Couple therapy in a therapeutic community setting†

An account is given of couple therapy offered as part of a comprehensive treatment programme in a unit run as a therapeutic community. The additional therapeutic force provided by couple or family therapy is important in dealing with adult patients who may not be highly motivated for change or who may not initially present their difficulties as springing from marital or family relationships. A combined approach with these kinds of patients may succeed where either group therapy or couple therapy alone is likely to fail.     

Do Marital Conflict Behaviors in Response to a Novel Stressor Uniquely Predict Adolescent Outcomes?

The goal of this study was to examine whether mothers’ and fathers’ marital conflict behaviors in response to a novel stressor are uniquely predictive of adolescent outcomes. Previous research establishing the detrimental consequences of marital conflict for child outcomes has relied exclusively on assessments of conflict that measure reoccurring or past conflict. From 153 adolescents and/or both of their parents, reports were gathered on marital conflict, adolescent conflict appraisals, parent-adolescent relationship quality, and adolescent adjustment. Couples engaged in two marital problem-solving interaction tasks—one that elicited conflict behaviors by requiring discussion of salient, reoccurring topics of disagreement and one that prompted conflict behaviors by requiring that couples worked together to solve an unfamiliar problem. Results indicated that compared to behaviors during the marital conflict discussion as well as parent-reports of the frequency, intensity, and resolution of typical conflict, conflict behaviors in response to a novel stressor, particularly those displayed by mothers, were uniquely associated with adolescents’ conflict appraisals and dimensions of the parent-adolescent relationship but not adolescent adjustment. Specifically more-negative (relative to positive) conflict behaviors in response to the novel stressor was associated with more-negative adolescent conflict appraisals; mothers’ more-negative conflict behaviors in response to a novel stressor were also linked to adolescents reporting less parental monitoring. In contrast, parent reports of typical marital conflict uniquely predicted conflict property appraisals, the affective quality of mother-adolescent relationships, and adolescent adjustment. Implications for future research elucidating associations between conflict behaviors in response to a novel stressor on children and families are discussed.     

The madman theory of war: a possible application in therapy

In therapeutic work a systemic approach has characteristically focused on the family or marital system. In this paper the author focuses on the patient/health care system in a particular case and argues that chronic disability can be seen as a systemic feature rather than a characteristic of the individual patient. A strategy is taken from the field of international conflict and its therapeutic value is explored.     

Behavioral-Systems Marital Therapy: Dealing With Resistance

Recently there has been a dramatic increase in attempts to integrate certain intervention components of behavioral and systems approaches with marital and family therapy. This paper elaborates on a previously described behavioral-systems approach by focusing primarily on the issue of resistance to therapeutic progress within the behavioral framework. First, potential reasons for major resistance phenomena are suggested. Then, in the context of a social learning theory model of assessment and intervention, specific clinical indications are discussed for departing from the basic behavioral approach in order to deal with resistance. Finally, a variety of interpretive and strategic intervention techniques are described and illustrated by clinical case materials     

Type A behavior and marital dissatisfaction: disentangling the effects of achievement striving and impatience-irritability

Previous research has documented an association between overall Type A behavior and marital dissatisfaction. The present study examines the nature of this relationship when a two dimensional approach to Type A behavior is adopted, and impatience-irritability and achievement striving are assessed separately. Subjects were 134 medical practitioners and specialists and their wives in South Africa. As predicted, husbands' impatience-irritability was associated with their own and their wives' marital dissatisfaction. However, neither their achievement striving nor global Type A behavior correlated with their own or their wives' marital dissatisfaction. The results are discussed in terms of the need for isolating the specific component of Type A behavior that is associated with marital dissatisfaction.     

Type A Behavior and Marital Dissatisfaction: Disentangling the Effects of Achievement Striving and Impatience-Irritability

Previous research has documented an association between overall Type A behavior and marital dissatisfaction. The present study examines the nature of this relationship when a two dimensional approach to Type A behavior is adopted, and impatience-irritability and achievement striving are assessed separately. Subjects were 134 medical practitioners and specialists and their wives in South Africa. As predicted, husbands' impatience-irritability was associated with their own and their wives' marital dissatisfaction. However, neither their achievement striving nor global Type A behavior correlated with their own or their wives' marital dissatisfaction. The results are discussed in terms of the need for isolating the specific component of Type A behavior that is associated with marital dissatisfaction.     

The Effects and Effectiveness of Marital Therapy A Review of Outcome Research

The literature on outcome research in marital therapy is reviewed. Issues considered include the nature of outcome criteria, the need to establish a base line against which to measure improvement, and therapeutic effectiveness as a function of treatment type and time-in-therapy. The overall improvement rate across a heterogeneous collection of patients, therapists, and treatment modalities was 66 per cent, suggesting, conservatively, at least a moderately positive therapeutic effect in light of the judgment that “spontaneous” rates appear to be much lower in marital than in individual therapy. Evidence of deterioration in marital therapy also was discovered. No support was found for the contention that co-therapy is more effective than treatment of the couple by a single therapist. The needs of future research in the outcome of marital therapy are discussed and possible fruitful directions for such investigations suggested.     

Understanding Betrayals in Marriage: A Synthesized Model of Forgiveness

Forgiveness is an issue that is problematic for many couples, particularly those in marital therapy. However, little attention has been paid to this construct in the psychological literature. The purpose of this article is to describe a synthesized model of forgiveness using constructs from multiple theories, including forgiveness, trauma recovery, cognitive-behavioral, family systems, and insight-oriented theories. Forgiveness is conceptualized as a process consisting of three stages, each of which has cognitive, behavioral, and affective components. Furthermore, these stages seem to parallel a person's natural response to traumatic stress. First, there is a response to the initial impact; second, there is an attempt to give the event some kind of meaning, or put it into context; and finally, the person begins to move forward and readjust. Forgiveness is conceptualized as attaining: (a) a realistic, nondistorted, balanced view of the relationship; (b) a release from being controlled by negative affect toward the participating partner; and (c) a lessened desire to punish the participating partner. Implications for marital therapy also are discussed.     

Teenage pregnancy: Seeking patterns that promote family harmony

Survey data from the RELATE inventory (www.relate-institute.org) was gathered for married couples (N = 374) and was analyzed for effects of marital quality on perceptions of weight as a problem in the marriage, activity level, and eating habits. Results indicate that wife marital quality was positively associated with weight being a problem for wives, while husband marital quality was negatively associated with weight being a problem for both husbands and wives in the relationship. Wife marital quality was also positively associated with husband activity level, while husband marital quality was negatively associated with husband activity level. Implications for clinicians are discussed.     

Prognostic factors and classification issues in the treatment of secondary orgasmic dysfunction

The present study examined patient and problem characteristics as well as therapy process factors associated with success and failure in sex therapy for secondary orgasmic dysfunction. Ss were 23 married couples selected for emotional and marital stability; all wives were suffering from secondary orgasmic dysfunction. Sexual functioning and satisfaction were evaluated before and after 15 sessions of therapy. Ss also engaged in daily self-monitoring throughout the therapy program. Two criteria of therapeutic success were used: the couples' global sexual harmony and the females' frequency of orgasmic response in couple sexual activity. Higher pre-treatment masturbation rates by the female, as well as better awareness of her partner's sexual tastes and preferences, were related to poor therapeutic outcome. Greater pre-treatment enjoyment of non-genital caressing by the female as well as higher incidence of interpersonal orgasmic response in the past were associated with therapeutic success. The theoretical and research implications of the present findings are discussed.     

The importance of similarity in the marital relationship.

Concepts such as "agreement," "consensus," "understanding," and "shared meaning" are very familiar to clinicians. It is argued in this article that similarity in perceptions between spouses is a crucial dimension of the family system underlying these concepts. Findings are presented that support the idea that families vary along a dimension of similarity of perceptions, with more functional families characterized by high similarity between spouses' perceptions of their marriage and their family. In addition, the structure of this similarity was stable over 2 years and little change occurred in the mean level of similarity. Of three sets of predictor variables--psychological stress, marital cohesion, and structural variables--marital cohesion was the most powerful predictor of marital similarity. The importance of similarity of perceptions between family members in clinical work is discussed.     

Gender differences in marital communication patterns

This study examined conflict-resolution interactions of couples, and related marital satisfaction to sequential and nonsequential communication patterns. Couples' satisfaction with marriage has been differentiated on the basis of the degree of coercive versus affiliative communication between partners. Results of this study indicate that this pattern differs, however, for individuals within couples on the basis of gender. Females and males were found to demonstrate different styles of response to dissatisfaction in marriage; men assume a coercive stance toward their partners while women take an affiliative position. Drawing on systemic and gender-difference theoretical perspectives, these patterns are interpreted as attempts by individuals with different world views to resolve conflict. A view is discussed whereby systems and gender differences can be integrated into a unified conceptual formulation upon which to base future development in research and therapeutic interventions.     

Rhizomatic affective spaces and the therapeutic potential of music in prison: a qualitative meta-synthesis

Research literature supports that music programmes in prisons can have a therapeutic effect in prisoners’ lives that could promote personal development and assist the process toward desistance. The authors use a meta-synthetic approach to examine 12 qualitative articles published worldwide to explore the therapeutic potential of such programmes. The findings suggest that music programmes in prison are perceived by participating prisoners as a liberating process, which encourages participation and allows for noncoercive personal development. The therapeutic potential of music programmes is located in the combination of the benefits emanating from the effect and practice of music and the creation of mental, spatial and temporal zones of free expression and those that derive from the egalitarian and nonauthoritative approach employed by the facilitators. These findings are discussed along with aspects involved in the provision of offender treatment as well as factors that affect treatment response and engagement.     

Getting engaged: A case study and a model of the engagement period as a process of conflict-resolution

This paper addresses the problem of why so many marriages end in divorce. It develops a preventative approach to marital breakdown by proposing pre-marital counselling as a resource to be made widely available to couples. The key psychological issues which a counsellor could use as the backbone of any such counselling or therapeutic work are outlined. It is suggested that these issues are part of the psychological ‘working-through’ period during an engagement, when the couple are preparing for marriage. The psychological difficulties that an individual may be struggling with are illustrated via an account of psychodynamic psychotherapy with a young woman during the year of her engagement.     

Problem Definition in Marital and Family Therapy: A Qualitative Study

This paper describes findings from a grounded theory study on the process of constructing problem definitions by marital and family therapists. Coding of the observations and interviews resulted in two meta-problem definition processes. In the first meta-process clinicians kept their definitions internal to themselves during the therapy session. In contrast, the second meta-definition process involved clinicians bringing forth their internal problem definitions and incorporating them into the therapeutic conversation. Implications for existing conceptualizations and marital and family therapy practice and supervision are discussed, as well as suggestions for further consideration.     

The therapeutic alliance in couples therapy: clinical considerations

This article presents clinical considerations about the therapeutic alliance in couples therapy, stimulated by pertinent new research findings reported in this issue. A loyalty dimension of the couple's relationship is described, as well as its influence on the therapeutic alliance in couples therapy. The therapist's establishment of a "meta-alliance" with the couple around their loyalty conflicts, avoidance of splits and disruptions, and prioritization of marital distress (versus individual symptoms) as the primary focus of treatment all serve to solidify the therapeutic alliance. In addition, identifying the partners' early family-of-origin distress can help predict and respond to strains in the therapeutic alliance that may occur later in therapy. Finally, the therapist helping the couple to balance their relational power differences in therapy and to address their concerns about the impact of the therapist's gender also strengthens their therapeutic alliance. A clinical case and vignettes are included to illustrate these issues.     

Facilitating marital intimacy through self-disclosure

Abstract

Intimacy is one of several interpersonal dimensions which describe the quality of a marital relationship. An operational definition of intimacy is presented. Evidence that a lack of intimacy is associated with nonpsychotic emotional illness, marital maladjustment and family dysfunction is reviewed. A technique is described which facilitates marital intimacy through self-disclosure. Evidence is presented that cognitive self-disclosure is a major determinant of a couple's level of intimacy. The assumption is made that facilitating cognitive self-disclosure will increase intimacy with subsequent improvement of neurotic symptoms and marital maladjustment. A case is presented which demonstrates that a structured technique for selfdisclosure of relevant assumptions in a reciprocal manner to a supportive listener can facilitate a couple's level of intimacy. The role of self-disclosure, modeling and cognitive restructuring as therapeutic factors are discussed.     

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.