1. Couple & Family Therapy : An Integrative Map of the Territory
Jay L Lebow
Chapter 3
The Empirical Base

2. Introduction Science & a Craft Origins in Theory Growth in Science
(Lebow, 2014)
Introduction
Science & a Craft
Origins in Theory
Growth in Science

3. Relevance of Science Two levels Local – local clinical scientist
(Lebow, 2014)
Relevance of Science
Two levels
Local – local clinical scientist
Science based perusal of data to make clinical decisions
Testing hypotheses
Gathering data of feedback
General
Gathering knowledge across all families/practices

4. Clinical Decision Making
(Lebow, 2014)
Clinical Decision Making
Best data from clinical trails
Too complex to put into algorithms
Too many decisions to make
Too many possible options
Limits to applicability to any one family

5. What does research offer?
(Lebow, 2014)
What does research offer?
Relatively little research done in the past that could inform practice
Some supported treatments exist
Research provides objective documentation
Efficacy/ evidence based practice
Reimbursement
Research provides info on best practices

6. What does research provide?
(Lebow, 2014)
What does research provide?
Probabilities
Similar cases
Options that have worked/ not worked
Objective Assessments
Expand beyond biases
Efficacy of specific decisions
Correlations
Ex: schizophrenia and expressed emotion

7. Limits of Research Poor research designs Fads
(Lebow, 2014)
Limits of Research
Poor research designs
Fads
Not enough control over variables

8. What can clinicians offer research?
(Lebow, 2014)
What can clinicians offer research?
Generating ideas for research
Providing feedback
Application in the real world

9. Quality of Research in Family Therapy
(Lebow, 2014)
Quality of Research in Family Therapy
Time - Longitudinal studies are increasing in number
Growing external validity - Increasingly multicultural
Children of Divorce
Children of Same-sex Parents

10. Demographics of Marriage & Family
(Lebow, 2014)
Demographics of Marriage & Family
Goal of therapy is strengthening relationships.
Families have a variety of options other than “institutionalized marriage”
Single or Two-Parent?
Only a slight majority of children live with two parents
Single parent families are the norm

11. Demographics of Marriage & Family (cont)
(Lebow, 2014)
Demographics of Marriage & Family (cont)
Divorce = 50%
Half of divorces take place in the first 7 years of marriage
Cohabitation = 8%
Rates of break-ups are higher than divorce
Predominant living arrangement is living alone

12. Epidemiology of Couple Distress
(Lebow, 2014)
Epidemiology of Couple Distress
20% (1/5) of couples are “distressed” at any point in time
Satisfaction levels decrease significantly over the first 10 years
Relationships are the most frequently cited source of emotional distress

13. Couple Distress Impacts individual psychopathology
(Lebow, 2014)
Couple Distress
Impacts individual psychopathology
Couple distress is linked to
Axis 1 disorders
Anxiety, mood, & substance related
Expressed emotion
Schizophrenia, bipolar, borderline personality, Etc.
Social functioning (Whisman & Uebelacker, 2006)
Social role functioning
General distress
Poorer physical health
Increase of suicidal ideation
Poorer outcomes in individual therapy

14. Effects of Relationships
(Lebow, 2014)
Effects of Relationships
“Patterns in family process and child rearing have vital and lasting effect on the development of virtually every personality characteristic and form of psychopathology” (p. 68)

15. Caveats for Effects of Relationships
(Lebow, 2014)
Caveats for Effects of Relationships
Correlation NOT Causation
Circular
Depressed people more likely to enter more difficult relationships which is more likely to lead to depression
System issues do not exist in isolation
Individual differences impact families

16. Characteristics of Relationships
(Lebow, 2014)
Characteristics of Relationships
What is satisfying and what is distressing?
Positive Sentiment Override (PSO) is satisfying
Positive feelings & behaviors outweigh negative ones
Gottman says 20:1
Negative sentiment override is distressing
Feelings have greater impact than behavior changes
How would you assess for PSO? How can you increase PSO?

17. Characteristics of Relationships
(Lebow, 2014)
Characteristics of Relationships
Separation of Positive & Negative Aspects of Relationships
Problems & Successes are independent
Don’t loose focus of what is working in a relationship

18. Conflict in Satisfying Relationships
(Lebow, 2014)
Conflict in Satisfying Relationships
Governed and focused
May have high emotion
Positive or neutral affect is mostly present

19. Conflict in Distressed Relationships
(Lebow, 2014)
Conflict in Distressed Relationships
Unfair fighting
Name-calling
Not listening
Multiple Issues in One Fight
Flooding of Negative Affect
Prusuar-Distancer Cycles

20. (Lebow, 2014)
Gottman’s Research
Intensive coding of videotaped interactions, assessments, interviews, Etc.
Goal of therapy:
Increase positive exchange
Decrease negative exchange
The Four Horsemen
Criticism
Defensiveness
Contempt
Stonewalling

21. Gottman’s Research (cont.)
(Lebow, 2014)
Gottman’s Research (cont.)
Topics of conflict same
Repeating the same fights happens to all couples
Amount of conflict doesn’t really matter
PSO needs to stay high
Accurate communication of feeling
May help develop intimacy, but…
Is not helpful for highly contemptuous feelings

22. Attachment Assessment
(Lebow, 2014)
Attachment
Bowlby - “Safe Base”
Early life experiences lead to attachments that are…
Secure
Insecure
Avoidant
Assessment
How do families sooth one another, connect, and maintain closeness?
Low attachment predicts dissatisfaction only when one or more members need attachment

23. Communication Most frequent focus of couple and family therapy
(Lebow, 2014)
Communication
Most frequent focus of couple and family therapy
Typical interventions
Modeling
Practicing speaking & listening

24. Speaker Listener Technique
(Lebow, 2014)
Speaker Listener Technique
RULES FOR BOTH: 1. The speaker has the floor. 2. Share the floor. 3. No problem solving. RULES FOR THE SPEAKER: 1. Speak for yourself. 2. Talk in small chunks. 3. Stop and let the Listener paraphrase. RULES FOR THE LISTENER: 1. Paraphrase what you hear. 2. Don’t rebut. Focus on the Speaker’s message.

25. Gender Differences Gender affects
(Lebow, 2014)
Gender Differences
Gender affects
Distribution of work
Responsibilities
Expectations
Co-equal relationships have greater satisfaction
Reality - Even in two fulltime working parent households, women have a greater amount of work in the home
Discuss when contributing to the issues

26. Family Violence Highly underreported, even among couples in therapy
(Lebow, 2014)
Family Violence
Highly underreported, even among couples in therapy
Correlated with
High conflict
Angry outbursts
Difficulties with self control
Low grade interactions especially high
Pushing, slapping
Under-reported
Gender
Defined as slapping, pushing, Etc. – equal

27. Family Violence (cont.)
(Lebow, 2014)
Family Violence (cont.)
Batterers - mostly men
20% poor prognosis for change
Antisocial behavior
Lack of remorse
Lower levels of psychological arousal when stressed
Family therapy is an invitation of risk, and most likely not effective

28. (Lebow, 2014)
Divorce & Remarriage
Divorce/ separation & remarriage/ newly cohabitating causes turbulent years
Two years of adjustment for divorce/separation
Remarriage
Normal to be less cohesive than original families
Better to gradually/slowly integrate

29. (Lebow, 2014)
Family Rituals
Stabilizing Effect
Dinner hour
What else?

30. (Lebow, 2014)
Reference
Lebow, J. L. (2014). Couple and family therapy: An integrative map of the territory. Washington, DC: APA books.