The Efficacy of Behavioral Couples Therapy and Emotionally Focused Therapy for Couple Distress

Twenty treatment outcome studies, 13 of which evaluated behavioral couples therapy (BCT) and seven of which evaluated emotionally focused therapy (EFT) were reviewed, leading to the following conclusions. BCT leads to short and long-term gains for moderate to severe couple distress. In the long term BCT probably leads to no better outcomes than its constituent components—behavioral exchange training and communication and problem solving skills training. Addition of a cognitive therapy component to BCT or the use of a variety of treatment formats does not improve the efficacy of BCT. Integrative couples therapy and insight-oriented marital therapy may be more effective than BCT, but studies supporting this conclusion require replication. EFT leads to short and long-term gains for mild to moderate couple distress. Addition of a cognitive therapy component to EFT does not enhance its efficacy. EFT may be more effective than problem solving therapy and less effective than integrated systemic therapy, but the two studies supporting this conclusion require replication.Michael Byrne, PhD, is a Clinical Psychologist, Midland Health Board, Ireland; Alan Carr, PhD, is Director of the Clinical Psychology Training Programme, Department of Psychology, Arts Building, University College Dublin, Belfield, Dublin 4, Ireland (alan.carr@ucd.ie). Marie Clark, PhD, is Lecturer, Department of Psychology, University of Surrey, United Kingdom.     

The Application of Facilitated Imagery to Marital Counseling

SUMMARY

The purpose of this study was to assess whether facilitated imagery is a successful technique for improving both marital satisfaction and individual psychological functioning. Twenty marital couples were randomly assigned to two experimental groups: Both received three sessions of structured marital enrichment and one also received three facilitated imagery sessions. Posttests were given at one month and four months following treatment. Subjects exposed to facilitated imagery showed significantly greater improvement on some scales of marital satisfaction and individual psychological functioning, and these improvements persisted at the four-month posttest. In posttest interviews, subjects reported the primary benefit was insight into themselves and their spouses.

A series of 2x(3) repeated measure analyses of variance were used to detect changes for husbands and wives. Subjects exposed to facilitated imagery reported significantly greater improvement than enrichment-only subjects on some scales of marital satisfaction and individual psychological functioning. In addition, improvements persisted at the four-month posttest for the enrichment-plus-imagery subjects, but declined for the enrichment-only subjects. In interviews, the majority of imagery subjects reported that the process had been helpful to them both personally and relationally. Subjectively they reported gaining insight into themselves or their spouse as the primary benefit obtained from the imagery work.     

The use of psychoeducational groups to improve marital functioning in high risk Israeli couples: a stage model

A modular and sequentially-based psychoeducational groupwork method, including the rationale for this type of work with couples in Israel, is presented. Modules of this form of groupwork are illustrated using two examples of groupwork with couples experiencing chronic post-traumatic stress disorder and groupwork with couples in low-income multiproblem neighborhoods. Issues that arise in the training of professionals to do this kind of psychoeducational groupwork in Israel are discussed.     

Observer reliability as a function of circumstances of assessment

THREE FACTORS CHARACTERISTIC OF EXPERIMENTAL SETTINGS WERE HYPOTHESIZED TO INFLATE ARTIFACTUALLY THE RELIABILITY OF OBSERVATIONAL RECORDINGS: (a) knowledge by observers of when and by whom their reliability is being assessed, (b) the absence of the experimenter or a monitor to prevent cheating, and (c) computation of reliability within- (versus between-) observer group. Three groups of four observers used a standard nine-category observational code for disruptive behavior in recording from videotapes of a classroom for 22 days. Analyses revealed considerable increases in average occurrence reliability as a function of the main effects of each of the experimental factors. The specific increases in reliability associated with each of the 12 combinations of the experimental factors are presented for each category of behavior. The possible role of observer-training procedures and behavioral definitions as determiners of nonartifactual reliability is discussed.     

Competences and occupational standards for systemic family and couples therapy

This article reports on the recent government initiative of 2007–2010 to delineate, for the major forms of psychological therapy, expected professional standards of practice and conduct in workplaces (the national occupational standards) and to specify expected levels of competent practice (the competences). The article focuses on the processes and outcomes of this initiative for systemic therapy and its clinical and political relevance. The rationale, research and consultation processes by which these formulations were achieved are described and the outcomes of the work are reported. We also discuss their wider implications, including the various ways in which these achievements might be used and their potential value for the field of systemic family and couples therapy.     

The impact of stress on marital quality: A stress-vulnerability theory

This article outlines a stress-vulnerability theory for describing how stress impacts marital quality. Implications for therapy are also discussed based on the stress-vulnerability theory.Appreciation is expressed to Joan Jurich, PhD for her helpful comments during the development of this theory.     

Standardized assessment of relationship functioning in OEF/OIF Veterans with and without PTSD

Posttraumatic Stress Disorder (PTSD) is associated with difficulties in intimate relationships, with most prior research examining associations with continuous, single-dimension, and often-unstandardized measures of general relationship quality or aggression. Standardized, well-normed assessments that include multiple couple problem areas could provide more precise information about the presence and specific nature of clinically significant concerns in patient care settings. This investigation aimed to replicate findings regarding increased difficulties in relationship functioning among Operations Enduring and Iraqi Freedom Veterans with PTSD and their romantic partners, specifically using a standardized assessment that permits identification of cases of clinically significant general couple distress and difficulties across multiple problem areas. We compared 32 male Veterans with PTSD and 33 without PTSD, and their romantic partners on reports of several problem areas using the revised Marital Satisfaction Inventory (MSI-R). All participants underwent structured diagnostic interviewing. PTSD couples reported clinically significant levels of relationship distress several times more frequently than comparison couples, both for general distress and across all specific problem areas (e.g., aggressive behavior, quality of leisure time together, sexual functioning, conflicts about finances and child rearing). The most notable problem areas for PTSD couples were affective and problem-solving communication. These results replicate associations of PTSD with general couple discord and multiple specific areas of couple difficulties and extend them by documenting the clinical severity of these problems. Mental health providers may consider incorporating standardized couple assessments into their evaluations of Veterans’ functioning. Couple therapies may consider using such measures to prioritize targets for treatment.     

Interactional patterns of bipolar patients and their spouses

This study examined the interactional patterns of eight bipolar patients (when manic and in remission) and their spouses by videotaping the couples' interactions and then quantifying those interactions using the Marital Interaction Coding system. These couples' interactions were compared to the interactions of eight happily and eight unhappily married nonbipolar psychiatric control patients and their spouses. The purposes were to determine (a) whether the interactional pattern between bipolar patients and their spouses changes or remains the same when the patient is in a manic vs. a nonmanic state and (b) how the interaction patterns of bipolar patients when manic and nonmanic compare to happily and unhappily married nonbipolar psychiatriccontrol patients. Significant differences in interactions were found between manic and nonmanic states, in addition to significant differences between these patients and the control groups. There were also expected differences between happily and unhappily married psychiatric control groups. Implications are discussed for marital therapy for manies that involves problemsolving and communication training.     

A case study of behavioral assessment and treatment of insect phobia

We assessed the academic performance of a 14-year-old boy with insect phobia in the context of feared stimuli. The dependent measure was math calculation rate across three conditions that varied therapist statements about the presence of crickets and the actual presence of live crickets. Subsequent treatment consisted of graduated exposure and contingent rewards for math problem completion. Assessment results indicated that the boy's performance was consistently low in the presence of live crickets but not when he was spuriously informed that crickets were present (the primary referral concern). Treatment results indicated no effect from exposure alone and a dramatic effect when exposure was combined with contingent rewards.     

The Role of Creativity in Marriage and Family Therapy Practice: A National Online Study

The purpose of this study, using an online methodology, was to investigate therapists' perceptions of the role of creativity in couples' and family therapy. Along with completing a quantitative measure assessing creativity in their work, participants responded to four open-ended questions which addressed the meaning of creativity, characteristics of a creative family therapist, some creative interventions they have used with couples and families, and barriers to their own creativity as a family therapist. A total of 142 marriage and family therapists in 36 states in the United States participated. The findings shed light on the unique importance of creativity in couples and family treatment.     

The Marital Communication Rating Schedule: An instrument for clinical assessment

The Marital Communication Rating Schedule (MCRaS) is presented as an observationally based clinical rating system for assessing verbal behavior in marital communication. Data from 35 response display discussions lasting from 20 to 30 min each, which took place between 11 married couples, were used to examine aspects of the reliability and validity of the instrument. Three raters made independent ratings of 37 MCRaS categories for each husband and wife for each discussion period. Reliability among the raters was shown to be high when calculated within one scale point. Concurrent validity was assessed by comparing MCRaS ratings for four categories with observationally based validation criteria independently coded and measured. Results indicated that for three categories — negative statements, overgeneralizations, and amount of talk — ratings produced results that were similar to those yielded by laborious coding of audiotapes. For one category, opinions requested, a relationship between the ratings and coded data was not found. The validation results were discussed in terms of possible differences in the basis of ratings for the categories subjected to validation. Although further research is needed, it was concluded that MCRaS has many of the desirable qualities needed in a clinically useful, observationally based rating system.This investigation was conducted in connection with the Sociobehavioral Research Project at The University of Michigan when Joyce Borkin and Claude L. Walter were affiliated with the project.     

Dyadic coping and marital adjustment during pregnancy: A cross‐sectional study of Italian couples expecting their first child

Although the transition to parenthood is currently defined as a normative event, it can be potentially stressful for the couple relationship as it may contribute to psychological distress and reduced marital satisfaction. Using the systemic‐transactional conceptualisation of stress and coping as a theoretical framework, we claimed that the ability of the parents‐to‐be to adjust to their new roles and identity is influenced by dyadic coping strategies. This study examined the effects of dyadic coping on marital adjustment in a sample of 78 primiparous couples. Women and partners completed the Dyadic Adjustment Scale and the Dyadic Coping Questionnaire during late pregnancy. Data were analysed using the Actor‐Partner Interdependence Model. Results revealed that both women and partners' scores on positive dyadic coping behaviours contributed to higher marital adjustment, suggesting that risks for marital dissatisfaction may exist for couples not able to implement adaptive dyadic coping strategies, or for those unsatisfied with the implemented coping behaviours.     

A multiple‐stimulus‐without‐replacement assessment for sexual partners: Purchase task validation

The current study developed and tested a multiple‐stimulus‐without‐replacement (MSWO) assessment for potential sexual partners for use in research on human immunodeficiency virus. College students (N = 41) first completed an MSWO assessment and then completed a hypothetical purchase task for encounters with partners identified by the MSWO as high, median, and low preference. Overall, hypothetical purchase task responding was consistent with that from the MSWO, in that the highest valuation was observed for the high‐preference partner and the lowest for the low‐preference partner. Potentially interesting individual differences in purchase task responding, however, were obtained; some subjects showed differentiated responding among the 3 preference levels (n = 15), whereas others similarly valued high‐ and median‐preference partners (n = 5), and others similarly valued low‐ and median‐preference partners (n = 18).     

Vulnerability schemas of individuals in couples relationships: a cognitive perspective

The professional literature has recently given attention to addressing individual schemas in couples relationships, with particular emphasis on the fact that individual vulnerability has a significant impact on couples relationships. This article addresses how this vulnerability can be restructured during the course of couples therapy. Case vignettes are used to illustrate how the model can be applied. Some of the implications of this model are considered in the discussion section.Authors note: Portions of this article were published in Norwegian by the first author and appear in Nordby, T.T. (2002): Kognitiv parterapi. En tilnærming som ivaretar betydningen av den individuelle sårbarheten i samspillet. Reprinted by permission of Fokus på familien 30, 46–60.     

Discrepant Alcohol Use,Conflict, and Couples Satisfaction in a Community Sample

Abstract

Discrepant alcohol use between partners has been shown to impact couples’ relationship functioning, emphasizing couples therapists’ need for careful assessment and informed treatment. This study recruited 514 participants from online crowdsourcing platforms to participate in an online survey. Participants were predominantly male (62.4%), heterosexual (76.1%), and Caucasian (47.6%). Ages ranged from 18 to 65 years and mean age was 33. Results indicated a negative association between couple satisfaction and both alcohol-related conflict and discrepant alcohol consumption. Being female combined with higher levels of alcohol discrepancies and couple satisfaction predicted increased alcohol-related conflict.     

Teachers' and mothers' assessment of children's behaviors from kindergarten to grade two: Stability and change within and across informants

Consistency between teachers' and parents' ratings of 229 children's prosocial and problem behaviors was investigated from kindergarten through grade two. Intrarater stability was also analyzed. Results indicated moderate but decreasing interrater agreement from kindergarten to grade two for boys on externalizing behaviors. Interrater agreement for the same behavior dimension for girls was moderate and stable, whereas it was low on internalizing behavior problems and prosocial behaviors, for both genders throughout the 3-year period. Moreover, difference between teachers' and parents' ratings of externalizing behaviors increased from kindergarten to grade two. Decreasing level of agreement through time appeared to be related to a reduction of teacher-rated externalizing behaviors not paralleled by a reduction in parent ratings. Analyses were also performed at the item level of the externalization scale to identify which specific behaviors were responsible for the increasing divergence in interrater agreement from kindergarten through grade two. Alternative interpretations were considered in order to account for present and past results. Implications for screening and assessment purposes were discussed.This research was supported by grants from the Social Sciences and Humanities Research Council of Canada and from Québec's Health Research Fund (FRSQ). We wish to thank the authorities and directors of the schools from the Val d'Or School Board as well as the kindergarten, first and second grade teachers, children, and parents for their collaboration. We also thank Lyse Desmarais-Gervais, Daniel Corriveau, Jean Desrosiers and Hélène Boileau for their participation in the data collection or analysis.     

The differential effects of acute marital distress on emotional,physiological and immune functions in maritally distressed men and women

Abstract

We examined the impact of acute marital conflict on emotion, cardiovascular arousal, and immune function in men and women. Subjects were 10 heterosexual, distressed couples, who panicipated in exchange for marital therapy. Each couple participated in a 40 minute conflict induction regarding an area of difficulty in their relationship. During this induction, blood pressure and heart rate were monitored and blood samples were drawn pre- and post-induction for analysis of immune change. Women responded to the experimental induction with significantly greater increases in depression and hostility, and with significantly greater increases in SBP than men. Women also responded to the acute marital distress with slight decreases in lymphocyte proliferative response to PHA, while men displayed an increase in PHA response. The sex by time interaction was significant Change in PHA was associated with change in hostility and SBP.     

Behavioral assessment of imipramine effects in a depressed child

A 7-year-old boy was diagnosed as suffering from childhood depression by two independent psychiatric evaluators who employed the Research Diagnostic Criteria. Multifaceted behavioral observations were performed on target behaviors which were identified as major problematic areas of functioning related to the child's depression. The behavioral assessment strategy included daily monitoring of on-task and disruptive behavior in the classroom, enuresis, and overall hygienic, social, and compliance behaviors as a means of identifying the specific drug-induced effects of an anti-depressant, imipramine. The assimilation and application of behavioral assessment strategies within child psychiatry have been slow and tenuous. Reasons for the resistance include theoretical differences and misconceptions among psychiatric personnel, who, although open to objective evaluations, may wish to employ nonbehavioral treatments such as pharmacologic agents. The primary purpose of this study was to demonstrate the viability of behavioral assessment as an integral adjunct to pharmacologic treatment in a psychiatric setting as a means of gauging the efficacy of a psychiatric intervention. Issues regarding the role of behavioral assessment in psychiatry and, in particular, pharmacologic interventions with depressed children are examined and discussed.This study was supported, in part, by NIMH Grant MH 30915.     

Utility of teacher behavior ratings for identifying special needs students

The purpose of this study was to explore the efficacy of a teacher behavior rating instrument for identifying special needs students. Using a modified form of theDevereux Elementary School Behavior Rating (DESB)Scale 35 kindergarten through grade 6 regular classroom teachers completed ratings on all of their 876 students. Subsequently, extensive aptitude, academic, social, and behavioral assessment was conducted and those students were identified who were in need of supportive educational programming to function adequately within the regular class setting. Analysis of the teacher behavior ratings indicated a highly significant difference between those students identified for special supportive services and their regular classroom peers on 9 of 11 behavioral factors. The findings lend clear support for the use of classroom teachers' behavior ratings in the identification process.     

Observational assessment of behavioral changes accompanying clinical improvement in hospitalized psychiatric patients

Naturalistic observational techniques were employed over a four-week period to assess the behavior of clinically improved (n=7) and unimproved (n=12) hospitalized patients suffering from acute psychiatric disorders. The population was selected from four clinical diagnostic groups. Patients were sampled on an individual basis. Categories of recorded behaviors included social behavior as well as spatial proximity measures between individuals. Social behavior was further divided into components of sending and receiving. Results showed that patients who clinically improved had significantly different behavioral profiles and greater degrees of behavioral change for the following categories: send affiliation, receive affiliation, send assertion, and receive assertion. Improved patients also maintained closer distance to other individuals during the latter stages of hospitalization. In most cases, week 2 of hospitalization marked the point at which behavioral divergence between improved and unimproved patients occurred. Clinical and theoretical implications of observational procedures are discussed.