RELATING PROCESS TO OUTCOME IN MARITAL THERAPY

Although there are a growing number of outcome research studies in marital therapy, there is a complete absence of research on change processes, and how such processes relate to outcome. This study attempts to analyze the process of change in the "best" sessions of Emotionally Focused Marital Therapy (EFT) (Greenberg & Johnson, 1986). Client performance in therapy was rated on depth of experiencing and the quality of interpersonal interactions. The occurrence of particular change events arising from the theoretical principles of EFT was also noted. Results confirmed hypotheses that higher levels of experiencing and more autonomous and affiliative interactions characterized "best" sessions of couples who were successful in therapy. The implications for treatment are discussed.     

BONDS OR BARGAINS: RELATIONSHIP PARADIGMS AND THEIR SIGNIFICANCE FOR MARITAL THERAPY

Contrasting conceptual paradigms describing the nature of intimate relationships are discussed. In particular, relationships may be viewed in terms of a rational bargain or as an emotional bond. The implications of each paradigm for the process of marital therapy are delineated, and the role of bonding and attachment in adult intimacy is considered. Some general conclusions are then drawn as to future directions for the marital therapy field.     

MARITAL THERAPY AND GENDER-LINKED FACTORS IN COMMUNICATION

Understanding the process of communication is important because communication is critical to all forms of psychotherapy. A proper understanding of communication is particularly important in marital therapy because communications is often a treatment target. A central question of this paper is whether or not communication training (CT) programs in marital therapy have been sufficiently sensitive to the complexities of gender in communication. A critical review of research on the role of gender in communication is presented. Existing data indicate that individuals tend to hold stereotypes of gender differences in language, but many of these purported differences have not been supported in empirical investigations. However, gender has been found to be linked to variables such as amount of conversation elicited, length of utterance, use of qualifying phrases, swearing, use of back channel cues, breaking of silences, function of tag questions, and compliment style. Numerous limitations of the empirical literature exploring gender differences in communication behavior are described. This paper advocates the development of models of communication in which gender is recognized as having significant implications.     

AFFECT IN MARITAL THERAPY

Affect has been conceptualized in various ways. These conceptualizations have influenced the manner in which emotion is dealt with in marital therapy. Using a network theory of emotion, the role of the evocation of emotion in emotionally focused marital therapy to create intimacy and facilitate conflict resolution is discussed. Accessing underlying primary emotional responses in partners makes available adaptive action tendencies which promote problem solving and helps change self- and relationship definitions. The role of emotion in creating change in cognitions, motivation and communication patterns in marital therapy is discussed.     

MARITAL THERAPY: QUALITIES OF COUPLES WHO FARE BETTER OR WORSE IN TREATMENT

To evaluate the effectiveness of couples therapy and determine the characteristics and qualities of couples who fare best in treatment, 139 couples presenting at a nonlaboratory sliding-fee clinic in Dallas, Texas, were evaluated. Observational and self-report measures of the Beavers Systems Model were taken at the first session and, for some subjects, at termination. Therapists also rated the couples on goal attainment and on dimensions of the therapeutic alliance. Not surprisingly, there was a direct association between number of sessions and goal attainment, with couples attending only one or two sessions having the lowest goal attainment. There were also significant family functioning qualities associated with success: more competent couples fared better in therapy. Another consistent finding was that couples with no children did better in treatment than those who were also parents. It is interesting that remarried couples without children did best in treatment, followed by first-married couples with no children, first-married couples with children, and, finally, remarried couples with children. Implications for screening and clinical work with couples are presented.     

DEPRESSION, BIOLOGY, MARRIAGE AND MARITAL THERAPY

Marital therapists have an, as yet, unrecognized contribution to make to the treatment of depression. It is incumbent upon them to keep abreast of the growing literatures concerning both biological and interpersonal aspects of depression, and to inform other mental health professionals, policy makers, and depressed persons and their families as to what marital therapy has to offer. Consistent with this goal, this article provides an introductory overview of recent findings concerning the biology of depression, the relative merits of medication versus psychotherapy, and the complex relationships between marriage and depression. While there is considerable evidence that many depressions have a biological component and that medication is an efficacious way of providing symptomatic relief, this in no way contradicts findings concerning the efficacy of psychotherapy and the importance of the marital relationship in the outcome of a depressive episode.     

DEPRESSION IN MATURE MARRIAGES: IMPACT AND IMPLICATIONS FOR MARITAL THERAPY

Recent reviews of MFT literature have shown a failure to address mental health issues of the aging. Chief among these issues is depression, one of the most common psychological disorders found in older people. Although the relationship between depression and aging is a well-researched topic, few studies approach this common problem from a systemic perspective. Using data from a national survey of preretirement- and retirement-aged couples, this paper discusses the association between depression and marital quality in mature marriages as well the possibility of mediating variables such as the personality construct hardiness. Implications for marital therapy with older couples experiencing depression and future research are discussed.     

PROLIFIC WRITERS IN MARITAL AND FAMILY THERAPY: A RESEARCH NOTE

Success and promotion within an academic setting depends heavily upon one's ability to publishscholarly work. The "publish or perish" syndrome, and how it relates to marital and family therapy, is of importance to current and aspiring academicians' futures as well as those who wish to impact the field. Research was conducted to identify the most prolific journal writers in the field, and 18 persons were surveyed in order to ascertain how they organized themselves personally and professionally, in order to write productively. The results are analyzed, and recommendations are made regarding the organization of oneself for publishing success.     

SEXUAL ATTARACTION AND ROMANTIC LOVE: FORGOTTEN VARIABLES IN MARITAL THERAPY*

The purpose of this paper is to address the lack of attention in the mariage therapy literature ot romantic love and sexual attraction. Although mot coupples marry because of romantic love and tent to divorce when they “fall out of love,” few guidelines are available to therapists concerning how to deal with love as an issue in therapy. In contrast to models of marriage therapy which focus on rational skill devlopment, the model presented here is based on the assumption that marriage problems are emotional in nature and that the success of marital theapists is dependent upon skill in addressing emotional states. Based on recent findings in neurobioloy, this model contends that the affective dimension of love is precognitive and similar to the attchment between infant and parnent. By providing nonverbal and precognitive experience whithin therapy that can alter the emotional pattern of couples, therapists can increase the likelihood of a successful outcome.     

EXPOSURE TO MARITAL AND FAMILY THERAPY IN MEDICAL SCHOOL: A STUDENT PERSPECTIVE

Most marital and family therapists, both medically and nonmedically trained, regularly interact with physicians on a professional basis. Though some physicians receive specific training in marital and family therapy in their postgraduate residency programs, (notably those in psychiatry and family medicine), for many, the only academic exposure they receive to this field comes during a 6- to 10-week clinical clerkship in psychiatry during their third or fourth year of medical school. No study could be located which examined marital and family therapy training in undergraduate medical education. The purpose of this study was to gain a better understanding of the level of marital and family therapy training in medical school and to provide information concerning physicians who are not family therapists, and how much knowledge about the field they can be expected to have.     

ENRICHMENT OUTCOME RESEARCH:A META-ANALYSIS OF PREMARITAL, MARITAL AND FAMILY INTERVENTIONS

The findings from a meta-analysis of 85 studies of premarital, marital, and family enrichment, representing 3,886 couples or families are presented. Metaanalysis is a method for statistically aggregating and evaluating empirical findings. Findings from the study are discussed in terms of overall enrichment effectiveness as well as salient program, subject, design, measurement, and analysis characteristics. The enrichment studies yielded an average effect size of .44, which indicates that the average person who participates in enrichment is better off following intervention than 67% of those who do not. The most powerful factors related to outcome were measurement variables rather than those related to program content, structure, leadership, or participant characteristics. Implications of these findings are discussed.     

WAITING LIST CONTROLLED TRIAL OF COGNITIVE MARITAL THERAPY IN SEVERE MARITAL DISCORD

Forty-one couples with severe marital discord participated in a controlled trial conducted to evaluate whether a form of marital therapy that is designed to enhance marital intimacy through facilitating self-disclosure of personal constructs was effective. The study found that there was no spontaneous remission in marital discord in couples on a 10-week waiting list. Couples subjectively reported improvement as a consequence of participating in marital therapy, and couples in therapy and on the waiting list showed a significant reduction in symptoms of nonpsychotic emotional illness. There was a significant pattern of improvement for wives in the therapy group compared to the waiting list group, but no such effect for the husbands.     

PREDICTING DIVORCE AT MARITAL THERAPY INTAKE: WIVES' DISTRESS AND THE MARITAL STATUS INVENTORY*

The Marital Status Inventory (MSI), a measure of divorce potential was given to couples in six independent samples. Scores from the five clinical sites and one marital enrichment sample (N = 241 couples) were used to provide adequate reliability, discriminant validity and predictive validity data. Compound probability for the five clinical sites supports the contention that, overall, wives' are more distressed than their husbands. The MSI was also able to identify couples who later divorced. However, the Guttman properties of the MSI, previously identified, were not replicated. Clinical implications of the higher wives' scores for prediction of divorce and marital therapy are discussed.     

THE NATIONAL MARITAL AND FAMILY THERAPY EXAMINATION PROGRAM

Examinations constitute one of the principal methods by which professions assess minimal competence in aspiring practitioners. The Examination in Marital and Family Therapy is used by most states which regulate the profession. This article provides the rationale for the examination program, describes its development and maintenance, and presents the knowledge base it samples. Administrative policies and procedures are also discussed as an aid to prospective licensure and certification candidates.     

PREDICTORS OF SUCCESS IN EMOTIONALLY FOCUSED MARITAL THERAPY

This study examined client variables expected to predict success in emotionally focused marital therapy (EFT), now the second most validated from of marital therapy after the behavioral approaches. The relationship of attachment quality, level of emotional self-disclosure, level of interpersonal trust, and traditionality to the therapy outcome variables, marital adjustment, intimacy, and therapist ratings of improvement, was examined. These variables were chosen for their relevance to the theory and practice of EFT and to intimate relationships in general. Overall, therapeutic alliance predicted successful outcome; the task dimension of the alliance in particular predicted couples' satisfaction. More specifically, one dimension of female partners' trust, their faith in their partner, predicted couples' satisfaction at follow-up. Females' faith also significantly predicted males' level of intimacy at follow-up. Males who were most likely to be nondistressed at termination indicated higher levels of proximity seeking on an attachment measure at intake, and older males and males whose partners had higher levels of faith in them were more likely to be nondistressed at follow-up. Traditionality was not found to be significantly related to outcome. Couples who made the most gains at follow-up also indicated lower initial marital satisfaction and included males who indicated lower levels of use of attachment figure on the attachment measure at intake. Males who made the largest gains at termination were older and were rated as less expressive by their partner on self-disclosure measures at intake. Age was the only variable significantly related to males' gains in satisfaction at follow-up, Implications for the practice of marital therapy and future research are delineated.     

MARITAL AND FAMILY THERAPY CERTIFICATION AND LICENSING EXAMINATIONS: ONE MODEL*

The design of the North Carolina Marital and Family Therapy Certification Examination is outlined by its authors to provide a frame of reference for the development of other licensing and certification instruments. The purpose, procedures, resources, guidelines, content, and normative data of the examination are described. The model is offered to stimulate meaningful dialogue on marital and family therapy licensing and certification instrumentation. Guidelines toward the development of a national marital and family therapy examination are also presented.     

THE EFFICACY OF MARITAL AND FAMILY THERAPY: AN EMPIRICAL OVERVIEW, CONCLUSIONS, AND RECOMMENDATIONS

Based primarily on the contributions to this Special Issue of JMFT, this article provides an overview of the empirical research on the efficacy of marital and family therapy for the following disorders and problems: schizophrenia; affective (mood) disorders; slected externalizing, internalizing, and pervasive developmental disorders of childhood; adolescent conduct disorder; marital distress and the prevention of divorce; alcoholism; adult and adolescent drug abuse; and various chronic adult, adolescent, and childhood physical disorders. Convincing scientific evidence supports the efficacy of broadly defined marital and family therapy for the treatment of many disorders, as well as its superiority to standard and individual treatments for certain disorders and populations. We conclude with recommendations for future research as well as for collaborative initiatives between marital/family therapists and other professionals working in the marriage and family field.