, Carlos Perez and Jorge Baraka, and in Italy. In Italy also, Camilo Regalia, Silvia Mazzoni in Desapienza. And I want to know I I try to look at people in Africa, Africa, and Asia, And, really, I didn't find, not only for this lecture, but in my work in the field. People you can say, this person is working in this field for ten years or twenty and is may is making relevant contributions in the main journals of the field. Not really. Mhmm. And I would like to talk a little bit also about the key people with high impact in social. Some of them are also researchers and others are not researchers, but they have a strong presence in the field of couple therapy.

39:17Of course, the the best, example is John Gottman. John Gottman has a institute and and his model is like although it's very cognitive behavioral, I I can say it's the Gottman model. It's so strong with a lot of books and and and trainings, and is really present in the media media, at least in in Europe. I think here could be the same. Sue Johnson, from Canada, the creator of the emotional dyspocussive couples therapy. Esther Perel, I'm I don't know if you are familiar with this author. She is from New York or or is located usually in New York, And she has some books about couples, and I think she has some publications, regularly in the New New York Times, Solomon, John Gray and Gary Chapman for their books, very famous, also in Europe.

40:32Mhmm. And this is some of the groups and people I can identify. Challenges in contemporary couple therapies. Okay. I want to mention nine nine challenges. I try to group in three blocks. First block, more focus on research and clinical challenges. Other more impractical challenges is what I how I decide decided to call it. And another challenge is related with the Catholic understanding of the marriage. So, in the research field, the the question of how one when the therapy ends, what happened after, and and if that improvements can maintain over time. Although there is some research focus on that, on on what happened after the end of the couple therapy, this is a weakness in the research bill.

41:47We need to understand better how to the therapy improves the relationships in the long term, which type of interventions or combination of interventions work better. Another challenge is the measure of change, how to monitoring the process of change of the couples. In a recent book, John Gottman presents a central idea. The time of self reports in research in psychotherapy is over. I will say also in psychology. We can't move forward. We can't understand really deeper sound processes using lonely self reports. We need to apply new and complementary forms to measure change in therapy. I agree. Technology is providing new and stronger ways of monitoring changes. There are some research labs as the one leaded by Eran Barkalifa in Israel where nonverbal analysis and facial expressions, psychophysiological variables, and other aspects of the couple interaction are measured in the lab through a series of couple therapy sessions.

43:11We need to understood better understand better what happens also outside the therapy session, not only to increase gut outcomes, but to detect therapeutic interventions clients do not better benefit from. The change mechanisms. Although some mechanisms of change have already been identified, There are still many questions about what creates change in couple therapy. To move forward in this question requires a complex interaction between theoretical models and strong empirical data stats. This is just another this is another area for improvement in cabo drug. If we go to the practical challenges, one first challenge is to increase the attendance to couple therapy. Couples do not seek couple therapy.

44:17Although divorce and relationship distress has, according with research, a negative impact in their lives, in their health, their relationships, their work functioning, their children if they have. People seek for treatment in depression more than in couple therapy. Why and how do couples seek couple therapy for their relationship? This is a question we need to clarify. Couples therapy is expensive. Many people can't have access to this resource either in The United States, but also in other countries. We need to find ways to provide good resources for couples with high distress rates. Health insurance does not cover couple therapy even in countries such as Spain where almost everything discovered by health insurance.

45:13Another issue in this, block of the practical challenges is the complexity of the training process of a couple therapies. According with some psychotherapists and experts, couple therapy might be the most difficult form of psychotherapy. We need to work with two clients in conflict with different demands and perspectives with high rates of uncertainty. Therapists who treat couples should be very well trained for dealing with these challenges. How to reduce the time for training a good couple therapies? How to improve efficiency, how to help how to help to learn easier, faster, and better. And the third one in this block and the last one in this block is to improve quality of couple therapies, especially in non English countries.

46:26Most therapies who offer couple therapy are not are not training in it. I mean, most psychotherapy training programs, whether in Europe or The US, do not offer a special subject or focus for training in couple therapy. And yet, these therapies will, in almost all the cases, offer couple therapy among their services. But this problem or challenge is much bigger than you could think. In the previous section about the main couple therapy approaches, I've talked about the levels of evidence according with the section proposal. And I mentioned it only two therapy approaches achieve the requirements for being considered evident based. In the third level of section classification, emotionally focused coupled therapy by Sue Johnson and integrative cognitive behavioral couple of therapy by Christensen.

47:40How many accredited couple therapies do you think you have in The States in these two models? You have several hundreds. Less than I will expect in the first economy country in the world. But let's take Spain. How many therapies accredited in emotionally focused coupled therapy do you think we have in Spain today? How many? Five. How many do you think we have in the integrative cognitive behavioral couple therapy? How many? Two. Seven for a country of almost 5,000,000 population. Thus, I think to improve the quality of coupled therapies is a challenge in the field. Let's go to the third block, the challenges related with the Catholic understanding of the marriage. Our first challenge I can identify is to have therapies with the skills to address sexual difficulties in Catholic marriages.

49:06When they when to the requirement of being trained in in couple therapy, we add training in sexology and will look for a therapist be able to conduct an intervention with a catholic couple, an intervention according with their beliefs, then the difficulties become even greater. The Francisco de Victoria University in Madrid has detected this big issue and has just launched a postgraduate course to try to help to reduce this gap. It's a first step, not complete or perfect, but a step to address this challenge. Another challenge in the field, if we think about the Catholic understanding of the marriage, is to integrate truth and love in the couple therapy process. There are a lot of couple therapies, they say they are Catholic.

50:15But they their practice is not different to any other couple therapist. And the training in the Catholic view of the human person and the Catholic faith is very weakness. Thus, the integration is not possible. But there are also a good bunch of Catholics. They say they know how to do couple therapy, but they are not really well trained even as general psychotherapists. This integration, this balance, this complexity of elements is an idea we can apply to all psychotherapy. But in my opinion, in marriage and coupled therapy, this becomes particularly an issue to address. And the third challenge, I thought about several challenges that I could write as the third one, but I did not find really one which seems to me more relevant than the others.

51:20So I want to suggest to invite you, you who are listening this lecture, either in person here or remotely, to think about what do you think is a challenge here in this third block or if you want in one of the others when we talk about couple terms. And please send to me your challenge using my email address. You can find in the slide, or if you use Google with my name and University of Navara, you will find my email. And I will consider all the challenges in the second part of the lecture in October. So my lab at the University of Navarro Since 2018 2018, I am part of the University of Navara where I work to try to transform to improve the couple therapy field in the Spanish speaking countries.

52:24This is my main research line, and we are working trying to address some challenges in the three levels I mentioned. In the clinical, the practical, and also challenges related with the marriages, Catholic marriages in therapy. We have conducted the first randomized controlled trial in couple therapy conducted ever in Spanish speaking countries. It's good news and bad news at the same time. We have tested emotionally focused therapy, approach. EFT is an attachment based model, and we think there are strong coherence with the Catholic view of the person and the marriage. We work with colleagues from Canada and The US and we are conducting other four empirical studies apart from the RCT. Our first step was to create a bridge between the best research in couple therapy, happens here in The States and Canada, and the Spanish speaking conference.

53:31The next steps we are currently starting is to develop a project to increase the quality of the training of the couple therapists in Spanish speaking countries. We have a lot of collaborators. Some of them are from here. Doctor. And doctor Holman. Doctor are also involved in some collaboration in this field. And so the model of Su Johnson, you are familiar with some of these books. We have the the randomized controlled trial we run, happen in five countries, Mexico, Costa Rica, Guatemala, Argentina, and Spain. The group of therapists and supervisors together with the researchers could be around 50 people. And we have a web page I can share with you, and it's translated also in English by by IIA, intelligence artificial intelligence.

54:44So I I don't know how good is that translation. So to finish, some of ideas to about considering the challenges, what we can do. Some ideas. We I I will I will be able to talk about future studies two hours or three, but only two minutes. DMU can lead a network to improve this field in the world with research and public engagement initiatives. DMU is in The US. The US has a strong idea of if nobody, is going to do it, I'm going to do it, more than in other countries. DMU is an ANAQUAC network with several countries, all I think no. Two are in Italy. But most of them, 80% of the ANAQUAC network is in Spanish speaking countries, mostly in Mexico. And you have very good collaborators and friends as Navara, the Catholic University of America, the John Paul II Institute, which is here in in in Washington, DC, inside the the Catholic campus that is a different institution.

56:10Also, I saw that the the Juan Pablo de Seco in Mexico is inside the Anahuac network. So I it's just an idea. You you can work in this line. Working with the model for human flourishing, what you know as CCMMP, to analyze and integrate this model with the main approaches in couple therapy, EFT and the integrative cognitive behavioral therapy, to develop an empirical study where couple therapies are trained in the metamodel, and to explore with a mixed method study the chi the changes in the therapies after get that course, that that training. Mhmm. And if we think about the challenges related with this Catholic understanding of the marriage, what are the challenges here in The States? I don't know what are the challenges here.

57:20But you you are growing. You can create an alumni network with clinicians, from EMU who are who have interest in this field of the marriage and the couple therapy and work, leading by a team of researchers. Some of them from here, for example, disconnects with the first idea to be able to develop empirical research to address these challenges you have here in The States. Thank you for your attention, and I would love to hear your comments, questions, thoughts after a break, I think. But We will break for three minutes, and then we will begin our question and answer period. Dralia, I'm one of the team leaders of the counseling team. What is your opinion to proceed with couples therapy when the couples have an intervention family order due to abusive relationships?

58:30Some of the magistrates courts in our country put in place court orders to attend couples therapy even knowing the high risk for the victim survivors. Mhmm. I I don't know the specific situation this question came from. I think for in the couple's therapy, the goals could be different. Not always the the goals can are create a safer space because sometimes the problem in the couple is they can't communicate each other. If I will find myself in this situation, first, I think about I want to be in this situation. I have an alternative. If I don't agree with this type of situation or I don't feel comfortable as psychotherapist, it's difficult for me to do a do a good job. So but maybe for other people, it's fine.

59:29They they feel okay for some reason, and I'm not saying it's okay or it's not okay. I don't know. We we have very few information about what the situation this person is talking about. So first first idea, think about I want to keep here. I'm I'm able to do a good job considering who I am in this type of setting. And if not, try to move to another job. And the second idea is caboz therapy can have different levels, different goals. For example, to apply emotionally focused caboz therapy in this context, I repeat that. We have limited information about the context, but with this information seems to me it's not a good model for this context because emotionally focused therapy try to create a safe space to increase vulnerability and this could not is not a good idea for this context.

1:00:40But if we need the couple talk and if it's mandatory, the couple should go there. As psychotherapist, I have a lot of freedom to decide what I'm going to do with this couple. I in my therapy room, I decide who is where for how long, if we are going to talk the three together or in individual spaces, etcetera, etcetera, etcetera. So try to look at that way to help. And and if you feel it's a very complex situation, try to look for supervision. How long does it take for one to get a certification in the area of couples therapy? How long? Depends on the person. But, at least some years, we I consider to get a certification in the area of couples therapy requires a strong training in cycle in psychology, bachelor in psychology or I know please read my words considering I am from Spain.

1:02:04In Spain, a social worker never is never a psychotherapist, But these these are the rules in Spain. I'm not telling here a, social worker can be a psychotherapist. But if we talk about couples therapy, after the master program to be trained in one of the two models I'm talking about, the models for the models with evidence based, mhmm, the third level, I will say between two and four years because you need to apply the model to receive supervision to be very focused on the process. Mhmm. How do you rate transactional analysis? This is an approach among others which has been used for many years by the Catholic Marriage Advisory Council in Hong Kong. Mhmm. Transactional analysis. First, I'm not an expert in transactional analysis, so what I'm going to say should be just a first idea.

1:03:14But as far as I know, transactional analysis, I'm sure is not an evident based couples therapy approach. So, if you look for the best thing you can give to the couple who comes, I will say transactional analysis doesn't seems to be the best thing. But at the same time, for helping the couples, we need several different levels of help, different settings. Sometimes the couples can receive an an advice and and counseling help, and another types of helps, and maybe could work. I will say if this center is a very is a center where you feel everyone there thinks transactional analysis is great. Try to talk with someone in another place, in another country that thinks transactional analysis is not very good.

1:04:26And talk a lot with this person and make, a new way of thinking about transactional analysis. And sometimes, there are all the people are trained in transactional analysis, and there are not an alternative. So we they can try to improve their training with another, approach or mhmm. We have recently had a debate among Catholic therapists about how to approach both a homosexual slash agnostic couple, etcetera, searching psychotherapist, from a Catholic perspective. Which are the limitations related to the issue of conscientious objection discussed a lot within EFPA? Mhmm. I don't know what is EFPA. Someone can help me with that. EFPA. Could be a a rule, a regulation. I don't know. Maybe emotion focused physician assistance?

1:05:39Em emotion? Mhmm. I don't know. Emotion focused. No. Position assistance. No. Position assistance. No. No. I I I will answer in Spanish, and Ferrara will translate me. Okay? Are you ready? Okay. This is a complex question. Okay. Yeah. I will say, welcome and and a loud track question. Similar to the prior situation, this is a very personal matter. So it requires it requires knowing someone who knows more about the issue. Yeah. To give an answer to this question, I think, is you need to share all the situation with someone that can know, much more details about what happened in this situation. Who are you? What how do you manage this situation? And someone with more experience, someone you trust in in in his or her criteria to try to make a.

1:07:18A joint discernment. A joint discernment. So if if we think about what's my opinion with this information, I don't have really an opinion. I think the the psychotherapy should be conducted in a in a in a space where both all the people involved feel comfortable as much as possible, because it it is about to create a deep relationship. So if if there are something for me as a therapist that, creates conflicts, this is everyday life in psychotherapy. But if if it's a very strong conflict, I will need supervision and maybe something more in this case. Okay. We have further questions here, but we are going to move to the the questions in here. And maybe if we have more time, I will be I will go back to the online questions.

1:08:39Please go ahead. I have a question, about the mechanic standpoint. How do you work in total therapy with the doses of a couple? So let me know what the approaches would be. Can you repeat the question? If the question is about myself or in general? I think in general. In general. Yeah. Honestly, I don't have an answer for that. Honestly. Because I I I only work with the heterosexual couples. It's not a choice. It's could be a choice, but all the couples that came to my, private practice are heterosexual. I think, there are a lot in the literature and in the training that is it can be applied to same sex couples or heterosexual couples. So, but, again, we came back to the question of, I think it's important the therapist feel okay and feel safe, comfortable in the in the therapy room as well as the couple.

1:10:02So, sorry because I don't have more ideas to share. Next question. Can we do something to reduce the the if I can do something, I can But I try to don't move my cell phone. Stay quiet. So I was wondering about, I know that in particular, like, within the gap that you can meet, there needs to be a lot of stigma around self therapy or marriage counseling. And so I was wondering, like, how would you propose lowering the stigma? And also, why does it exist? I feel like in more secular communities, it's more accepted to, like, the homeless counseling, but for some reason, within the Catholic Mhmm. I think it's the I've experienced very, like, very, very cute type of thing. Mhmm. When you say stigma, do you mean the the marriages and the couples don't go to couple therapy or the stigma?

1:11:10Is is that what you mean? Yeah. Okay. Yeah. I think this is, this was passed bad in the past. It's getting better, at least in Spain. I I have the impression people are more able to say, I need couples therapy. I'm going to I think we need to talk about the benefits. We need to talk about, sometimes you need, to reach for help. And as you reach for help in other issues, it it makes sense to reach for couple therapy if you need it. Maybe some training in the in the preparation courses for the for the marriage where someone can explain what is it about couple therapy because people doesn't know. Sometimes the people when in the first interview, I use some minutes to explain what's the therapy about and and what they can expect.

1:12:37I think if we move that information to the Catholic general population will be some something to help. And I will think about other ideas. Thank you. Thank you for your presentation. Thank you, Marcelino. I really like it. Thank you. I have two short questions. One is, have you ever thought about prevention in terms of even preparing couples to get married? Mhmm. And if so, could you share some of your thoughts in that? The other one is I'm very impressed that you are working with so many countries and so many different cultures. Mhmm. To what extent the difference in culture, how much does it weigh in being able to apply therapies to everyone if you will. Mhmm. How how much? I I don't understand very well the second.

1:13:44The cultural differences, how much they are relevant for, Do you mean if we can apply the same things to every culture? Okay. So going to the first question, of course, I think the lot in prevention, I also teach or give some trainings to couples, which are not in therapy or just general information or training workshops to trying to prevent the problems. I I think this is very different in the Spanish speaking world and in the English speaking world. In I found in The States and the English the English word things in the marriage as in, it it has an a negative and a positive side. But this issue of in the English speaking countries where everything is about a business. So I'm I'm I'm married, so I need to invest in my relationships to try to this keep going well.

1:15:03And this is sounds negative for me, but it takes a big side, which is then I'm going to try to reduce the problems in advance to take care of the relationship. This is stronger in the English speaking countries. It's more the number of couples I saw in February in the workshop in Bethesda, the workshop leading by doctor Klawicki was impressive for me. It it there are a lot of couples. In Spain, it will be difficult to solve something about, please go to this course to try to improve your relationship. But my relationship is fine. It's okay. I don't need it. So they they don't go. But we are losing, we already lose, I think, in the last forty years in Spain and probably in other countries an opportunity in the Catholic church because, now in Spain, people don't get married and only very few.

1:16:26But twenty years ago or thirty years ago, most people get married and they should go through a course. The church offers and is mandatory to go. And if if we be able to offer a very good course in that setting, that will be a great way of helping the marriages. But that that training usually is terrible. It's not worse. Usually. Sometimes not. So I think prevention is a big issue. I don't talk about prevention in this lecture because it's focused on couples therapy. But we can prepare another lecture only about a couple education and and the all the programs that are and and talking about the challenges. And yes. I have questions for you, doctor. And the second sorry. So the second question, I forgot.

1:17:41The cultural the cultural question. Mhmm. I think the for a therapist to know the culture is a plus. It helps a lot. And but it's the same this is my opinion. It's not it's not evidence based. It's my opinion. When someone asked me about the teletherapy, in couples therapy, I I should say, really, we need to wait to check what research says, but, the therapy is a very complex process where there are a lot of variables. If you ask me to choose between in person and online, I am sure in person is better, but there are other variables. If you need to choose between a very good trained couple therapies in emotionally focused therapy, for example, battle nine, And another one with a very bad training in a model nobody knows, I will do the online.

1:19:08Yeah? There are different variables, and you need to check. And so for the culture, it's the same. I think several aspects of the of the processor of the processor are the same. And if if you know the culture, then you can do it even better. And this is a good point to to make sure the process is going as fast as possible. But several aspects of the of the different cultural differences are very, very difficult to see. The for example, if we compare emotionally focused therapy in Spain, in The States, or in Finland, there are differences in the in the distance between the clients and the therapist. There are differences in the change of the intonation. There are differences in how the couple express themselves.

1:20:19But here in The States, if you take 10 couples, there are differences between them. Okay? Maybe not in the distance between the therapist and the couple if it's the same therapist. Okay? So there are some differences, but in several other aspects, I I will I can look up to a video in Finland, Spain, and States and say and and I can say, it's emotionally focused therapy. So please. This question is a clarification from the question earlier about, how to work with sexual couples Okay. In neurotherapy. You presented emotionally focused therapy and the integrative cognitive behavioral couple therapy as the only two that are evidence based. Okay. Which means that they're the only two that have randomized controlled trials.

1:21:17Right? My understanding is that those randomized controlled trials are only with heterosexual couples. And so I'm wondering, do you know of any research in either of those modalities Mhmm. That has randomized controlled trials for homosexual couples showing the effect efficacy of the treatment modality being the same Mhmm. As it would for a heterosexual couple. Mhmm. No. I don't I don't know. Yeah. I I can't say as a researcher. I'm sure there are no, but I I don't know. But because maybe yesterday was a new manual grade. That, but I I don't know. No. I I have yet to find them, so if you find them, please let me know. It's it's you know, we do that. We say, here's everything for one population, and then we apply it to other populations.

1:22:10And it may not necessarily be as effective in those other populations. Yes. Will be. Right. Mhmm. And then I have a second question about that. Gottman, John Gottman presents his model as if it is evidence based. Mhmm. Is that so how would you approach that model? No. I I I'm sorry. No. John Gottman models has a lot of research, but according with this classification is not evidence based. It could be in the second level, but not and we can discuss about if if it's, better or not, but according with this classification, it's not evidence based. K? One one important thing I explained to some people is, it it's possible we have here in the other street, couple therapies that work very well. And in fact, his his therapy works and improves the couple's, distress and reduce the couple's distress.

1:23:28But the problem is what this therapist is doing, how can I learn what he's doing, and and and what's the name of that? If we want to increase the quality of the couples therapies, increase the the the people who goes to couples therapy, the number of therapists, We need models we can train in the in the universities. We can test through research. So evidence based means they they have going through all these process, and they are evidence based, but maybe other models or other therapies work very well and their work works, but are not evidence based because they don't have all these studies behind. Okay? I think Thank you, doctor Rodriguez Gonzales, so much. Now as we conclude our lecture, please note that the Newman series will resume in the fall.

1:24:51In fact, as you heard a little bit earlier, we already have a next lecture scheduled, October 8. Doctor Martino Rodriguez Gonzalez will rejoin us on current status and future directions in couples therapy part two, marriage and couple therapy, integrative faith and anthropological reflections, and international approach in Catholic context. So looking a little bit more at the application side, and the context piece as well. And so, please do plan to join us in the fall for that lecture. Thank you all for coming. Good night.