A randomized trial of emotion-focused therapy for couples in a training clinic

Forty married couples participated in a randomized trial comparing 8 weekly sessions of emotion-focused therapy (EFT) for couples to a group of couples who were placed on an 8-week waiting list. A composite marital satisfaction score was created from scores on the Dyadic Adjustment Scale, Positive Feelings Questionnaire, and Personal Assessment of Intimacy in Relationships scale. Controlling for pretest scores, participants in the treatment group had significantly higher levels of marital satisfaction after 8 weeks than wait-list participants. Supplementary analyses identified variables associated with gains in therapy and with dropping out of the study.     

PREDICTING MARITAL THERAPY DROPOUTS*

The purpose of this study was to predict therapy dropouts using data gathered at marital therpay intake. Intake data included standardized assessments and demographic information. The sample consisted of 474 couples who were seeking marital therapy and who attended at least one therapy session. Seventy-two couples met the dropout criteria, and a random sample of equal size was drawn from the rest of the couples for the analyses. Data from these two groups of couples were analyzed with multiple regression and discriminant analysis formulas. Three variables-having less than two children, having a male intake clinician, and a presenting problem relating only to one spouse-were significant predictors in accounting for couples who would drop out of therapy. In the best model, high phobic anxiety scores for husbands and a presenting problem relating to parenting, along with the other three variables, produced a model that accurately classified 82% of the couples who dropped out of therapy.     

TREATMENT OF MARITAL CONFLICT AND PREVENTION OF DIVORCE

This paper provides a review of previous literature reviews on the effectiveness of marital therapy and evaluates the long-term efficacy of couples therapy in preventing marital separation and divorce. There is general agreement that marital therapy can be effective in reducing marital conflict and promoting marital satisfaction, at least in the short term. Research examining the long-term efficacy of couples therapy for the prevention of marital separation and divorce is sparse but promising with respect to its effectiveness in promoting marital stability. Predictors of successful marital therapy outcomes, the clinical significance of marital therapy outcomes, and the cost effectiveness of marital therapy are also discussed.     

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.     

MORNING AND NIGHT COUPLES: THE EFFECT OF WAKE AND SLEEP PATTERNS ON MARITAL ADJUSTMENT*

This study explored the effects of spouses' wake and sleep patterns on marital adjustment. A total of 150 couples from three states completed questions on wake/sleep patterns, marital interaction, marital adjustment, and problem solving. Couples whose wake and sleep patterns were mismatched (e.g., an evening person married to a morning person) reported significantly less marital adjustment, more marital conflict, less time spent in serious conversation, less time spent in shared activities and less frequent sexual intercourse than matched couples. Contrary to expectations for matched couples, night couples did not report more involvement in extra-familial social activities than morning couples. Morning couples engaged in sexual intercourse more frequently in the morning than night couples; night couples had sex more often in the evening than morning couples. There were no significant differences in the intercourse rates for morning couples and night couples. Compared to matched couples, mismatched couples with high marital adjustment reported more flexibility and adaptability in their marital problem solving. The implications of these findings for premarital counseling and marital therapy are discussed.     

Effectiveness of Narrative Therapy on Communication Patterns for Women Experiencing Low Marital Satisfaction

The current study was designed as quasi-experimental with a pretest and post-test evaluating the efficacy of narrative therapy on communication patterns for women experiencing low marital satisfaction. Thirty women experiencing low marital satisfaction were chosen using convenience sampling and were randomly assigned to an intervention and waiting list group. The intervention group was treated individually by narrative therapy in eight 45-minute sessions. Results from repeated measurement ANOVA revealed significant differences between and within the groups and interaction between and within groups. Independent and paired t-test results showed significant improvement in the intervention group in their marital satisfaction, male-demand/female-withdraw, and total demand/withdraw with maintenance at eight weeks follow-up. Results included increased marital satisfaction, reduced male-demand/female-withdraw, and reduced total demand/withdraw. Thus, results show that narrative therapy is effective in increasing the marital satisfaction indicators of male-demand/female-withdraw, total demand/withdraw, and marital satisfaction.     

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.     

AUTONOMY AND RELATEDNESS IN MARITAL FUNCTIONING

The current investigation expands the focus of cognitive behavioral formulations of marriage by exploring the constructs of autonomy and relatendness in marriage. One hundred forty-one married couples matched to the 1990 U.S. census data on age, race, and income completed a number of self-report marital inventories including the Autonomy and Relatendness Inventory (Schaefer, Edgerton, & Burnett, 1991). Autonomy was measured by evaluating spouses' perceptions of the extent to which partners encouraged a sense of independence and individuality for the spouses. Relatedness was measured by evaluating spouses' perceptions of the amount of closeness that partners provided. It was found that autonomy and relatedness were significantly positively correlated with each other, as well as with marital adjustment for both males and females. It was found that for females, the provision of relatedness (as reported by their husbands) was significantly related to the standards that they held for the relationship. In addition, it was found that for females, the provision of relatedness (as reported by their husbands) was significantly related to the standards that husbands held for the relationship. However, no significant relationships were found between husbands' standards and relatedness (either as reported by wives or husbands). It was concluded that it is appropriate to help couples think of autonomy and relatedness as being tow important aspects of marriage that can exist together and are related to a satisfying marriage. Implications of the findings suggest that marital therapists could expand the conceptualization of marital therapy beyond being primarily relationship focused to include attention to individual needs of the spouses. Relatedness was measured by evaluating spouses' perception of the amount of closeness that partners privided. It was found that autonomy and relatedness were significantly positively correlated with each other as well as with marital adjustment for both males and females. It was found that for females, the prpvision of relatedness(as reported by their husbands) was significantly related to the srandards that they held for the relationship. In addition, it was found that for females, the provision of relatedness(as reported by their husbands)was significantly related to the standards that husbands held for the relatinship. How-ever, no significant relationships were found between husbands' standards and     

COMPONENT ANALYSIS OF BEHAVIORAL MARITAL THERAPY: 2-YEAR FOLLOW-UP AND PREDICTION OF RELAPSE

The present study provides 2-year follow-up data for a comparison between a complete behavioral marital therapy treatment package (CO) and two of its major components, behavior exchange (BE) andcommunication/problem-solving training (CPT). Data are reported for 34 couples who were randomly assigned to one of these three treatments, completed the treatment to which they were assigned, and were available for the 2-year follow-up. The effects of therapy at the 2-year follow-up were evaluated using a global measure of marital satisfaction and a checklist of presenting marital problems. Statistically significant differences between the three treatments were not in evidence on any of the measures. However, couples in the CO treatment condition were most likely to be happily married and least likely to be separated or divorced. Attempts to identify variables which predicted long-term outcome were largely unsuccessful. Ananalysis based on standardized telephone interview indicated that, while neither therapist attributes nor maintenance of treatment-derived relationship skills were associated with long-term marital satisfaction, stressful life events subsequent to therapy termination were negatively related to marital satisfaction.     

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).     

Marital Discord and Subsequent Dissolution: Perceptions of Nepalese Wives and Husbands

The author examined the influence of marital discord on separation and divorce in a rural South Asian setting. Little is known about how marital discord influences marital outcomes in settings with low personal freedom and limited access to independence. Using a sample of 674 couples from the Chitwan Valley Family Study in Nepal, the author investigated the impact of marital discord on the rate of marital dissolution and the extent to which wives' and husbands' perceptions of discord influence dissolution. The results revealed that (a) spouses' perceptions of marital discord increase the rate of marital dissolution, (b) both husbands' and wives' perceptions of discord have an important influence, and (c) the influence of wives' perceptions of discord is independent of their husbands' perceptions. Overall, these findings suggest that both spouses' perceptions of discord are important for marital outcomes, even in settings where the costs of marital dissolution are relatively high.     

Antecedents and consequences of negative marital stressors

Many couples seeking therapy report the occurrence of severe, negative marital stressors (e.g., infidelity, threats of marital dissolution). In addition, existing research has demonstrated that these marital stressors precipitate Major Depressive Episodes and psychological symptoms. This longitudinal study examines the antecedents and consequences of negative marital stressors to help clinicians and researchers develop interventions that might prevent these stressors and their outcomes. Forty-one women completed a semistructured interview and measures of marital discord and depressive symptoms within one month after experiencing a marital stressor (baseline) and at a 16-month follow up. The results indicate that baseline marital discorded contributes to the occurrence of additional marital stressors during the follow-up period. Although baseline depressive symptoms do not predict additional marital stressors, depressive symptoms along with marital discord predict future depressive symptoms. Finally, baseline marital discord and additional marital stressors contribute to future marital dissolution. Clinical and research implications are discussed.     

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.     

ENGAGING THE NON-ATTENDING SPOUSE IN MARITAL THERAPY THROUGH THE USE OF THERAPIST-INITIATED WRITTEN COMMUNICATION

There is currently rather widespread acceptance among clinicians that conjoint marital therapy is the preferred format for treating marital difficulties. However, more often than not, it seems that the marital referral or inquiry for therapy stems from the efforts of one spouse, with the other spouse remaining uninvolved or resistant. Consequently, engaging the non-attending spouse in therapy is an important issue for professionals working with married couples.     

STRUCTURED MARITAL SEPARATION AS A MARITAL TREATMENT METHOD*

This article describes therapist-structured marital separation for distressed couples during their critical period of deciding whether to divorce or remain married. Characteristics of marital distress appropriate for structured marital separation are identified and discussed; potential benefits are explicated; and the design of the separation contract is specified. Issues addressed in the structure of the separation include the duration of the separation; the frequency of contact between partners; sexual contact between partners; dating; sexual contact with others; privacy; and contact with children.     

TREATMENT ACCEPTABILITY OF ALTERNATIVE MARITAL THERAPIES: A COMPARATIVE ANALYSIS

Client acceptability of treatment procedures has recently become a significant concern in the assessment of psychotherapeutic effectiveness (Kazdin, French & Sherick, 1981; Wolf, 1978). Formally, acceptability refers to the fairness, appropriateness and intrusiveness of the treatment procedure as judged by clients, lay persons and nonprofessionals (Kazdin, 1980a). Unfortunately, marital and family therapists have yet to utilize this criterion in an evaluation of their psychotherapeutic interventions. Consequently, the purpose of the present investigation was to examine the acceptability of four differing therapeutic models (psychoanalytic, behavioral, systems and eclectic) used in the treatment of marital discord.     

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.     

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.     

PREDICTING MARITAL SUCCESS FOR PREMARITAL COUPLE TYPES BASED ON PREPARE

Recent studies have shown that group differences in marital stability and satisfaction can be predicted based on premarital relationship quality. There is also a growing literature indicating that there are distinct types of relationships, both premaritally and developmentally over time. This study examined the relationship between the four premarital types (Vitalized, Harmonious, Traditional, and Conflicted) identified by Fowers and Olson (1992) and relationship outcome over a 3-year period with 393 couples. A substantial relationship was found, with conflicted couples being the most likely to separate or divorce. Vitalized couples had the highest levels of satisfaction, followed by Harmonious, Traditional, and Conflicted couples. Traditional couples were less likely to have divorced than Harmonious couples, even though Harmonious couples had higher premarital relationship satisfaction scores.     

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.