Couples Therapy

1. Couples Therapy Günce Hazman Seradil Eylül Uyal

2. Couples Therapy • 20% of couples have marital distress • Half of marriages end in divorce • 10-15% separate in 4 years • 70% last a decade

3. Couples Therapy • Couples therapy is the only evidence-based treatment. • Aimed at marital difficulties but also preventive and enrichment work.

4. Couples Therapy • Marital distress brings work difficulty, health problems, problems with children.

5. Couples Therapy • Various DSM-IV disorders double in people experiencing marital distress. • Whissman (1999); 15% mood disorders, 28% anxiety disorders, 15% alcohol and substance use disorders. • Couples therapy is seen to be effective in individual disorders of depression, anxiety, substance use.

6. History of Couples Therapy • Gurman and Fraenkel (2002) describe it in 4 phases: • Phase I, atheoretical marriage counseling formation. • Phase II, psychoanalytic experimentation. • Phase III, theoretical expansion • Phase IV, development of empirical treatments.

7. Couple Processes • John Gottman says that “first understand the characteristics of unsatisfied couples, then prevent and treat dissatisfaction”. • Several differences between satisfied and unsatisfied couples; * Satisfied couples show higher rates of positive behavior than negative (5/1). Unsatisfied couples (0.8/1). *Distressed couples show high rates of “The Four Horsemen”: defensiveness, criticism, contempt, stonewalling.

8. Couple Processes • Not only our behaviors but also our cognitions contribute to dissatisfaction. • Positive sentiment override-feeling positively aboutone’s partner and the relationship is crucial. • Many unhappy couples experience demand-withdrawal. One partner tries to communicate while the other one withdraws.

9. Assessment of Marital Distress • Couples can be assessed along behavior, cognition, affect, and internal dynamics. • Lots of assessment tools are available. Many of these are self reports filled out by couples before the therapy session. • Marital Satisfaction Inventory • The Area of Change Questionnaire....

10. Treatment Approaches

11. Behavioral Couples Therapy • The goal is to increase positive behavior demonstrated by each partner and make them realize that one’s behavior influences the other. • There are two main components: behavior exchange and communication/problem solving training.

12. Behavioral Couples Therapy • Behavior exchange aims to increase positive behaviors in daily life. The therapist gives homeworks such as “love day”. • Communication/problem solving training aims to teach some skills that will help them solve future problems. • Reflective listening: one partner expresses his/her a feeling or a thought and the other one restates, summarizes it before responding.

13. Cognitive-Behavioral Couples Therapy • Based on a belief that people evaluate their relationship and partners according to unreasonable standards. • If people’s appraisals of events are altered then there will be positive changes in behavior and emotion accordingly. • Two different stresses: primary distress and secondary distress.

14. Cognitive-Behavioral Couples Therapy • Primary distress comes from one partner’s unmet needs (affiliation, intimacy, autonomy...). • Secodary distress emerges when that partner uses wrong strategies to address the conflict coming from unmet needs (ignoring, verbally or physically attacking).

15. Cognitive-Behavioral Couples Therapy • Delivered within 8-25 sessions. • First 2-3 sessions are for the assessment and followed by a feedback session. The couple and the therapist define the treatment goals together. • Socratic questioning and guided discovery techniques may be used.

16. Cognitive-Behavioral Couples Therapy • Socratic questioning involves asking the client a series of questions to reevaluate the logic behind his/her certain beliefs. • Guided discovery involves creating experiences (role playing, pros and cons of the relationship) to have different perspectives.

17. Integrative Behavioral Couples Therapy • Adds “emotional acceptance” to BCT to increase positive feelings. • Jacobson and Christensen (1996) say that in the early stages, partners tolerate the differences in personality and see it them as the source of attraction. • In time, these differences become sources of discontent and concern, and result in polarization, vilification.

18. Integrative Behavioral Couples Therapy • This therapy is interested in the agent of behavior and the receiver together. • According to this therapy increased acceptance reduces conflict and is a catalyst for change. • Acceptance techniques’ aim is to soften the adversarial attitudes partners take toward eachother.

19. Integrative Behavioral Couples Therapy • Gottman says that some problems cannot be solved. Instead of aiming to solve them the sources of conflict can be turned into sources of intimacy. • IBCT therapists determine a central theme which summarizes the central issue. • They believe that as partners try to change eachother, polarization occurs. This is called the mutual trap.

20. Integrative Behavioral Couples Therapy • The effort to change eachother creates a defense, therefore the partner who want to change the other experiences a frustration and hopelessness. • The theme+polarization+mutual trap= the formulation. • Interested in the history of the relationship, the individual’s family, and individual’s previous relationships.

21. Emotionally Focused Couples Therapy • Susan Johnson • Focuses on couple emotion and attachment • Recreating bonds in couples by restructing and expanding their emotional responses • Three main tasks • Create safe, collaborative alliance • Access and expand emotional responses • Restructure interactions • Humanistic techniques

22. Object Relations Couples Therapy • Infant primarily driven by the desire to have a relationship with a nurturin figure. • This theory holds that couples seek lost parts of themselves in their spouses, and through marriage unacceptable parts of self can be expressed vicariously. • Therapist provides safe holding environment.

23. Affective Reconstruction • Couple difficulties often stem from injuries sustained in previous relationships that cause partners to develop defensive strategies that interfere with intimacy. • “ the interpretation of persistent maladaptive relationship patterns as having their source in previous developmental experiences” • Six fundamental tasks

24. Affective Reconstruction • Developing a collaborative alliance • Containing disabling relationship crises • Strenghtening the marital dyad • Promoting relevant relationship skills • Challenging the cognitive components of relationship distress • Examining developmental sources of relationship distress

25. Brief Integrative Marital Therapy • Focus on present • İnterpersonal and intrapersonal world together • Three central goals • Teach relationship skills • Challenge dysfunctional relationship rules • Inculcate systematic thinking

26. Narrative Couples Therapy • Change happens when couples modify their views of themselves and others

27. Integrative Problem-Centered Therapy • Problem solving by integrating individual, family, biological therapies. • Hierarchical approach that employes specific psychotherapeutic techniques • Begins from the simpliest to complex. • “Problem maintenance structure”

28. Feminist Couple Therapy • Intimacy achieved with equality

29. Special Problems • Sex therapy • Infidelity problems • violence

30. Ethical Issues • Confidentiality and record keeping

31. Research Assesing Effectiveness of Couple Therapy • Couple therapy is as effective as individual therapy. • High return problems

32. Couples Therapy Günce Hazman Seradil Eylül Uyal