|Ideal sources for Wikipedia's health content are defined in the guideline Wikipedia:Identifying reliable sources (medicine) and are typically review articles. Here are links to possibly useful sources of information about Relationship counseling.
- 1 Redirect
- 2 Distinguishing between counseling, therapy and coaching
- 3 Improving article
- 4 Novel practices
- 5 Popularized methodlogies
- 6 Relationship counseling for bisexuals/homosexuals
- 7 Sanger comments, apparently non-germane
- 8 marriage counseling parodies and cartooning
- 9 Extensive relationship counseling research notes & links, focus on integrative and empirically validated methods & reviews
- 10 Apparent typo inside text attributed as direct quote to non-web source
- 11 Constructive criticism
this article was started by:
- 22.214.171.124 11:54, 19 Jan 2005 (UTC)N.Subramanya, Ph.D
This needs quite a bit of work, and it's one of at least three articles on essentially the same subject. I've put merge tags on all the articles I've seen, but this is probably the most comprehensive -- at least in intent. Style is a big problem, appropriate linking is a problem, and reference and logical structure are problems. -- MatthewDBA 12:23, 11 January 2006 (UTC)
This struck me as highly biased, especially towards the end, as an outright advertisement is included in the final sentence. The line about AA being more effective than Counseling is twisting the facts. AA may be the most effective therapy group in the United States, but it has nothing to do with couples counseling. In the article this "fact" is used to promote peer to peer therapy. This article should be removed from this site.
- I agree, the article is in need of help. For now I have removed this "The numerous contributors: psychologists, social workers, and psychiatrists comprising the coalition of relationship educators can read at smartmarriages.com" which just reads like an ad. If I can rememeber how to do a cleanup tag I will add one. (ex-Wikipedian) 126.96.36.199 14:12, 15 May 2006 (UTC)
Distinguishing between counseling, therapy and coaching
Likewise I think it's a mess. The definition "to better manage or reconcile troublesome differences" grates. My hunch is to cut swathes out of it, then build a logical structure to carry impartial content and then merge it into a subsection of counseling.
BUT there's a trouble on and between pages related to counseling, therapy, psychotherapy and coaching. For example-
Relationship counseling is clearly distinguishable from psychotherapy. Yet counseling redirects to psychotherapy, which it is not. Likewise marriage guidance may be very different in some contexts yet is re-directed to this article on relationship counselling. If you type counseling with a double LL viz. counselling you get re-directed to a useful page of related subjects. That page could be a list of counseling types much like the List of psychotherapies. As it stands the counselling list is incomplete, for instance I have added Community Counseling, Counselling psychology, Rehabilitation counseling, School counselor, Navy Counselor, Vocational Guidance Counsellor and Philosophical counseling but I cannot add Marriage Guidance Counsellor because it refers to the eponymous Monty Python satire.
I imagine philosophical counselling could itself be distinguished from Existential therapy but neither are linked to each other, which one might be able to do with overarching lists of therapies (family, couple and individual), counseling (including health, business and personal) and coaching styles. If each list commenced by distingishing between these areas, it might help clarify the endemic bowl of spaghetti they currently reside in.
On that counselling page, if you click on Marriage and Family counseling you are re-directed to family therapy. Neither marriage nor family counseling are forms of family therapy though they are related. Relationship coaching, marital coaching and intimacy coaching are all distinguishable from counseling and from therapy and these too could be accounted for on the coaching page.
Relationship coach exists at section 4 of Life coaching and at section 5 there, a distinction is made between coaching and therapy and more fully on. Talk:Life coaching--Ziji 09:11, 25 February 2007 (UTC)
Just to let you know I am back on the job after a long absence and have reshaped the article somewhat. In line citations is next and I will draw on the work of John Gottman and Sue Johnson among others.--Ziji (talk email) 21:40, 26 January 2009 (UTC)
What's going on here. Some days its there other's its deleted. I can't agree with putting Men are From Mars int he same para as Gottman - the latter 30 years of research the former ZERO--Ziji (talk email) 00:01, 30 June 2009 (UTC)
- I don't know why it's deleted regularly, but I think it's better to have it than not. And I agree that there's a world of difference between Gottman and Gray. However, I think the "Novel practices" section should come ahead of "Popularized methodologies", since the former - like the "Basic practices" - requires the intervention of a counselor/therapist, so I've moved it. Marschalko (talk) 07:43, 30 June 2009 (UTC)
- It's important that the section be here. Except for Gottman's seminal works, the contents are negotiable.
- I personally think "Men Are From Mars, Women Are From Venus" was only marginally useful to me - but that's just my opinion. The Top 101 Experts Who Help Us Improve Our Lives says that the "Men Are From Mars" series vastly outsells Gottman (more than 40 million copies for Gray) - on notability, Gray has the edge.
- Note: This link might be worth reading in full. Simesa (talk) 09:40, 30 June 2009 (UTC)
I reverted the edit by MrOllie that removed this section (again). I don't know whether he looked at this part of the talk page (or whether it would have made any difference to him if he did). While I still think it is better to have the section than not, I agree that it is somewhat problematic in terms of being "spamish" (as MrOllie describes it), and I think some further arguments justifying its presence are needed. One justification, from my POV, is that professional relationship counseling is just one (fairly recent) manifestation of the many types of "help" or "counseling" that people have offered each other since forever about relationships. This "help" has included "advice" of all kinds and from various sources, and does not necessarily have to include the direct in-person intervention of a third party. Self-help books are one manifestation of this "advice". Indeed, self-help books are often recommended by professionals as an adjunct to professional counseling. Nevertheless, having said all that, I think some more specific and objective criteria will need to be developed for including some sources and excluding others.Marschalko (talk) 08:10, 23 October 2009 (UTC)
Relationship counseling for bisexuals/homosexuals
There are some unique circumstances that need to be taken into consideration for people who are bisexual or homosexual. I think there should be a section devoted to counseling them. Joshuajohanson (talk) 17:38, 8 October 2009 (UTC)
- Hi Joshua. What were some of the differences counselling LGBT and straight relationships that you are thinking about including in a new section? It's a good idea. There are a number of other groups that also could be included in their own or a general section on unique populations. For example, mixed marriages where race, religion, nationality or mother tongue differ and couples where one or both have a physical disability. In different countries, each of these groups have special issues that impact on their relationship, particularly where there are criminal sanctions against their preferences.Ziji (talk email) 20:55, 13 October 2009 (UTC)
Sanger comments, apparently non-germane
marriage counseling parodies and cartooning
I am coming across more and more gags and joke websites and videos across the Internet dedicated to marriage counseling and sort of poking fun at the whole system, such as this http://www.youtube.com/watch?v=M4mkVD0N2tE&sns=em and many more where that came from. With that in mind, I was hoping a section in the article could be made dedicated to parody of the whole idea and set up of marriage counseling. The very concept is mocked and ridiculed. I don't know. Food for thought. 188.8.131.52 (talk) 17:32, 23 January 2014 (UTC)
Research studies http://ibct.psych.ucla.edu/
Married With Problems? Therapy May Not Help By SUSAN GILBERT
Published: April 19, 2005 http://www.nytimes.com/2005/04/19/health/psychology/19coup.html?pagewanted=1&_r=1
With an experimental approach called integrative behavioral couples therapy, for example, 67 percent of couples significantly improved their relationships for two years, according to a study reported in November to the Association for the Advancement of Behavior Therapy. Instead of teaching couples how to avoid or solve arguments, as traditional counseling techniques do, the integrative therapy aims to make arguments less hurtful by helping partners accept their differences. It is based on a recent finding that it is not whether a couple fights but how they fight that can destroy a relationship. ...
Three types of couples therapy have been found to improve people's satisfaction with their marriage for at least a year after the treatment ends. The oldest approach, developed more than 20 years ago but still widely used, is behavioral marital therapy, in which partners learn to be nicer to each other, communicate better and improve their conflict-resolution skills. Another, called insight-oriented marital therapy, combines behavioral therapy with techniques for understanding the power struggles, defense mechanisms and other negative behaviors that cause strife in a relationship. With each method, about half of couples improve initially, but many of them relapse after a year. A relatively new approach that studies have found highly effective is called emotionally focused therapy, with 70 to 73 percent of couples reaching recovery - the point where their satisfaction with their relationship is within normal limits - for up to two years, the length of the studies. Dr. Johnson, who helped develop emotionally focused therapy in the 1990's, said that it enabled couples to identify and break free of the destructive emotional cycles that they fell into. "A classic one is that one person criticizes, the other withdraws," she said. "The more I push, the more you withdraw. We talk about how both partners are victims of these cycles." As the partners reveal their feelings during these cycles, they build trust and strengthen their connection to each other, she said. Surprisingly, Dr. Johnson said, until emotionally focused therapy came along, therapists were so intent on getting couples to make contracts to change their behavior that they did not delve into the emotional underpinnings of a relationship. "It was like leaving chicken out of chicken soup," she said. Dr. Johnson's latest research, completed in January, included 24 of the most at-risk couples, people who were unable to reconcile because their trust in each other had been shattered by extramarital affairs and other serious injuries to their relationship. "These injuries are like a torpedo," she said. "They take a marriage down." The study found that after 8 to 12 sessions, a majority of the couples had healed their injuries and rebuilt their trust. Most important, these gains lasted for three years. "It's very satisfying to know that we can make a difference with these couples and that it sticks," Dr. Johnson said. Alice, a library program coordinator in Honesdale, Pa., credits her couples therapy, which focused on emotional issues, with getting her and her husband to reunite after a yearlong separation. "The marriage counselor brought us back together," she said. Alice, who did not want her last name used out of privacy concerns, said an important catalyst for their reunion was the therapist's asking each to think about the ways that the other person wanted to feel appreciated and loved. Gradually, she said, she has come to see that her husband's needs were different from her own. "Going back to this exercise is one thing that has gotten us through hard times," she said. ... Researchers have begun to identify which qualities in a couple make for a lasting relationship. The findings challenge some common assumptions - that couples who fight a lot are beyond help, for example. Over more than two decades of videotaping and analyzing the behavior of happy and unhappy couples, Dr. Gottman has found that all couples fight and that most fights are never resolved. What is different between happy and unhappy couples is the way they fight.
The happy couples punctuate their arguments with positive interactions, he said, like interjecting humor or smiling in fond recognition of a partner's foibles. The unhappy couples have corrosive arguments, characterized by criticism, defensiveness and other negative words and gestures. Of course, even the happiest of couples can get nasty sometimes. But Dr. Gottman has found that as long as the ratio of positive to negative interactions remains at least five to one, the relationship is sturdy. When the ratio dips below that, he says, he can predict with 94 percent accuracy that a couple will divorce. Dr. Gottman says that couples therapists can use this information to help keep couples together. "You can't just teach a couple to avoid conflict," he said. "You have to build friendship and intimacy into the relationship. If you don't, the relationship gets crusty and mean."
J Consult Clin Psychol. 2000 Apr;68(2):351-5. Integrative behavioral couple therapy: an acceptance-based, promising new treatment for couple discord. Jacobson NS, Christensen A, Prince SE, Cordova J, Eldridge K. Department of Psychology, University of Washington, USA. Although traditional behavioral couple therapy (TBCT) has garnered the most empirical support of any marital treatment, concerns have been raised about both its durability and clinical significance. Integrative behavioral couple therapy (IBCT) was designed to address some of these limitations by combining strategies for fostering emotional acceptance with the change-oriented strategies of TBCT. Results of a preliminary clinical trial, in which 21 couples were randomly assigned to TBCT or IBCT, indicated that therapists could keep the 2 treatments distinct, that both husbands and wives receiving IBCT evidenced greater increases in marital satisfaction than couples receiving TBCT, and that IBCT resulted in a greater percentage of couples who either improved or recovered on the basis of clinical significance data. Although preliminary, these findings suggest that IBCT is a promising new treatment for couple discord. PMID: 10780137 [PubMed - indexed for MEDLINE]
J Consult Clin Psychol. 2004 Apr;72(2):176-91. Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples. Christensen A, Atkins DC, Berns S, Wheeler J, Baucom DH, Simpson LE. Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095-1563, USA. firstname.lastname@example.org Comment in: • Evid Based Ment Health. 2004 Nov;7(4):117. A randomized clinical trial compared the effects of traditional behavioral couple therapy (TBCT) and integrative behavioral couple therapy (IBCT) on 134 seriously and chronically distressed married couples, stratified into moderately and severely distressed groups. Couples in IBCT made steady improvements in satisfaction throughout the course of treatment, whereas TBCT couples improved more quickly than IBCT couples early in treatment but then, in contrast to the IBCT group, plateaued later in treatment. Both treatments produced similar levels of clinically significant improvement by the end of treatment (71% of IBCT couples and 59% of TBCT couples were reliably improved or recovered on the Dyadic Adjustment Scale; G. B. Spanier, 1976). Measures of communication also showed improvement for both groups. Measures of individual functioning improved as marital satisfaction improved. PMID: 15065953 [PubMed - indexed for MEDLINE]
J Consult Clin Psychol. 2005 Aug;73(4):624-33. Improving relationships: mechanisms of change in couple therapy. Doss BD, Thum YM, Sevier M, Atkins DC, Christensen A. University of California, Los Angeles, USA. email@example.com In a sample of 134 married couples randomly assigned to traditional or integrative behavioral couple therapy (TBCT vs. IBCT), a multivariate hierarchical growth curve analysis using latent variable regression revealed that measures of communication, behavior frequency, and emotional acceptance acted as mechanisms of change. TBCT led to greater changes in frequency of targeted behavior early in therapy, whereas IBCT led to greater changes in acceptance of targeted behavior both early and late in therapy. In addition, change in behavioral frequency was strongly related to improvements in satisfaction early in therapy; however, in the 2nd half of therapy, emotional acceptance was more strongly related to changes in satisfaction. Research and clinical implications are discussed. Copyright 2005 APA, all rights reserved. PMID: 16173850 [PubMed - indexed for MEDLINE]
J Consult Clin Psychol. 2006 Dec;74(6):1180-91. Couple and individual adjustment for 2 years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Christensen A, Atkins DC, Yi J, Baucom DH, George WH. Department of Psychology, University of California, Los Angeles, CA 90095-1563, USA. Christensen@psych.ucla.edu Follow-up data across 2 years were obtained on 130 of 134 couples who were originally part of a randomized clinical trial comparing traditional versus integrative behavioral couple therapy (TBCT vs. IBCT; A. Christensen et al., 2004). Both treatments produced similar levels of clinically significant improvement at 2 years posttreatment (69% of IBCT couples and 60% of TBCT couples). Both treatments showed a "hockey-stick" pattern of change in which satisfaction dropped immediately after treatment termination but then increased for most of follow-up. The break point when couples reversed courses and gained in satisfaction occurred sooner for IBCT than TBCT couples, and those couples who stayed together generally fared better in IBCT than in TBCT. Finally, there was evidence of greater stability during follow-up in IBCT than in TBCT couples. There was little change in individual functioning over follow-up, but when change occurred it was strongly related to change in marital satisfaction. Given that this sample was selected for its significant and chronic distress, the data are encouraging about the long-term impact of behavioral couple therapy. ((c) 2006 APA, all rights reserved). PMID: 17154747 [PubMed - indexed for MEDLINE]
Behav Ther. 2008 Jun;39(2):137-50. Epub 2007 Nov 19. Observed communication and associations with satisfaction during traditional and integrative behavioral couple therapy. Sevier M, Eldridge K, Jones J, Doss BD, Christensen A. California State University, Fullerton, CA 92834, USA. firstname.lastname@example.org To investigate changes in couple communication and potential mechanisms of change during treatment, 134 distressed couples, who were randomly assigned to either traditional or integrative behavioral couple therapy (TBCT; IBCT), were observed in relationship and personal problem discussions prior to and near the end of treatment. Analyses were conducted using the Hierarchical Linear Modeling program. Over the time in therapy, during relationship problem discussions, positivity and problem solving increased while negativity decreased. Compared to IBCT, TBCT couples had the largest gains in positivity and reductions in negativity. During personal problem discussions, negativity decreased, while withdrawal increased and positivity decreased. TBCT couples had larger declines in negativity. In both discussion types, increases in marital satisfaction were associated with increases in positivity and problem solving. Declines in marital satisfaction were associated with increased negativity during relationship problem interactions and increased withdrawal during personal problem interactions. However, no treatment differences in these associations were found. Differences in rule-governed and contingency-shaped behavior change strategies between the two therapies and implications of findings are discussed. PMID: 18502247 [PubMed - indexed for MEDLINE]
J Consult Clin Psychol. 2009 Feb;77(1):160-73. Prediction of response to treatment in a randomized clinical trial of couple therapy: a 2-year follow-up. Baucom BR, Atkins DC, Simpson LE, Christensen A. Department of Psychology, University of California, Los Angeles, CA 90095-1563, USA. Many studies have examined pretreatment predictors of immediate posttreatment outcome, but few studies have examined prediction of long-term treatment response to couple therapies. Four groups of predictors (demographic, intrapersonal, communication, and other interpersonal) and 2 moderators (pretreatment severity and type of therapy) were explored as predictors of clinically significant change measured 2 years after treatment termination. Results demonstrated that power processes and expressed emotional arousal were the strongest predictors of 2-year response to treatment. Moderation analyses showed that these variables predicted differential treatment response to traditional versus integrative behavioral couple therapy and that more variables predicted 2-year response for couples who were less distressed when beginning treatment. Findings are discussed with regard to existing work on prediction of treatment response, and directions for further study are offered. PMID: 19170462 [PubMed - indexed for MEDLINE]
J Consult Clin Psychol. 1989 Feb;57(1):39-46. Behavioral versus insight-oriented marital therapy: effects on individual and interspousal functioning. Snyder DK, Wills RM. This study compared the effects of behavioral marital therapy (BMT) and insight-oriented marital therapy (IOMT) on both interspousal and intrapersonal functioning in a controlled outcome study. A total of 79 couples seeking treatment for relationship distress were randomly assigned to BMT, IOMT, or a treatment-on-demand (TOD) waiting-list control group. Results indicated the significance in individual and relationship functioning. Both treatment approaches produced significant effects from intake to termination that were substantially maintained at the 6-month follow-up. Behavioral and insight-oriented therapies resulted in significant improvements in self-reports of global marital accord and, to a lesser extent, in the reduction of overall psychological distress and in the enhancement of self-concept, with no significant differences between treatment conditions. The magnitude of these effects in comparison with those reported in previous marital outcome studies and in more general psychotherapy research is discussed, and possible mechanisms for the equivalence of these technically divergent treatment approaches are explored. PMID: 2925973 [PubMed - indexed for MEDLINE]
http://www.psychpage.com/family/library/ibct.html Integrated Behavioral Couples Therapy Review of Jacobson and Christenson's model of Couples Therapy
Jacobson and Christenson's Integrated Behavioral Couples Therapy (IBCT) is a newer model based on traditional models of behavioral couples therapy. The traditional model is based on a few basic ideas:
• talking about how you feel and think about problems is not very helpful; rather, doing something about them is what helps • most partners can learn ways break bad patterns of behavior that cause problems • most partners can learn new ways to compromise and resolve problems, and thus make each other happier • as a result, most any couple can be happy and content When traditional models of behavioral therapy for individuals are applied to couples, therapy tends to produce significant improvements in functioning initially in just over half of couples. While in the past, this treatment appeared to be extremely effective, more recent studies have shown that it is not as effective as previously thought, and a few smaller studies may have made it appear overly effective. Further, other studies have found that at the end of therapy, only about a third of couples recover from their problems well enough to look like happily coupled partners. The rest are still distressed and unhappy. Two years later, a fourth to a third of behavioral therapy couples say they are worse off then when they went to therapy, and after four years over a third are divorced. Thus, the initial improvements do not appear to last. The addition of a "communication skills" module to traditional therapy seems to help improve the lasting effect of treatment to some extent though.
Jacobson and colleagues have done research to improve the effectiveness of behavioral therapy by adding an element of "emotional acceptance." Jacobson and colleagues argue that some problems can be resolved by compromise, but some likely can not. The greatest harm to the couple comes not from the incompatibilities; rather, the greatest harm comes from the rigid, negative, and excessive emotional responses that develop from these unresolved issues. Thus, the IBCT model is based on a few simple ideas:
• talking about how you feel and think about problems sometimes is necessary before you accept them • most partners can learn ways to alter the negative emotional responses they have to problems, responses that make them, as well as their partners, unhappy • most partners can learn new ways to resolve problems and the emotions that come with them • as a result, most any couple can be happy and content
There have been three promising studies showing the IBCT approach is better than the traditional one. Christenson and colleagues conducted a fourth study though that is especially interesting, in that for this study they purposely took the most distressed couples they could find. They treated 134 couples for an average of 23 sessions over 36 weeks, half with the IBCT approach and half with the traditional approach. They found that about two-thirds of couples reported significant improvements (slightly better than traditional behavioral therapy), half were able to recover from their problems well enough to look like happily coupled partners (again, better than traditional behavioral therapy).
Resources For more information • Christensen, A., Atkins, D. C., Berns, S., Wheeler, J., Baucom, D. H. & Simpson, L. E. (2004). Traditional versus Integrative Behavioral Couple Therapy for Significantly and Chronically Distressed Married Couples, Journal of Consulting and Clinical Psychology, 72, 176–191. • Jacobson, N. S., Christensen, A., Prince, S. E., Cordova, J., and Eldridge, K. (2000). Integrative Behavioral Couple Therapy An Acceptance-Based, Promising New Treatment for Couple Discord, Journal of Consulting and Clinical Psychology, 68, 351-355. • Wimberly, J. & Waltz, J. (1998). An outcome study of Integrative Couples Therapy delivered in a group format. Paper presented at the 32nd annual convention of the Association for Advancement of Behavior Therapy. Washington, D.C. • Shadish, W.R., & Baldwin, S.A. (2005). The effects of behavioral marital therapy: A meta-analysis of randomized controlled trials. Journal of Consulting and Clinical Psychology, 73(1), 6-14.
Upcoming research presentations:
Acceptance and change in couple therapy. Andrew Christensen. Master Clinician Presentation, World Congress of Behavioral and Cognitive Therapies, Boston, Massachusetts, June, 2010.
Behavior Change in Traditional and Integrative Behavioral Couple Therapy: Examination of Changes Through 2-year Follow up. Katherine J. Williams. Association of Behavioral and Cognitive Therapies. New York, New York.
The Impact of Behavioral Couple Therapy on Attachment in Distressed Couples. Lisa Benson. Association of Behavioral and Cognitive Therapies. New York, New York.
Physical intimacy over the course of couple therapy and follow-up. Meghan McGinn. Association of Behavioral and Cognitive Therapies. New York, New York.
Integrative Behavioral Couple Therapy An Acceptance-Based, Promising New Treatment for Couple Discord
"As Table 4 indicates, 64% of the TBCT couples either improved or recovered by the end of therapy; in contrast, 80% of the IBCT couples either improved or recovered."
Journal of Consulting and Clinical Psychology © 2000 by the American Psychological Association April 2000 Vol. 68, No. 2, 351-355 For personal use only--not for distribution
Neil S. Jacobson Department of Psychology University of Washington Andrew Christensen Department of Psychology University of California, Los Angeles Stacey E. Prince Department of Psychology University of Washington James Cordova Department of Psychology University of Washington Kathleen Eldridge Department of Psychology University of California, Los Angeles ABSTRACT Although traditional behavioral couple therapy (TBCT) has garnered the most empirical support of any marital treatment, concerns have been raised about both its durability and clinical significance. Integrative behavioral couple therapy (IBCT) was designed to address some of these limitations by combining strategies for fostering emotional acceptance with the change-oriented strategies of TBCT. Results of a preliminary clinical trial, in which 21 couples were randomly assigned to TBCT or IBCT, indicated that therapists could keep the 2 treatments distinct, that both husbands and wives receiving IBCT evidenced greater increases in marital satisfaction than couples receiving TBCT, and that IBCT resulted in a greater percentage of couples who either improved or recovered on the basis of clinical significance data. Although preliminary, these findings suggest that IBCT is a promising new treatment for couple discord.
James Cordova is now at the Department of Psychology, University of Illinois at Urbana—Champaign. After the completion of this article, but prior to its revision, Neil S. Jacobson died suddenly and unexpectedly. His untimely departure is a major loss not only for his family and friends but also for the field of marital therapy, to which he contributed so much. This research project was supported by Grant 5 R01 MH499593-02 from the National Institute of Mental Health. We thank Steve Clancy, Peter Fehrenbach, Joan Fiore, Susan Price, and Debra Wilk, who served as therapists for this project. Correspondence may be addressed to Andrew Christensen, Department of Psychology, University of California, Los Angeles, California, 90095. Electronic mail may be sent to Christensen@psych.ucla.edu Received: February 2, 1999 Revised: September 12, 1999 Accepted: September 17, 1999 Traditional behavioral couple therapy (TBCT; also known as behavioral marital therapy) has been the most widely studied approach to treating marital distress, and its efficacy has been repeatedly demonstrated in over 20 randomized clinical trials ( Baucom, Shoham, Meuser, Daiuto, & Stickle, 1998 ; Christensen & Heavey, 1999 ; Jacobson & Addis, 1993 ). Several of these clinical trials were conducted by Jacobson and colleagues using the version of TBCT summarized by Jacobson and Margolin (1979) . In an analysis of the clinical significance of various treatment approaches, Jacobson's version of TBCT yielded higher rates of success than the others examined ( Jacobson et al., 1984 ). This is not to say that TBCT is the only effective approach to couple therapy. In fact, as Baucom et al. (1998) have documented, other treatments, such as emotionally focused couple therapy Greenberg & Johnson, 1988 ), have shown promise. But TBCT is the only couple therapy to receive the highest designation as an "efficacious and specific intervention" ( Baucom et al., 1998 , p. 58).
At the same time, these studies have also revealed significant limitations in both the clinical significance and the durability of TBCT. First, at least one third of the couples studied in randomized clinical trials of TBCT are clear-cut treatment failures, remaining in the maritally distressed range at the conclusion of therapy ( Jacobson & Addis, 1993 ). Second, even among those couples who improve, many do not maintain their improvement over a 2-year period ( Jacobson, Schmaling, & Holtzworth-Munroe, 1987 ).
The purpose of the present study was to provide preliminary data on a new approach to treating marital distress, integrative behavioral couple therapy (IBCT), which was developed by Andrew Christensen and Neil S. Jacobson ( Christensen, Jacobson, & Babcock, 1995 ; Jacobson & Christensen, 1996 ).
Whereas TBCT focuses on helping spouses "change" in light of their partners' complaints and requires active collaboration and compromise between partners, IBCT includes strategies to help spouses accept aspects of their partners that were previously considered unacceptable. However, despite the label, the purpose of "acceptance work" is not to promote resignation to the relationship as it is or mere acceptance. Rather, it is designed to help couples use their unsolvable problems as vehicles to establish greater closeness and intimacy. For couples who have difficulty changing their behavior, acceptance provides a viable alternative for building a closer relationship. For couples who do benefit from the traditional approach, IBCT can facilitate further progress by providing an alternative way to establish a closer relationship, given that there are problems in every relationship that are impervious to change.
Paradoxically, acceptance interventions are also predicted to produce change in addition to acceptance, often more efficiently than the direct change inducing strategies that constitute TBCT, because at times the pressure to change may be the very factor that prevents it from occurring.
Participating Couples and Therapists
Participants in this study were 21 couples requesting therapy for marital distress. To be eligible for the study, couples had to be legally married and living together and both spouses had to be between 21 and 60 years old. In addition, each was required to score above 58 on the Global Distress Scale (GDS) of the Marital Satisfaction Inventory (MSI; Snyder, 1979 ), indicating clinically significant levels of marital distress. Couples were excluded if either spouse was in some concurrent form of psychotherapy ( n = 8), taking psychotropic medication ( n = 8), alcohol dependent ( n = 2), engaging in moderate to severe domestic violence within the past year ( n = 2, using criteria from Jacobson, Gottman, Waltz, Babcock, & Holtzworth-Munroe, 1994 ), or if the sole presenting complaint was sexual dysfunction ( n = 2). We were also prepared to exclude couples if either spouse met the criteria for schizophrenia (current episode), drug dependence, or mania, although no such couples were encountered.
After qualifying for the study, couples were randomly assigned to either TBCT or IBCT. Table 1 presents a summary of pretreatment demographic variables for each spouse (age, education, duration of
Page 2 of 8 11/27/2000 http://spider.apa.org/ftdocs/ccp/2000/april/ccp682351.html Page 3
marriage, number of previous marriages, and number of children) as a function of treatment condition.
None of the demographic variables were significantly different in the two treatment conditions.
Cases were assigned to one of five therapists as the therapist was available and as needed to ensure that therapists saw cases in both conditions. Each therapist saw a total of two to six cases and, with the exception of one therapist who saw an extra TBCT case, saw equal numbers of cases in each condition.
The five therapists, who included four licensed psychologists and one master's-level marriage and family therapist, were trained by first attending a didactic workshop presented by Neil S. Jacobson. They were then asked to read both the IBCT ( Christensen et al., 1995 ) and TBCT ( Jacobson & Margolin, 1979 ) treatment manuals. Once they began seeing cases, half were supervised by Andrew Christensen and half were supervised by Neil S. Jacobson, who both supervised cases in each treatment condition.
All of the treatment sessions were audio- or videotaped and mailed to supervisors, and each therapist had weekly 30-min telephone conversations with each supervisor during which the supervisor provided feedback and answered questions regarding the therapist's current cases. In addition to these weekly phone contacts, Andrew Christensen and Neil S. Jacobson met monthly with therapists in Year 1 and bimonthly in Year 2. During these meetings, taped segments illustrating both treatments were viewed, difficult cases were discussed, and any violations of treatment protocol observed by the adherence raters were reviewed. These strategies were successful in preventing drift across supervisors and in revising the IBCT treatment manual so that versions could be published for therapists (Jacobson & Christensen, 1996 ) and for clients ( Christensen & Jacobson, 2000 ).
Treatment Conditions TBCT.
The version of TBCT used in the present study was an adaptation of the one used by Jacobson and Margolin (1979 ), as specified in a companion manual. 1 IBCT ( Christensen et al., 1995 ; Jacobson & Christensen, 1996 ).
This approach includes three interventions designed to promote acceptance between partners: empathic joining, unified detachment, and tolerance building. In IBCT, these acceptance strategies are integrated with the change-oriented strategies of TBCT. The relative emphasis on acceptance versus change depends to some extent on the individual characteristics and needs of the couple.
IBCT treatment began as clinically indicated for each couple in the study on the basis of the case formulation developed during the initial assessment sessions but usually began with acceptance interventions. Subsequently, change techniques were integrated with acceptance strategies as needed.
All of the couples in both treatment conditions were allowed up to 26 sessions (which included 2 individual sessions during an evaluation phase) and, in fact, received between 13 and 26 sessions. The mean number of sessions for TBCT couples was 20.72 ( SD = 3.55), whereas the mean number of sessions for IBCT couples was 21.00 ( SD = 4.15); the difference between groups was not significant.
Of the 11 couples assigned to TBCT, 1 couple experienced substantial improvement early in treatment and, in agreement with their therapist, terminated after the 14th session. Of the 10 couples assigned to IBCT, 1 couple did not complete treatment, deciding to divorce after 13 sessions.
Therapist adherence and competence.
We constructed an adherence scale that included eight items reflecting change-oriented interventions
Page 3 of 8 11/27/2000 http://spider.apa.org/ftdocs/ccp/2000/april/ccp682351.html Page 4 and nine items reflecting acceptance interventions. Two senior graduate students served as coding trainers and calibrators, and three additional graduate students served as coders. Eight TBCT and eight IBCT cases were coded for adherence. Nine tapes were coded per case (three early, three middle, and three late sessions); within these constraints, the exact tapes to be coded were determined randomly.
Twenty percent of the coded tapes were also coded by a calibrator. Coders were blind as to both treatment condition and which sessions were coded by the calibrator. They rated the degree to which each intervention was observed in that session on a 5-point scale ranging from 1 ( not at all ) to 5 ( extensively ). Reliabilities were calculated based on intraclass correlation coefficients and represent the agreement between each rater and the calibrator. Reliabilities for the three coders ranged from .87 to .95 for change ratings and from .74 to .88 for the acceptance ratings.
In addition, we conducted a second, completely independent manipulation check to ensure that our ratings of adherence were not influenced by rater bias. The adherence ratings described above were conducted by clinical graduate students familiar with TBCT and IBCT and who therefore were often able to discern the treatment condition. Thus, we created a second, simpler system using global codes and trained undergraduate raters who had no previous knowledge of TBCT and IBCT to use this global coding system. This system included a code for "instigate change," which consisted of any of the change interventions defined in the earlier system, and "acceptance," which consisted of any of the acceptance activities defined in the earlier system. After watching an entire session, coders rated the extent to which therapists engaged in these activities on a 9-point scale. Six sessions from each of the 21 cases (two sessions each from the early, middle, and late phases of therapy) were rated by four teams of three or four undergraduate observers who were trained in the global coding system but who were uninformed about TBCT, IBCT, and the nature of the study. In fact, they were not told that two kinds of therapy were being compared but rather that we were examining the correlates of different types of therapist activities. Ratings on these two global scales were reliable (average alpha was .86 for change and .80 for acceptance). Finally, to document that TBCT received a fair test in the present study, we had 120 TBCT tapes coded for competence by Donald H. Baucom, a recognized expert in TBCT. These manipulation checks and their results are described in greater detail below. Outcome Measures We measured pre- to posttreatment changes in marital satisfaction using the GDS of the MSI ( Snyder, 1979 ) and the Dyadic Adjustment Scale (DAS; Spanier, 1976 ). Both are well-validated instruments for assessing satisfaction in marriage.
Adherence to Treatment Protocols
Table 2 compares the overall change and acceptance ratings for TBCT versus IBCT on our molecular
Adherence scale. The table shows that change-oriented interventions were significantly more likely to be used in TBCT than in IBCT, whereas acceptance interventions were significantly more likely to be used in IBCT than in TBCT. The means reported in Table 2 represent the sum of the ratings for each item in that subscale. Thus, the range for the Change subscale (eight items) is 8 to 40, and the range for the Acceptance subscale (nine items) is 9 to 45. Of particular note is that the mean for Acceptance items in TBCT is very close to the minimum, indicating that there was very little acceptance work going on in TBCT and thus very few protocol violations. On the other hand, because IBCT includes the change-oriented strategies of TBCT, some change work is appropriate. As expected, there were a moderate
Page 4 of 8 11/27/2000 http://spider.apa.org/ftdocs/ccp/2000/april/ccp682351.html Page 5
number of change interventions observed in IBCT, but not as many as in TBCT. In addition to the above, we conducted a second manipulation check using naive raters and global codes of instigate change and acceptance described earlier to ensure that our adherence data were not an artifact of the raters' biases. Primary analyses consisting of 2 (treatment group) × 6 (session) repeated measures analyses of variance revealed significant main effects of treatment group.
As predicted, average ratings of acceptance were much higher for IBCT therapists ( M = 6.47) than for TBCT therapists ( M = 4.28), F (1, 17) = 35.61, p < .001, whereas mean ratings for instigate change were much higher for TBCT therapists ( M = 6.08) than for IBCT therapists ( M = 3.32), F (1, 17) = 33.45, p < .001.
Further, when we created a ratio of acceptance to instigate change, we found no overlap in the two distributions: The lowest ratio among IBCT cases was higher than the highest ratio among TBCT cases.
In short, results indicate that these two systems for rating adherence were able to discriminate between TBCT and IBCT and, further, that therapists conducting both treatments were able to keep them distinct: They were successful in avoiding acceptance interventions in TBCT and in incorporating such interventions when conducting IBCT.
Therapist Competence in TBCT One possible explanation for promising results when testing a new treatment approach is the effect of therapist allegiance: Perhaps the therapists' greater enthusiasm for the new treatment and/or their corresponding decreased confidence in the old treatment lead them to provide a less than optimal test of the latter. Therefore, it was important to ensure that TBCT was performed with a high degree of competence and that therapist bias toward IBCT did not influence our results. To this end, we had 120 TBCT tapes coded by an expert in TBCT, Donald H. Baucom from the University of North Carolina.
Baucom had no other connection to the study beyond his role as a consultant who provided competence ratings of TBCT. In collaboration with Baucom, we designed a scale, called the Behavioral Couple Therapy Competence Rating Scale, which is designed to have a maximum score of 66. A score of 40, which indicates an average rating of "good," is considered the cutoff for competent performance of TBCT. Baucom rated up to 16 tapes per couple for 8 couples assigned to TBCT. The first 4 tapes (1st conjoint session, individual assessment sessions with both husband and wife, and feedback session) were viewed for case conceptualization purposes only; competence ratings were completed for Sessions 5—16. Results indicated that TBCT was conducted with a high level of competence. Ratings for individual sessions ranged from 43 to 66, with an overall mean rating of 61.1. These ratings consistently exceeded our established minimum standards of competence and indicated that the TBCT performed in this study was state of the art.
Treatment Outcome Because of the small sample size and inadequate statistical power of the present study, we made a decision to confine our analyses to descriptive statistics reflecting both effect size and clinical significance of the group differences but not to use statistical analyses for hypotheses-testing purposes.
Table 3 presents the results of our primary outcome analyses. The table shows pre- and posttest scores for husbands and wives on the GDS and the DAS, our two primary outcome measures. Results are presented for all 21 couples who participated in the study, including the 1 IBCT couple who did not complete treatment. For the latter couple, because we were unable to obtain posttest scores, their pretest scores on each outcome measure served as the termination score. As the table shows, both husbands and wives experienced greater improvements in their satisfaction following IBCT than they did following TBCT. The effect sizes indicate moderate (based on the DAS) to large (based on the GDS) group differences favoring IBCT.
Finally, we assessed the clinical significance of the observed group differences using the criteria for
Page 5 of 8 11/27/2000 http://spider.apa.org/ftdocs/ccp/2000/april/ccp682351.html Page 6
improvement and recovery derived by Jacobson and colleagues (e.g., Jacobson & Truax, 1991 ). Table 4 shows the number and proportion of couples whose increases in marital satisfaction were both statistically and clinically significant using the GDS. Clinical significance referred to both spouses scoring in the nondistressed range at the conclusion of therapy, whereas improvement referred to scores that indicated increased marital satisfaction but were still in the distressed range for 1 or both spouses posttreatment. To ensure that the magnitude of change exceeded that which could reasonably be explained by measurement error, we also required that each partner's magnitude of change had to be statistically reliable on the basis of the modified reliable change index ( Jacobson & Truax, 1991 ). As Table 4 indicates, 64% of the TBCT couples either improved or recovered by the end of therapy; in contrast, 80% of the IBCT couples either improved or recovered.
Discussion The results of our treatment development study suggest that IBCT may be a promising alternative to TBCT. First, through our adherence ratings, we demonstrated that IBCT was a distinct treatment from TBCT. Second, we showed that the therapists in this study were able to successfully implement our independent variable by confining acceptance-focused interventions to IBCT and by providing an intensive, state-of-the-art test of change-oriented interventions in TBCT. Third, and most importantly, IBCT, performed by therapists with no prior experience with the treatment, obtained results that were impressive both in an absolute sense and relative to TBCT. Besides these outcome results, there are several additional findings that support the future study of IBCT. Christensen and Jacobson (1996) reported that IBCT produced as much or more change in some areas of the relationship than TBCT, despite the emphasis on acceptance, rather than change, in IBCT. Consistent with the theory of change underlying IBCT ( Jacobson & Christensen, 1996 ), the contextual shifts following successful acceptance work can be a more effective way of shifting the contingencies of reinforcement in a way that supports spontaneous change. Acceptance may not only be conducive to an improved relationship in its own right but may also at times be a more efficient way of producing behavior change than the direct attempts to induce it, which characterize TBCT. Furthermore, evidence of differential processes occurring in the two treatments was found in an examination of couples' in-session verbal behavior ( Cordova, Jacobson, & Christensen, 1998 ). Using a system designed to rate husband—wife interaction, coders were trained to rate early, middle, and late therapy sessions on the occurrence of spouse behaviors expected to discriminate between the two treatments. Results indicated different kinds of interactional changes in the two treatments that were in accord with the theories of change underlying the two treatments. For example, two categories of spouse behavior, empathic joining and unified detachment, behaviors that are encouraged in IBCT but not in TBCT, were indeed more common in IBCT sessions, especially toward the end of therapy. This study provides further evidence that the types of interactional change targeted by the two treatments are actually reflected in couples' in-session behavior, especially in middle and later sessions. Since we conducted this original trial, two additional unpublished studies, summarized by Christensen and Heavey (1999) , have provided further preliminary evidence as to the scope of IBCT. Not only does it appear to be possible to successfully apply IBCT in a couples—group format, but the treatment may also be a viable alternative to individual therapy when depression in 1 spouse coexists with marital discord. Although these results, taken together, warrant further exploration, they must be interpreted in the preliminary spirit in which the data were collected. The next step is a randomized clinical trial with sufficient statistical power to establish both the replicability and the reliability of group differences Page 6 of 8 11/27/2000 http://spider.apa.org/ftdocs/ccp/2000/april/ccp682351.html
Page 7 between IBCT and TBCT. In fact, we have begun such a trial at two sites–the University of California, Los Angeles, and the University of Washington–where 150 couples are being randomly assigned to IBCT or TBCT in what will be the largest study of marital therapy efficacy ever undertaken. Only after such a trial has been completed will we know if the early promise demonstrated in the present study can be confirmed. The study currently under way will also address a question that is crucial to the value of a marital treatment but beyond the scope of the present treatment development study: the durability of acceptance and change produced by the two treatments under study. Not only do we need to know about the immediate benefits of IBCT, but a major reason for its development was also the hope that an integrative treatment would lead to permanent improvement, a goal that has not yet been tested, even in a preliminary way. References Baucom, D. H., Shoham, V., Meuser, K. T., Daiuto, A. D. & Stickle, T. R. (1998). Empirically supported couple and family interventions for marital distress and adult mental health problems. Journal of Consulting and Clinical Psychology, 66, 53-88. Christensen, A. & Heavey, C. L. (1999). Interventions for couples. Annual Review of Psychology, 50, 165-190. Christensen, A. & Jacobson, N. S. (1996, November). The measurement of acceptance and change in integrative versus traditional behavioral couple therapy. (Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy, New York, NY) Christensen, A. & Jacobson, N. S. (2000). Reconcilable differences. (New York: Guilford Press) Christensen, A., Jacobson, N. S. & Babcock, J. C. (1995). Integrative behavioral couple therapy.(In N. S. Jacobson, & A. S. Gurman (Eds.), Clinical handbook of couples therapy (pp. 31—64). New York: Guilford Press.) Cordova, J. V., Jacobson, N. S. & Christensen, A. (1998). Acceptance versus change interventions in behavioral couples therapy: Impact on couples' in-session communication. Journal of Marriage and Family Counseling, 24, 437-455. Greenberg, L. S. & Johnson, S. M. (1988). Emotionally focused couples therapy. (New York: Guilford Press) Jacobson, N. S. & Addis, M. E. (1993). Research on couples and couple therapy: What do we know? Where are we going? Journal of Consulting and Clinical Psychology, 61, 85-93. Jacobson, N. S. & Christensen, A. (1996). Acceptance and change in couple therapy: A therapist's guide to transforming relationships. (New York: Norton) Jacobson, N. S., Follette, W. C., Revenstorf, D., Baucom, D. H., Hahlweg, K. & Margolin, G. (1984). Variability in outcome and clinical significance of behavioral marital therapy: A reanalysis of outcome data. Journal of Consulting and Clinical Psychology, 52, 497-504. Jacobson, N. S., Gottman, J. M., Waltz, J., Babcock, J. & Holtzworth-Munroe, A. (1994). Affect, verbal content and psychophysiology in the arguments of couples with a violent husband. Journal of Consulting and Clinical Psychology, 62, 982-988. Jacobson, N. S. & Margolin, G. (1979). Marital therapy: Strategies based on social learning and behavior exchange principles. (New York: Brunner/Mazel) Jacobson, N. S., Schmaling, K. B. & Holtzworth-Munroe, A. (1987). A component analysis of behavioral marital therapy: Two-year follow-up and prediction of relapse. Journal of Marital and Family Therapy, 13, 187-195. Jacobson, N. S. & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19. Snyder, D. K. (1979). Multidimensional assessment of marital satisfaction. Journal of Marriage and the Family, 11, 813-823. Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage Page 7 of 8 11/27/2000 http://spider.apa.org/ftdocs/ccp/2000/april/ccp682351.html
Page 8 and similar dyads. Journal of Marriage and the Family, 38, 15-28. 1 The TBCT manual can be obtained from Andrew Christensen by written request. Pretreatment Demographic Variables Overall Adherence Ratings Pre- to Posttreatment Improvement by Treatment Condition Clinical Significance Data Page 8 of 8 11/27/2000
The history of couple therapy: a millennial review. Family Process, 07/22/2002, Vol. 41 No. 2 Pg. 199 By: Alan S. Gurman; Peter Fraenkel
In this article, we review the major conceptual and clinical influences and trends in the history of couple therapy to date, and also chronicle the history of research on couple therapy. The evolving patterns in theory and practice are reviewed as having progressed through four distinctive phases: Phase I—A theoretical Marriage Counseling Formation (1930-1963); Phase II--Psychoanalytic Experimentation (1931-1966); Phase III--Family Therapy Incorporation (1963-1985); and Phase IV--Refinement, Extension, Diversification, and Integration (1986-present). The history of research in the field is described as having passed through three phases: Phase I--A Technique in Search of Some Data (1930-1974), Phase II--Irrational(?) Exuberance (1975-1992), and Phase III-- Caution and Extension (1993-present). The article concludes with the identification of Four Great Historical Ironies in the History of Couple Therapy.
What is the relative effectiveness of different couple therapies? To borrow a borrowed phrase from Luborsky, Singer, and Luborsky's (1975) discussion of the comparative efficacy of individual psychotherapies, "Everybody has won, and all must have prizes" (p. 995). More accurately, all those couple therapies that have been reasonably well put to the empirical test to data have won, i.e., have proven superior to no treatment. These methods are Behavioral (including cognitive-behavioral) Therapy, Emotionally Focused Therapy, and Insight-Oriented Marital Therapy. Thus far, there is no strong evidence that any one of these approaches is more effective than the others, or any other. To date, there have been very few head-to-head comparative studies in clinical trials, so that the occasional differences that have been found may be quite unreliable, and, in any case, have not been replicated.
At the same time, not all influential approaches to systems-oriented therapy even deserve consideration for "prizes" to date for their treatment of couples, e.g., Structural, Strategic, Bowen Family Systems, Solution-Focused, and Narrative methods with couples have essentially never been tested empirically. This fact should certainly not lead us to dismiss outright treatments that have not yet been tested empirically. Nonetheless, the proponents of such untested methods have a collective obligation to provide more than anecdotal evidence of their efficacy and effectiveness. —Preceding unsigned comment added by 184.108.40.206 (talk) 00:31, 7 December 2009 (UTC)
Apparent typo inside text attributed as direct quote to non-web source
"The common counterbalancing satisfaction these both needs, intimacy and autonomy, leads to alternately satisfaction in the relationship and stability. But it depends on the specific developing duties of each partner in every life phase and maturity".
It seems clear that "of both these needs," was the meaning intended.
I think this article is very well done. My only criticism would be the lack of historical perspective and point of view. I would like to see more info on the history of marriage and relationship counseling as far back as the beginning of the institution of marriage. When and how did the occupation come into being. Lets develop a history and timeline section. 220.127.116.11 (talk) 17:37, 23 January 2014 (UTC)
- Vern L. Bullough Encyclopedia of birth control
- Jennifer Terry, Jacqueline Urla Deviant bodies: critical perspectives on difference in science and popular culture