THE GUILFORD FAMILY THERAPY SERIES Alan $. Gurman, Editor (Clinical Handbook of Maria Therapy ‘Nei §: Jacobson and Alan § Curman, Edars Marriage and Mental ines: A Sex Roles Perspective Re full Hatner ving through Divorce: A Developments! Approach to Divarce Therapy Joy K Rice aod Davi G, Rice Generation to Generation: family Process in Church own H, Frlsdinan fallares in Fantly Therapy Sanda 8. Calera, Editor Caschook. of Marital Therapy Alan. Carman, Editor amis and Other Systems: The Macrosystemie Context of Family Therapy John Schinatzman, élite ‘he Miltary Family: Dynamics and Treatment Florence W Kaslow and Richard 1, Ridenour, Edtars Marriage and Divorce: A Canternporary Perspective Carol €. Nadelson and Derek Polanaly,Edtors Fail Care of Schizophvenlt: A Problem-Solving Approach to the Treatment of Mental iness Jan fe. Faloon, jefe L Boyd, and Chusine We MEG The Procats of Change Peasy Pano Farnly Therapy: Principles of Straten Practice Allon ass, Eliot Aesthetics of Change Bradford Keeney Fal Therapy in Schizophrenia Wiliam Re Mefailane, fltor Mastering Resistance: A Practical Gude to Family Therapy ‘Anderson and Susan Stewart Farily Therapy and Family Medicine: Toward the Primary Care of Fanies Wiliam { Dohary and Macaran A. Baitd Ethnicity and Fasiy Therapy Moni BcColdrich, jak & Pearce, and joseph Ciowano, Edits Pattens of Bret Family Theapy: An Eeosystemlc Approach Steve de Shaver “The Family Therapy af Drug Abuse and Addiction IM, Duncan Stanton, Thomas C, Tod, and Asoe'ctes From Psyche to System: The Evolving Therapy af Car! Whitaker John . ell and David P. Kosher, Nora Family Process roma Walt, Etor Helping Couples Change: A Social Learning Approach to Mi Richard 8. Start nd Symagoaue Therapy | i i CLINICAL HANDBOOK OF Marital Therapy Edited by NEIL S. JACOBSON University of Washington ALAN 8, GURMAN Uuvenity of Wisconsin Madical Schoo! THE GUILFORD PRESS New York Loudon© 1986 The Guilford Press A Division of Guilford Publications, Ine 200 Park Avenue South, New Yak. NY. 1090" All sights reserved No part ofthis hook may be reproduced, stored ns Fettieval ssstem, of sisted in any fon oF by any ‘means, electronic, mechanical, photoenpying. ‘microfilming, recording, or cthenvise, without permission in writing from the Publisher PRINTED INTHE UNTTED are Library of Congress Cataloging in Publication Dats Main entry unde title: Clinical handbook of maital therapy (The Guilford family therapy series) Includes bibliographies nd indexes I Mantel pychotherapy —Hlandiols, manus, ee |. Jacobson, Neil S193 Garman, Alan S. Tit, Sepen TONLE 1 Mantal Thevopy WME 33 Cit) RGAE SC5H5 Ton GIAB'ISE as 31559 ISBN 0-89862.067- Contributors CAROL Mt ANDERSON, PhO Wester Poychintric Institute and Clinicy Unisersily of Pitsburgh, Pitsburgh, Pennsylvania ROBERT C AYLMER, EAD Lifeeyele Center, Newton, Massachusetts BONALD H. BAUCOM, PAD Department of Psyehniogy, Unive lina, Chapel Hill, North Carelina ELLEN M. BERMAN, MD Department of Paychiaty, University of Pennsylvania, Philadelphia, Pennsylvania, and Marriage Covel of Philadelphia, Philadephia, Penneyleana GREGORY BROCK, PhO Department of Psychology, University of Wisconsin— Stout, Stout, Wisconsin LAURA S. BROWN, PhD Private practi, Seattle, Withington JOHN F. CAHALANE, ACSW Western Psychiatrie Insite and Clinic, University of Pitshurgh, Pithuegh, Pennsylvania LARRY L. CONSTANTINE, MSW Private practice, Acton, Massachusetts IANETTE COUFAL, PhO Department of Psychology, University of Wisconsin Stout, Stout, Wisconsin JAMES C. COYNE, PhD Department of Family Maticire, University of Michigan Medical School, Ann Arbor, Michigan CHRISTOPHER DARE, MD _ Department of Children are! Adolescents, the Maucsley Hospital, Denmark Hill, London, England WILLIAM), DOHERTY, PHD Department of Family Medicine, University of ahora Health Sciences Center, Oklzhoma City, OXishema CELIA JAES FALICOY, PRD San Diego Family initets, ane Department of Pychiainy University of Caltfonia, San Diego, La Jolla, Califomia LARRY 8, FELDMAN, PhO Department of Paychiany, Loyola University Medical School, Maywood, Ilinois ity of North CatFRANK). FLOYD, PhO Department of Psychology, Chicago, tikinais SHARON W. FOSTER. PhO. Department of Pediatrics, University of Wiscoxsin Medical School, and University of Wisconsin Hospital and Clinies, Madison, Wisconsin MARTIN GOLDBERG, MO Department of Pavehiaty, Univesity of Pennsyleania, Iphia, Petsyhania, and Mariage Counel of Philadelphia, Piviadeipns, LESLIE'S. GREENBERG, PRO Department of Counseling Paychology, U: British Columbia, Vancouver, British Columbia, Canada BERNARD GUERNEY, JR. PhO Department of Human Development, The Penn sylvania State Urivesity, University Park, Pennsylvania ALAN S.GURMAN, PHO Departnient of Poychiatry, Univesity of Wiseon: School, Madison, Wisconsin RIUUAN HAFNER, MO Depactment of Pyehiatey, Finders Medical Cente, Bedford Park, Avstalia JULIA. IEDAN, PH Piychiatry and Behavioral Scienoes, Harborview Camymnity Mental Health Center, University of Washington School of Medicine, Seale, Washington A.HOFFMAN, PhD. Department of Fuychology, University of Noth Carolina, Chapel Hill, Noch Cavolina AMY HOUZWORTH-MUNROE, MS Department of Psychology, Univesity of Washington, Seale, Washington NEILS. JACOBSON, PhO Department of Paycholowy, University of Wash aile, Washinigon SUSAN M. JOHNSON, PhO Department of Counseling Psychology, University of Buti Columbia, Vancouver, British Columbia MELVIN R, LANSKY, MD__Departatent of Psychiatry, UCLA Medical School, Los Angeles, Califorais, and Brentwood Veterans Administration Medical Center, Brentwood, California HAL C. LEWIS, PhD Depattinent of Psychology. University of Denver, Denver Center for Masital and Family Studies, Denvec, Colorado E. JAMES LIEBERMAN. MD The Pamily Institute, Washinglon, D.C. SUSAN . LEGERMAD, PhO ‘The Family Institute, Washington, D.C. GAYLA MARGOLIN, FAD Department of Paychotogy, University of Southern Cal. ifomia, Los Angeles, California HOWARD J, MARKMAN, PRD Department of Psychology, University of Dens Denver Center for Marital and Family Studies, Denver, Colorado ANN L. MILNE, ACSW Private practice, Madison, Wisconsit TIMOTHY |. OFARRELL, PAD Department of Psychiatry, Harvard Medical Schoo! Boston, Massichwsets, and Vetesns Administration Medical Center, Brockton, Massachusetts K, DANIEL O'LEARY, PD Depactnent of Poscholugs, State al Stony Brouk, Stony Brook, New York linois Insitute of Technology, kf ston, ersity of New York, | i DOUCLAS J. RESS, PMD Western Prychological Institute and Ch of Pittsburgh, Pitsburgh, Peunayhania DAVID.G. RICE, PhO Department of Feyehiatyy, Univesity of Wisconsin Medical School, Madison, Wiseonsin JOYK.RICE, PhO Dejatments of Educational Poticy Shalies and Women's Studies, Univesity of Wiseonsin-Madison, Madison, Wiseonti ALAN ROSENBAUM, PhO Departnient of Poychology, Syracuse Univesity, Syracuse, New York CLIFFORD J. SAGER, MD _Jowish Boatd of Family Services, New York, New York, and Department of Psychiatry, New York Hospital-Comell Medical Center, New York, New York SCOTEM. STANLEY, MA Department of Py chology, Univers Center for Marital and Family Studies, Denver, Colorado THOMAS C. TODD, PhD Maseiage and Family Therapy Training Program, Bristol Hospital, Bristol, Connecticut ZIMMER, MEd "Private practice, Seattle, Washington ic, University of Denver, DenverPreface $n 1978, Use wu of us were involved in a spitted debate that was published in the journal Family Process. In that debate, we disagreed on the relative merits of a behavioral approach to marital therapy. If asked, we are certain that our colleagues would have assumed that we were not speaking t one anather. No one (including ourselves at that time) would have predicted that we would ever collaborate on a book. How did we move from ideological advetsarics to co-editors in seven short vears? One of us would like to believe that the other was a closet behaviorist all along, and simply saw the light. The alleged “closet bchaviorist” attributes the rapprochement to the other's personal analysis. While there is probably no resolution to this debate, the reconciliation can not he denied. This book is the result In actuality, as we became friends and exchanged ideas over the past seven years, we leamed that there were several common elements to ur practices, despite rather fundamental diffezeners in ease conceptual ization More importantly, as we continued to study, teach, and utilize marital therapy techniques, we became increasingly sensitive to the commen de= nominato:s and bottom lines imposed by aculely distressed couples seeking therapy. Although differences in technique certainly exist between therapists, it is possible to bring any group of experienced marital therapists together and find much common ground, Most of this common ground arises from work in the trenches. However disguised it might be by jargon which is theory-specific, there. is a collective pool of clinical wisdom from which experienced marital therapists drave Unfortunately, it is hard to find this clinieal wisdom in the literature Despite a growing body of articles and books on the research and practiceof marital therapy, there ate few detailed guides to clinical practice, and even fewer Uat are comprehensive in their scope. This book is an attempt fo veclfy this deicieney in the curent lilerature. Iti te fist comprehensive suide ty Ure clinial practice of marital therapy ‘As ne explain in Chapter 1, the book includes five parts: “Major Models of Macital Therapy”; “Emerging Models of Marital Intervention” with Various Populaions and Relationally Defined Problems"; “Marital Therapy and Selected Psychiatric Disorders”; and “Special fssues.” W' exceplion, the contsibatars are noted authorities on their topic ateas of focus, and they were all given an outline to guide them in their w 1g. Although the oullines varied somewhat from section to section, they were al] geared toward a focus on clinical issues. In particular, authors were asked to discuss chatacecnics and attributes of good manta therapists, strategies used fo overcome common clinical roadblocks, and examples of “bad therapy.” We are delighted by the outcome. We hope that others are as well. NEL 5. AcOBSON Nass Cumnnn Contents Contributors Preface 1 Marital Therapy: From Technique to Theory, Back Again, and Beyond ALAN S, GURMAN AND NEIL S, JACOBSON PART I: MAJOR MODELS OF MARITAL THERAPY 2 i) Psychoanalytic Marital Therapy is CHRISTOPHER DARE 3 f) Marital Therapy: A Social Learning—Cognitive Perspective i NEIL S.1ACORSON AND AMY HOLTZWCRTHMUNROE 5) }) structural-Strategic Marital Therapy 7 THOMAS 6.1000 29 aby BR cyber bee paprinrhiok x = eb (emer loth 5. S ax Qhowen Family Systems Marital Therapy 107 ROBERT C. AVLMER PART fl: EMERGING MODELS OF MARITAL INTERVENTION 6 : Integrating Marital Therapy and Enrichment: ast ‘the Relationship Enhancement Approach BERNARD GUERNEY, IR, GREGORY BROCK, [AND JEANETTE COUFAL {Prevention 173 Prat | MARKOAN, FRANK). HOW, Sco, STANLEY AND HAL Wis 8 Divorce Mediation: A Process of Self-Definition iy) and Self-Determination 197 ANIL MILNE 9 \{ Marita! Therapy and Family Medicine 217 \Wititana 5. DOHERTY 10 al couples Group Therapy 237 JAMES UIFBERMAN AND SUSAN B, LIEBERSLAN 11 . Emotionally Focused Couples Therapy 253 LESLIE 8. GREENEERG AND SUSAN M, JOHNSON % PART III: INTERVENTIONS WITH VARIOUS POPULATIONS. AND RELATIONALLY DEFINED PROBLEMS 12 RK Separation and Divorce therapy _ ‘DAVID G, RICE AND JOY K. RICE contents sill 13 ‘Therapy with Unmarried Couples 301 ELLEN M4, BERMAN AND MARTIN GOLDBERG 14 Therapy with Remarried Couples 321 CLIFFORD |. SAGER 15 Sex-Role Issues in Marital Therapy 345 LARRY 6, FELD MAK 16 “Le Treating Sexually Distressed Marital Relationships 361 JULIA REIMAN , 17 ‘The Treatment of Marital Violence 385 ALAN ROSENBAUM AND K, DANIEL O'LEARY 18 Jealousy and Extramarital Sexual Relations 407 LARRY L, CONSTANTINE Cross-Cultural Marriages 429 (CELIA JAES FALICOV 20 ‘An introduction to Therapy Issues of Lesbian and Gay Male Couples 451 LAURA 5. BROWN AND DON ZIMMER PART IV: MARITAL THERAPY AND SELECTED PSYCHIATRIC DISORDERS: 21 Marital Therapy for Agoraphobia a7 JULIAN HAFNERvp) 22 Strategic Marital Therapy for Depression JAMES C. CONE 23 Marital Therapy in the Treatment of Alcoholi THMOTHY |, FARRELL 24 Marital Therapy with Schizophrenic Patients ‘CAROL Mi. ANDERSON, DOUGLAS J REISS, AND JOHN F CAHALANE 25 Marital Therapy for Narcissistic Disorders MELVIN &, LANSKY 26 Marital Treatment of Eating Disorders SHARON W: FOSTER PART V: SPECIAL ISSUES 27 The Effectiveness of Marital Therapy: Current Status and Application to the Clinical Setting DONALD H, BAUCOKs AND JEFFREY A, HOF 28 Ethical Issues in Marital Therapy GAYLA MARGOLIN Author Index Subject index 495 537 557 575. 597 621 639 651 Marital Therapy: From Technique to Theory, Back Again, and Beyond 1 ALAN 8. GURMAN NEIL S. JACOBSON Only two deeades ago, one observer of the marital therapy scene referred to the field as “a technique in search of a theory" (Manus, 1966), for while Prychotherapists were increasingly treating couples with marital problems, there was litle conceptual clarity or coherence to their work. Manus's assessment of the state of the field was provocative and largely accurate. At that time, psychotherapy with couples was indeed a hodgepodge of unsy tematically employed techniques grounded tenuously, if at all, in partial theories at best. The only coherent theory of human behavior that had been applied frequently to the clinical study and treatment of marital problems was the psychoanalytic perspective (e.g, Mittelman, 1444; Oherndoxt, 1938), and the only identifiable long-term, in-depth clinical project involving this area of study (Dicks, 1964, 1967) that has had any cnduring impact on comtemporary thinking in the field w2s grounded in object relations theory Indeed, Manus's (1966) assessment 20 years ago of the state of the relationship between theory and practice in marital therapy may have been an under. statement, for while psvchoanalytic theory and object-relations theory were obviously already at relatively advanced stages, there were few clearly developed implications for clinical technique that had been derived from these sehools of thought (Gurman, 1978, 1981) and then, as now, “psychodynamic” conjoint marital thecapy regularly called upon technical operations that were in no way derived from psychodynamic principles for understanding humai behavior or conducting the psychotherapeutic experienc Though marital therapy of the 1960s lacked a coherent conceptual grounding, st did tot lack a history. Indeed, it had multiple, independent i Aan. Gama, Depart of fe Nei 8. Fasluon, Depatinent of Pee7 AS.CURMIAN AND 5 JACOMSON histories, Several historians have mapped the beginnings 2nd the evohution of the field in great detail (e.¢., Broderick & Schrader, 2981, Curman 1978; Haley, 1954 Nichols & Fveret, 198%; Oon, 1970), and have even traced the progress, of emerging ide and clots pact «ald syed te teint eg Guan PN) A sn the historian, so there is no single tale to be tld cf 298 Nichole & Everett, 1986), Marital and family therapists are now guite clear on the Virtues of the “double description” (Buteson, 1979) of relationships, throngh which a more comples, and richer, arpreciation of a mart or fam system may be genetated. Such a polyocalar perspective of “the” history of tharitl therapy likewise commended tothe render, who may contult the ‘writings of the authors referred to earlier to distill his or her own meaningfa therapy, and one which relates centrally to the rationale for why the present volume was needed, involves the relations bet en marta therapy ind “family therapy" (Gunman & Kniskem, 1979; Haley, 1984). The simple the word "and." as i the preceding sewenve, itself grammatically lates the core issue at hand: are “marital therepy” and “family therapy”, in fact Uepaenble? Fhaley (1954) has provncatively argued the case against such a distinction, sed largely on the ground: that “The dyad does sot se be a conceptual unit on which theory can be built” (p. 3), ancl ona dyad forces the observer to ignore the structure in whi functions” (p. 5), that is, the broader stems of interlocking tia which the dyad is inevitably embedded, including that of the clinical triangle couple-plus-therapist ; fi weet agree whith and disagree with the position soffected) hy Haley 1984). We agree (Gunman & Knishern, 1979 that “marital therapy” fs best “conceived as a particular variant or subtype of faruily therapy. We do not agree that a conceptwal and technical focus on the marital dvad precludes J Sinica useful theory-building. AT mo-els of “marital” for “fanny” or “individual”) therapy necessarily address the nature and meaning of the relationship between the therapist and bis or hier patients because that re- lationship, and the relationship between the therapist and each indlividnat patient participant, is the vehicle and the medium through which m specific therapist actions, that is, “technignes,” set the occasion for th possi of deed change, The fst tht marl heaps epi conducted ima triangular interpesonal arrangement \Guninan, 1985) does not, however, reclude the stody of the manta dvad gua dyad. Indes, as we believe this olume attests, there have been very comiderable conceptual and empiccal Sdvances in the development of clinically useful theories of the matital dyad since the time when Manus (1966) proclaimed his depressing assessment | ofthe field. There now exist several coherent theories of me 4 ey jeraction 1 SSABITAL THERAPY: BROKE TECHNIQUE TO THEORY 3 and dysfunction (see Patt 1, “Major Models of Marital Therapy,” and Part U1, "Emerging Models of Intervention”), and within each of these theories, | ly derived therapeutic techniques have heen developed and reined Moreover, the application of these models to the treatment of both explicitly relational problems (see Part IM, “Interventions with Vasios Populatr and Relationally Defined Problems”) and to prablerns of adults traditio defined in individual diagnostic terms (see Part 1V, “Marital Theapy and Selected Psychiatrie Disorders”), has been made inctcasingly clear in the last decade or less. In addition, several very important and clearly articulated models and methods of marital ion im domains typically seen a falling outside the purview of “cnarital themp;” e.g., prevention and en- richment programs) have been developed both conceptwally and technically In fact, therein lies the essential rationale for the need in the field of family therapy for a volume which comprehensively adresses the application of clinical strategies for working with couples. We agree with Haley (1984) that exclusive oF predominant training in prychotherapy with couples dacs nol adequately prepare neophyte therapists to work effectively with lirger social units (the niclear family, the extended family, ctc.), We would also | argue that exclusive training for clinical work with such larger social systerns | does not adequately prepare therapies for effective work with couples (urnan, 1955), Beyond the issue of the training of neephyte therapists, we would note that most psychotherapists who refer to themselves as “family therapists,” # in fact, devote an enormous amount of their clinical time to work with @ couples, perhaps even a majority of their time. in addition, there isa large constituency of clinicians in all the mental hea'th professions who ps: 7 as “generalists” and sper Still, most texthooks om the theories and practices of fumily therapy po: only very Kmited attention to elinical work with couples (c.g, Gurman Kniskern, 198], Hoffman, 1981; Nichols, 198 Wolman & Stricker, 1953). ‘Thus, for both confirmed family therapists and neophyte family therapies, as well as for the general practitioner of psychotherapy, there seemed to be a need in the literature for a broad coverage of clinical interventions for working with couples. Thus, this volume was conceived with the aim of bringing togcther detailed specifications of treatment models, strategies and teclonigues, and demonstrating how these approaches are grounded in theory In keeping with this decidedly clinical emphasis, the two concluding chapte (sec Part V, “Special Issues") on the assessment of outcome and ethical 2es in marital therapy also reflect this clinicel focus. large portions of their face-to-face «lin MAJOR MODELS OF MARITAL THERAPY Part I of this Clinical Handbook presents detailed considerations of what currently appear to be the dominant and most influential models of marital4 AS. CURMAN AND N.S NCOBSON { therapy, that is, psychodynamic, behaviotal, structural/strategic, and | Bowens, Asin the chapters in Parts Mand til, on the treatient of explicitly relitional problems, anud on the marital treatment of pyychiatric disorders, the aim in Part vas to articulate the direct linkages between theoretical models of marital rolationships and strategies of mtervention. Each author was asked to addres the following issues: 1. The theoretical model of marital distressdysfunetion; 2. The theory of therapeutic change: a. rationate for how the treatment approach follows from of distiess b, overall stategy for bringing about relationship chan, agnostiolusessment procedures, typical goals, typical therapy sessions, hypothesized active ingrediewts of the 3. Specific techniques (including discussion of obstacles to successful treatment and how they are deat with, and limitations and contsa- indications of the approach), 4. The tole of the therapist (including discussion of typieal technical exons}, and 5. Common significant clinical issues (eg.. working with “difficult couples, managing resistance and noncompliance, handli rarital distress, the role and use of individual sessions andiot therapeutic adjuncts, termination) While each author of the chapters in Pact 1 is firmly committed to a specific theoretical model, there emerges in this section as a whole, a most fascinating pattern. Each of these major models is shown cleatly to be sufficiently concepually coherent and flexible to be able to inensporate effectively both specific treatment techniques and therapist stances that are typically associated with allemative models. Thus, for example, Dare (Chapter 2) provides a rationale for the use of both directive and paradoxical techniques in the context of couples therapy firmly rooted in psychoanalytic thinking: within a social Teaming/cognitive (“beltavioral”) framework, Jacobson and Holizworth-Mussros (Chapter 3) emphasize the importanie of the therapist's capacity to provide “emotional nurturance” to couples, and to remain attuned to the need far attention to “individual” issues; Todd (Chapter 4) offers solid conceptual justification for the inclusion of communication and problem- solving shill training in sthuctoral’strategie therapy, and Aylmer (Chapter 5) rakes clear that couples therapy from a Bowenian perspective can comfortably incomporate both direct and indirect therapist interventions, and can be responsive to both the short-term crisis management needs of couples, and to longer-term desires for change in multigencrationa! family systems. The repeated theme in Section Hof technical flexibility paired with conceptual integrity is consistent with recent explicit efforts in the ficld to integrate apparently incompctible theories and methods of treatment (c.g.. Feldinan, “1985; Gurmuan, 1978, 1981; Pinsof, 1983; Stanton, 1981), and, in our view, we model tructute proach 1. MARITAL INERAPY: FROM TECHNIQUE TO THEORY 5 cust in the field to identify common ilitating therapeutic change signals the eommendabl mechanisins and is 0 EMERGING MODELS OF MARITAL INTERVENTION. A cleat exansple of such attempts to int rgent views of intimate relating, and to integrate elinieal concem with bath the intapsychic/afetive and interpersonal interactional dimensions of marital telatonships, is provided by Greenberg and Johnson (Chapter 11), While their chapter ilusteates well such newly emerging interests in the field towaed integration, it algo sighals what appears to be a genuine re-emergence of interest in es and methods of relationship change. Likewise, the Liebermans ti contributios on group couples therapy (Chapter 10) rekindles our awareness of the patency TER methods of Working with couples In addition to those two chapters, which reconnect vs to certain views 7 lect * and aporagtes thal have fot in the field, Part I also presents detailed discussions of four more recentl the boundaries of “rnarital therapy,” yet which, from the perspective of public health potiev, reflect the iced forthe development of clear melts of professional involvement. tmportandly, recent developments in all four of these domains (entichment: Cuerney, Brock, & Coufal, Chapter 6 pre= vention: Markman, Floyd, Stanley, & Lewis, Chapter 7, divorce mediation: Milne, Chapter 8; family medicine: Doherty, Chapter 9) place a very strong emphasis on empowering clients via education and skill taining. And all four of these intervention models simultaneously addtess bath the resolution of curreat conceras and the lowering af the probability of being at tisk for fi is. Ik will be interesting to observe the extent to which the educationa!~preventive emphases of miatital intervention models such as to influence the practices of marital “therapy” in the years aficad ely Eallen into a state of INTERVENTION WITH VARIOUS POPULATIONS AND RELATIONALLY DEFINED PROBLEMS In our view, the scupe of marital therapy may be heuristically conceived as comprising two major domains. The first domain is that which addresses the application of various treatment methods te problems which are probably consensually seen as interactive and interpersonal and constitute, more oF Jess, the “standard fare” of marital therapy. The second domain, treated in Part IV of this volume, addresses the application of clinical methods to the treatment of problents that ate traditionally viewed in the mental health professions as disorders of individuals, Past IU includes nine chapters that may be soughtly grouped into three ters. The first thee chapters by Rice and Rice (Chapter 12, “Separation ch6 1S. GURWAN AND N.S. JACOBSON and Divorce Therapy”), Berman and Goldberg (Chapter 13, “Thesapy with Unmarried Couples"), ‘and Sager (Chapter }4.“Therapy with Remartied Couples”) constitute what may be called the “coupling-uncoupling-reen poling” cluster. Asa group, these chapters adds clin invoking predictable and nodal events and peoresses in the formation, isolation and modification of the emotional ane stractural honds of marriage. ‘What is especialy salient in cach of these chapters isthe explicit recosnition of the fact that while couples stressed during any of thy opmental transition share common dileinmas and issues, th configurations of relationship difficulte consequently, there ed for tailoring treatment interventions to different types of couples’ needs, For example. clinical work with couples m coupling-uncoupling-recoupling context probably soquites as much sustained aention to the dynamics of individuals as any commonly occursing marital problems, and requires especially carefully balanced attention and sensitivity fovboth individial dynamics i suc aval dotnntcs The sccond cluster of chapters in Part HL, including these by Feldman (Chapter 15, “Sex-Role Issues jn Mar tal Therapy”), Falicov (Chapter 19, “Cross-Cuttutal Marriages”), and Brown and Zimmer (Chapter 20, "Therapy, Ieies of Veshian and Gay) Male Couple:”), aay be called, “the role of values in couples therapy.” While the values of therapists and patients ‘operate in significant wavs in auy paychotherapy eneouinter Jacobson, 1983) some problems brought to the favo ways. Fist, inercasing numbers of conples seck help in zesalsing ean which explicitly involve deeply tield personal values in areas such as x role expectations and cultura) differeiies based on etlinicty, religion, ete Second, while any presenting problesn has the potential tg eheit untoward antitherapentic reactions from the therapist, especially in the form of coalitions between the therapist and one partner against the other partner, some, such as those involving issues of sex role identity and cultural identification, have greater potential to do so than others, And Ws can additional potential for complicating, and even f seablishment of, a workingalliance with both memhers of a couple, when they are attached to powerfully socialized values, Perhaps nowhere is this more fikely thar when “straight” therapists work with gay male of lesbian cuuph ‘The final triad of chapters in Part Iil, by Heiman (Chapter 16. “Treating Sexually Distressed Marital Relationship), Constantine (Chapter 18, “Jealousy and Extramarital Sexual Relations”), and Rosenbaum and Q’Leary (Chapter 17, "The Treatment of Marital Violence”), may he calted, “problems of passion.” These areas of marital difficulties are inked by the intensity of in presenting problems in these areas, and may also be Titked concurrently or sequentially in disteesed marriages. “Though not unigue in this regard among matital problems, this triad of difficulties reminds us, offen dramatically. that “relationship problems” often exist on a foundatia of individual prychological conflict, and that explicit the is have expecially great value sales in macy pis attention to 2. MARFIAL THERAPY; FROM FECHNIQUE TO THEORY 7 such individual conflict that predates the maniage is offen called for, in addition to the attention that needs to be directed to current interactional forces that maintain marital disharmony. As Constantine {Chapter 18) em- phasizes in his discussion of the problems of jealousy and extramarital relations, “Regardless of the therapis’s eommitmert to a ‘systemic form individual dispositional factors need to be faker into account.” MARITAL THERAPY AND SELECTED PSYCHIATRIC DISORDERS ‘Constantine's view that a genuinely systemic approach to treatment necessitates attention to multiple levels of psychological experience is fundamental to the chapters in Part TV of this Tandbook, including thave by Hafner ‘Chapter 21, *“Mantal Therapy for Agoraphobia”), Coyne (Chapter 22, Marital ‘Therapy for Depression”), O'Farrell (Chapter 23, “Marital Therapy in the Treatment of Alcoholism”), Anderson, Reis, and Cahalane (Chapter 24, “Marital Therapy with Schizophrenic Patients"), Lansky (Chapter 25, “Marital Therapy for Narcissistic Disorders”), and *oster (Chapter 26, “Marital ‘Treatment of Fating Dirorsen”). Bach of there problems haa been tzaditionall viewed 2s largely. if mot exclusively, residing within individuals, both in terms of their origins and their maintenance. Logically, then. psychotherapy, for such problems has, in the main, emphasized the treatment of such troubled individuals apart from the current interpersonal context in which their problems are manifest. Contemporary clinical systemic theory, by contrast, seems often to bypass attending to such problems as disorders in their own right, or even to deny the existence of such “diserdets.” Since four own view is that these problems involve genuine disorders which exist apatt from, as well asin significant connection ith, relationship dynamics, we requested that, jn addition fo the ines to be considered in the chapters in Pact 1 (’Maior Models of Marital Therapy”) which were identified eatlicr, authots of chapters in Part IV also addzess the following questions: 1. What is the usual definition of this problem? 2. How do relationship issues contribute te this (individual) problem? 3. How docs the (individual) problem contrite to marital discord? 4 What nondyadic factors, if any, play ax important role in either the etiology’ or maintenance of this discrdex? 5. Are there limitations of a purely “ma‘tal therapy” approach ta treating this problem? 6 other interventions (¢.g., medications) used in treating this problem within a mar ed therapy? Perhaps the most controversial issue in the realm of systemically sensitive treatment of psychiatric disorders is whether “individual” problems are func8 AS. CURMAN AND 5, ACORSON tional for relationships, that is, serve functions in the marital system or in other, lauger systems in which the marriage is embedded. Perhaps a moce praginatically importaot variation of this question, and a conceptually mote challenging one to consider, is not whether individual symptoms serve expersusial funeons, but when do they do so? Posing the issue in’ this way allons for the possibility (indeed, in our view, the likelihood) that (a) some individual sytaploms are routinely, or at least often, interpersonal functional; (b) some individual symptoms are never, or at least tacely, in terpersonally functional; and (c} some individual symptonns ate rmose vatial infeepersonally functional, Whatever the eventual status of evidence on Uh matter may be, it is quite clear that, at least for the isatital and fsmily treatment of soine individual psychiatric disorders, such as schizophrenia, intervention not based! on the assumption of the functions of syraptoms 15 currently the preferred method of treatment (Gurman, Kniskern & Pinsof, 1986) ETHICAL AND EMPIRICAL ISSUES IN MARITAL THERAPY ‘The field of marital therapy has clearly progressed in the last two decades from one in which clinical techniques hungered for solid conceptual foun dations (Manus, 1966) and, as this volume attests, now articulates wumerous colerent theories of marital distress and treatment, and technical iunovations vnith direct theoretical linkages. ‘Thus, it might be said that marital therapy has gone from teclinigue to theory, and back again. In addition, marital therapy has also gone beyond technical and theoretical innovation and clarification, and aow has accumulated a substantial body of empitical research (Gurman, Kniskem & Pinsof, 1986) which both documents the efficacy, in general of (conjoint) couples therapy, and provides an em basis for at feast some important and recurrent decisions thas must be made in clinical practice, as Baucom and Hoffman (Chapter 27, “The Eillectiveness of Marital Therapy”) show in Part V of this volume. Marital therapists have also moved beyond attending to considerations of teclinique and theory with increasing public confrontation ofthe cnotmously significant and cotaplex ethical issues involved in the proctice of marital therapy (see Margdlin, Chapter 28, “Ethical Issues in Marital Therapy”), and Kaslow aud Curman (1985) have secently written in detail about ethical considerations in mavital/family therapy research. These ethical issues touch ‘on virtually every aspect of clinieal practice by requiting the field's atleution to such fundamental matters as the competence of therapists; the therapist's responsibility to beth the individual partners in a relationship and tothe relationship”; confidentiality and privilege; informed consent, and therapist values. Undoubted'y, such ethical issues should, and in all probability will, receive incieasing scrutiny in the years ahead. Indeed, one of the major cthical challenges ir the field, that of our collective professional accountability for the efficacy of tiaital therapy (Foster & Gurman, 1985), forms a direct 1. MARITAL THERAPY: FROM TECHNIQUE TO THEORY 9 fink between the issues considered in the final two chapters of this Handbook, and therefore is ultimately relevant to all the theoretical and technical matters considered elsewhere in REFERENCES Batson, GAY) Mind and nator, A easencr unity, New York: Daton Brodercl, CB, & Secale, 15}, The hid of peokeaonal mariage atl faniy therapy. bn AS, Guinan & D. P. Kacers (Eas Honabual of faniy theapy. New York, Buses Musa Dicks, H. V- (196%, Conccps uf rusia dagnons and Hers ar developed 9 the Tavistock Farly Paychiaie Citic; Landow, Eglad. In B. M. Nash, L fesse &D, W. Ase (Ed, Marie cert acto. Chapel th: Uuvernly of Nac Calas Press. Dicks, DV. (GT) Mani eign. New York Baie Books Peidn, B85}. flea apy. Jounal of Martel end Pomily Theapy 1, 35 Foster, 5S, & Garman, A. 8, 1945). Socal eange ane cules Usa. tC. Nude 6 M. Palonahy Pls vid divars- Contenpuray peopatives New Yer Guilford lat AS 13 apy Ext uct resi al practice, Pusu Pret, 22 4s78 Guman, A. Suni, ba evel fa cu spoay marl theapice A eigue and compattce auabsis of poche seas theory apreachen In T. Pas 6B, McCray Eas Merragt New York Bounect Gumi, AS. (1981 otgentoc mal Uerapy Tana the deep TmeS, Badan id). Para of bri therapy. Now York Gul sesa, AS a,j (195. Carb of marital drpy. New York Gul wo, 8S. & Keister, DP il wl spy andr fray decays: Whats io Ararat, Aatction for M iy Thay Assucaton Novalter, 103), 1 oan amen (AS. & Rnshetm, D. PEds 0951) Hendon of keily thy, New Yorks Brute! Gasman, A.S., Knbhera, DP, & Basal, W. M. (1986) Reich onthe paces and cunt of rata sa fay theses. S- Gach & A, Bein Ede) Qlaeuak of Bevchathwaes and eavionchunge (Sole). New Yutk, Wile: Unley, J 981), Mage or Bu decay? Amerie Juena of Panay Vivepy, 2, 3-14, Hofinan, L (61, Foondoease offal therapy. New Ye: Base Beaks FMeobuon, N.S. (2963) Beyond ects The bli thtap Amie Therpp, 1, 1-24 our of Pematy Kanlow, Nf & Gunny, A. 8 cation anil rape td Vole, Manes, G1 966), Mating counscling su tn seat ofa Hay, fo he Pani, 28, HOA, B. (1944), Complementary iat, 13, 9001, actions in itacewloustigs, Phicnatse ay: Concepts and matads. New Yak Grades Pres eC. (1986), Fa facts sporael. New York: Gulla Pycdannatis ples Pychoonajtic Review, 25, 4-475. st and Eas (gain veview, Journal ef Marige and the hes Taal the esi a al oyeletherapics fos of Mu harp, 9, 1936 Sutin, M.D. 11991}, Moria Desay Gu alate veel, In P, Shula (B8), nurital eras. New York. Spec, 1953), Haedbook of fly and wana se vidual 3. Ness Yatk Plenum,MAJOR MODELS OF MARITAL THERAPYPsychoanalytic Marital Therapy CHRISTOPHER DARE PSYCHOANALYSIS AND MARRIAGE The ideas expressed in this chapter do not derive from a specialist practice cof marital therapy. 1 am a psychoanalyst and child psyehianist, and in my professional wotk my interests focus on the effort to identity a range of psychoanalytic psychotherapies appropriate to a mixed practice of clild and adolescent psychiatry and private consulting psychoanalyhe psychotherapy That is, my practice is in two distinct halves. First, 1 work with children and adolescents in a National Health Service facility die a university setting of a postgraduate teaching and research hospital). ‘The second setting for my clinical work is a private practice in which the main cefertal is of adults who span an age range from young adulthood to midlife and who, for the ‘most part, request psychoanalysis or psychothera rom the outset of my clinical practice | have been involved with the development of a riguraus conceptualization of the psychoanalytic therapeutic process (Sandler, Dare, & Holder, 1972). At the same time, I have been strongly influenced by my attempts fo apply psychoanalytic conceptualizations of therapy and personality to the spectrum of problems and motivations for which help is requested in the Nationa! Health Service facility Psychoanalysis provides a wide-ranging scope for the description of the individual personality (Dare, 1981) and is a rich framework for the con- ceptualization of individual development (Dare, 1985} and the therapeutic process Sandler et al., 1972). Cinapie De Condon, England Deyartncrt of Chien aad Alewcts, The Mauey Hsp, Denmae ill, 314 ae 2: POYCHOANALYNE STA THERARY 15 Nevertheless, after some years of training in pegchnanaletically based of the different elements ofa system are nat predictive of the rules governing child psychiatry, | became convince that psychoanalytic psych the overall interactional organization of the system made up of the totality addressed to a child or young person as an indivichial had ofthe elements. Psychoanalytic understanding of the individ al and systemse applications within child psychiaiy, being effective in perhaps understanding of the marriage and family relationship can be integrated by ‘The inapplicabilits to the broad range oF cases does nat ster ig 4 carefn! distinction between the imtenor mental workings of the! \% of refer om an inability to form a psychoanalytic understanding of the cases, which is always essential individnal as a description of the elements of the system and the curtently and illuminating, but largely reflects the relatively high level of motivation impinging interpersonal contex* as the superordinate system, and necessarily long time span that the therapy requites if i is to have a The inadequacy of the explanations of the mechanisms and dynamics chance of being successful. These emerging considerations led me into the of interpersonal fone 4 a preconscious awareness, may be a reason , ficd of crisis weatmients and conjoint therapies, The latter revealed a limitation why the most influential and prestigious psychoanalytic journals (e.g, Journal [ of psychoanalytic theory in the conceptualization of interpersonal relationships of the American Psychoanalytic Association, International Journal of Paycho~ ‘As Rycroft (1956, p. 62) has said, “. . the knowledge and theories that we Analysis, Quarterly Journal of Psychoanalysis) ate noticeably lacking in even have about intertelationships between individuals... have never been ig Feferences to marriage as an important feauure of people's psychological satisfactonly incorporated into metapsychological theory.” [beliove that the arch through th tiles and indexes of vohimes of tese three antes, problem of incorporating a more thoroughgoing interpersonal frariework in the last 10 years reveals no articles on marriage, although there ate cop: within psychoanalysis calls for the development af a farther supplement to seferonces to other family dyads; no extensive accounts of prychalogical the “metapsychalogical points of view” |Freud, 1915) and that this additional atures or causations of marital relations; and only passing references to framework can be supplied by general systems theory (von Bertalanffy, 1950), fact that marty ofthe peaple represented in the ease histories, 20 extensively 38 utilized by family and marital therapists reported, are married. The main psychological insights offered by current It must be emphasized that this view of the current limitations of pychuaalyss, im the journals surveyed, is an inking. partner selection psychoanalysis in providing fall theory of interpersonal and Ernily Rinetoning (object choice”) to earlier patterns of relations, especially mother-ch Md is not intended as a destructive criticism but as a pointed reminder af the fother-child, and oedipal configurat need for de1 nts in the theory and practice of psychoanalysis to take ‘There is a contrast between the “official” presentation of psychoanalysis seriously the special features of interpersonal processes ae distr form in the printed litcrature and discussions with practicing psychaanalysts about pychic paychology. tam drawing attention to a difference hebween their patients. Soch discussions make it very clece that, at least in the British for understanding, on the one hand, the internal workings of a person's Psycho-Analytical Society, there is a strong acceptance of the intensity and mental life, and on the ether hand, the smuckare of their persorsl nntually determined rigidity of the marital reltionships of the patients in Tbelieve that some psychoanalytic writings (e.g., Blanck & Blanck, 1968 treatment. In informal clinical descriptions marriages, ike neurotic symptoms, fail to make this distinction. ‘This is relevant not simply for the pusposes of ane seen as multiply determined compromise foumations, Confliets are seen understanding what goes on between xeople, but, even more, for the fo exist between currently ego-syntonic object-re ated needs and relationship ployment of effective therapy. A failure to take careful ac tendencies onganized around importations inta the current lie ofthe patient distinction results in what I regard as c-ass attempts to apply psychoanalytic of elements of past relationship cxperienees. Uneonscions and p jour treatment methods designed for the incividual to families and co motivations for marital choice are usually seen as distorted by, if not wholly context and dramatis personae of a therapeutic endeavor shoud shape the determined by, the transformations of instinct-criven fantasies qualities of that endeavor. The contrast bebween jaychoanalstic therapy for The links hetween marital object choice ard earlier object-related ex- adults and that for young children shows that “orthodax” psychoanalytic periences are very important for my understanding of the current structure practice is capable of encompassing this distinction. In the development of of marital relationships and contribute to part of my practice in marital 2 psychodynantic understanding of the couple, T have been most influenced therapy. These links are considered in greater detail later in this chapter. j by other therapists who have made the transition from individual to conjoint ‘work but have not abandoned an appreciation of their psychoanalytic roots feg., Dicks, 1967; Framo, 1982; Skynner, 1976; Whitaker, see Neill & SYSTEMS THEORY AND PSYCHOANALYTIC Knicker, 1982), and by work from the Institute of Marital Studies in London MARITAL THERAPY | Bannister & Pincus, 1965; Pincus & Dare, 1978) According to general systems theory (€.g., Katz & Kabn, 1966: von Having said how important itis to integrate the psychoanalytic understanding Bertalanffy, 1950), the sules that govern the individual separate functioning of individual prychological developmient, personality stretare, and ebjoct16 pane choice. | must also esuphasize that there is actually only a relatively stall body of literature om the application of systems thinking to the marital system. Tor esample, in Puolino and McCrady’s (1975) comprehensive volume on marriage and marital therapy. Steinglass (1978) useful susnmary of sone principles of the application of he systems approach, to miattiage, but he draws on very little work actually addressed to the marital dyad as opposed to the general literature of the family ay a syvtenn (within the general systems theory definition). Olson's (1975) and Gurman’s (1978) Classifications of contemporary marital therapies place systems therapy along side psychoanalytic and behavioral approaches as one uf the three major groups, yet identify relatively few published discussions that focus on Ue ‘marriage using systems theory thinking. From the point of view of this chapter, systems theory, as it is usually mobilized in the theory of funily therapy, has implications both for the psyeitoanalytic model of marriage and for psychoanalytic marital therapy Fors an extremely Marriage as a Transactional, Interpersonal Structure A ystems orientation ersphasizes the need to see the couple as a reference point in its own right and mot simply as an artangement of two separate and wpatholegies. What goes on in the marriage, hes or nol both partners are overtly implicated, must be considered a fiough it were an expression of aspects of each partner, Each individual is assuined and expected to have an investment in the attitudes. sctivitis, expeclations, and symptomatic qualities of the partnes, rexardless of what their conscious wishes and beliefs would suggest to the contrary. Each individual is also assumed and expected to engage in behaviors, to take up conscious and unconscious attitudes, and to modulate affects ane the express of sexual fn ways that diminish the direction and amplitude of change in their partner ard in themselves. That is to say, homeostatic negative feedback mechanisms are coustantly brought into play. The couple will be likely, therefore, to have long-term features, demonstrating the stabilizing aspecis of these mechanisms. Systems observers, frum Haley (1963) onward, have uoted the balance of complementarity and symmetry ina given marriage, and at one time it looked as if i would indeed prexe possible to establish 13” of maztiage (Goodrich, 1968}. Although such descriptions of 1s of relationships from moment to moment are useful, they carely seem relevant to an understanding of the sustained, persistent qualities of a matital relationship. Hierarchy and Control. 7. o« Minuchin (1974) has clearly demonstrated and articulated the importance of the hierarchy of power and control in the systemic understanding of the structure of a marriage that is in the parenting phase, Stanton (1981), in 2: ISYCHONNALYTHC MIMRTAL THERAPY 7 an illuminating chapter on the applications of techniques that is akia to Minuchin's approach, makes it couples without jerarchy and conttol are nol given a central role. In" my experience from cultures i which the husband is customarily given rights t his wife carely come forward for marital therapy, 1 have wotked with couples in which one partner comes from a Hindu or Muslin culture. In those cultures, the traditional pattem of marriage is one of highly differentiated marital roles, with a balance of power and control residing in the husband. This cultural tradition is incorporated in the gender identity of the members of the culture, although it is opposed by values sequited in adulthood, and is often in conflict with the expectations of the spouse of North European cuttme, Psychoanalytic marital therapy seeks to ore canfliets deriving fom the cultusal differences rather than fo establish the hierarchy children, concepis of Boundaries which are also so characteristic of the theoretical, structural stemic therapists {e.g., Minuchin, 197-4), and whose properties wal farnily therapy, are as mily therapy, whether or Boundary iss are 50 actively sought and addressed in struclu nauch a feature of marital therapy as of whole not children ate present in the family. fn marital therapy, however, the crucial boundaries that must be the concem of the therapist are those Ddefween the couple and the ouisde world, anid the couple and theit fumilies of origin, as much ay those between thé couple and the children of the The central point here is #hat understanding features of the marriage fiom a systems point of view addresses issucs of importance to the pswchoanalytic) marital therapist that are not zeadily describable in psychoanalytic language, {not be so. The psychoanalytic Mhezapist needs to be aware of these muse the customary systems langeage to deseribe them, and ean seck to understand the implications for tte constraints and qualities of these feaiuces for the internal psychological functioning of the marital partners Ai the sime time, the therapist needs to be concerned with the ways in which such systemic processes will be adapted to personality structures derived from long-standing expectations and attitudes deriving from object- ated experiences. and nee THE DISTINCTION BETWEEN PSYCHOTHERAPY AND PSYCHOANALYSIS, Marital therapy can be a Tegitimate forms of paychoenalstic psychotherapy and to describe it {wish to draw a general distinction between psychotherapy id psychoanalysis. 1 propose that psychotherapy can be regarded as anDp psychotherapist’s skills. But the recucst for snsight, as an end in itself, is {not the same as a request for symptomatic or chavactezological change. A central precept in the psychoanalytic theory of treatment is that therapeutic 18 c.oane activity spanning a broad spectrum that con merge with “pure” pyychounalysis asa clinical activity. As Paolino (1978) has emphasized. mychounalysis is a word denoling a body of theory as well as a clinical practice. Ir my practice, however, [make a distinction between psychotherapy and psychoanalysis by both the initial and continuing rrotivation that brings the patient into treatment, In general, the more an individual preseats wath Specific eymptoms from which relief is ungently requested, as the fist and persisting motivation for therapy, te more that therapy will tend to be on. the psychotherapy cd of the spechum. The more the individual presents with a conscions of latent wish to enderstand himself ur herself, the mete the process will resemble “pore” py¥ehoanalysis. Thuis distinetion is never ahicte, However urgent their ned for symptomatic rei. few pope ae completely uninterested in the development and workings of theit own ming. Sinilaly, no one who ostensibly seeks enlightenment about himself or hetself fa “training analysis") does not also harhor some wish to change important and even fundamental agpects of the self. Harm not aware of any © general acceptance of this distinctien, but it js important in my practice. 1 thik thatthe request for enighienient fa legate ons for he atent= client (the analysand) to make and an honotable one for a practitioner to attend to, and | believe it t6 he highly henefieial in the developnen uf a change im adults (but not in young children) is in some way mediated insight. It is also clear thar, om the one hand, mnch else gues on wi significance for change within psychoanalysis, a Haley (1963) has written i Tabout so claquently, and that, om the offer hand, 2s Sandier et al. (1972) | have emphasized, there ate limitations to the role af msight in peyehnanalysis Its my experience that itis rare for a psychotherapy that benefits the patient [ocre%i! inmy practice, “the patient” isa seman phase to incline an individual. oer ie Ta couple, a family, or even a stranger group) not le include or tesult in - Some changes in the subject's self-understanding. 1 think this is tme for alt pevehological therapies, even those in which theve is no eanseions intention om the part ef the therapist to make interpretations or communicate insight For example. the experience of abvaining «lief from a phobic state by an expomure program of graded desensitization or by implosion communicates 0 Va certain view as to the nature of the person undergoing the tneatment and results in a change in the subject's se!Eunderstanding. My obyervations have bbeen that such behavioral treatments may also result in some changes that, as.a psychoanalyst, I would describe as “structural “The importance of distinguishing mativations for iosight and motivations for symptomatic relicf Ties in the implications for activity on the part of the paychoanalvst. In a psychotherapy. the psychoanalyst will use the psycho- snamic formulation about the nature of the profslem to devise a therapeutic strategy. The implementation of the strategy would not preclude the proffering 2. PSYCHONNAOTC MARITAL THERAPY 19 of interptetations with #he aim of developing “insight.” At the same time. and pethaps principally, the therapist will give support, advice, ar stratecte directives based on the psychodynamic hypothesis whereby the individuals and their interpersonal relationship patterns are tbe understood, and whose nature and timing will be determined by the analyst's perceptions of the curent state of the transference, A strong positive transference, for example, may provide an opportunity to suggest to the patient the making of some sigtuficant life changes, in the expectation that “he transference will allow the patient to fect safe about undertaking the activity. The changes advised will have been determined by the therapist's notion tha: the changes are likely to be within the patient's current capacity but will extend the range ambivalent transference can be taken advantage of to make a statement that may ave the form of an intespretation but tha: is strategically devised to have a paradoxical intent. For example, the “interpretation” may contain a prediction that the patient cannot do what is said to be intensely sought for, with a psychodynamic explanation as fo why that is he case. Ina psychoanalysis, by contrast, the therapist is not nearly’ so constrained by the presstite 1o achieve change’ into devising motivating interventions The process ts a collaborative explarstion of the meaning and development of the patient's inner life and extemal relationship experiences. In an analest the therapist is always attempting to help the patient enlarge his or het awareness of the potential for achievements, relationships, and recreation, but the schicle is the increasingly accurate perception of what ig inside the self of the person. Asa rule, paticnts seen as couples are rarely motivated by a simple wish to enlarge their personal self-awareness though such couples are encountered occasionally, Mostly, couples seck ungent relief fom the symptomatic state ‘of one partier, or they snffer fiom overt maria’ distress. For this reason communication of insight-promoting interpretatons are given, not sim for the understanding they contain, but for stategic, change-provoking seasons (Gutman, 1951) The therapy is psychoanalytic in that the under standing of the individuals is psychoanalytically informed, and raany af the interventions ate couched in terms that make thers resemble interpretation ‘That is, the interventions contain information that overtly refets to processes both within and between the individuals, and thatis assumed by the therapist to reflect an accurate understanding of these individual and dyadic pracesscs. of actives and aublimations of the patient, In Tike ranner, @ tongyg Vie INDICATIONS FOR PSYCHOANALYTIC MARITAL THERAPY Life-Cycle Considerations Ifthe interventive style of a particular piece of pryshoanalytic paychatherapy is determined by the major motivation for therapy, then considerations of20 cose who is to be engaged in the therapeutic sessions ie determined by the life- Je location of he person or persons presenting with difficulties or requests for help. suggested an approach to the problem of determining idus! or a conjoint therapy was indicated, She ideatified the optus using cate, smught around the world by pscbeana ie training institutes, asa young adult, separated fiom and living telatively independently of the fanily of origin, whose presenting problents could be understoud to have prevented the development of tice into a family of creation, By the contrary argument, the more a poteutial paticit is closely involved in, and by implication “heuratically” snasled intu, a fauuily of ics origin or a faguily of creation, the less psychoanalysis ig predicted fo take a Go straightforwaid course (and hence to be a “suitable training case"). By the paradigm that Martin suggests, family therapy is indicated for problems presenting in people, notably children and adolescents, who are living with and elosely absorbed in their families of origin, Individual therapy is indicated for young adults who have psychologically separated from their families of origin sufficiently to live independently, but who have not yet settled into Jong-tern cohab ting love relationships. u By this unalsis, marital therapy is seusibly conteinplated in all cases ‘when the presenting problem is located within somicone whe isin a partnership {hat has not yet produced children. Fora married ar cohabiting couple who ve childien, the indication for maritat therapy must be determined by & the estent to which the children are or are not actively and persistently drawn into the marital interactions. Clearly, no therapist is likely to believe that any child czn be exempted froin some psychological participation in his or her parents’ marital arrangement, and so the juginent has fo do with the degree of invalverent, My rule of thumb has to do with symptomatology. {Ifa child is symptomatic, then the therapist should assume that a whole | funily investigaticn is esvential, however niach the parents proclaim a mutital * problem, Marilal therapy should not be prescribed on account ofthe therapists observations of marital disharmony when the presenting problem is ascribed to a child of the fumily. Marital cherapy may well be indicated when a couple who have childeen complain vigorously of their relationship problems, Marital Therapy with Childloss Couples ‘The most likely indication for marital therapy is for those couples (married - ‘or not) who have not yet had children. This is, indoed, the most common occasion for mantal therapy in my practice. These couples present in two wats, The first node of presentation is that the parters come jointly, asking for help because of marital tensions and rows, ‘The question whether to break up or stay together and have childien is apparent immediately or rapidly. In family life-cycle terms, the couple is trying to decide whether to enter the next phase, that i, to become a trce-person, parenting structure. 2 PSYCHORNALYEIC MARITAL THERAPY a ‘The alternative is to separate and start again in onder to reach, eventually, the parenting phase with another partner. ‘The second mode of presentation of childless couples i that they come via one partner asking for individual therapy (eithet, by uy definition, for psychotherapy or psychoanalysis}. The initially presenting partnes may have a sanely of symptoms tanging from persisting depressions ot atisictics toa lack of success and satisfaction im wotk. The partner leading the request for help may be in professional training thal carries with ita eadition of receiving Personal therapy, that is, in a helping profession that uses counseling of psychotherapeutic skills, However the refertal is organized, whether it be a1 overt sequest for symptomatic relief or a training experience in which insight is sought openly, 1 try, fist, to see the partners together. Even with diverse requests, located in the individual, its often quite explicit that the sue between the couple iy whether to have children. Fur example, when fone partner fo @ mactiage requests an analysis fox training purposes fas patt of an institutional requirement or ouit of persunal interest), there is often a discussion about whether their joint financial zesources should be used on having a baby or for une of them to have an analysis. This comes out, usually in a shaightforward way, when the thetupist asks direct questions about their plans to bave children, ‘To my mind, there is an ethical isue in not seeing the couple when one partner requests an analysis unless itis fairly obvious that the decision not to have children has been very fully worked out by the couple. There is also aut efitical dilemuna for me in taking info analysis ou individual who is mazried or in a long-term partnership, Knowing, a8 do, that a pychoanalysis is a potentially powerful intrusion into married lite, For this reason, most of the manticd. people T have in analysis have had a previous marital therapy. In summary, thers are three indications for psychoanalytic mcital Uierapy ina couple who have not yet liad offspring: «aj when both members of a partnership are asking for an understanding ofthe nature of their relationship and of the problems that trouble them withit it; (b) when one member af the marriage is secking “insight” therapy, but there is not good evidence that the implications for his or her marriage have becn seriously worked though: and {c} when one member af 2 partnership lias syinptoms for which psychoanalytic psychotherapy is indicated; that is, there are symptoms for which there is neither an uegent elamos for telief noe an obviously efficacious but as yet unpreseribed safe medication, or a behavioral technique that is Bkely to be effective. Marital Therapy with Couples with Children The main indications for pyychoanalytic psychotherapy in a couple with children ‘is fos serious marital problemas, especially with people who come from a miliew in which a reflective evaluation of personal relationships and selFunderstanding are expected and appreciated. ‘The therapist has to be22 pane dren in the ma cither sure that there are no significant invohemonts of ch problem, as demonstrated by their sympiomatic states. fone or both members of such couples are also members a culture in which individual psechoanalytic psychotherapy is the custon resort for all personal and relationship problems, and for whora therap without accompanying offers of insight development from the therapist would be alien ane umacceptable THE COURSE OF PSYCHOANALYTIC MARITAL THERAPY ‘The Setting and Subject Matter of Therapy THE STRUCTURAL PROBLEM OF MARITAL THERAPY In marital therapy. a consistent difficulty that is an inevitable concomitant of a three-person group has to do with the danger of alliance formations and taking sides. So strong is the problem of asymmetry—a couple consists ofa man and a woman, and the therapist has tn he either male or fewiale— that it may be an indication for co therapy. ‘The relative tive nature of psychoanalytic marital therapy is itself commpatihle with a. co therapy mode, provided the two therarists have a basic aligrmet theoretical orientation and in their tecknique (Rice, Fey, & Kens I find co-therapy congenial in marital therapy (for reasons of th countertransference isms raised in a subsequent section), bul t alse think that there ate many problems inherent in working out the co-therapy re lationship. and 20, in practice, f rarely engage in co-therapy except with my wile as therapeutic partner In the absence of co-therapy as a colution to the inherent structaral problem of marital therapy, the therapist must exercine constant surveillance of all the practices of the therapy in oder to counteract the attendant risks The hour arranged fr the therapetic meetings should be aoranged wth strict regard for equalizing the importance of the activities of both partners. always ty to negotiate with both members of the marriage, asking them to use hyo telephone © if possible, in scheduling ont initial session In the therapy room. the chairs shoud he located so that there is no apparent favoring of one partner, and social graces should be deployed symmetrically in, for example, deferring politely on the threshold, For patients seen in private practice, | find it important to leave the bill in a neutral spot in the room so that the comple can decide who picks it up. rather than hand it to one or the other of them. It is crucial tc be symmetrical in body orientation, tone of voice, balance of affective responsiveness, and s0 on. At every session, and many times in each session, the therapist has to review the interaction pattern between therapist and couple lo identify any iishalance, hth as a 2, PSYCHOANALYTIC MARITAL THERAPY 2B ce of information about the current state ef the couple and to avoid a bias in the therapeutic relationship (see Gurman [1981] for further discusston of establishing early therapeutic alliances in marital therapy}, As to the frequency of therapy a week or once a fortnight fs the most customary. Each session Ja lytic hour fe, 50 minutes). A longer time is necessary for some enuples in crisis, but a shexter tine is too brief to establish a theme and sce it through to a sense of having done a clear piece of work RLY STAGE OF MARITAL THERAPY ‘The comple is us left to begin the session, commonly starting of a conspicuons disagreement in the time si P mtact or, iFone or the other is symptomatic and the thereby, a description of symptoms oceurting in the in qu beginning of the therapy, the couple can be “trained” to talk to each other, for the most part, rather than to the therapist, both by being told so te de and by the therapist's ooking toward the sileni, listening member of the couple when one spouse is talking, By this means, the therapist can observe the couple’s interaction and is less often put on the spot by attempts cn the part of one or the other syne lo gaint alliance with the theaapst. As the couple get under way in the session, the thernpist may have to re'kiess the balance of utterances pouring from one spouse by urging the speak member of the couple to get a response from the silent sponse to obtain symmetry is a consistont feature and zn ex need for a ditective clement in marital therapy. The therapist has to avoid being treated as a witess to grievance, or worte, as a judge in the marilal disagreements, The attempt by a spouse to gain the therapist as an ally hay to be countered by: openly disavewing any intention of taking sides and by confronting the couple with each attempt to get the therapist in alliance against a spouse, mple of the constant LATER STAG (OF MARITAL THERAPY Later in therapy, an exploration of childhood experiences of one or the other spouse in being a confidant, a helpless obicrer, or a scapegoat of a parent in interparental marital disputes may be undertaken and made the subject of reconsinuctive interpretations. However, the therapist rr attention t6 Ensuring a balance between the exsloration of the ori des and roles within the marriage out of the spaxses individual child experiences and attending to the hete-and-now interactions. Reconstruction af childhood origins of the macriage is important litle way into the thentpy in order to take the heat out of a persisting quanelsome episode and invite some sympathy an the part of each spouse for the other. A formal genageam is wseful for this purpose. Part of the insight that will ustally be evolved i the therapy is some understanding of the pats of their childhond thata cake 2. SYCHOANADTIC HARITAL THERAPY 25 the marriage, both insofar as there are aspects of childhood that injunetions, or interpretations, or by straightforward task setting. ‘That is, vein compelled to repeat in the manniage and paris that they attempt there is no “ideal” interpretation as the preferted mode of intervention that ip tleanai aveaeanise is “pore” and, therefore, right. The task of the therapist is to help the couple of any discussion about current ennflicts, or in th alter patterns in their marriage that they dislike aud that prevent then amination of past influences on the present, the therapist ean be Wentifying achieving current satisfactions, and of taking advantage of individual life- processes between the couple. The say into process is by noting, frst, the vele possibilities. Interpretation may give the couple the freedom they seek affective tone of both partners in an inteichange, seeing hhow it moves in to be more fully together or to separate (if that seems right), but so may ihe course of discussion, and identifying repetitive sequences. The couple's tiger 3 sraightonyd or paradoxical tak (see Gunman (1982) fora discussion jendencies tu get into pattesns (e.g., of attack and defensiveness, defeatism of the use of paradoxical interventions in psychdynamic marital therapy). wer ant jy aie aucogt are observed. Once wet, We therapit AA tash or patadosical prescription ean be given because i may be @ mote has the option of pinting out the sequence; of amplifying the pattesn by ful communication of the psychodynuamies of the couple than an explicit encouraging more open expression of the affects, of urging one member of ; ynner, 1981) To tell s coupe te techs wekebal haiti the couple to help the partner to break the pattern by noticing what is have “happy” dreams, which, of course, contain seenes of graceful swooping happening, of exploring what reminiscence of family of origin is represented movements in the warme sun and sea, may be as good a way to get then in the sequonces, or of encouraging exploration of the personal psychdy namics in a mood for mutoal sue as explicit sexual therapy or an of the pattern. These options show that directive and interpretative possibilities interpretation of the origins of their sexual inhibitions. The dynamic meaning reside in roost of the material, and the therapist, at cach poiat in the session of each of these interve the same. The form is chosen according and in the overall span of the therapy, must make decisions about where to the couple’s culhal and intelectual style, the inventiveness and preference the balance should lic, in uxging more interaction, encouraging mutual ‘of the therapist, but, above all, what seems ta be liberating for the couple rellectiveness, forcisly opposing compulsively repeated sequeticess, or in~ atthe monica terpreting individual conflicts and patterns of attitudes. The fssues of Transference and Countertransference "| The Balance of Digctive and tntepretative Interventions "Del Ashas been made clear here and elsewhere (Gunman, 1978, 1981}, however aanaes much the therapist uses a psychoanalytic understanding of the individuals of the marriage and their interaction, psychoanalytic marital therapy cannot In psychoanalstic psychotherapy of the individual, the dyadic natute of the be a5 exclusively interpretive as a psychoanalysis seems to be. The sepatitive ruceting and the cclitive neediness of the patient ot client cnbances the sequences between the spouses are likely to be se foreeful and compelling development of trinsferences of a parcnt-child sort. Fur this veason, in the that interpretation alone will ncither imtervupt them in fall ight not elisninate psychoanalytic literature the evolution of technique has emphasized working them. Within the session, the therapist may have to block thera by open with archaic mfantile tcansferences, seemingly revealing aspects ofthe ea piohibition while encouraging the couple to undertake their own control, phases of psychological life, The setting of couples therapy 1s, by it thre thithin the session, of unproductive patterns of nagging and intimidation, person nature and by the presence of the couple with theit actual or potential on the one hand, (x collusive, ansicty-reducing “assistance,” on the other sexual life, much kely to give rise to oodipal transferences, with all For patticulasly rigid and intensely conBictua! aspects of married life, pushing the jsucs af allimees, coalitions, rivalries and jealousies, boundary fostnations, the couple o discus: solutions to out-of session. areas of conflict ov symptomatic and triangulation that that slage impiies. But it must be noted that although activities may be necessary, and it is essential to return to these areas in ihe couple as individuals may, in thetr neediness, have potential child | pttotheir agreements. Failure subsequent sessions to see if the couple have to keep to agreed-cn salutions is a rich source of material for enlight pist (und this certainly occurs}, the major inherent i¢ therapist a3 an intrudiug child or adolescent, as a rival transference is to {the couple as to their unnctting commitment to painful pattems that, at sib, oF as a parect who will resext the oedipal child's closers to the other * \ conscious level, they would like to avoid and is therefore a way into and a parent. These tansferences need to be observed (and produce complea val for further exploration of the unconscious origins of marital disharmony <3), bl their interpretation is rarely therapeutically indicated. “There are no fixed rules about whether a patter ean best he handled They are best managed by ensuring thal the spouses interact with each other by the therapist by 1 aud exploration; by reconstructive interventions and are pushed into having as symmetrical a relationship as possi about interactions or personal dy i arnies; by prescriptive ur prohibitive directives, the therapist. le with26 pane Nevertheless, the concept of transference, althongh siictly concerned with the relationship of patient fo therapit, is relevant to phenomena occurring between the spouses. Indeed, Gutmar (1981) has noted that the husband wife transferences are the central transferences in, marital therapy tequiting the therapist's actixe attention and intzwvention. The relationship between a couple always contains elements of child to parent (especially to mother) features derived from the infaney and childhocd of the partners in their Exmilies of origin. In this sense, 9 great deal of “transference” intezpretation goes on in psychoanalytic marital therapy as the therapist unfolds the infantile Origins of qualities of married life CCOUNTERTRANSFERENCE, Most of the manuevers to gain a syrrmetrical relationship described thus far deal with the complex countertransferences that evolve in. marital therapy Inevitably the therapist, especially if tained in individual therapy. will be put in the position of the helping adult to the needy client or patient. This position is comfortable and gratifying. To be drawn into the positian of intruding child or parent, or of disruptive adolescent, is hewildering and can lead to poor technique. Commonly, when the therapists viewed positively, he or she wil find that there isa sort of “grandparent” transference, whereby the couple attempt to use the therapist (cerhaps appropriately} to goin Freedom from superego prohibitions and ideals This complex web of cuuntertransferences iy compounded by what is the most spocific and uncomfortable aspect of marital therapy for the therapist, namely, the secursing theme of the thrsat of divorce (Gurman, 1983, 1985) Few marital therapies, whether initiated for overt cuartal disharmony: or on account of the symptoms of one spore, will avoid coming up against the possibility of separation, Indeed, mos. couples seem to need to get to the point of realizing that divorce is possible for them to make significant movement in their relationship. This produces very painfal and disequilibrating coun tertransferences in therapists, who so often have, fran) their backgrounds, persisting parentified child selfexpectations. To oversee a couple who are likely to partis, for many therapists, 2 disabling reenactment of vivid childhood fears. It is one reason why personal pychotherapy, in which counterttans- ferences from current therapeutic work are examined, is such a valued concomitant of training in marital theraps. Similarly, regular supervision, inchiding review of video or audio tapes af sessions, is also valuable, CONCLUSION [As described in this chapter, psychoanalytic marital therapy is oot a pase form. The main stress lies in the concepfnal framework wherehy individual psychodynamies are postulated as strvcturing the marital relationship by tunconscious family-oForigin motivations of transference-like qualities. These 2. PSYCHOANALYTIC MARTAL THEREPY 7 processes can by interpreted, and thus clements and variations of paychoanalytic poychotherapeutic techniques are employed. The major part of the therapy, like all marital therapies, is dominated by the need to gain a symmetrical relationship with the couple. ‘This is all the more important the more the therapist tends to passivity, Because all activities on the pact of the therapist have meaning, interpretations can be expressed explicitly as verbal staternents communicating the therapist's understanding of the couple to the couple; for the meaning can he communicated analogically by fasks, injunctions, ar enactments by the therapist (expressing rage, pain, hopefilness, restlessness, bewilderment, or whatever). The actual pattern of therapeutic activities will, be altered by the phase of a session or therapy. Preexisting cultural and intellectual tendencies inthe couple, the pressure of ssmptoms and intercurrent, life events, will also affect the therapist's tye; while the ever-present possibility ‘of separation. divorce, or other majer life charges will also have irmportant technical implications REFERENCES Ronwiser, K., & Pines, L (19651. Shamed phomtonr in mero problems. They in four fers ‘wlaisbip Lond Taito Iie of Hamas Relations ‘Blanek, R. 8 Blanch C. (L958). Marmage and penoneldovlamant, New York Columbia Univer Press Dare, CW). Prysheonayts thors of the peronaliy. fa F. Franella), Penonality: Theory, Imesturerant and remorh pp M86) Lonlon: Methven Dre. © T9851 Poychanabti terse of deslopmant. in M, Rutter & L. Hoe ‘hj, Child ad dhloent pci: Mom apache ps 204-215) One, Eg: Blk Selenite Diets HEV. 17). Mart tensions. Landon: Roedge and Regan Pot Fania, J L_ 1982), Explorations se marta! ond family thay. New Vor. Springer, rend. 8 (1915) The vtec, Stndod etkion, 3, 16 Gondbich W958) “Tsards 2 lxanomy ef mareage. Inf Maynor (EA), Mader pehnsneti ‘New York Beste Book Gunman. A'S. 1579, Contemporary muita thespics A eins sve compare anals of ge hosraltic,hehavionl sta Ry spremcher bE]. Puokine B.S. McCoy Monge and manta! thn ip 455-386) New York Frionee Moceh. Gorman ACS "TERT tegen marta herp Tod the dsshnment af ntperona appesceh Im S. Becman ed, Ror fbr them. New York Gillon! Pre Gorman, A. 8.1982) Using pada i pgehetsnamss san thers. Aperan Jnana of Fon “Tree. ih, 7274 Gorman, A'S. 1985) The herp: prema experince in eking it dvoring couples Amerie Teurnatf Fame Trempy. 11, 75, (Gorman, AS. (1098) The terapit rafe n cpl’ dein verse. amily They Neier, pes Haley. | 1063). Straten of pevchorbrepy: New Yorks Crane & Staton, Kates BF, a2 Ka, RL. 985) Caton charlie of pn utr hn Phe ei pelo of gavin is 1429) Now York Wiley. Morin F (1077) Same iphetinns fom the theo and rratice of fail then fo individ “Bersp land vice ses Bit Juma of Moye! Pusch 50, 59-828 pate Minuchin, $0974, Pasi sa foils dea. Carbide, MA’ asad Ui R., & Kniden, D. P (Ede). (1982) Prom peut te watom, The eva ofan Wau Sew Ya. Cui Pow i (bun, BLU), Mia sn ayy A tal wee nA. Cuan & DG. Rice Marital Therapy: A Social {E) Coupde nofts po 1202) New Ye sor are , Paolino, T. J. (L978). lnteduetion: Some bone eoncept of porcaualte gxychotherap. In T. J. Learning—Cognitive Perspective Folin & B. §. MeCiad (Es), Massage and nit thapy. New York Brann Maze zs Poctina, Tf & MeCtdy BS. c876). Mariage ond ‘ew York Brunner sz | NEIL 8. JACOBSON Pincus, Le, & Date, ©. ‘Secrets in the fart. Low and Faber AMY HOLTZWORTH-MUNROE Rie, BG, Fe, WF & Repes, J. (1972, heap experience snd iy” a eel co hesps For Baca, 12 oi yw (195. The anaes Gaon oth nas comsmeniaton tee patent fmineton si aly gp 6-8). Loom Haga es Sandi Fs Daze, & Haide, A ( oni Skyanes, A.C. R (1976) One flak Separate pens, Lond Cota Skynet A. C. Re JOS). An open sens, geupeanytcappoml fry Heaps. fa AS Girma & B. P Keven Ek) Hom therapy. Non Yrk Benet Stanton, MCB. 158), Marley fat start sunege vena tn GP Sle Ul) The fadbook of ravage and manta tay pp. 303-394, New Yo Spee Ste F108 Thc of manage fm» tong tay pepe 10 J | aps! Tibet cs HRovcge Proline & 8 § Meceay (Ul), Adeigs ond mural fap, Nem Va Besa eel L Bz aT on Brandy, L (L950) Te theo The approach to marital therapy described in tif chapter hes evolved froin ceaily vetsions of what has come to be known as behavioral mazital therapy (BMT) Whereas behavioral marital therapy fias generally been defined as the application of social leaming and behavior exchange principles te the treatment of marital preblems Jacobson & Margolin, 1979), our version of BMT has evolved to the pomt where a new label seems appropriate. Over the last 10 yeats there has been a distinct tend toward broadening the conceptual and technical domains of BMT to include an analvsis of cognitive and affective variables, this has been true notonly ii our own work (FTaliawauth- * Muritoe & Jacobson, 1985; jacobson, 1983a, 1984, Jacobson, MeDonald, Foete, & Berley, 1955, Wood & Jocabson, 1985) but a in dhe work ot icham & O'Leary, 1983; Margolin, Christensen, & Wen, 1975, Margolin, 1953; Schindler & Veilmer, 198% Revenstorh, 1954; Doherty, 1951; Weiss, 1980, 1984). With the development of a sophisticated clinical literatare on marital therapy from 3 behaviaral perspective, ithas gradually become elzar that treating cauples is moze complicated that early behavioral formulations would have had us believe (Jacobson, 1983a,- 1983b, Jacobson & Margolin, 1979, Liberman, Wheeler, deVisser, Kuchnel, & Kuchnel, 1981; Margolin, 1985; Stuart, 1980). Moseovee, research findings fave tended to point us avay fom parsimony, as ithas become apparent 7-73) that nonmediational models account for relatively litle variance in marital 7" satisfaction (Jacobson & Mouse, 1951). Perhaps what is most important, one inescapable conclusion from the wealth of controlled-outcome research, he patont andthe amas, open ssn in physio and bihay. Siem 8, Rail. Jacobein an Amy Holtzwrth- Manse, Department Pelelag, Univeral of Withington, tl, Wathiaton 2930 [RS.JACORSON AND A, HOLTZWORTH: MUNROE niques are not always effective 984), vioral in BMT is that standard behavioral (acobson, Follette, Revenstorf, Baucom, Mabhveg, & Margolin, x, With thi broadening and expanding ofthe mode, the term behav Y seems to have been eclipsed. Yet the cormitment to empirical investigation, 7 hich has ustil new dstinguished behavioral from mosbehaviona model remains unaltered SOCIAL LEARNING--COGNITIVE (SLC! MODEL, (OF MARITAL DISTRESS Social learning theories have been characterized by a dual emphasis on the social environment and cagnitive-perceplual processes as determinants of behavior (Bandura, 1977). The SLC perspective on marital distress certainly falls within that tradition. First and pethaps foremost is a continued belief in the preeminence of the social envixonment as 2 determinant af maritat satisfaction, Both marital stability and stbjective marital satisfaction are see a: determined by the relative frequency of positive and negative behavior exchanges between spouses (Jacobson & Moore, 1981; Skuse, 1969; Weis, Hops, & Patterson, 1973). This model of marital satisfaction has been described as both functional and hedonistic. Funetionality is implied by the emphasis on the relationship between behaviors emitted by spouses in a marital relationship and the environmental antecedents and consequences. The model is hecanistie because i begis with a sraightorward proposition that benefits received determine whether or no tionships. Indeed, there is abiandant cvidence that nondistressed couples exchange higher fequencies of rewards, and lowes Requencies of punishers than do their distressed counterparts (Birchler, Weis, & Vincent, 1975 Gottman, 1979; Jacobson, Pollete, & MeDonatd, 1982; Margolin, 19 Margolin & Wampold, 1981, Marlanan, 1979, Vineent, Weiss, & Birch 1975; Vincent, Freidman, Nugent, & Messestey, 1979) In addition #0 differing in the amount and degree of exchanged sein- forcement and punishment, distressfd and nondistressed couples can be distinguished by the pailem of reinforcing and punishing exchanges. Dishessed couples are highly reciprocal in their exchanges of negativ behaviors (Goltnian, 71979; Margolin & Wampold, 1951; Schupp, 1984), whew one spouse delivers a punisher to the other, the latter is ver Tikely to eeiprocate, which hegins a chain of escalating coercive interaction (Hahlweg et al Moreover. 4, distressed couples are highly reactive to iramediate relationship events, whether * they are rewarding or punishing (Jacobson et af., 1982), ‘This means that unishers have an immediate impact that is more punishing, and rewards have an immediate impact that is moze rewarding, for distressed than for rnondistrescd couples. Thus, punishing achavior has a particularly deleterious impact on distressed spouses and is highly Tikely to lead to escalation. In contrast, happily marred couples are relnively unlikely to reciprocate pushing Bast behavior (Cottman, 1979). Morcover, couples sho are happy less reactive to immediate events in a relationship (f ‘Thus, these couples exhibit both a r from immediate contingencies that ay 1 to be to cobson et al. I nd a relative independence bsent in couples who are not ge wi? Pannitnbn de ave h aatunrsbienok The expansion of the model has heen primarily in two directions: away from a nonniediational and toward 2 mediational theory; and from a pu finetional model that is basically content fiee to one that attempts te spec’ of the topographical parameters in marital satisfaction-distvese. More alls, movement tonord a mediationa) model is reflected primar’ls in an emphasis on the cognitive and perceptua.procestes associated with marital distress (Baiicom, 1981; Doherty, 1981; Fincham & O'Leary, 195%; Holtaworth Munroe & Jacobson, 1985; Jacobson, McDonald, Follette, & Berley, 1985) and a more recent em both fumetional and dysfunctional matatproeesie (Gottman, 1982, Levensorm & Gottman, 1983}, ‘Cognitive rescarch has focused om the role of causal attributions in producing, maintaining, and exacerbating marital distress The research cited ahove indicates that distrcssed couples tend to attribute their partners’ negative behavior to factors that maximize its negative impact sued al the same time undermine the impact of positive behavior thretigh causal attributions that deny the partner credit for it. This is simply one cxample of an area of research that suggests itis not only the things that spotses do and say that cause ther problems but also how those events are construed and perceived. Attention to the role of affect even newer to the literature, but recent research by Gottman and his associates appears to offer some promising new ditections. For example, Gottman (personal co munication, 1954) recently offered an escape cenditioning model to explain why conflict-avoidant tendencies exist in distressad couples. This model is based on evidence that husbands nranifest strong sympathetic nervars system arousal during conflict exercises and that the duration of intense sympathetic arousal is greater for men than it is for women. Gottman believes that there may be scx differences in the aversiveness of negative affect, {nals the undernousithed skeleton of traitional by has been nourished in teeent years by altempis to craracterie the topography of marital satisfaction and distress. Much of this work has iavehed The specific kinds of deficiencies that exist in distressed relationships. As one cxample, specific deficits in communication skills seem to characterize distressed couples (Gottman, 19791. These deficiencies are especially evident in strategies that distressed couples use for dealing with conflict, @ fact that servesas the rationale for teaching couples confictesolution skills in marital therapy (Gottman, 1979, Jacobson & Mangolin, 1979; Margolin & Wampold, 1981; Schaap, 1954), Moreover, topographical analyses based on spouse reports of behavior in the home show that communication problems are better predictors of daily manital satisfaction than complaints in other areas Jacobson & Moore, 1981). In addition to research elucidating the sole of ARRING-COCNTTIVE REREPECTIVE 3 hasison therole of affect in controlling f, iasforal models aWo: and egoliatio ~ as well as 32 NS-IACORSON AND 4, HOLTZWORTIEMUNEOE nmnunication deficiencies in marital conflict, theoretical speculation exists a a aumnber of arcas. Weiss (1990), for ene ae eee shall deficits sinpainting, providing supportive and understanding communicatios J ieeotiaen of bli ov changes he hay suggested that these sill dite in the area of problem ing, best differentiate distress from nondistressed couples. Jacobson {1983b) has identified traditional 30 role structures as conducive to matital distress and has provided recent evil at ach pans rai negate spose fo nh therapy (Jacobson, Follette, & Pagel, H. z Sn ‘conceptual research and theorizing in the SLC area is occursing in a number of different laburatories all over the world (cf. Hablweg & Jacobson, 1984}. Itappeaty that the relationship between theory and practice is reciprocal rather than unidicectional. Many exainples of theoretical de- velopinents have produced clinical innovations, as the paragraphs belew indicate. However, clinical observations have also been a plentiful source of research findings Gacobsun, 1984), A THEORY OF THERAPEUTIC CHANGE Oar version of matital therapy is one of many that have beet: developed in various clinical research laboratories around the world under the “behavioral rubric. After te piorcering work of Richard B. Stuast and the collaborative effort between Gerald R. Patterson and Robest L, Weiss at the University of Oregon, marital ‘reatment programs from_this perspective have been studied by K, Danicl O'Leary and associates at Stony Brook, Gayla Margolin and Audy Christensen in Los Angeles, John Cottman at the University of Whinois, Donald H. Baucan at the University of Noah Carolina, Kurt Hallegg and Disk Revenstsf at the Max Planch fatty Mucich, Gaul 7 Koumnllamp in lla, Hosand Mutinan i Derser and csewbcge Por the tcmainder of thischapter, we focus on our own version af marital herapy from an SLC pesspective. Despite soine differeaces between the various apptoaches cited above, some overriding technical and conceptual sintilarities make the choice of which model to focus on sormewhat arbitrary. Since > outs is the one with which we are the most familiac, it receives primary attention. : ‘The SLC marital therapist derives treatment strategies from a number of sources. Fle or she is Eamiliar with the conceptual framework discussed in the previous section. During assessment phases, attention tends to focus on behaviors and problems identified in research studies as those that dis- criminate between happy and unhappy couples. In other words, although these areas do not automatically receive attention in marital therapy, they always receive close scrutiny during a marital assessment Based on the rescarch findings that distressed couples actually exchange fewer rewarding and agreater number of punishing behaviors that: nondistressed 3. A SOCIAL EABRING-COGAITIVE ASFECIINE Fe ovale ne inal goal of maria therapy ito inetewe the rato of positive {o negative behavior exchanges, ‘This is aecomplished mainly through focusing 72 ‘9h increasing positive instead of decreasing negative behavior, ‘There & evidence that positive-ahd negtative cvente are ielalively dependent Wills |e Weiss, & Patterson, 1974) and that negative behaviors tend to diminish sulomiatically duting succesful marital therapy, even if they are mol the main focus of therapeutic interventions (Margotin & Weiss, 1978). ‘The j assumption is that if « supportive enirunment can be created for the ae. celeration of positive behaviors, not only will behavior changes occur but | cognitive and affective changes will xsult. Thus, in atteanpting to produce| increases in the exchange of positive behavior, primary attention is focused 2.017 on creating @ context for the occurrence of suck chariges that will also prosllice ignite SiC affective changes thal reinforce the behavior changes Tx short, the SLC approach is hased in part on the assumption thal behavior change is uot only important in its own right but offers a lever for producing cognitive and affective changes. While a dierapist working within this framework might be more inclined than others to insist on Behavior change before being willing to designate a case as successful, this same therapist would not claim success, despite fordamental behavior changes, unless couples report that they ate happier with the relationship. ‘Thus, the eonpliasi on beitvior change ia means to an end as enuch 96 it 'an end A second premise of the SLC approach is that (Ls Ye required i order to maintain a satisfactory intimate telationship overa Tong petiad. No uatter how attracted two people might be te one another initially, and no matter how “legitimate” the basis for attaction, love and altraction ave not etiough to sustain a relationship across the nuytiad of obstacles and husdles that life throws in one's path. Couples need a variety of sills, including the ability to deal constructively with confiiet, provide support and under: | standing to one SuotbeF, aiid perform a variety of instrumental and affectional tasks. ‘The SLC perspective atfempts during the assessnent phase to identify the areas of deficiency and target those for change ducing marital therapy. = ‘The area ol shall deticiency most commonly ctaphasized is that of conflict resolution, When couples enter therapy manifesting dssfurictional strategies for resolving conflict, the therapist usually has no way of knowing whether these performance deficits bear a causal cclationship to other ruatital problems ‘Thus the categorization of these deficiencies us skill deficits is as much for heuristic purposes as itis because the label is believed to be literally true, The advantages of such a categorization are, first, that the reattibution of ‘mavital problems as manifestations of skill deficiencies is generally more benign than the aétribustions made by the spouses themselves in attempting to account for theiz diftculties; and second, it allows the thetapist to focus qqasruning ip problem-solving and confiet-rsolution shill ting mata thetapy. Problem-solving training is 4 very effective therapeutic technique +, sshen usidas part of 8 marital dhesapy regimen, whatever the rationale ori NS IREORGON AND A. 10 ‘ ! 5}, Among oiler things, {Jacabson, 1984, Jacobson & Pollelte, 2965), Among oer things See ee me lies and deal with conflict constructively with 7 anor they ae mac eter able to funtion as thet own sab when conflict arises in the future. In short, Fesides the immediate therapeutic impact of conflict resolution training stratogics, they also serve a prevental a other mor category of itervention that follows from the SLC gnc fomewh inoue an aerpl is overcome reife! esi, which refers to the tendeney for spouses eo long-term " thst enol satily ome another. The causes of reinforcenient Seedon te nameteus Seat Sees abtuclign fe saiseutesporsion be SLC marital theipy help eerie the effets of enforcer erosion by teaching couples to tack telatinshig quality an a das today basis au devote the me and stention to itequized fo maintain high levels of mata satisfaction Stages of Therapy ; : 7 itis antithetical to the SLC perspective to diseuss "stages azul, which imglics an iiogaphic aprrach to asement ad treatment. Conceivably, the stages of therapy could differ Secrecy ae couple ip another fn practice, however, mart thenpy docs ted to follow a wel defied structive that sflects 0 pants clinica research context in which much of he fechnologs was devcloped and the common denominat unite many kinds of marital problems despite divergence in content. STAGE 1 ASSESSMENT ce ‘The SLO marital therapy distinguishes asensnent fom therapy. Unles mipy in a state of act criss. two to three sessions ai ned echoes aesmncnt ane Ssh, During the anced ples are told that no commitrient has heen made by either side Teiwcet together Rater the poe ofthe ulation etermine whether marital therapy isthe optimal plan, and if wot fr the Mhespvorcommandaemtic nutes ofan eg ous tp forone ot hoth spouses), Couples are fartacr told nate eae improvement i relationship during the evaluation, since the focus is on collectin Inert er thin ifenenton ast a eeakorshiy cahacsment The speciic lactis and states sed to conduc an SLC marta assenment inclade a variety of slFtapot questionnaires, both eonjomnt and india spouse intense, daly a fletion by sca, home, and a gstematic evaluation of communication patterns, These techmues ate eli descsbed cleuere Jacobson Ehwnd, & Dalla, 981; Jacobson & Margolin, 1979; Margolin & Jacobson, 1981; Wels & Margolin, 1972) 3-4 SOCIAL LEARNING. COGNITIVE PERSPECTIVE 35 The important point is that many techniques can be used to achieve the same goals, which are to understand what the determinants Gounle’s current dissatisfaction. Assessment is comprchemsive and a the Fame time focused on those arcas of relationship fanctionine the? veceing Eat ular cinphasis within an SLC framework eotamunication and poblens Soins sis both potently and actualy exchanged seinfareing werd punishing havior: patterns of escalation and coercion: areas of inienmant wih efiencys cognitive schema, belch, and atbutioral oceses and repel interactional themes, ‘The process of assessment has several noteworthy features besides the isformation-gathcring function, Fits, the informalion-gathcrngpreccaune Gen bane a therapeutic eect, despite the therpis'sinsience toe contre Since the focus is on relationship strengths a8 wall a problem ste aed sacs every eflort is made to understand the basis fora given couples attachment to each other, the questions asked by ths therapistClien Kactiaas sPomes’ attention te snore positive aspects of the relationship. Civen thet fauples often enter therapy selectively tracking negative aepeck ot thet lationship, this refocusing of attention ean oRen bing salt and yas Paritive fect. Moreover, the experience of being it thetapy and talking te A cits! objective third party about relationship problems can inte Oe ‘tel mutigate feclings of hopelessness and enhanse positive expecrrcin about the relationship. Second, the outcome of this assessment process could be a decision nat fo proceed with mavital therapy. The zecognition of"no therapy” asa rahe opkion #8 Ye important for a marital therapist because ualess sich options are actively explored, the danger exists that couples will be inadectenthe maneuvered into marital therapy even when it is not in the best interests of one: or bath of them (Jacobson, 19833}. For exemple, at the fee ae Jack and Connie entesed mital therapy, Connie he already spent € monte fsengaing fom the eelationship in various ways lachnding me indepenlene actisties with other people, the acceptance of job that reqited more Fayering, and some emotional withdrawal fom fick. Civen Jack's Tong Ritory of ahssical abuse. the discngagement process seemed te the here to be healthy and in need of suppot!. A treatment program oriented tncoad enhanced intimacy would have required a greater degree of rehwrechoene in the relationship than was warranted at present, given sll of the nocnmeee information. ‘Thus it was very important that the option of contivacd aie egngernent be thoroughly considered and explored during the awsesement phase, ofa pasticutar ROUNDTABLE DISCUSSION After the therapist has completed the evaluation, ste or he presents the Souple witha formulation ofthe problems, an assesment of thet senate 364 couple, and a proposed treatment plan. If marital therapy is indicated,36 NSIACOBSON AND A HOUIZWORMENMUNROE both therapist and spouses agree on a time-linnited course of treatment with specitic goals. Quily once this treatment regimen has bees agreed upon can it be said that thesapy has begun. SSNGAHION OF SNCREASES IN POSITIVE BEHAVIOR Very often therapy begins with an emphasis on the generation of positive changes ia the natural environment. These interventions are designed to have short-term but immediate effects on the lationship, to provide couples vith, a shot in the am. Typically, the interventions feature directives from the Hiotapist regarding assignments to be implemented at home, Following implemontatien, the couple return for the subsequent session un the home ‘vor assignment is debricfed. The content of this next session is determined by the outcone of the previous homework assignment. If the wsigament went well, the couple are ready to mose on to the next step. If st went poutly, some Houbleshooting might be necessity in order to remediate whatever difficulties the couple had with the assignment, The primary purpose of these instigative interventions is to produce short-term increases in positive behavior exchanges. Relationship skills designed to extend these benefits over time axe deemphasized. If the therapist were to slup treatment fol owing a successful round of such instigative interventions, the probability of relapse stould be great Jacobson, 1984, Jacobson & Follette, 1985). However, it not completely correet to Say that these interventions are dewid of slill-‘raining components. As we claborate in the following section, couples learn to pay daily attention to the quality af the relationship, identify problem areas when they exist, aud inlervene in effisacious ways to enhance daily marital satisfaction, These skills are offen novel wv couples ssho enter therapy without understanding that celationships require cate and attention in order to succeed. SKILL ACQUISITION ‘The bulk of therapy session time in the typical case is devoted to. the acquisition of new dchaviors generally conceptualized as skills. Most often, the primary focus in this phase is on communication skills, especially problems solving skills. Less offen, but not infrequently, other skills receive prismaty attention, such as parenting or sexual enrichment skills, Dusing the skill- acqusition phase of therapy, the therapist is quite diggstive, the sessions highly stouctuced, and the techaiques largely pryshocducational GENERALIZATION ANE MAINTENANCE Since the ultimate goals of therapy involve changes in the relationship that peisist independently of the therapist, itis important that his or her influence hgins to subside oxce the shills have been acquired. The skills are designed to allow the couple to function independently of the therapist; but in order for couples fo acquite the necessary independence, stategies for generalization and maintenance must be inserted into the treatment program. ‘The influence 2. SOCIAL LERRNING-COGNITIVE PERSPECIIVE 7 of the therapist must fade, couples must assume ineteas , couples must assume inereasing responsibility for managing theit own offs, and the therapy sesion ile! mut ptadally GENE 10 Bethe focus of all important relationship ses. This las phase of herapy atlernpis to foster couples’ independence through a var vc aie lial precedes ee Gea ee © attempt lo fran spouses to become their ovis therapists has been! wonky partially successful, Recent evideuce indicates ft while the sil laught to couples within the SLC framework do extend the benefits of therapy: gxer time, even with this focus the efeets gradually fae foe mary couple Phus we are currently in the process of experimenting with some clinical innovations designed to enhance long-teu outcomes, Included among our! caren efforts are the use of booster sessions beginning 6 months fallowing formal tesination. The underlying principle behand our cuteent eles Is that the former expectation regarding the permanence of our Lcabnent elfcets was naive. Why should a shorter treatiient program result in Bermanent changes in a relationship subjected to numeious influences olher han thexapy? Livan atternpt to cope sith this debunking of our omnapotence ] oC \ } myths, the concept of marital therapy is being gradually altered. Instead of the ilea that thetapy isiatensive, disteie, and has specie terpnaln daie, long-term relationship enhancement may be taore likely with a mode! hat deemphasizes format tenmination. tn this model a telahonship is formed between a couple and a therapist, but itis considered ongoing ven beyond the end of weekly sessions. [Lis expected that couples will rete far periodic £ visits, much like the regular visit ta 2 dentist, a ovexview {0 clinical research settings, where a relatively standardized treaties package is used, therapy consists of 20 sessions, 60 to 90 minutes cach, se week, During the generalization and maintenance phase, sessions oceut less fequently: ‘The sesions themselves tend to be highly stticturer, beginning with ao agends negotiated between the therapist and the couple. After the agenda js set for a given session, homework from the previsus session discussed and debriefed. Most sessions inclade a tain body of “new business, which to some extent falfows fiom the previous week's hontewouk, Sessiots voually end with some sort of recapitalation of the events of the session. and conclude with the prescutation of 2 new homnework assignment, SPECIFIC TECHNIQUES ‘The therapist working within an SLC frainework has a wide assortment of techniques from whieh to select. The assessment process and roundtable session establish the specific goals to which both therapist and couple have committed themselves to work in therapy. From that point on, techniques can be chosen that ase most appropriate fo meeting those goals. The techniques38 NS.SACORON AND A HOU ZWORTHLARUNKOE mmonty used, and they sill be usually appear. N nit plans are tailored to the new uples. and we organize according to techn and! case of presentation. to be discussed in the present section discussed in the order in which the important to keep in mind that tream individual convenience levestheless, it is ds oF Behavior Exchange Techniques Therapy often begins with a few sessions devoted to instigating inereases in the rate af positive behavior exchange. Aer months or years of focusing selectively on the negative events in the relationship, un early ermphasis in therapy on pinpointing and increasing positive behavior car: help overcome this perceptual bias. {n addition, behavior exchange ‘BE} techniques can be effective in countering spouses’ feel ngs of helplessness at the beginning of therapy, which usually manifest thenselves in the expressed! conviction that there is nothing they can do to improve the quality of the relate ‘One version of this conviction is the claim that the other's behavior is solely responsible for how the relationship i going. Anothicr is that feelings of satisfaction and dissatisfaction are inelfable and a cmrelated to the occurrence or nonoccurrunce of specific behaviors. ‘The BE pinpoint the behaviors associated with their own and their partnets subjective Satisfaction and dissatisfaction with the relationship, They also learn f0 1 their own behavior to enhance the quality of the relationship on a day-to= day hasis. When the interventions have the desired effect. not only do they result in short-term increases in marital satisfaction but also a sense af control over the course of the relationship on a day-to-day hasis. ‘The concept that maintaining marital satisfaction requites daily vigilance and atlention is introduced, as is the notion that even small changes in heliavior can have a major impact on marital etisfaction. Although itis not oneommoen for couples to complain about the artificiality of some therapist ean ustally reassie them by insisting that such premeditated attention i pecessary when the goal is to medi long slanding, habitual behavior patterns ‘At the beginning of thezapy, couples are offen 50 entrenched in theie habitual patterns of Blaming one another for the marital problems that the callahorative set necessary for the successful resolution of tong-xanding issues is virtually impossible to establish. Initially. BE does not focus of major areas of conflict, and as a result i Tess demanding and therefore moe likely to pay off during the carly stages of Uherapy. Tasks and assignments are graded in such ay that partners can experience sccess without having to change high-cor! behaviors, Subsequent fo their experience af enhanced satisfaction, they are oRen more eallaborative and therefore willing te take fon some of the demanding tasks that comprise the Behavior exchange relies heavily om homewor for enhancing telationship quality. tn fact, the tl around the previous week's homewors assignmient. celniguues help cuuples atfer stages of therapy assignments as a vehicle sessions revolve he beginning of a 5. SOCIAL CFARNING-COGNTTIVE PERSDECTIVE 39 session is spent debriefing the previous assignment; the middle of the session. is often spent troubleshooting those aspects of the assignment that did not work well; and the latter part of the session is spent presenting a new assignment that emerges in part from the just-completed disctission of the prior assignment, One of the underlying mesiages of BE is that marital therapy is not simply attending a session for an hour a week; indeed. from the beginning couples Jearn that the work at home is much more central to the success of the therapy enterprise than what transpires during the therapy session, ‘This may be one of the cental differences between the SLC perspective and other theoretical frameworks. Other techniques, stich as communication-problem-solving training, vtilize the session ‘self as a vehicle for change; with BE, the vehicle for change is the home environment The BE techniques typically begin with the request that both spouses focus on themselves. This means that each spouse is asked, in a number of different ways, how she ot he is contributing to the problems in the relationship, and what power she or he has to improve its quality hy making behavior changes. The commitment to focusing on oneself is sought during the roundtable discussion and before therapy actually begins. By encouraging hoth spouses to avoid blaming their partners for the paucity of gratification currently existing in the selationsleip, and by insisting on solutions that involve each spouse targeting his or her own behavior for change, the therapist interrupts a long-standing and unproductive pattem involving bath passivity, with each spouse feeling powerless and waiting for the partner to hange first,” and excessive preoccupation with one’s own victimization The sclffocus activates spouses and restructures their efforts to imp: tclationsttip. Once couples have committed themselves to focusing on their ‘own behavior, time is spent teaching them to “pinpoint” be repertoires salutary impact on daily marital satista change directives are then delivered by the therapist, in whic is asked to increase the frequency of some of hese pinpoin and fo observe the impact of these inereas fers daily mar isfaction, which is being continuously recorded. Each spouse. chy this task independently hut simultaneously, and so the behav directives are at once parallel and wnilateral, OF sp. ‘v0 cimensions of this assignment that deviate fron directives(Finsh dot ypotheses) char ‘al interest here Iehavior exchange < initially asked to come sp with their own Bont what will be reinforcing for theit partner, as opposed Io the umal-ricthod of asking each spouse what she or he wants from the ther: eco spouses to change particular b the the?apist delivers rather general instructions to increase the freq of “some” behaviors from a poo! of potential reinforcers. ‘The rationale fe both of these modifications is that they maximize the amount of chnice fe spouse regarding what hehaviors to acccletate, Based on sociat-psv chological reactance theory, choice should decrease the likelihood of resistin to the directive on the part of the giver. More innportant, choice re40 RSISCOISON AND A. HOHZWORTHL MUNROE mote likely that any behavior change that docs occut will be viewed by the recipient as intemally mativated, voluntary, reflective of a poviive attitude and likely to continue (Holtawoith-Munroe & Jacobson, 1985}. Thus, BE isstiuctured, not me.cly to encourage behavior change, butalso to maximize the likelihood that vecurring behavior changes will be supported by cor responding cognitive and perceptual shifts. hore are a number of variants on the basic BE themes. Stuart (1980) asks spouses to bold “eating days,” where each spouse is to act as if she oF he cared for the other and accordingly engage in behaviors designed to be pleasing, Weiss, Ho2s, and Patterson (1973) instruct spouses to hold “love days,” where on cevtaid days, withont announcement to the partner, spouses double o tiple their ates of positive behaviors. Liberman, Wheeler, JeVisser, Kuchiiel, and Kuchnel (1981) teach pinpointing by encostraging their couples to “catch your spouse doing something nice” asan early homework assignment, and foster accelerations in positive behavior using the “perfect marriage j fantasy,” where partners generate ideas for posible ways of improving the relationship. To illustrate our use of BE procedures, we shall use an example where hypothesized reinforcers and punishers are dexived from the Spouse Observation Checklist {SOC}. The SOC is a daily checklist of marital behaviors completed by each partnct once a day. It was originally developed by Paiterson, Weiss, and their associates (Pacterson, 1976} and has been revised by Weiss and Perey (1979). Our version (Jacebson, Follette, & McDonald, 1982; Jacobson & Moore, 1981; Jacobson, Waldion, & Muore, 1990) consists of 409 items Givided into 12 categories of marital behavior (e.g., Companionship, Sex, Houschold Responsibilities}. ‘The task is to report retrospectively over the past 24 houis whether or not 2 particular behavior has occurred and then to rate ils impact (postive, negative, or neural) if occurred, ‘Thus. if each spouse completes the SOC nightly for a week, you have a daily record of the positive, negative, and neuteal events that ovcus. Furthermore, when ‘each spouse is asked to rate the overall marital satisfaction for that day on ~®a S-point Likert Seale, daily frequencies of pasicular types of events ean be correlated with subjective satisfaction to generate hypotheses regarding the potent reinforcers and punishes in the relationship. Couples can be taught to generate hypatheses using the SOC. Later, they are asked to test those hypotheses by inereasing their delivery of some hypothesized reinfozcers and then observing their impact on the partner's marital satisfaction ratings. ‘Again, as we mentioned above, each spouse chooses fram a list of reinforcers the behaviors to deliver; and each spouse generates her ot his hypotheses regarding what behuviois would increase the partuer’s satisfaction cating, without input from the partner. Later, when the couple return for their nex! session, input fom the recipient s added regarding behaviors that she or he would like to see increased. ‘Vhe following isa portion of an early therapy sesion where BE techniques ‘were utilized. The therapist is reviewing a homework assignment from the 2. ASOICIAC LEARNING- COGNITIVE PERSPECTIVE a preceding week, which had involved each spouse's attempting to generate, fiom the partner's SOG, a list of behaviors that appcated to be associated with high martal satisfaction ratings. Later that same week, they were to Increase the frequericy of four or Five af these hypothesized reinforcers Tnsevnst: OK, so weve atl ty pel mt fe sen ving which Bhai, ‘cl afson thong inceased your pote alc wth te mange sre ets Jou teu were cone Tu ke yk which Heme fom the SOC yeu pat oyun ect tehuvon dat might pease your pou, Would yu ie to sar Bebe Lina pty log it God Ht nea hte ate fy of ways you might be bie ease An. + Neth, and ¥ noted dt «ft fen mere unde he Communica stn of br for Tike. “Suse ted toe abot his day" and “We dscusel a prclese = ‘hose wece all mathed with aps sign when thy occarred. Except he eta ot neon has som "Seems lobe mes, il exen sib taling abot something wi eka thee la That sult tif noma about rows Tht’ tu. fal nated tht wy ating ks of commana and Bab wast, That st of tet me Dot he ida’ een uolce ‘wuRARST: thas inpertatsyoaton and yer etn «what leases ane on tay not bea the aie asa lene tet peso, Uhould have ward you shes that twee, Bieyon are ach here SCs, at gd so ge i up now, Oe with coupes wane the tinge ey ely wetop al se oe ‘So, vou think that ara af your selasonship, communication, might be important Uiferent el thats osmal. .. fur al, sour tit is plese yous spouse, su what's ‘important & knowing what will do thay, since it may aus be the sane as what pleases songs LK lyf hen Bb ings Bowe, ba nwo be th ag Rov gh a TMEAAPST OL. ats god sample: An la pit teen hah et oer ay ot tll By 5 ipa ate Ka thle, Att so tat he a oXin fon: EI fh eps oF heey nest THERAPST: Yes, DSR. on bo eth els igs dss when wd 2 tLe let eagle of ae her BSW ean oes thy om Sta. aa ge th my ee vk snd be BS kr hat pom se" Bata Bo nc sons i ny eH a Be = because ‘ sounds like there are some uf thuse. Abo, F want to remind oe talk this week - Ga ‘sane, OK. sot ale how fine wie ese AN, Od yu a our Mr : youta [NS INCOMSON AND A, HOITEWORTH MUNROE so Yeah the fst cole of iy Poe been beter shou iii Spurrier Can gon shee some eample? oo Wall, serv dy wher Igo ome bed her hs. Ke sw Sraenarisr” Gest ing Tn event he et at anew her metber, rt Tanke she waned toll abt Ta we sent ll ‘ : seni "hates lites good sor. hd the things ce eee Now’ sation poe Well, hee DSH had been a Sve ess easy “Tatami” Yow mean ince you sed sing het how er dus ws and kel about the ine call ia Yeah, it’s really trae. Plus [ told him that T liked it, zi Steamer Coes is eal nice sen sn leermeone io yo appre Hei ers 2erinmes spl he seed It ach her tr ge el ea he shen thy ane felng sea shou somhing the oh pounn id How dito make vo fel oor : sen Coed You bnow what afr a gh wih he momen Wy new gl smn ancl me have an anu ler cae she's et abot He Bght otha ent ipren he time reenatne Seite ike by asking ht etal yr ere able Yo prevert argument tow Yeah, Tees 2 ‘The session continued with a focus on Ann and the behaviors she tried 0 increase. "This brief excespt illustrates many facets of BE, slong with many of the clinical issues that generalize to other domains of marital therapy. First the therapist keeps each spouse focusing on herself or hisasell. Second, the emphasis is on increasing positive behavior and tracking positive aspects of the homework assignment, although couples often tend to dwell wn the one day when things did not go well or the ane argument they might have bad, the therapist wants to maintain their focus on the positive aspects of the relationship in order to build on those and modify their biased, negative tracking, ‘Third, the therapist encourages the spouses to be specific so that each person understands exactly what Fchavioss were atternpted and so that Suecersfl experiences can be replicated, Fourth, the therapist normalizes ifferences between spouses in their preferences, thus suggesting that people do not have to be identical in order to he compatible. Fifth. the therapist not only underscores and specifies the sucessful experiences but also attempts, sshenever posible, to state the general principle underlying the specifie experiences. In this case, the therapist poisted out that anew method for dealing with the wife's stormy relationship with her mother may have emerged. "These examples are in no way meant to be a comprehensive list of BE techniques, The BF techniques can te used not only fo generate positive exchanges at the beginaing of therapy but can also he extended to cover major areas of discord. In short, BE nvolves any instigative interventiont where the goal is to generate behavior change between spouses at home. TE is to be distinguished fom the more procesrariented communication= | | |. SOCIAL LEARNING-COONITIVE PERSPECTIVE 43 problem-solving training to be discussed in the next section. For some couples, BE will be a sufficient treatment. Most couples require tactics in addition fo BE, however, because BE does not directly addsess the quality of marital interaction. Thus it provides litle basis for weaning couples from the therapy environment. What it does provide is reltef from the feelings of hopelessness that often pervade the decision to seck marital therapy, practice in pinpointing currently cxisting resources, and the important lesson that relationship quality can he directly affected by charges i relatively Jow-cost behaviors. Most frequently, itis designed to pave the way for the more intensive process-oriented work to be discussed below. Communi jon—Problem-Solving Training Pethaps the one therapeutic technique found universally in marital therapies. regardless of theoretical orientation, is communication: training. Research supports the widespread utilization of such techniques, Distressed couples eshibit a variety of dysfunctional communication patterns (Gottman, 1979) Moreover, there is some evidence that these fzulty communication pattems ‘not ony precede but actually predict subsequent marital distress (Maskman, 1979), Finally. recent studies shove spouse-teported communication to be the content category most highly cortelated with daily marital satisfaction gacobson & Moore, 1981). Thus, even if none of this rescarch proves that commnication deficiencies are causally rlated to subsequent marital distress, they show that both observers and spouses report pervasive deficiency in communication dissatisfaction with communication, or both, in amounts that are ditectly propattional fo the overall functioning of the marriage ‘The distinguishing characteristic between communication training from an SLC perspective and that of other theoretical schools is its use of direct teaching strategies to prominte positive communicetion. With the exception af Guerney’s work ‘see Chapter 6, this volume}, no school of marital therapy other than the SLC relies on behavior rehearsal as a primary component of the training (cl. Jacobson & Margolin, 1975), The SLC method of communication training is complicated and multificetedit involves didactic instructions, practice by the couple, and feedback from the therapist based fon the practice sessions, There is good reason to belicve that such tactics are necessaty to promote the acquisition of new communication skills: Jacabson and Anderson {1980} found that only the complete package produced in- cremienty in communication growth relative lo no tcining: nether instructions alone, instructions and rehearsal without feedback, nor instructions and feedback without rehearsal produced any notable changes in interactional performance ‘This section pays special attention to problem-solving training, which is communication training oriented toward enhancing the ability of matital partners to talk to one another about conflict issues in the relationship,44 NS. JACOBSON AND A, HOMIZWORTEL MUNROE Problem-solving tesiniing (PS) has played a central cole in our model throughout its history, However, before discussing PS, some attention wil} be devoted te other forms of communication taining, patticulaily the teaching of receptive aud expressive skills. These latter areas have been increasingly tmphasized in out own work and have long been 9 maior coniponcnt of both behavioral and other Kinds of mauital therapy (Cauemey, 1977; O'Leary & Turkewitz, 1978 Weiss ef al., 1973) ‘TEACHING RECEPTIVE AND EXPRESSIVE COMMUNICATION SKILLS istotically, behavioral marital therapists taught listening and expressing as preludes to working on problem solving and behavior change. They once played a subordinate role in our work. In recent years, however, we have begun to focus more explicitly on these skill as important targes For therapeutic change in their own right, There are two main reasons for this renewed emphasis. Fizst, our clinical experience told us that the exclusive focus on the more instrumental communication skills taught during PS nas cleatly helping our couples to become better companions, but it was less clear that it was producing geaater emotional closeness and intimacy ‘Jaccbson, 19§3b; Margolin, 1983), Teaching couples to share feelings with one another ina supportive, undersunding way seems to complement nicely the mute cational, cognitive emphasis of PS. Second, we have begun to view communication training as a powerful method for promoting egalitarianism. Since we believe that relationships with unequal power are aimust guaranteed! to promote continued distress to one if not both partners, the movement toward egal itarianism is believed to be inherent in all our work with couples. Therefore, anything that promotes it is clinically usefull to an SLC perspective The techniques themselves are highly derivative and nt in any way unique to our mods]. In fact, in large part they are the same skills emphasized by Gucrney and his associates (this volume) in their relationship enhancement approach. We have also been influenced by Gottman and his associates (Cottman, Markman, Notarius, & Gonso, 1975}, Often, we begin by teaching listening skills thar include paraphrasing, reflecting, and validating, Most of the couples who come to us for therapy do not listen iv ote another carefully, fal to indicate to the other that the later has been heard, or both, We emphasize the value of these skills as ways to promote clarity uf com- munication, but abo their utility in communicating care and concern, Most people in matital -elationships find it gratifying to be understood by thels spouse. The therapist discusses and models nuuverbal micthods as well as the more obvious vebal ways to communicate attentian and interest. Nonverbal emphases include the use of eye contact, expressiveness in the lace, body language, and nodding the head as methods to indicate to the speaking partner that she or he is being tracked. Verbal attention is taught using Cucrney’s (1977) tactic of creating discrete roles of “speaker” aind "listener and having spouses alternate those roles during training, Listeners are not to interrupt speakers; listeners are fo listen carefully while the speaker is talking and then rephrase or restate what the speaker has said. After para | i | | | | ' {5 ASOCIAL EARNING-COCNITIVE MxEPRCHINE 49 phrasing, the listenier asks the speaker whether the paraphrase was accurate If so, the speaker can either elaborate or give up the float so that the listener has an opportunity to become the speaker, if not, the speech is repeated, followed by the paraphrase, with this eyele continuing Until the speaker is satisfied that he or she has been understood Expressive skills are usually taught afier listening skills. Speakers are taught to use “I statements,” which qualify and emphasize the subjective reality of thei: perspective (¢.g,, “As I see it, Mexico is a better choice than Tacoma for a vacation, at least, | think thal T would have # better time in Mexico”). The self-reference technique helps the speaker avoid presenting the perspective as if i were objective reality. Otherwise, the listener may lispute the truthfulness nf the message rather than simply listen and attempt te understand the speaker's perspective. The use of these expressive techniques promotes the idea that one’s experience of the world is subjective, and often what are perceived a5 “facts” in relationships are perceptions that can un derstandably diverge from the perceptivas of anather hunan being, whose subjective experience of the world is bound to be unique, Speakers are alse _shcouraged to identify theis feelings and communicate them to the listene: as part of the “I statement.” By including aflective expressions whenever appropriate, the speaker accomplishes many tasks at once, all of which promote closeness and intimacy. To illustrate the functions of including affective expressions as putt of an “{ statement,” consider Jack and Clara, a couple in therapy. One of theie sepeated argunicnis involved Jack’s menacing, intimidating manner of speech. Whenever he grew frustrated or disagreed with Clara, he began to rabe his voice and point his finger at Clara, At the beginning of therapy, Clata would complain about Jack's behavior by saying, “You shouldn't act that way; Im not going to tolerate violent behavior.” In response to such. shtements, Jack would aise his voice, point his finger at her, and insist, “Tarn not acting violent; am just disigreeing with you to make sute that you understnd my point." Her “I statement” afier some communication, faaining was, “When you raise your vice and point your finger at me, get scared, probably because even though you may not intend violence, it appears menacing and intiraidating to me.” In that one temark, Clara is now disetesing something about herself that is probably going to make her Position more understandable to Jack, that promotes intimacy through self- disclosure, and that is almost inhercotly more likely to induce sympathy than a remark that emphasizes the behavior of the other person. Here, Clara is revealing something faicly intimate about herself, emphasizing that her perception of his behavior is subjective and may actually be an inaccurate reaction given his intentions. Intimate selé-disclosures involving atlective expression’ are muck Tess Likely to lead to continued escalation than staternents dexoid of such expression and that fail to acknowledge the subjective reality Expressive skills training may also include leaming to make constructive reyuests for behavior change. Couples can be taught to request change without the typical overgenezalizations, character assassinations, and irre- { }46 IIS IACOBSON AND A, IOUTZWORTHE MUNROE levancies that so frequently contaminate the behav or change requests a by people in dissatisfying marriages, Instead, the request is specific, oriente toword. increas ng positive rather then decreasing negative hehavior, and takes the form of, “If you would do X [specifically defined’, in situation Y, T would feel Z [sharing feelings and positive consequences)." OF course, even these very concise, polite requests will not always be accepted by & pattner; thus, teaching couples palatable ways of saying no are also inaportant fo this exercise In training couples to use these communication skills, modeling is often used. Spouses sometimes find i easier fo try out these new strategies with a therapist than with the partner, The therapist needs to be active, directive, and persistent in stopping destructive communication while aiding in the acquisition of these new communication skills. Once skills ate practiced effectively in the therapy session, couples are givers homework assignments to practice them at home. It is not suprising that home practice ofien uncovers difficulties that either failed to emerge or had ostensibly n resolved during the therapy sessions. We would almost never ask couples to practice a skill that has not been successfully mastered in the therapy it is often easier to begin with nonconflict issues. We often begin with having couples talk about the time when they return home at the end of a day. Neutra topics allow couples to focus on the process iiself rather than become distracted by the content of am emotionally louded issue, tt should also be pointed out, however, that neutral or make-believe topics without emotional fallout may not provide practice that will generalize to the major conflict areas. Moreover, too much time spent on trivial topics disengagement from the therapy process, particularly for high-conf who need some immediate relief Refore conchuing this section, we ant fo mention ou of communication training. As we said above, comn be a powerful tool for restructuring relationships along egalit Gur hypothesis ss that patterns of dominance and power offen manifest then in the habitual rales that each spouse assumes during everyday conversation. Often, when a thera and encourages cach spouse to assum these new behaviors have poweful ramifications for current patterns of dominance, and in fact often ate completely inconsistent with those pattems. This creates the possibility that the patterns will change, depend ng on how skillful the therapist ig in promoting equal power in other areas of the treatment program. We have recently experimented wits interventions that wed the discussion of the couple's day as a vehicle for both observing and altering patterns of dominance. When spouses reunite al the end of the day to exchange in- formation and cormmmnicate about wat has happened to cach of them in the time they have been apart, two prtterns af dominance tend to emerge -sest application cation training cam onwersation process the dominant mee throu ing" (DT) patiern shows a speaker absorbed in details of his or her day, with little apparent interest in eliciting information from the partner's day, When the listening does bring up an event front his ar her day, the speaker either dex attention or quickly returns to his or her own day. The listener reinfo this self preoccupation by seldom offering infotmation shout Iie ot her daw and by encouraging the speaker to elaborate. The expreisions of the undivided attention, and the requests for elaboration all serve to pr for the speaker a gicen light to debrief thoroughly all events that have transpired in his or her day, It is as if everything that happened to the speaker is important and worth recounting én detail, while both spouses seem 19 agtec that the events in the Tistener’s day were trivial, Hushands are more commonly speakers in this patte ‘The second dosninance pattern that manifests itelf in discussions regarding ccvonts of the day if the “dominant listener" (DL) pattem, Here, the listene dominates the conversation by a lack of interest in what the other ss saying and by coucorsitant witholding of any information. The listener is disensaged slic or he leans away’ from the speaker, daes not lock diseethy at the speaker, and appears bored and uninterested in the conversation. ‘The speaker falke ahout a variety of topics, but there is the sense that the speaker could be talking to himself or herself, in this pattern, wives are usually the speckers During training in receptive and expressive commmnication skills, the therapist's directives shitt the interaction away from these habirial patte of dominance, For esample, the therapist might say, “Now [ would ike you {the dominant listener! to paraphrase everything she says with vour eves maintaining contact with hers, while sitting up in your chair and leaning slightly forwavc.” Usually, bot partness are at least somewhat uncomfortable with such directives, and the key to success with this tsk is fr the therapist to be bath persistent and willing to exptore each spouse's inhib engaging in the task Cognitive and affective explorations often reveal cognitions such as, “Nothing that happens to me is important” or “My job is to clevate the self-esteem of everyone else in the family; that is all Lam good for, and affect involving fear of change, of ambiguity, cf becoming vulnerable The pornt is that the task provides a vehicle for exploring and tater madiing rigid, stullfving pattems of interaction that seem to have implications beyond those initially intended in communication. training evercises part PROBLEM-SOLVING TRAINING Conflict-resohution skills ate typically taught after couples have master basic listening and expressive shill. The focus is on facilitating. spou ability and willingness to discuss conflict areas constructively and teach viable solutions io them. ‘The hope is that they ww therapy is over to deal with future conflicts that ative. use these skills aff48 NSCINCOBSON AND A. HOLTWORTH MUNROE Conflict-resolusion skills taught in the SLC framewark represent asteuce tured, higlily specialized kind of interaction, There atc specific concepts for couples to learn, rules for them to follow, and a format in which problems are to be discussed. As an introduction to the format, the sules, anrl the concepts, they read a manual watten for couples and taken from the Jacobson and Maxgalin (1979) book. The manual provides a detailed discussion of the problem solsing process Then the skills are taught during therapy sessions, with the therapist playing the role of teucher aid cach Often, the therapist will begin by modeling the SMesphining the principle involved, and providing the couple with fecdback as they practice the skill. When the skill is performed incorrectly, or wher spouses lapse into their destructive, mnalalaplive putters, the therapist interrupts them and provides them with farther feedback. Once spouses can perform a particular skill adequately in the therapist's office, they ate given horrework assignments to practice the skill at honte The problem-solving process is divided into bvo distinct phases: the definition phase and the resolution phase, Couples are taught first to define the prublem, during which time they avoid suggesting possible solutions, and then te focus exclusively on solutions and avoid further elaborations on what the problem js. ‘This distinction is maintained because couples often falter in their con Bit-resolution discussion through a contamination of these processes: If solutions are suggested prematurely, that fs, before the problem hhas been properly defined, often the wiong problem is being discussed; conversely, by confinuing to redefine the problem during the discussion of, solutions, Couples effectively avoid the more difficult ask of decidingavhat they are going to do te solve the problem. Problem definitions are characterized by the following rules: 1. Problem identification should be preceded by expresions of eppreciation.. ‘These expressions place problems in perspective. Mest peuple find it easter to accept eriticiam when itis placed within the context of overall appreciation for one’s positive altribules and qualities, Thus, for example, “You forgot to empty the garbage” is more likely to clicit a defensive, noncollaborative response than “I really appreciate the help you've been giving me around the house lately, even though I do get arigry when you forget to take out the garbage.” 2, Problerns should be identified specifically, in behavioral terms, and without derogatory adjeetives or personality-trait labels. Instead of “You are disgusting and inconsiderate,” the PS format would favor, "You often fail to call me to tell me what time you'll be home.” 3. When defining problems, include divect expressions of feeliag. When one or boil spouses pinpoint problem behaviors to the other, Wey are encouraged to- make explicit the affect associated with the behavior, For example, inslead of saying, “It is not nice to ist with other women at pariies,”” partners are encouraged to include expressions such as, “When you flist with other women at parties, I feel hurt and angy.” Peeling 3. A SCICIAL LEARNING-COGNIRVE PERSPECIIVE 48 expressions tend to be disaciings the recipient of a complaint that includes a fecling expression is ess likely to countercomplain ot desty responsibility and moie likely to accommodate to the fecling Validation, Collaboration, and Acceptance of Responsibili ‘Condlictresohution discussions are most likely to break down shortly after the problem is fist defined. ‘The habitual response toa complaint is to defend oneself through denials, eross-complaints, excuses, or justifications, ‘The problem-solving format precludes such responses and substitutes one ‘of many possible collaborative responses; empathy, admissions, apologies, and recognition of the ather’s feelings are possible alternatives, itis equally inmportani that spouses who have identified problem behaviors in the partner are willing to acknowledge whatever zole they play in cither creating. main- teing, oF exacerbating the problem. Vhen defining problems, the rules in the training program are design tg civcummognt all ofthe habitual maneuver tut heal tea hrekdone the diseussi’m. The definition phase is where problem-solving discussions tusually die in distressed telationships. Most of the rules are designed to promote engagement and collaboration in the couple by generating changes in the way complaints are expressed and received. Complaints are expressed in such s way ay to maximize the likelihood that the recipient will teceive the complaint in a0 exgaged and collaborative manne; in addition, spouses ae encouraged to receive complaints not as challenges or thyeats, bul a3 sclutionship problems that are inthe interests of both of them to solve. _ Hae is an exanple of a couple, Ed and Sue, defining one of their remaining probleme at home ducing the latter stages of thexapy SU: Ed Lave been delighted by the way yuu've been vending to the ebiddsen fe the sven, The lve On the weer ll mak i ant Dt ou dat spend moze tive wath them eo: So yuu'te saying that yon do apotecial thot U spend sone of that eclaty that T spend sone of any evening time with ‘Toro an Kathy, but since T don't spend time with then on weekeuds you Tel anges fs tha ight su Veab 0: You've sight that {don’t spend much weekeud tine with the bid gn {can understand vohy that wou be upsetting te sou sve fe panapanp Tralee of the pn ‘ ale rh ont of the espns nese an gt nour ee about eng shes Jeeves hie ke say fone Juco he pend sth he eile 1 [after paraphrasing: Let's figuce out what we eas do about this, After the problem has been defined, the couple moves iata the solution phave of the discussion, where they mdve sequentially through three tasks: brainstorming, identifying the components Of a carat ead Eee ee writen contact Led ek, and forming50. NSSIRCOBEON ANP | HOLTZWORTH MUNROE BRANSTORMING During brainstorming, a list of solutiors is generated, from which a contract will eventually be formed. The instructions to the couple are to generate a ist of possible solutions by verbalizing all ideas that enter their consciousness, without censoring anvthing. Evafuative comments are not allowed during the brainstorming exercise, ‘The purpose of this exercise is te allow partners the opportunity to generate ideas without having to evaluate them. They are told not to worry about the quality of the idea at this point in the discussion, and in fact the therapist reinforces this luck of concer with quality by suggesting some absurd, ard probably humorous, solutions. This exercise is designed tu counteract the couple's tendencies to censor themselves and evaluate ail ideas negatively before seriously considering them. Here is the list of solutions generated by Sue and Ed regarding the problem identified above: 1. Sue could sean the newspaper and come up with a Tist of children’s activities available for an upcoming weekend and then ask if Ed would like to take the kids to any. Ed could agree to spend every Saturday afleruan with the kids. Sue and Ed could give the kid ap for adoption Ed and Suc could take the hids to the park together on Saturday aftetnaons, 5. Ed could take 30 minutes on Friday night to think of home activities {svelt as puzzles or drawing) and then play with the kids sometime over the weekend, in the activity he chooses 6. Sue could accept Ed's limitations as a father and withdraw the com plaint, 7. Sue could help Ed with some of the weekend chores so that he would have more time for the kids. 8, Ed could give up his Saturday moming baseball games to make sure he has more tine to spend with the kids. IDENTIEVING THE COMPONENTS OF A CONTRACT From the list of proposed solutions generated during brainstorming, the partners elininate those that are patently absurd. Then each ofthe remaining, proposals are discussed from each of two perspectives a) Were this proposal tobe adopted, would it either salve or cantrsbute tha solition to the problem: and (6) were this solution to be adopled, what would be the benefits and costs to cach of the spouses. After each perspective is considered, a decision is made regarding the disposition of the proposal imider discussion, “Three dispositions are possible. Ener the praposal is to be included as a component fof a contract, eliminated because the costs outweigh the benefits, or labled for roconsidctation after other proposals on the list are eoasideted. Eventually, this process generates a set of compenents to be combined systematically into a change agreement or contract 3K SOCIAL LENRNING-COGAFTIVE FERSPECTIVE 31 FORMING § WRITTEN CONTRACT is fina! step in the pinblem-solving process involves sunthes

You might also like

• Clinical Casebook of Couple Therapy Optimized PDF Download

  

  No ratings yet

  Clinical Casebook of Couple Therapy Optimized PDF Download

  14 pages
• Clinical Handbook of Marriage and Couples Intervention

  

  100% (2)

  Clinical Handbook of Marriage and Couples Intervention

  375 pages
• 8 TI1 Clinical Handbook of Marital Therapy

  

  No ratings yet

  8 TI1 Clinical Handbook of Marital Therapy

  336 pages
• Developmental: Approach

  

  100% (3)

  Developmental: Approach

  296 pages
• Clinical Handbook of Couple Therapy 4th Ed Edition Alan S. Gurman PHD Updated 2025

  

  No ratings yet

  Clinical Handbook of Couple Therapy 4th Ed Edition Alan S. Gurman PHD Updated 2025

  85 pages
• (Applied Clinical Psychology) Robert P. Liberman, Eugenie G. Wheeler, Louis A. J. M. de Visser, Julie Kuehnel, Timothy Kuehnel (auth.) - Handbook of Marital Therapy_ A Positive Approach to Helping Tro.pdf

  

  100% (2)

  (Applied Clinical Psychology) Robert P. Liberman, Eugenie G. Wheeler, Louis A. J. M. de Visser, Julie Kuehnel, Timothy Kuehnel (auth.) - Handbook of Marital Therapy_ A Positive Approach to Helping Tro.pdf

  267 pages
• The Timing of Divorce - Predicting When A Couple Will Divorce Over A 14-Year Period PDF

  

  No ratings yet

  The Timing of Divorce - Predicting When A Couple Will Divorce Over A 14-Year Period PDF

  9 pages
• Early Recollections - A Compelling Intervention in Couples Therapy

  

  No ratings yet

  Early Recollections - A Compelling Intervention in Couples Therapy

  10 pages
• Differentiation of Self Predicts Life Satisfaction Through Marital Adjustment

  

  No ratings yet

  Differentiation of Self Predicts Life Satisfaction Through Marital Adjustment

  16 pages
• Integrative Couple Therapy

  

  67% (6)

  Integrative Couple Therapy

  162 pages
• Compulsive Sexual Behavior Disorder Understanding Assessment and Treatment 1st Edition Ed Balon Richard PDF Download

  

  No ratings yet

  Compulsive Sexual Behavior Disorder Understanding Assessment and Treatment 1st Edition Ed Balon Richard PDF Download

  121 pages
• Case Conceptualizations

  

  100% (1)

  Case Conceptualizations

  6 pages
• Handbook of Family Therapy Vol2 Bredus

  

  No ratings yet

  Handbook of Family Therapy Vol2 Bredus

  21 pages
• Family Systems & Murray Bowen Theory: January 2009

  

  100% (1)

  Family Systems & Murray Bowen Theory: January 2009

  11 pages
• Family Therapy: Tupas and Tajala

  

  No ratings yet

  Family Therapy: Tupas and Tajala

  18 pages
• Baucom Despre Cuplu

  

  100% (1)

  Baucom Despre Cuplu

  388 pages
• Pluralism, Diversity, and Sophistication in Family Therapy Research

  

  No ratings yet

  Pluralism, Diversity, and Sophistication in Family Therapy Research

  16 pages
• Colapinto Structural Family Therapy

  

  100% (1)

  Colapinto Structural Family Therapy

  27 pages
• A Premarital Assessment Program

  

  No ratings yet

  A Premarital Assessment Program

  9 pages
• Contemporary-And-Cuttingedge-Strategies-55620048: Download PDF

  

  No ratings yet

  Contemporary-And-Cuttingedge-Strategies-55620048: Download PDF

  109 pages
• MSI-R Manual Chapter 1

  

  100% (2)

  MSI-R Manual Chapter 1

  5 pages
• Safran 1993: REPAIRING ALLIANCE RUPTURES

  

  No ratings yet

  Safran 1993: REPAIRING ALLIANCE RUPTURES

  7 pages
• "Adlerian Metaphors in Couples Therapy"

  

  100% (2)

  "Adlerian Metaphors in Couples Therapy"

  18 pages
• Reflexive Questioning As A Means To Enable Intimacy With Couples

  

  No ratings yet

  Reflexive Questioning As A Means To Enable Intimacy With Couples

  20 pages
• The Resentment Rating Scale For Couples RRS-C Deve

  

  No ratings yet

  The Resentment Rating Scale For Couples RRS-C Deve

  8 pages
• Legal and Ethical Issues in Couple Therapy: M C. G J L G L. S

  

  No ratings yet

  Legal and Ethical Issues in Couple Therapy: M C. G J L G L. S

  20 pages
• Relationship

  

  No ratings yet

  Relationship

  128 pages
• FAMILY THERAPY Final 1

  

  No ratings yet

  FAMILY THERAPY Final 1

  36 pages
• Couples Therapy

  

  100% (3)

  Couples Therapy

  120 pages
• Stretegic Family Therapy

  

  100% (2)

  Stretegic Family Therapy

  16 pages
• Culture and Reflexivity in Systemic Psychotherapy

  

  100% (2)

  Culture and Reflexivity in Systemic Psychotherapy

  105 pages
• Couples Therapy: Commitment First

  

  No ratings yet

  Couples Therapy: Commitment First

  9 pages
• Multidimensional Family Therapy PDF

  

  100% (1)

  Multidimensional Family Therapy PDF

  21 pages
• Emotionally Focused Couples Therapy: Status and Challenges

  

  No ratings yet

  Emotionally Focused Couples Therapy: Status and Challenges

  13 pages
• MSI-R Manual Chapter 1 PDF

  

  No ratings yet

  MSI-R Manual Chapter 1 PDF

  5 pages
• The Challenge of Creating Dialogical Space.... Peter Rober

  

  No ratings yet

  The Challenge of Creating Dialogical Space.... Peter Rober

  17 pages
• SUE JOhnson

  

  100% (8)

  SUE JOhnson

  72 pages
• An Integrative Approach To Treating Infidelity

  

  No ratings yet

  An Integrative Approach To Treating Infidelity

  8 pages
• Marital Therapy Techniques Guide

  

  No ratings yet

  Marital Therapy Techniques Guide

  61 pages
• Hetherington, E. Mavis - Coping With Divorce, Single Parenting, and Remarriage - A Risk and Resiliency Perspective-Taylor and Francis (2014)

  

  No ratings yet

  Hetherington, E. Mavis - Coping With Divorce, Single Parenting, and Remarriage - A Risk and Resiliency Perspective-Taylor and Francis (2014)

  372 pages
• 29 Gerald Corey Sos

  

  No ratings yet

  29 Gerald Corey Sos

  21 pages
• EFT Presentation Short

  

  100% (7)

  EFT Presentation Short

  96 pages
• Clinical Handbook of Couple Therapy

  

  100% (1)

  Clinical Handbook of Couple Therapy

  2 pages
• Trauma Symptom Check

  

  100% (1)

  Trauma Symptom Check

  3 pages
• A Mindfulness Based Rebt

  

  No ratings yet

  A Mindfulness Based Rebt

  13 pages
• Unveiling Sexual Identity in The Face of Marianismo

  

  No ratings yet

  Unveiling Sexual Identity in The Face of Marianismo

  22 pages
• Client Centered Therapy

  

  No ratings yet

  Client Centered Therapy

  8 pages
• Circular Questioning An Introductory Gui

  

  No ratings yet

  Circular Questioning An Introductory Gui

  6 pages
• Handbook of Family Therapy

  

  90% (20)

  Handbook of Family Therapy

  575 pages
• Structural Family Therapy

  

  100% (1)

  Structural Family Therapy

  14 pages
• Couples Therapy Homework Planner

  

  25% (4)

  Couples Therapy Homework Planner

  7 pages
• Circular Questioining An Introductory-Guide-Jac Brown PDF

  

  100% (1)

  Circular Questioining An Introductory-Guide-Jac Brown PDF

  6 pages
• Choice Theory for Adults

  

  100% (1)

  Choice Theory for Adults

  6 pages
• Gottman Assessment

  

  100% (5)

  Gottman Assessment

  12 pages
• Polyamory and Gay Men - A Family Systems Approach

  

  No ratings yet

  Polyamory and Gay Men - A Family Systems Approach

  22 pages
• Solution-Focused Premarital Counseling

  

  No ratings yet

  Solution-Focused Premarital Counseling

  10 pages
• Clinical Handbook of Couple Therapy - 6th Edition ISBN 1462550126, 9781462550128 Official Download

  

  No ratings yet

  Clinical Handbook of Couple Therapy - 6th Edition ISBN 1462550126, 9781462550128 Official Download

  17 pages
• Clinical Handbook of Couple Therapy Third Edition Alan S. Gurman Download

  

  0% (1)

  Clinical Handbook of Couple Therapy Third Edition Alan S. Gurman Download

  48 pages
• Clinical Handbook of Couple Therapy 4th Ed Edition Alan S. Gurman PHD PDF Download

  

  No ratings yet

  Clinical Handbook of Couple Therapy 4th Ed Edition Alan S. Gurman PHD PDF Download

  158 pages
• Handbook of Clinical Family Therapy - 1st Edition High-Resolution PDF Download

  

  100% (14)

  Handbook of Clinical Family Therapy - 1st Edition High-Resolution PDF Download

  15 pages