Couples Therapy

Günce Hazman
Seradil Eylül Uyal
Couples Therapy
 20% of couples have marital distress
 Half of marriages end in divorce
 10-15% separate in 4 years
 70% last a decade
Couples Therapy
 Couples therapy is the only evidence-
based treatment.
 Aimed at marital difficulties but also
preventive and enrichment work.
 Couples Therapy
 Marital distress brings
work difficulty, health
problems, problems
with children.

Marital difficulty Psychopathology

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.
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.
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.
Couple Processes
 Not only our behaviors but also our
cognitions contribute to dissatisfaction.
 Positive sentiment override-feeling
positively about one’s partner and the
relationship is crucial.
 Many unhappy couples experience
demand-withdrawal. One partner tries to
communicate while the other one
withdraws.
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....
Treatment Approaches
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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
1. Create safe, collaborative alliance
2. Access and expand emotional responses
3. Restructure interactions
 Humanistic techniques
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.
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
Affective Reconstruction

1. Developing a collaborative alliance

2. Containing disabling relationship crises
3. Strenghtening the marital dyad
4. Promoting relevant relationship skills
5. Challenging the cognitive components of
relationship distress
6. Examining developmental sources of
relationship distress
Brief Integrative Marital Therapy
 Focus on present
 İnterpersonal and intrapersonal world
together
 Three central goals
1. Teach relationship skills
2. Challenge dysfunctional relationship
rules
3. Inculcate systematic thinking
Narrative Couples Therapy

 Change happens when couples modify

their views of themselves and others
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”
Feminist Couple Therapy
 Intimacy achieved with equality
Special Problems
 Sex therapy
 Infidelity problems
 violence
Ethical Issues
 Confidentiality and record keeping
Research Assesing Effectiveness of
Couple Therapy
 Couple therapy is as effective as individual
therapy.
 High return problems
Couples Therapy

Günce Hazman
Seradil Eylül Uyal