COMMUNICATION / PROBLEM-SOLVING

19 SKILLS TRAINING

Pamella H. Oliver and Gayla Margolin

Communication training historically has been an integral component of behavioral

marital therapy and continues to be a fundamental procedure utilized in contemporary
forms of therapy for marital or couple distress (Jacobson & Christensen, 1996), prevention
programs for couples (Braukhaus, Hahlweg, Kroeger, Groth, & Fehm-Wolfsdorf, 2003;
Floyd, Markman, Kelly, Blumberg, & Stanley, 1995; Hahlweg & Markman, 1988), and
parent training programs or interventions (Dishion & Kavanaugh, 2003; Forgatch, &
DeGarmo, 1999;Kazdin, 2005) . Com munication training involves the practice and
enactment of two sets of skills-speaker / listener skills and problem-solving skills. These
skills

PROPOSED MECHANISMS OF EFFECT

Many therapeutic treatments for distressed fam ily members include communication
training. Often families do not apply the basic listening and problem-solving skills
presented here to the difficult, conflictual issues of their relationships . Many have never
used such skills. Others, who may be skilled communicators in some situa tions, dispense
with good listening and problem solving when such skills are most needed, that is, in
moments of frustration and anger. Instead, these family members either withdraw from
the interaction or resort to bombarding others with the same ill-stated point.
Thus, the are components of many efficacious treatments, rationale for this procedure
is derived from interventions or programs . For this chapter we focus on the specifics
of using communication training in marital or couples therapy with the
recommendation that these same techniques can be adapted for use with children
and families in a variety of interventions. Based on social learning theory, behavior
marital therapy focuses on improving couples' interaction through skills training and
through changing conditions in the environment that establish and maintain behavioral
patterns. Jacobson and Margolin (1979), the traditional treatment manual for behavior
marital therapy, provides a detailed description of communication training as well as a
description of other elements of therapy such as behavior exchange. The steps of
communication training are also provided in other, generally more recent, manuals for
therapists (Epstein & Baucom, 2002; Jacobson & Christensen, 1996) and for clients
(Christensen & Jacobson, 2000; Forgatch & Patterson, 2005; Cottman, Notarius, Gonso, &
Markman, 1976; Notarius & Markman, 1993).two models. One is a skills deficit model,
the other a stimulus-response model. Communica tion skills training is basically a skills
oriented approach. The training is sometimes prescribed to counteract family members'
lack of basic interpersonal skills with which to negotiate con flict. In contrast, the stimulus-
response model assumes that although family members pos sess communication skills in
general, they do not use effective communication behavior in the particular context of
relationship tension. From this perspective, communication training is used as a means
of stimulus control. That is, communication training provides a struc ture to circumvent
the family's well-developed patterns that preclude using effective commu nication and
problem-solving skills. Whether the destructive behavioral patterns are seen as etiologic
or as maintaining the problems, the therapeutic objective is twofold : to learn and practice
any necessary skills, and to utilize the structured procedures in such a way that the
context of conflict is fundamentally changed
A third model describing a proposed mechanism of effect is through a construc tive,
positive environment. Because parents frequently are the ones facilitating change toward
the goal of reducing child or adolescent problem behavior, parents' abilities to relate to
their children are important, particularly their supportive communications and limit-setting
communications . The general goal of increasing parents' positive emotional connection to
the child can be enhanced through communication skills of initiating contact and showing
interest (Liddle, Rodriguez, Dakof, Kanzki, & Marvel, 2005). Beyond developing a more
positive affective interaction between parents and children, communication interventions
also are used to foster a constructive environment for structured problem-solving
(Forgatch & Patterson, 2005).

COMMUNICATION SKILLS TRAINING PROCEDURES

Communication training falls into two general rapidly escalating conflict or frustrated with
drawal. Such patterns generally are fueled when one person, feeling misunderstood, repeats
and reiterates the same information. The other per son, feeling attacked, defends or
counterattacks by responding to one small segment of infor mation . The goal of practicing
speaker/ listener skills is to interrupt such ritualized patterns by building in steps that
guarantee family mem bers accurately receive each other's messages. Instructions that insert
additional steps in fam ily communication dramatically slow down the communication
process and thereby interrupt well-rehearsed patterns. The additional steps change the
fundamental nature of the communi cation and promote different expectations about the
purpose of the interaction . When success fully enacted, these changes allow participants to
figure out and articulate what they truly want to say and to ensure that the partner has
accurately received the message . In addition to imparting new skills, speaker/ listener
skills training also creates a stimulus situation that triggers the enactment of
constructive speaker and listener behaviors skill sets: speaker/ listener skills to
generate
rather than angry or divisive behaviors
--E
understanding and problem-solving skills. As Weiss (1978) noted, communications often fall apart when
one person simply wants to be understood and the other person starts to problem solve. Speaker/ listener
skills result in understanding and validation of a partner's perspective . These skills are an important goal in
themselves as well as a preliminary step to problem solving. Productive problem solving occurs only when
partners fully understand one another's viewpoint. Problem-solving skills lead to changes in the way
partners handle a given situation. However, issues that do not require an action-oriented response need
not progress to the problem-solving phase.

FUNCTION OF SPEAKER / LISTENER SKILLS

The goal of practicing speaker/ listener skills is to facilitate the accurate sending and receiving of messages.
A common pattern in distressed couples and families is that communication falls into highly ritualized
patterns, characterized by
(Margolin, 1987). The enactment of these
behaviors results in a greater closeness and intimacy despite the fact that the partners do not necessarily
resolve the problem . This process of using problem discussions to enhance closeness is similar to the
processes of "empathic joining" (Jacobson & Christensen, 1996) or ''building a joint platform" (Wile,
1993).

STEP-BY-STEP PROCEDURES
FOR SPEAKER / LISTENER SKILLS

For the purposes of training and practice, the speaker and listener roles are clearly defined . One
partner, the speaker, introduces a topic that she or he wants to discuss, and the other partner, the listener,
is to demonstrate that she or he understands what is being said.

The Listener's Role

The therapist defines and demonstrates four sep arate skills of increasing complexity that demon strate
accurate listening (Jacobson & Christensen,
6 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY

1996; Jacobson & Margolin, 1979). Parroting, the most straightforward skill, requires the listener simply to
repeat back verbatim what the partner has said. Paraphrasing requires the listener to rephrase, in her or his
own words, the content of the communication. Reflection requires the lis tener to discern the emotion behind
the speaker's message and to verbally check out that emotional interpretation with the speaker. Validation
con veys to the speaker that her / his perspective is understandable . Thus, the speaker's statement, "I
can't believe you didn't call your mother to let her know we'd be late for dinner," could be repeated back
in those exact words, paraphrased as "You wanted me to call my mother letting her know we'd be late,"
reflected as "You're angry at me for not calling my mother and maybe also embarrassed that we delayed her
dinner party," or validated as "It makes sense that you'd be angry at me if you thought I had made the
call." It is important to note that none of these responses require the listener to agree with the speaker.
These four listener skills are introduced
sequentially. A new skill is introduced only
 19 • COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING 7
is particularly distressing. According to Wile (1993), spouses' seemingly out-of-proportion anger often
stems from feeling unentitled to very reasonable and normal reactions. Different dimensions of the
process of expressing the core, underlying feelings associated with a problem have been described as
leveling (e.g., Cottman, et. al, 1976) or as disclosing "soft" as opposed to "hard" emotions (Jacobson &
Christensen, 1996). For the listener to accurately restate the speaker's message, that message
needs to be stated succinctly. Thus, an important role for the therapist is to interrupt statements
that are too long and to cue the listener to restate what has been said thus far. This process of
chunking speaker statements into manageable units provides the speaker with essential feedback
about what portions of her/ his statement have been received, thereby reducing the tendency for
speakers to repeat the same message. Moreover, listeners can be encouraged to restate part of the
speaker's statement but to raise questions if another part is still confusing. Only when the speaker has
finished stating her or his complete point and
when the previous skill has been mastered. The
8 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY
the listener has demonstrated understanding
 19 • COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING 9
--E
therapist actively directs the back-and-forth
communication, prompting the listener's re statement, and asking the speaker if the listener's statement
was correct. If the listener was not correct, the entire process is repeated . The communication is thus
slowed down considerably by building in checks for clarity and accuracy before a reply can be given.

The Speaker's Role

At the same time that one partner is practicing listening skills, the other is practicing expressive skills.
Expressive skills are as important as listening skills in fostering productive communication .
Frequently, a speaker begins to present a concern without fully knowing or acknowledging what makes
that situation upset ting. Accurate expressiveness, or being able to state what is truly on one's mind, often
evolves through the communication process. Through clarification and feedback from the listener, be it
the partner or the therapist, the speaker gains fur ther understanding about why a given situation
10 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY
of the entire message does the listener present
her / his perspective . At that point, speaker and listener roles reverse. There is no guarantee in this
process that the new speaker will not come across as angry and defensive but at least she or he has
accurately heard the original speaker's point of view.
As contrasted with the equal status between two adult partners, the differential status between parents
and children is reflected in somewhat different practices of speaker/ listener roles. Some basic "do's" and
"don'ts" still apply (e.g., see Forgatch & Patterson, 2005). Behaviors to be encouraged include: staying focused
on the speaker, attempting to understand the other's perspective, and using active listening skills. Behaviors
to be discouraged include: being defensive, criticizing the speaker, and lecturing or giving advice.

The Therapist's Role

As described earlier, the therapist plays an active role to maximize the likelihood of success in
 19 • COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING 11
speaker Ilistener skills training. The therapist models both speaker and listener behaviors, and encourages,
prompts, and reinforces the part ners' efforts in this process . Most importantly, the therapist monitors and
interrupts the pro cess when it is not working to bring it back to a more productive course. Some
instructions for communication training include extensive lists of rules. Certainly, it is important for the
therapist to demonstrate and prompt ways for partners to express strong feelings without provoking an
immediate counterattack. However, the pri mary objective of speaker/ listener skills training should not be
overshadowed by undue attention directed to a list of communication rules. The overriding goal is to create
an atmosphere of mutual respect and openness so that spouses can get their most difficult and controversial
points across to one another.

FUNCTION OF PROBLEM-SOLVING SKILLS

Problem-solving skills training is designed to provide spouses and family members with
 12 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY
should be documented in writing to help keep the process on track and to avoid disagreements about the
specifics of the agreed-upon plan.

STEP-BY-STEP PROCEDURES FOR PROBLEM-SOLVING SKILLS FOR COUPLES

Defining the Problem

Problem definition is the most important and most difficult step in problem solving. It is the most
important because it sets up a framework for thinking about and approaching the problem . It is the most
difficult because it requires trans lating one person's complaint into a nonblam ing relationship issue. It
also requires balancing the specificity and generality of the problem definition -specificity so that
participants know what problem is being addressed, and generality so that they do not solve a small
manifestation of a larger issue.
Ideally, problem definition acknowledges the role of both people and the consequences of the problem for
both spouses. When those com
ponents are included, spouses find it easier to
a strategy for examining and responding to
 19 • COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING 13
collaborate with brainstorming solutions. How
 14 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY

--E
situations that they want to change but are
in disagreement about how to change. Thus, problem-solving skills are used when the family members
feel "stuck"because each is entrenched in her or his own position that is different from, if not diametrically
opposed to, the other's position . The steps involved in problem-solving skills are threefold . The first is to
define the problem in a manner that is noninflammatory and incorporates the role of both people,
thereby increasing the motivation of both to want to solve the problem . The second is to generate a
broad array of solutions to the problem, thereby increasing the likelihood that the partners will find some
set of solutions upon which they can agree. The third is to craft a carefully considered plan of action that
can be put into effect quickly and, in subsequent sessions, can be monitored and modified . Proposed
solutions are construed as 'works in progress'. Even if successful, they generally need to be updated and
revised as the problem starts to resolve and/ or as circumstances change. The content of each phase of
the problem-solving session
 19 • COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING 15
ever, in generating the problem definition, it is
common for spouses to revert to a pattern in which one partner complains or criticizes and the other partner
defends her or his behav ior. This situation is best managed by: (1) not defining problems when either
spouse is angry;
(2) reminding spouses to state the problem in a way that is easiest for the partner to hear;
(3) employing listener Ispeaker skills as needed ;
and (4) making sure that spouses do not side track from one problem to another Oacobson & Margolin,
1979).
Particularly when couples are first learning problem-solving skills, the therapist needs to play an active role to
ensure that spouses define the problem in a way that opens up creative and constructive possibilities for
addressing the problematic issue. For example, the initial complaint of a wife who comanaged a business
with her husband was that the husband was obsessed with the business . This complaint directed toward
the spouse was translated into the mutual issue that the couple had no relationship time apart from
their business
16 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY

dealings. The redefinition of this problem opened up possibilities for new solutions toward reserving special
relationship time as well as making sure that mutual business issues were adequately dealt with in a timely
fashion.

Brainstorming Solutions

Once the partners and the therapist have agreed on a problem definition, the brainstorming pro cess
begins. The primary rules of brainstorming are that: (1) any idea, no matter how outrageous, is worthy of
mention, and (2) no evaluation of ideas takes place until the entire list is generated and rated . As a result
of these rules, partners are less inhibited in presenting their ideas and they stay focused on the one
problem under discus sion (Jacobson & Margolin, 1979). Each solution is written down until a list of 10-20
solutions is generated .
Rating Brainstormed Solutions
Still without discussion, spouses independently rate each suggestion (1 = suggestion is good; 2 =
suggestion may be worthy of consideration ;
 19 • COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING 17
behaviors practiced in session and extend the behaviors to a new topic. When learning speaker/
listening behaviors, family members typically are asked to set aside a half-hour once or twice during the
week with each person alternately taking the role as speaker and as listener. Similarly, once the
family members have practiced problem solving with the therapist on several different issues, they can
be asked to try the same procedures at home. For the first such assignment, the therapist may want
the complete problem definition in the session and then have the clients do the brainstorming and
problem solution at home.
It is generally advised that the topics selected for homework practice of speaker / listener skills or of
problem-solving skills should be less con flictual than those addressed in the session. Having family
members tape-record their com munication skills homework is a good way for the therapist and clients
to review homework practices. As with all between-session assign ments, the therapist must fully debrief
the home
work during the next session. Ultimately, the
3 = suggestion is bad). Each item rated as a 3 by
18 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY
goal is for the family to recognize when they
 19 • COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING 19
--E
both spouses is immediately removed from the
list. Each item with a 1-1 or a 1-2 combination is discussed to develop a plan based on one or more of
these ideas.

Developing and Revising the Plan

The initial plan should incorporate suggestions that can be put into effect within the next week, with the
possibility of revision or incorporating other steps in future weeks. A problem solution thus is reevaluated
and revised until the prob lem is solved or a long-range solution is in place. What makes this process of
problem solving very rewarding to spouses is that they discover mul tiple mutually acceptable solutions to
a problem that previously seemed unsolvable .

GENERALIZABILITY

Following each session of communication skills training, family members are given a homework assignment
to practice and consolidate the
20 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY
need to use communication skills and to then
employ the skills on their own.

EVIDENCE-BASED APPLICATIONS

Research on the efficacy and effectiveness of communication skills training is embedded in empirical
research on behavioral marital therapy, prevention training, and parenting interventions. Baucom and
colleagues (Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998) have determined, based on more than 20
published, controlled treatment outcome investigations, that behavioral marital therapy is an "efficacious and
specific intervention" (Chambless & Hollon, 1998) for maritally distressed couples. Similarly, a recent meta-
analysis indicates behavioral marital therapy is significantly more effective than no treatment for distressed
couples (Shadish & Baldwin, 2005). Research on the efficacy of communication and problem-solving skills
training for committed couples has been established (Braukhaus et al., 2003; Kaiser,
 19 • COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING 21

Communication Training

Listener/ Speaker Skills

Listener behaviors:Repeat verbatim
Paraphrase Reflect Validate
Speaker behaviors:Make succinct statements
Clarify and express accurate feeling statements
Problem-Solving Skills
Define problem in mutual non-blaming language Brainstorm and then rate problem solutions Develop plan
to be enacted in stated time period Implement plan
Review implementation and revise plan

Hahlweg, Fehm-Wolfsdorf, & Groth, 1998) with intervention couples having significantly more positive
communication and less negative communication than the control couples. With respect to the long-
term effects of
 22 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY
behavioral marital therapy. These studies have reported positive consumer ratings (Baucom et al., 1998).
Dropout rates are estimated to be low, as suggested by a 6% attrition rate found by Hahlweg and Markman
in their meta-analysis
communication skills training in particular,
 19 • COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING 23
of behavioral marital therapy studies (1988).
 24 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY

--E
a component analysis of behavioral marital
therapy indicated that after 6 months the communication skills training component showed superior
maintenance of treatment gains over the behavioral exchange component (Jacobson, 1984). However, a
subsequent 2-year follow-up indicated no differential benefit of either component, and approximately 30%
of couples who had improved in ther apy later relapsed (Jacobson, Schmaling, & Holtzworth-Munroe,
1987). Although research overall indicates that couples appear to benefit from communication training,
there is a small set of women who demonstrate a decrease in marital satisfaction across time if, as a
result of an intervention, they have been extremely positive and rarely negative in communication
(Baucom, Hahlweg, Atkins, Engl, & Thurmaier, 2006). These findings indicate the importance of the
expression of both negative and positive communication .
In addition to questions of efficacy, a limited number of studies also have investigated the effectiveness, or
real-life generalizability of
 19 • COMMUNICATION/PROBLEM-SOLVING SKILLS TRAINING 25
Improved parent-child communication
generally has been examined in the context of comprehensive programs to change children's behavior or to
improve family functioning around difficult issues. Parenting programs, such as Adolescent Transitions
Program (Dishion & Kavanagh, 2003), based on the Patterson (1982) ecological model of antisocial behavior
and coercive family interaction pat terns, have empirical evidence that intervention groups of at-risk
adolescents in treatment had less negative engagement and a significant reduction in home problem behavior
after a program focused on parent-teen relationship skills. These relationship skills included communication
skills, problem-solving skills, and negotiating . Based on similar models, there is extensive empirical
evidence of the efficacy of programs that utilize components of communication skills and problem solving.
A sample of these are a program for divorcing mothers and their young sons (Forgatch & DeGarmo, 1999),
Incredible Years parent intervention program for young children
26 GENERAL PRINCIPLES OF COGNITIVE BEHAVIOR THERAPY

with conduct problems (Webster-Stratton & Reid, 2003) and Parent Management Training (Kazdin, 2005) for
children and adolescents with aggressive and antisocial behavior .

SUMMARY

Communication skills training sets up the struc ture and expectation that family members will listen to
each other and approach problem solv ing in new ways. Interaction behaviors to be enacted are shaped
with the therapist initially doing much modeling and reinforcing and fam ily members gradually doing the
steps more independently. Although the steps of communi cation skills training are spelled out in several
manuals, the timing and sequencing are left to the therapist's judgment. Toward the goal of optimizing
each person's likelihood of success at each therapeutic stage, the therapist uses her or his judgment with
respect to when to introduce communication skills training, how to pace the training, whether to begin
the training on more or less serious problems, whether to combine communication training with other
intervention procedures, and whether to introduce communi cation skills in a formal, educational manner
or to work them in seamlessly as needed in ongoing discussions of the couple's or family's problems .
Dishion, T. J., & Kavanagh, K. (2003). The Adolescent
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