Couples with Intimate Partner Violence Seeking Relationship Help: Associations and Implications for Self‐Help and Online Interventions

In‐person conjoint treatments for relationship distress are effective at increasing relationship satisfaction, and newly developed online programs are showing promising results. However, couples reporting even low levels intimate partner violence (IPV) are traditionally excluded from these interventions. To improve the availability of couple‐based treatment for couples with IPV, the present study sought to determine whether associations with IPV found in community samples generalized to couples seeking help for their relationship and whether web‐based interventions for relationship distressed worked equally well for couples with IPV. In the first aim, in a sample of 2,797 individuals who were seeking online help for their relationship, the levels and correlates of both low‐intensity and clinically significant IPV largely matched what is found in community samples. In the second aim, in a sample of 300 couples who were randomly assigned to a web‐based intervention or a waitlist control group, low‐impact IPV did not moderate the effects of the intervention for relationship distress. Therefore, web‐based interventions may be an effective (and easily accessible) intervention for relationship distress for couples with low‐intensity IPV.     

Using Acceptance and Commitment Therapy to Treat Distressed Couples: A Case Study With Two Couples

Although the field of couple therapy has made significant strides in recent years, there continues to be a need for theoretically sound and empirically supported treatments. The current case study examines whether Acceptance and Commitment Therapy (ACT), an experiential acceptance-based behavior therapy, can be effective in treating distressed couples. Although ACT has demonstrated effectiveness in treating a variety of disorders in individuals, it has not been systemically applied to the treatment of couple distress, and the current study is the first empirical examination of ACT for the treatment of couples. Two married couples participated in the study. A number of core ACT interventions were modified to treat couples in a conjoint format. Cognitive defusion exercises were used to help couples reduce their fusion with and the believability of negative thoughts and feelings related to the relationship. Mindfulness and acceptance techniques were used to help couples increase awareness of their reactions to negative relationship cycles. Finally, value-directed action was used to help partners act in ways consistent with relationship values even in the presence of unwanted thoughts and feelings. The results of this preliminary case study suggest that ACT may be effective in increasing marital adjustment and satisfaction, and in reducing interpersonal and psychological distress in couples. Future studies with larger samples and more controlled designs are needed to build on the results from this single-case study.     

Spouse disclosure patterns in distressed and nondistressed couples

Abstract

To determine whether spouses in nondistressed marriages show greater equity and reciprocity of exchange and a greater degree of congruence than spouses experiencing marital distress, interactive patterns of self-disclosing behavior were examined using the Self-Disclosure Coding System. Clinical wives were found to disclose greater percentages of self-references and at a higher rate than their husbands, and discriminant function analysis correctly discriminated 80% of these spouses. In contrast, the disclosure patterns of nonclinical partners could not be distinguished, indicating greater equity of exchange. Examination of within-couple reciprocity patterns revealed highly similar topographical patterns of disclosure among the nondistressed couples but not among the distressed partners. Finally, the association between content intimacy and affective manner of presentation was stronger for the nondistressed husbands (r = .81) and wives (r = .97) than for the distressed husbands (r = .10) and wives (r = .36), indicating greater clarity of self-revelations among nondistressed couples. These findings are discussed within the context of equity, communication, and behavioral exchange views of marital adjustment.     

A Clinical approach to marital problems: Evaluation and management

Abstract

This study reviews two instruments designed to assess marital complaints as related to marital behavior: the Areas of Change Questionnaire (AC) and the Comprehensive Areas of Change Questionnaire (CAC). Although the AC is a reliable measure, it evaluates only 13 of the 29 categories of marital problems (Mead&;Vatcher, 1985) described by Geiss and O'Leary (1981). The CAC was developed to measure all 29 categories. Fifty distressed and 50 nondistressed couples were administered the CAC and the Marital Adjustment Test (MAT: Locke&;Wallace, 1959). The CAC is reliable overall, r=.84 and 20 out of 29 categories are reliable r=.40 or greater. Test-retest reliability was greater than r=.82 for all but one scoring method and for 21 of the 29 categories for all respondents with 2 additional categories stable for men and 2 different categories stable for women. The CAC differentiates distressed from nondistressed couples M=59.96 and 11.74 and individuals M=29.98 and 5.87, respectively. The CAC correlates with the MAT r=? .50 and ? .67 for nondistressed and distressed couples, respectively, when 5 extreme scores were removed from the distressed sample. Clinical utility of the CAC is discussed and further research into the nature of marital complaints is recommended.     

Behavioral Marital Therapy: An Outcome Evaluation of Conjoint,Group and One Spouse Treatment

Abstract

Behavioral Marital Therapy has focussed on the modification of marital behavior in conjoint and couples group settings. This study extends previously published outcome studies in that one treatment condition involved treating only one of the partners. Fifty-seven couples were consecutively assigned to one of the three treatment conditions. Outcome evaluations included an independent assessment, marital satisfaction, sexual adjustment and an assessment of target problems. The results revealed no significant differences between the three treatment conditions. However, couples in the conjoint treatment resolved their target problems more rapidly than the other two treatments. The implications of the result as well as issues of outcome prediction, cost-effectiveness and the viability of treating one spouse are discussed.     

Distress and aggression during dating conflict: A test of the coercion hypothesis

Research with clinically depressed and maritally discordant couples suggests that women's distressed behaviors function to suppress their partners' subsequent aggressive responses. We applied this coercion hypothesis to a nonclinical sample of dating couples (N = 288). We further examined whether these effects were gender‐specific, and whether distressed and aggressive behaviors differ within physically violent versus nonviolent relationships. Women but not men reported engaging in elevated rates of distress in response to partner aggression during past dating conflicts. However, both women and men expected distressed behavior to suppress partner aggression during future conflicts. Expectations about the functional effects of distressed behavior did not differ for participants with physically violent partners versus nonviolent partners. However, participants in violent relationships reported enacting more distressed behaviors and had greater expectations for partner verbal aggression during future conflicts than did participants in nonviolent relationships. Future research may identify the early onset of dysfunctional interaction patterns in couples and concomitant psychological distress.     

Conjoint Couple's Treatment for Intimate Partner Violence

Abstract

Despite lingering concerns in the field about the wisdom of seeing couples conjointly when there has been Intimate Partner Violence (IPV), the research literature and clinical practice experience both indicate that this approach can be safe and effective for at least some couples. In this paper, we briefly review the existing outcome research on Couple's treatment for IPV and then suggest best clinical practices for this work. Best practices, in our view, include seeing Couple's treatment of IPV as a clinical specialty necessitating specific training, working as part of a coordinated community response to IPV, modification of the structure of therapy to increase safety, as well as careful screening of couples and on-going assessment of the propriety of conjoint treatment.     

Emotion-Focused Therapy for Couples in the Treatment of Depression: A Pilot Study

Emotion-focused therapy (EFT) for couples was compared to pharmacotherapy in the treatment of major depressive disorder. Eighteen distressed couples in which the female partner met diagnostic criteria for major depressive disorder were randomly assigned to 16 weekly sessions of emotion-focused therapy or pharmacotherapy with desipramine, trimipramine, or trazadone. Twelve couples completed the study. Both interventions were equally effective in symptom reduction. There was some evidence that females receiving EFT made greater improvement after the conclusion of treatment than those receiving pharmacotherapy. The results suggest EFT might be useful in the treatment of comorbid major depressive disorder and relational distress.     

Assessing Couple Therapy as a Treatment for Individual Distress: When is Referral to Couple Therapy Contraindicated?

In order to better understand the effects of initial level of psychological disturbance on treatment outcome, a retrospective case control study of 95 couples who received couple therapy was conducted by sorting couples into one of four groups based on the degree of distress reported by individuals at intake: Neither distressed; both distressed; male distressed, female not distressed; female distressed, male not distressed. When partners started treatment with similar levels of disturbance both responded well in couple therapy. However, if the female reported clinical levels of disturbance at intake but her partner did not, outcome for the female was especially poor in contrast to outcomes for females receiving individual therapy. Clinically disturbed males showed significant gains in treatment even when their partners were not disturbed. These suggestive results argue for the possible value of conducting controlled studies of treatment assignment decisions that maximize positive outcomes.     

Creating Structure in a Time of Intense Stress: Treating Intimate Partner Violence

Violence is an increasingly visible problem in the United States, with the news and other forms of media bringing this into the forefront of the public’s awareness. Violence comes in many different forms, including intimate partner violence (IPV), which occurs for about 36% of women and about 29% of men across the United States. Given the high incidence in the United States, it is imperative to consider the best ways for mental health professionals to treat violence in relationships. Some professionals in the field have developed and utilized conjoint treatment models for working with couples who have a history of violence. This article presents the application of attachment theory to a conjoint treatment model for couples that have experienced violence. A case study is included to demonstrate the implementation of an emotionally focused therapy framework and provide a sample outcome of this treatment approach. The framework of this article provides clinicians with insight into how to approach working with violent couples in a safe and productive way. Mental health professionals are at the front lines of implementing evidence-based interventions and creating lasting change for the clients whom they work with.     

The areas of change questionnaire: A cross-cultural comparison of israeli and american distressed and nondistressed couples

Abstract

This study examines Israeli couples' presenting complaints about their relationship, their perceptions of one another's complaints and perceptual accuracy between actual and perceived complaints, using the Areas of Change Questionnaire (ACQ). Samples were obtained of both distressed and nondistressed couples. Each sample met stringent criteria for categorization as distressed and nondistressed. Normative data for both samples are examined and areas of similarities and differences are discussed. The instrument is found to discriminate distressed and nondistressed Israeli couples. Results are compared with a previous study of American distressed and nondistressed couples. The American finding that women desire more change in marriage is not replicated in the Israeli sample, nor the American finding that distress and stage in the life cycle are related. However, there is an indication in both samples that men, compared to women, perceive more requests for change. Men in both cultures also feel more change is asked of them than they themselves ask in return.     

Capitalization in distressed couples: A pilot study and outline for future research

Capitalization—seeking “support” when good things happen—is linked to healthy couple functioning but has never been studied in distressed couples. We examined whether perceptions of capitalization and traditional social support related to couples' satisfaction prior to, and following, couples' therapy at a Veteran Affairs Medical Center. Perceptions of capitalization and traditional social support were associated yet distinct. Not all distressed couples had poor perceptions of support, and greater perceived support related to greater satisfaction at treatment entry. Relationship satisfaction was higher posttreatment for individuals whose partners reported providing them with greater capitalization support prior to treatment. We focus our discussion on the development of systematic research to investigate how capitalization may promote adaptive processes in vulnerable couples.     

Randomized Controlled Trial of Imago Relationship Therapy: Exploring Statistical and Clinical Significance

For decades, couples around the world have used Imago relationship therapy (IRT) to improve their relationships. While anecdotal success stories abound, no randomized controlled trial of IRT's impact has been accomplished until now. The authors review the results of a randomized controlled trial of distressed, treatment-seeking couples who completed 12 sessions of IRT and the impact their involvement had on their marital satisfaction. Results showed that (a) individuals in the treatment condition experienced statistically significant increases in marital satisfaction, while couples in the control group did not; (b) levels of marital satisfaction did decrease significantly from posttreatment to follow-up but remained significantly higher than at pretreatment; (c) though statistically significant, the improvements experienced by the treatment group were not clinically significant improvements; and (d) while approximately one-third of participants achieved recovery during treatment, at the dyad level, only one couple achieved recovery. Further analysis and recommendations for future research are discussed.     

Couples in Therapy: Actor-Partner Analyses of the Relationships Between Adult Romantic Attachment and Marital Satisfaction

This study was the first to investigate the relationship between adult romantic attachment and marital satisfaction in a clinical sample of 172 distressed couples seeking therapy. Fifty-six therapy-seeking nondistressed couples were also assessed for comparison. Analyses of variance showed that attachment avoidance was a distinctive characteristic of distressed couples. Actor-partner analyses revealed that attachment avoidance (for men and women) and attachment anxiety (for women only) were predictive of marital dissatisfaction for distressed couples. Gender-stereotype discordant partner effects were also found. Results suggest that attachment orientations (especially avoidance) are relevant predictors of marital dissatisfaction in distressed couples seeking therapy, and that couple therapists can gain important information by assessing partners’ attachment orientations.     

Maintenance of Gains in Relationship and Individual Functioning Following the Online OurRelationship Program

In the United States, more than 40% of marriages end in divorce and more than one third of intact marriages are distressed. Unfortunately, only a minority of couples seek couple therapy to improve their relationships. Online interventions, with their increased reach and reduced costs, offer the potential to improve relationships nationwide. The online OurRelationship program has been shown in previous nationwide studies to improve relationship and individual functioning. The present study examined whether initial gains in the OurRelationship program were maintained in the following year and whether the extent of maintenance varied across important demographic and individual factors. In this study, 151 distressed heterosexual couples (302 individuals) who were randomized to the OurRelationship program were assessed 3 and 12 months following the intervention. Initial gains in relationship satisfaction, relationship confidence, and negative relationship quality were maintained through 12 months; positive relationship quality significantly improved over follow-up. Furthermore, couples maintained their initial gains in depressive symptoms, perceived health, work functioning, and quality of life; anxious symptoms continued to significantly decrease over follow-up. Finally, there was no evidence that historically underserved groups—racial/ethnic minorities, lower income couples, or rural couples—experienced greater deterioration. In fact, Hispanic couples reported continued improvement in relationship confidence and negative relationship quality in the 12 months following the program. The ability of the OurRelationship program—an 8-hour, primarily self-help program—to create long-lasting improvements in distressed relationships indicates it may have the potential to improve the lives of distressed couples on a broad scale.     

Relationship factors in the treatment of sexual dysfunction

The role of marital harmony in the development, assessment and treatment of sexual dysfunction is addressed in the present study. Twelve couples with mixed sexual dysfunctions received both sex therapy and marital therapy in a balanced cross-over design. The major variables investigated were therapy outcome on measures of sexual satisfaction and marital adjustment as a function of treatment modality (sexual or marital) and relationship functioning. Findings showed significant differences in outcome between treatment approaches with a strong mediating effect of relationship factors. Limited interpersonal understanding and inaccurate perceptual agreement in relationship functioning characterized those couples who failed to exhibit a differential response to treatment in favour of sex therapy over marriage therapy. Implications of these findings for the assessment and treatment of sexual dysfunction are discussed.     

The Impact of PREP Training on Marital Conflicts Reduction: A Randomized Controlled Trial With Iranian Distressed Couples

The purpose of this study was to examine the efficacy of the Prevention and Relationship Education Program (PREP) training on marital conflict and marital satisfaction among a sample of distressed couples in Iran. The research procedure was experimental with a pretest, posttest, and follow-up design, including a control group. The sample included 76 volunteer couples among a sample of distressed couples who were randomly selected and assigned to the experimental or control group. They completed demographic questions, the Marital Conflicts questionnaire, and a revised Marital Satisfaction Inventory in pretest, posttest and at the 1-year follow-up. Results showed that PREP training effectively led to decreased marital conflict and improvement of marital satisfaction of couples at posttest and at the 1-year follow-up. The result of covariance analysis showed significant differences between the experimental and the control groups' marital conflict and marital satisfaction at posttest and at the 1-year follow-up.     

Couples treatment for major depression: critique of the literature and suggestions for some different directions

Current couples approaches to the treatment of depression show considerable promise for some couples, but have substantial room for improvement – in terms of efficacy as well as applicability and acceptability to a broader population. Although conjoint approaches have been shown to be efficacious in reducing couple distress and are possibly efficacious in ameliorating depression that co-occurs with couple distress, methodological problems hamper generalization from the published findings. Therefore, it is not clear that most depressed persons are likely to benefit from currently available conjoint formats. Most basically, there may often be obstacles that prevent or delay partner involvement, highlighting the need for treatments that can enhance relationship functioning without relying on a conjoint format. Existing treatment delivery systems may also fail to reach a considerable segment of the population. Developing a more flexible set of options for implementing couple-focused treatment, as well as rethinking dominant assumptions about depression, may be integral to extending the viability of couples therapy for depression.     

Infertility: Couples' experiences and the use of counselling in treatment centres

Abstract

Infertility can have profound effects on couples, who may spend years in an increasingly stressful quest for conception; by law, counselling must be offered to those undergoing licensed treatments. This study found that such couples relied on their own partnership as their main resource for managing stress. Predominantly the partnership was organized in a psychological division of labour -the woman experiencing emotional pain, the man supporting and seeking positive solutions. Normally a functional joint defence, this could become a dysfunctional split under excessive stress. Where counselling was offered directly, with a couple approach, couples who took it up were enabled to re-establish their own defences more adaptively. However, where access to counselling was by clinical referral - often of a distressed woman partner alone - the couple approach was more difficult to apply though apparently no less relevant. The counsellor-clinician partnership could mirror the ‘division of labour’, with a similar tendency towards dysfunctional splitting under stress.