Behavioral Therapy for Marital Disharmony: An Educational Approach*

A behavioral approach to marital therapy in groups includes training in communication skills; increasing the recognition, initiation, and acknowledgement of pleasing interactions; redistributing time spent in recreational and social activities; and contingency contracting. These treatment modules are offered during eight to 10 sessions spaced over a three month period. The specific techniques are imbedded in a matrix consisting of an alliance between the spouses and the co-therapists, and group cohesiveness. Evaluations of the approach with 40 couples indicate that the group methods produce statistically significant improvements in marital satisfaction. An experimental comparison revealed that the behavioral methods led to significantly greater improvements in the observed interactions between spouses than in a group which used a discussion-interaction format.     

Client narratives about experiences with a multicouple treatment program for intimate partner violence

A handful of clinical trials have concluded that conjoint couples treatment for intimate partner violence is safe and at least as effective as conventional batterer intervention programs, yet very few researchers have explored couples' perspectives on conjoint treatment. Using qualitative narrative analysis methodology, the researchers conducted 48 client participant interviews and five staff interviews to better understand couples' experiences of a conjoint treatment program for intimate partner violence. Themes that recurred throughout participants' narratives included (a) perceptions of safety, (b) benefits received, (c) attitudinal change, (d) behavioral change, and (e) important learning. Research directions and training implications are discussed.     

Implementation of Behavioral Marital Therapy

Implementing behavioral marital therapy is discussed with emphasis on the techniques of problem-solving, communications training, behavioral contracting, and homework assignments. The therapist's intervention style and the aspects of treatment which aid in generalization and maintenance of therapeutic gains are also described, and a typical treatment session is outlined.     

REFOCUSING FROM CHILD TO MARITAL PROBLEMS USING THE MARRIAGE CONTRACT GAME

Couples experiencing marital distress often request treatment for child behavior problems. These families have been found to respond poorly to behavioral parent-training programs and to reject offers of marital therapy. The Marriage Contract Game (MCG) structures and teaches problem-solving and communication skills; the game can be used to improve the skills of distressed couples and to refocus their attention away from their children and toward their own marriages. A multiple-baseline design was applied to four distressed couples who requested treatment for a target child. Results showed that game play improved couple's problem-solving and positive feeling statements in home discussions of problems, parents' ratings of target children's problems, and, in three cases, couples' perceptions of the difficulty of resolving their problems. Therapists untrained in behavioral methods were able to use the game with success and comfort. While four sessions of the MCG were not sufficient treatment for this population, intervention improved couples' skills and shifted their focus away from child problems and toward their own.     

Utilizing the Fundamentals of Science in Educating for Social Work Practice

This paper explicates a competency-based direct practice curriculum for graduate social work education. Specifically, admission and graduation requirements related to five knowledge-skill areas are outlined: (1) interpersonal behavioral control, (2) judgment and decision making, (3) contracting and goal setting, (4) selection and application of change method, and (5) assessment of outcomes. The implications of this empirically based educational model are discussed in terms of accountability and congruence between educational objectives and practice behaviors.     

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.     

Navigating the COVID-19 pandemic in the contingency framework: Antecedents and consequences of public’s stance toward the CDC

This study applied the contingency theory of conflict management to examine how contingency factors influence the public’s perceptual and behavioral responses to COVID-19 and stance toward the Centers for Disease Control and Prevention (CDC). In particular, we tested political ideology as an important individual characteristic variable to examine its roles in the contingency theory framework. The findings revealed that two situational variables (i.e., threat appraisal and attitudes toward CDC) positively influenced the public’s contingency accommodation stance toward the CDC. Furthermore, greater conservatism was significantly associated with lower levels of threat appraisal and more negative attitudes toward the CDC, however it did not influence the stance toward the CDC. Theoretical and practical implications of the findings and directions for future research are discussed.     

WHO'S DRAGGING THEIR FEET? HUSBANDS AND WIVES SEEKING MARITAL THERAPY

Despite its demonstrated efficacy, marital therapy's impact has been limited by couples' general reluctance to seek help until their problems become severe. To understand this delay, 147 married couples (294 individuals) in the process of seeking marital therapy were surveyed. Using multilevel confirmatory factor analysis, three relatively independent steps (problem recognition, treatment consideration, and treatment seeking) were identified. On average, wives were rated as completing all three steps before their husbands. Gender-role orientation, demographics, relationship satisfaction, and specific relationship problems (especially husbands' dissatisfaction with sex) were also predictive of the steps toward therapy. Implications for marital therapy are discussed.     

The Impact of Behavioral Couple Therapy on Attachment in Distressed Couples

Emotion‐focused therapy (EFT; Greenberg & Johnson, 1988 Emotionally focused therapy for couples. New York: Guilford Press) is anchored in attachment theory (Johnson, 2003 Attachment processes in couples and families. New York: Guilford) and considers change in attachment schemas essential in the process of improving satisfaction in relationships (Johnson, 1999, Research and couples therapy: Where do we go from here? American Family Therapy Academy Newsletter). However, there are little data on how measures of attachment change over the course of EFT or any other couple therapy. The current study examines whether increases in attachment security predict improvements in marital satisfaction during behavioral couple therapy, which would suggest that change in attachment style is a key process variable even for a non‐attachment‐focused treatment. Multilevel models of data from 134 couples participating in a randomized clinical trial of integrative behavioral couple therapy and traditional behavioral couple therapy (Christensen et al. Journal of Consulting and Clinical Psychology, 72, 2004, 176) indicate that although there is a trend for early change in attachment‐related anxiety and avoidance to predict later change in marital satisfaction, early change in marital satisfaction strongly predicts change in attachment‐related anxiety through the end of treatment and 2‐year follow‐up. These findings suggest that changes in satisfaction may lead to changes in attachment rather than the reverse and that change in attachment may not be the mechanism of change in all efficacious couple therapy.     

The role of appraisal distortion, contempt, and morality in couple conflict: a grounded theory

A common goal of couples' therapy is to help individuals modify their view of each other and the relationship. Distorted views and appraisals contribute to conflict, and these can be manifest by use of rationalization or denial. This study explored appraisal distortion as an evaluative and moral process that occurs during partner conflict, particularly when it becomes contemptuous and aggressive. Using a philosophical base that is grounded in the ethical relationship, a model of appraisal distortion and couple conflict was created using constructivist grounded theory methods. The theoretical concepts derived from the data show relationships between one's relational stance, appraisal distortion, and verbal and physical aggression. This model implies that helping individuals take responsibility for appraisals is important in treating conflict.     

When Strategic Approaches get Stuck: Maps out of the Mire

Using a biopsychosocial model, a three dimensional map provides guidelines for changing from strategic therapy when progress in this approach falters. The method is pragmatic and atheoretical, and brings together ideas from various schools which empirically have been found useful. Practical and inclusive guidelines are offered for family (and individual) therapy which address two important issues: reinforcement of change when progress is occurring, and a shift from an interactional to another dimension when stuck points are reached. The multi-dimensional approach is clear, can be used by individuals or teams, lends itself to teaching and is of particular value for entrenched and complex problems. Four case histories are presented to highlight the approach.     

Taxing utility

In order to assess the efficiency of a tax, we should examine its effect on the behavior of individuals. In general, the less a tax affects behavior, the more efficient it is thought to be. The standard example of a non-distorting tax is a lump-sum tax, which does not change with the behavior of the taxpayer. However, this article demonstrates that behavioral distortions can and do arise from a change in even a lump-sum tax. The only truly non-distortionary tax would be one based on utility itself. Utility, which has been used as a norm for distributional analysis, is also the ideal base for efficiency analysis. In fact, any reasonable attempt to describe a minimally distortive basis of taxation will significantly resemble the notion of a tax on utility. Therefore, utility itself is the best basis for evaluation of the efficiency of a tax. Such a tax has many additional features which make it more useful for analytical purposes than lump-sum taxes.     

A contingency approach to nonprofit governance

A number of contingency factors may be relevant for effective nonprofit organizations and their boards. Although all boards must fulfill certain critical roles and responsibilities, strategic choices can be made about adopting different governance configurations or patterns. These choices can be meaningfully informed by understanding organizational contingencies such as age, size, structure, and strategy—and, even more important, by external contingencies and environmental dimensions such as degree of stability and complexity. This article extends or layers contingency thinking beyond its traditional focus on an alignment between the external environment and the organization's structure to focus as well on the alignment of the organization's governance configuration with its structure and environment. Structural contingency theory in general, and specifically within nonprofits, is reviewed. Two cases are presented of organizations that used an approach based on contingency theory in an action research process to examine and change their governance configurations. The steps they followed may help other nonprofits adapt their governance structures and practices and fulfill their responsibilities for board assessment and reflection.     

Ready or not: uses of the stages of change model in child welfare

This article reviews the popular stages of change model, its potential applications in child welfare, and relevant research. Empirical evidence indicates that behavioral change does not occur in a series of stages. The article considers the validity of the stage model, its underlying assumptions, and other conceptualizations of readiness for change. Although the stage model may have some heuristic value, the empirical evidence suggests that its practical applications are severely limited.     

“Vision,passion, and care:” The impact of charismatic executive leadership communication on employee trust and support for organizational change

This study explored how charismatic executive leadership communication during change influences employees’ attitudinal and behavioral reaction toward change. Specifically, it proposed and tested a conceptual model that links charismatic executive leadership communication during change, characterized by envisioning, energizing, and enabling behaviors, employee organizational trust during change, and employees’ openness to change and behavioral support for change (i.e., cooperation and championing). Through an online survey of 439 employees who had experienced a company-wide organizational change in the past two years in the United States, results showed that charismatic executive leadership communication during change positively influenced employee organizational trust, openness to change, and behavioral support for change. Employee trust toward the organization during change positively influenced employee openness to change, which in turn, contributed to employee behavioral support for change. Employee trust was revealed as a partial mediator for the positive impact of charismatic executive leadership communication during change on employee openness to change and behavioral support for change. Theoretical and practical implications of the findings are discussed.     

Contingency Learning and Reactivity in Preterm and Full‐Term Infants at 3 Months

Learning difficulties in preterm infants are thought to reflect impairment in arousal regulation. We examined relationships among gestational age, learning speed, and behavioral and physiological reactivity in 55 preterm and 49 full‐term infants during baseline, contingency, and nonreinforcement phases of a conjugate mobile paradigm at 3 months corrected age. For all infants, negative affect, looking duration, and heart rate levels increased during contingency and nonreinforcement phases, whereas respiratory sinus arrhythmia (RSA, an index of parasympathetic activity) decreased and Cortisol did not change. Learners showed greater RSA suppression and less negative affect than nonleamers. This pattern was particularly evident in the preterm group. Overall, preterm infants showed less learning, spent less time looking at the mobile, and had lower Cortisol levels than full‐term infants. Preterm infants also showed greater heart rate responses to contingency and dampened heart rate responses to nonreinforcement compared to full‐term infants. Findings underscore differences in basal and reactivity measures in preterm compared to full‐term infants and suggest that the capacity to regulate parasympathetic activity during a challenge enhances learning in preterm infants.     

NIDA: Plethora of treatments for SUDs,regardless of substance

When people refer to “evidence‐based” treatment, they mean treatment that has been proven to be effective and has been incorporated into strict protocols via manuals, so they can be replicated. The National Institute on Drug Abuse (NIDA) has been tracking the many treatment models for general substance use disorders, as well as for specific substances. Motivational interviewing (MI), medication‐assisted treatment (MAT), contingency management (CM) and cognitive behavioral therapy (CBT) are all evidence‐based modalities, explained Ruben Baler, Ph.D., NIDA health scientist, in an email to ADAW.     

Dysfunctional control by client verbal behavior: The context of reason-giving

Dysfunctional control exerted by reason-giving in adult psychopathology is interpreted from a radical behavioral perspective. Verbal-social contingencies which support the establishment of reason-giving and its control over maladaptive actions are reviewed. A contextual approach to psychotherapy, comprehensive distancing, which attempts to weaken dysfunctional verbal control is described briefly. Data relevant to therapeutic process are presented. The overall results suggest that comprehensive distancing facilitates therapeutic change through a process consistent with a behavioral analysis of reason-giving. Suggestions for further research and radical behavioral approaches to psychotherapy are discussed.

     

What clients of couple therapy model developers and their former students say about change, part II: model-independent common factors and an integrative framework

Proponents of the common factors movement in marriage and family therapy (MFT) suggest that, rather than specific models of therapy, elements common across models of therapy and common to the process of therapy itself are responsible for therapeutic change. This article-the second of two companion articles-reports on a study designed to further investigate common factors in couple therapy. We used grounded theory techniques to analyze data from interviews with MFT model developers Dr. Susan M. Johnson, Dr. Frank M. Dattilio, Dr. Richard C. Schwartz, former students of Dr. Johnson and Dr. Schwartz, and each of their clients who had been successful in couple therapy. This article reports model-independent variables, that is, general aspects of therapy that are not directly related to the therapist's model. Model-independent categories include client variables, therapist variables, the therapeutic alliance, therapeutic process, and expectancy and motivational factors, each with several subcategories. We also present a conceptual framework that outlines how model-dependent and model-independent common factors may interact to produce change. We discuss our findings and proposed framework in relation to the current common factors literature in psychology and MFT. We also discuss clinical, training, and research implications.