MARITAL PARADIGMS: COMPATIBILITY, TREATMENT, AND OUTCOME IN MARITAL THERAPY

Marital paradigms comprise the guiding images that serve as reference models for a couple's relationship. Such individualized images can be understood as variations on a small set of basic themes. An understanding of clients' marital paradigms can help foeus treatment on the most appropriategoals usingapproaches and techniques that are most effective for a particular couple. An unselected group of 103 couples seen in systems-oriented marital therapy were reviewed, to identify outcome and treatment issues as a function of marital paradigm. Based on outcome criteria that took marital paradigm into account, 92% of 38 cases where both partners identified with the same basic paradigm were judged to be treatment successes, while only 60% of the cases where the partners identified with different paradigms could be considered successful outcomes. Clinical approaches based on experience with marital therapy conducted within a paradigmatic framework are presented.     

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.     

CREATING HEALING RELATIONSHIPS FOR COUPLES DEALING WITH TRAUMA: THE USE OF EMOTIONALLY FOCUSED MARITAL THERAPY

Emotionally focused marital therapy (EFT), a marital therapy that particularly focuses on the creation of secure attachment, has proven in empirical studies to be effective for distressed couples. This paper discusses the application of EFT in couples where one or both of the partners have experienced significant trauma. EFT, in this context of trauma, incorporates the nine steps of conventional EFT and also encompasses the three stages of the "constructivist" self development theory of trauma treatment. This paper illustrates how the integration of EFT and trauma treatement can prove effective in treating not only relationsip distress but also the individual symptoms of posttraumatic stress disorder (PTSD).     

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.     

BATTERING AND COUPLES THERAPY: UNIVERSAL SCREENING AND SELECTION OF TREATMENT MODALITY

As family therapists begin to experiment with couples treatment models for batterers and their partners, a basic question is: Which couples can be safely treated with conjoint therapy? Following a definition of battering and a review of rationales for considering couples therapy in cases of domestic violence, a framework for assessment of domestic violence is outlined, including sample questions, criteria for excluding couples from conjoint therapy, how to conduct a lethality assessment, and how to conceptualize postassessment treatment recommendations. This article also introduces family and couples therapists to domestic violence literature that is often not well integrated in family therapy theory and practice.     

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.     

THE SYSTEMIC TREATMENT OF SHAME IN COUPLES

Shame remains largely a hidden phenomenon in the treatment of couples. It can manifest itself as a determining factor in events ranging from entrenched blaming to missed appointments. Although there is a growing body of literature on individual shame dynamics and, to a lesser extent, on couple and family shame dynamics, there is little written on how to incorporate these theories into treatment. This paper offers working definitions of shame, proposes a systemic definition of shame as seen in couples, reviews the literature on coule shame dynamics, and explores issues of therapeutic stance and treatment techniques in working with shame in couples therapy.     

THE PROCESS OF CHANGE IN COUPLES THERAPY: A QUALITATIVE INVESTIGATION

Open-ended interviews with 24 couples therapy clients regarding their experience of the process of change revealed shifts in clusters of affect, communication, and cognition. Six additional contextual preconditions for change were also identified. The change process within couples was uniformly reported to be gradual.     

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.     

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.     

COMPUTER-BASED INTERPRETATION OF THE MARITAL SATISFACTION INVENTORY: USE IN TREATMENT PLANNING

This paper describes the computer-based interpretive system for the Marital Satisfaction Inventory (MSI) and its application in initial phases of clinical assessment and treatment planning. The automated MSI interpretive report contains sections regarding profile validity and global marital affect, spousal communication, specific areas of interaction, concerns regarding children, role orientation, and family history of distress. A case study and sample narrative demonstrate the manner in which the MSI computerized report can be incorporated into initial clinical assessment and treatment planning. Clinical findings at intake are compared with MSI profiles for this couple obtained at termination and follow-up. Both strengths and limitations of self-report measures and computer-based interpretive reports in marital therapy are considered.     

MARITAL RELATIONSHIPS OF ALCOHOLIC,CONFLICTED, AND NONCONFLICTED COUPLES*

Twenty-six couples with alcoholic husbands, and 26 maritally conflicted and 26 nonconflicted couples without alcohol problems were compared. As predicted, the alcoholic and maritally conflicted couples did not differ, and both groups of problem couples showed greater relationship distress than nonconflicted couples on measures of marital stability, change desired, and positive communication behaviors. Contrary to predictions, alcoholic couples were not unique with respect to struggles for control, a pattern of wife dominance, a responsibility-avoiding style of communication by the alcoholic husband, or impaired perceptual accuracy. Unexpectedly, alcoholic husbands reported less marital unhappiness than both their wives and maritally conflicted husbands on most of the self-report marital satisfaction measures.     

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.