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 difficultyPsychopathology

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