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A comparative treatment study of experiential and behavioral approaches to marital therapy Johnson, Susan Maureen 1984

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A COMPARATIVE TREATMENT STUDY OF EXPERIENTIAL AND BEHAVIORAL APPROACHES TO MARITAL THERAPY By SUSAN M. JOHNSON B.A. University of H u l l , 1968 M.A. University of B r i t i s h Columbia, 1980  A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION in THE FACULTY OF GRADUATE STUDIES (Department of Counselling Psychology)  We accept this d i s s e r t a t i o n as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA March 1984 ©Susan M. Johnson, 1984  In p r e s e n t i n g  this  thesis  r e q u i r e m e n t s f o r an  in partial  f u l f i l m e n t of  advanced degree a t  the  University  of  B r i t i s h Columbia, I agree that  the  Library  shall  it  freely  and  study.  I  available  for reference  agree that permission for  f o r extensive copying of  s c h o l a r l y p u r p o s e s may  department or  by  understood that for  financial  h i s or  be  g r a n t e d by  gain  the  shall  not  be  of  this  Department of  d^QU^j^il  The U n i v e r s i t y o f B r i t i s h 1956 Main Mall V a n c o u v e r , Canada V6T 1Y3 Date  lO  <N^,  ir^j  further this  P&\Zj (M-(j(OCj lj  Columbia  l^jf  thesis my  It is thesis  a l l o w e d w i t h o u t my  permission.  make  head o f  her' r e p r e s e n t a t i v e s .  copying or p u b l i c a t i o n  the  written  A l l our actions take Their hues from the complexion of the heart As landscapes their variety from l i g h t W.T.  Bacon  Emotion i s a transformation of the world. J.P. Satre  ABSTRACT  The  present study compared the r e l a t i v e effectiveness of two  interventions i n the treatment of marital discord, a cognitive behavioral  intervention, teaching problem solving s k i l l s , and an  e x p e r i e n t i a l intervention, focussing on emotional experiences interaction  underlying  patterns.  F o r t y - f i v e couples seeking therapy were randomly assigned to one of these two treatments or a wait l i s t control group.  Each treatment was  administered i n eight sessions by s i x experienced therapists whose interventions were monitored and rated to ensure treatment f i d e l i t y . Results  indicated that the perceived  strength of the working a l l i a n c e  between couples and therapist and general equivalent  across  treatment groups, and that both treatment groups made  s i g n i f i c a n t gains over untreated  controls on measures of goal  attainment, marital adjustment, intimacy reduction.  therapist effectiveness were  levels and target complaint  Further, the effects of the experiential treatment were  superior to those of the cognitive behavioral adjustment, intimacy, adjustment scores  treatment on marital  and target complaint l e v e l .  At follow-up, marital  in the experiential group were s t i l l  higher than i n the cognitive behavioral  group.  significantly  - i i iTABLE OF CONTENTS Page Dedication  i  Abstract  i i  Table of Contents  i i i  L i s t of Tables  v  L i s t of Appendices  vii  L i s t of Figures Acknowledgements  viii •  ix  Chapter I  INTRODUCTION  1  Background  1  D e f i n i t i o n of Terms  7  Summary of Hypotheses II  III  •••  9  LITERATURE REVIEW  11  Outcome Research i n Marital Therapy  11  Conceptual Models of Interpersonal Conflict and Marital Distress  14  The Role of Emotion i n Therapy  33  Emotion i n M a r i t a l Therapy  41  A Description of Interventions Used  48  THE METHODOLOGY OF THE STUDY  57  C l i e n t Population  57  Therapists  59  Instruments  •  61  - iv -  Page Data Collection Procedures Hypotheses  IV  V  72 •  • 75  Data Analysis Procedures...  76  Limitations of the Study  78  RESULTS AND DATA ANALYSIS  83  Stage 1:  Item and Test Analysis  83  Stage 2:  Testing Assumptions  88  Stage 3:  Pre-Test Post-Test and Follow-Up Measures  93  Descriptive Data  113  DISCUSSION OF RESULTS  117  BIBLIOGRAPHY  132  APPENDICES  146  - v  -  LIST OF TABLES Table  Page  1.  DAS:  2.  Pair Perceived:  3.  Pair Expected:  4.  Couples Therapy A l l i a n c e Scale:  5.  Summary ANOVA:  Couples Therapy A l l i a n c e Scale  90  6.  Summary ANOVA:  Pre-Test Couple Scores  93  7.  Pre-Test Pair Perceived  8.  Summary ANOVA:  9.  Multivariate Analysis of Variance: Variables  10. 11.  Test S t a t i s t i c s  83  Test S t a t i s t i c s  85  Test S t a t i s t i c s  86 Test S t a t i s t i c s  87  Couple Scores  95  Post-Test DAS Total Scores  Summary Repeated Measures ANOVA: Scores Repeated Measures Analysis: D i f f e r e n t i a t i n g Variables  97  Treatment Outcome 99 Total DAS Follow-Up 108  Follow-Up Scores on 110  12.  Percentages of Couples Improved on Total DAS  115  D-l  DAS:  201  D-2  DAS Males:  D-3  DAS Females:  D-4  Pair Perceived:  D-5  Pair Perceived  D-6  Pair Expected:  D-7  Pair Expected Individual Scores  E-l  Summary of ANOVAS:  E-2  Test of Emotional Style:  E-3  Couples Therapy A l l i a n c e Scale Individual Scores  Subtest Correlations Test S t a t i s t i c s  202  Test S t a t i s t i c s  203  Subtest Correlations  204  Individual Scores  205  Subtest Correlations  Demographics Analysis of Variance  206 .  207 209 210 211  - vi -  Page E-4  Summary ANOVA:  Task Dimension of A l l i a n c e Scale  212  E-5  Therapist Effect on Post-Test Total DAS Scores  213  E-6  Therapist Effects on Post-Treatment Variables  214  E-7  Pre-Test Pair Expected Couple Scores  215  E-8  Post-Test Pair Expected Couple Scores  216  E-9  Summary ANOVA:  Pre-Test and Post-Test Pair Expected  Scores  217  E-10 Individual Pre-Test Pair Perceived Scores  218  E - l l Individual Post-Test Pair Perceived Scores E-12 Individual Post-Test Scores  219 220  E-13 Repeated Measures Analysis: Non-Differentiating E-14  Summary ANOVAS:  Follow-Up Scores on  Variables..  Individual Total DAS Scores at Follow-Up..  E-15 Individual Follow-Up  Scores on D i f f e r e n t i a t i n g Variables...  E-16 Individual Follow-Up Variables  Scores on Non-Differentiating  221 222 223  224  - viii -  LIST OF FIGURES Page 1.  Groups Means on Total DAS Scores at Pre-Test and Post-Test and Follow-Up Assessment  116a  - vii -  LIST OF APPENDICES  Page A.  Treatment Manuals  146  B.  Instruments Used i n the Study  175  C.  Forms:  195  D.  Item Analysis  200  E.  Data Analysis  208  Consent and Follow-Up  - ix -  ACKNOWLEDGEMENTS  I would l i k e to thank a l l members of the research committee and Mr. Bob Prosser for his invaluable assistance i n s t a t i s t i c a l analysis. I would also e s p e c i a l l y l i k e to acknowledge the p a r t i c u l a r and extraordinary support encouragement and assistance give to me by my advisor, Dr. L. Greenberg. Acknowledging a l l of the above however this thesis i s dedicated to my mother, Winifred Dorothy B e l l , who taught me how to s t r i v e .  1  CHAPTER I INTRODUCTION  Background Interpersonal  c o n f l i c t appears to be an inevitable part of a l l  human relationships.  Blake and Mouton (1978) have suggested that  the  most pressing task facing modern society i s that of educating i t s c i t i z e n s to resolve interpersonal c o n f l i c t without reference solutions such as the law.  One  to  sub-set of such c o n f l i c t which seems  p a r t i c u l a r l y disruptive i n the everyday l i f e of people i n North America i s the c o n f l i c t which arises between spouses.  In Canada and  one marriage i n three currently ends i n divorce Census, 1976,  (U.S.  the U.S.A.  Bureau of the  Adams & Nagnur, S t a t i s t i c s Canada, 1981).  There i s also  evidence that marital disruption i s a s i g n i f i c a n t stressor with a greater incidence  of psychiatric admission, motor vehicle  physical i l l n e s s and alcoholism separation  accidents,  occurring during or after marital  (Bloom, Asher & White, 1978).  The negative consequences of  marital disruption for children i s well documented (Wallerstein & K e l l y , 1974), and Renne (1971) has suggested that i n terms of physical marital distress can be as damaging as marital On the other hand there i s now  separation.  evidence to suggest that positive  close relationships seem to help innoculate stresses of l i f e .  health,  Myers, Lindenthal,  those involved against  the  Pepper and Ostrander (1975) have  shown that intact marital status appears to make i t easier for persons undergoing l i f e stress events to.avoid impairment.  increased  psychiatric  Lowenthall and Haven (1968) in their analysis of adaption  2  i n the l a t e r years of the lifespan were "struck by the fact that the happiest and healthiest among them often seemed to be the people  who  were or had been involved i n one or more close relationships" (p. 20). Other researchers  such as Rosow (1967) have found support for the  assertion that the depth of intimacy experienced with others i s a key correlate i n a person's a b i l i t y to adapt over the l i f e s p a n ; i n fact Lowenthal and Weiss (1976) suggest that men motivation  and women find the  to l i v e autonomous s a t i s f y i n g l i v e s only through the presence  of one or more mutually supportive and intimate dyadic relationships. The main vehicle for such intimacy i n our society would appear to be through the i n s t i t u t i o n of marriage. Given the significance of intimate dyadic relationships and  the  fact stated above that one i n three marriages currently ends i n divorce i t would seem to be no accident that marital therapy as a f i e l d grown substantially i n the l a s t decade (Gurman & Kniskern, growth of marital therapy may  has  1981).  The  also be viewed as being part of a s h i f t  towards a concern with human transactions rather than just the behaviour of i n d i v i d u a l s . The influence of Sullivan (1953), who  viewed  personality as the enduring pattern of recurrent interpersonal situations characterizing a human l i f e , of Leary (1957) and of Carson (1969) can be seen i n the present therapy approaches.  flowering of marital and  family  Duke and Nowicki (1982) point out that e f f e c t i v e  treatment outcomes i n a l l t h e o r e t i c a l orientations are linked to changes in the c l i e n t ' s customary ways of i n t e r a c t i n g with others, the attitudes he or she maintains towards others, and the b e l i e f s he or she holds about him or herself.  3  S u l l i v a n (1953) stressed that such b e l i e f s about the self are, above a l l interpersonal i n both their development and current contents.  This view i s echoed by K i e s l e r (1982) who  evolving  suggests that  the  s e l f i s s o c i a l , interpersonal and transactional i n i t s development and functioning throughout l i f e . M a r i t a l therapy has grown not only as a separate entity but as a component or general mode of intervention for a wide variety of problems t r a d i t i o n a l l y treated by i n d i v i d u a l psychotherapy including a f f e c t i v e disorders, alcoholism, and obsessive  sexual dysfunction,  childhood  behaviour problems  compulsive disorders such as agoraphobia.  l a s t decade marital therapy may  In fact i n the  be viewed as having evolved into one  of  the most s i g n i f i c a n t psychotherapeutic interventions i n the mental health f i e l d  (Gurman, 1978).  Also as Lewis, Beavers, Gosset and  Austin  P h i l l i p s (1976) point out i n their study of psychological health in family systems, interventions at the l e v e l of the marital relationship have considerable  potential for creating change at other l e v e l s , and  that i f only one l e v e l could be approached ( i n d i v i d u a l , marital or family) the marital l e v e l would seem to have p o t e n t i a l l y the  greatest  impact upon both the i n d i v i d u a l and the t o t a l family. As the f i e l d of marital therapy has grown research into the e f f e c t s of such therapy has also grown (Gurman & Kniskern, 1981).  By  1978  Gurman and Kniskern (1981) were able to state that i n general non-behavioural marital therapy appeared to produce b e n e f i c i a l e f f e c t s i n 65% of cases, which i s e s s e n t i a l l y the same gross improvement rates noted for non-marital i n d i v i d u a l therapy by Bergin  (1971).  Jacobson and  Weiss (1978) were also able to document the effectiveness of the  4  behavioural approach to marital therapy.  However studies examining the  comparative e f f i c a c y of behavioral approaches as opposed to other treatment methods are nearly non-existent (Gurman & Kniskern, 1981). Jacobson (1978) has commented upon the need for comparative outcome studies to evaluate treatment approaches hitherto unexamined by empirical methods, such as the more psychodynaraic interventions.  The  need for comparative studies of behavioral and treatment methods i s then well recognized i n the l i t e r a t u r e . The completion of such comparative studies has been hampered by the fact that considerable homogeneity of interventions exists across d i f f e r e n t t h e o r e t i c a l models.  This homogeneity of interventions i s  reflected for example by the fact that Sager, a  psychodynamic  p r a c t i t i o n e r (1981) and Weiss, a behavioral p r a c t i t i o n e r , (1978), both use operations such as behavioral contracting. also become more encompassing.  P a r t i c u l a r models have  O'Leary and Turkewitz (1978) point out  that even behavior therapy has tended to become ambiguous as a result of the cognitive trend i n psychology. A comparison of different kinds of interventions from d i f f e r e n t models addressing s p e c i f i c problems would then address the need for an investigation into what kinds of interventions are most e f f e c t i v e i n the marital context.  A s p e c i f i c a t i o n of the target of change would also be  a desirable refinement i n any study comparing interventions taken from d i f f e r e n t models of therapy.  In marital therapy one of the most l o g i c a l  targets would appear to be the c o n f l i c t engaged i n by distressed couples.  There i s agreement i n the l i t e r a t u r e that e f f e c t i v e c o n f l i c t  resolution interactions between spouses i s c r u c i a l for the maintenance  5  of marital s a t i s f a c t i o n (Glick & Gross, 1975), and that distressed couples have greater numbers of unresolved problems and episodes than do non-distressed  conflict  couples (Birchler & Webb, 1977).  Since  one of the main goals, i f not the sine qua non of marital therapy, i s to f a c i l i t a t e the resolution of c o n f l i c t between spouses, the effect of d i f f e r e n t kinds of interventions on marital c o n f l i c t resolution would appear to be a f r u i t f u l area of i n v e s t i g a t i o n . Although i t i s often d i f f i c u l t  to distinguish d i f f e r e n t types of  interventions encompassed within contrasting models, there does seem to be a clear d i s t i n c t i o n between the r a t i o n a l problem solving t y p i c a l l y employed by cognitive behaviorists (Jacobson, 1981; & Margolin, 1979;  O'Leary & Turkewitz, 1981)  exploration operations (Feldman, 1982;  operations Jacobson  and the emotional  of the more experiential and dynamic approaches  Wile, 1981;  Perls, 1973).  E x p e r i e n t i a l l y oriented  treatments have emphasized the importance of a s s i s t i n g c l i e n t s to explore and experience previously disavowed emotional material i n order to help resolve their problems, whereas approaches based upon c l a s s i c learning theory have viewed such a process as far less relevant to the process of change, and have focussed  upon changing environment response  relationships (Borkovec & Grayson, 1981).  A comparison of interventions  taken from these two approaches would then address the comparative e f f i c a c y of two  intervention modes currently operating  in the f i e l d of  marital therapy and would also add to the knowledge i n the f i e l d i n other ways.  For example, considerable  interest has been recently shown  i n the role of affect i n behavior therapy (Rachman, 1981)  and i n marital  therapy i n p a r t i c u l a r (Margolin & Weinstein, 1983); however therapeutic  6  operations  geared towards working w i t h emotion have been a s s o c i a t e d  psychodynamic or h u m a n i s t i c f o r m u l a t i o n s , themselves to e m p i r i c a l  study.  oriented  describe  operations  be v a l u a b l e The conflict  in  and  To  stipulate specific  emotionally  itself.  r o l e of emotional e x p e r i e n c e i n the r e s o l u t i o n of and  i n the  f a c i l i t a t i o n of c o n f l i c t  E m o t i o n a l e x p e r i e n c e has detrimental,  ranged from being c o n s i d e r e d  or i n c i d e n t i a l to n e c e s s a r y and  R e c e n t l y t h e r a p i s t s such as E p s t e i n  irrelevant,  and  facilitating  f a c t o r s i n problem  different solutions  Mahoney (1980) has  r o l e of a f f e c t i n psychotherapy i s a key  of d i f f e r e n t p e r s u a s i o n s b i a s e d of a f f e c t .  As  a consequence there  has  therapeutic  change.  upon and  The using  c o n t e x t of m a r i t a l  emotion thus has  evaluation  a f f e c t i v e l y based treatment f o r m a r i t a l d i s c o r d evaluation  expression which  facilitate of  interventions  significance  outside  therapy.  In summary t h i s study i s concerned w i t h the  preliminary  c o n t r o l or  may  general  and  suggested  been a l a c k of s t u d i e s  s t i p u l a t i o n and  and  issue with t h e o r i s t s  e i t h e r towards the  examine s i t u a t i o n s i n which a f f e c t i v e e x p r e s s i o n  the  solution),  such as Zajonc (1980) have argued f o r the dominance  primacy of a f f e c t i n human e x p e r i e n c e .  focussing  therapeutic  Bishop (1981) have  ( f o r example anger f a c i l i t a t e s an a g g r e s s i v e / d e f e n s i v e  the  exploration.  even c r u c i a l to  s o l v i n g s i n c e d i f f e r e n t emotions tend to s t i m u l a t e  theorists  interpersonal  r e s o l u t i o n or other changes  requiring further  proposed that human emotions f u n c t i o n as  that  r e a d i l y lend  t h e i r e f f e c t i v e n e s s would then seem to  i n therapy i s then a c o n t r o v e r s i a l i s s u e  change.  which do not  with  s p e c i f i c a t i o n of followed  by  an  a  of the e f f i c a c y of t h i s treatment when compared  7  w i t h a wait l i s t  c o n t r o l group and w i t h a problem  c o g n i t i v e - b e h a v i o r a l treatment. appear  solving  As suggested above such a study would  t o have c o n s i d e r a b l e c u r r e n t s o c i a l , c l i n i c a l and t h e o r e t i c a l  r e l e v a n c e ; a d d r e s s i n g the need f o r the s p e c i f i c a t i o n and e v a l u a t i o n o f approaches approach  to m a r i t a l therapy o t h e r than the well-documented  behavioral  and the more g e n e r a l q u e s t i o n of the r e l e v a n c e o f a f f e c t i v e  e x p e r i e n c e i n the treatment of r e l a t i o n s h i p s .  D e f i n i t i o n o f Terms O p e r a t i o n a l d e f i n i t i o n s of the key concepts used i n t h i s as  study a r e  follows: M a r i t a l Therapy:  Gurman (1978) d e f i n e s m a r i t a l therapy as therapy  i n which the m a r i t a l r e l a t i o n s h i p i s the p a t i e n t .  Gurman and K n i s k e r n  (1978) view m a r i t a l therapy as a subtype of f a m i l y therapy, and comment that  some f a m i l y t h e r a p i s t s focus on and c o n c e i v e of the spouse  b e i n g the core f a m i l y sub-system However, i n t h e i r a r t i c l e semi-independently  r e q u i r i n g change ( S a t i r ,  dyad as  1967).  they e v a l u a t e m a r i t a l and f a m i l y therapy  s i n c e t h i s i s i n keeping w i t h the c u r r e n t l a b e l l i n g  p r a c t i c e i n the f i e l d .  M a r i t a l therapy i n v o l v e s the m o d i f i c a t i o n o f an  i n t i m a t e r e l a t i o n s h i p between two p a r t n e r s , i n such a way as to reduce p a i n and d i s c o m f o r t and i n c r e a s e s a t i s f a c t i o n and a sense of well-being.  Such m o d i f i c a t i o n may i n v o l v e f a c i l i t a t i n g a renewal of the  r e l a t i o n s h i p on a more a c c e p t a b l e b a s i s or f a c i l i t a t i n g a s e p a r a t i o n of the spouses.  The p r o c e s s may be viewed  i n m o l e c u l a r terms as the  c r e a t i o n of a more a c c e p t a b l e c o n t r a c t , i n the sense of b e h a v i o r s  8  exchanged, or i n molar terms as a r e d e f i n i t i o n of the r e l a t i o n s h i p i n the sense of the p o s i t i o n s taken by each p a r t n e r Marital Conflict:  D i f f e r e n t extensive  phenomenon are summarized i n Chapter I I . conflict tic  Koren, C a r l t o n and  i s an adversary  relationship.  T h i s d e f i n i t i o n was  i n a r e l a t i o n s h i p so that the process  distinguished marriage and  intimate  toward  employed i n t h i s study. unresolved  between acute  their Altman  interpersonal  or l o s s of i n t i m a c y  and  rewards  moves to " s u c c e s s i v e l y more  of the r e l a t i o n s h i p " ( p . 173). p r o g r e s s i v e and  Waller  habituated  suggest that the deeper the investment and  i n a r e l a t i o n s h i p the more c o n f l i c t the  of an ongoing  of i n f l u e n c i n g each other  a c t s to c r e a t e " d e p e n e t r a t i o n "  areas  antagonis-  Shaw (1980) s t a t e that " M a r i t a l  T a y l o r (1973) suggest t h a t continued  superficial  this  social  spouses a l s o a f f i r m or r e d e f i n e the c h a r a c t e r of  m a r r i a g e " ( p . 461).  conflict  F i n k (1968) d e f i n e s  event w i t h i n the context  Thus i n the process  opposing content  and  c o n c e p t u a l i z a t i o n s of  i n terms of a n t a g o n i s t i c p s y c h o l o g i c a l r e l a t i o n s or  interaction.  conflict  i n the r e l a t i o n s h i p .  and  Hill  conflict  (1951)  in  ego-involvement  tends to be viewed as a t h r e a t to  self. Conflict Resolution:  outcomes can be e v a l u a t e d on mutual s a t i s f a c t i o n and objective resolutions. viewpoints  Koren et a l . (1980) suggest t h a t from two  major p e r s p e c t i v e s , one  another that focuses  T h i s study w i l l  conflict that  focuses  on the attainment  of  attempt to address both  by a s s e s s i n g outcome s a t i s f a c t i o n and  by an  observational  assessment of agreement or r e s o l u t i o n , as w e l l as an assessment of s p e c i f i c goal  attainment.  Problem S o l v i n g Treatment:  T h i s treatment i s d e f i n e d as  problem s o l v i n g i n t e r v e n t i o n s d e s c r i b e d  the  i n Appendix A, which focus upon  9  the t e a c h i n g of new interaction.  s k i l l s and  rules for resolving  conflictual  Problem s o l v i n g i s d e f i n e d by Jacobson  as "a s t r u c t u r e d i n t e r a c t i o n between two  and M a r g o l i n  people designed  (1979)  to r e s o l v e a  p a r t i c u l a r d i s p u t e between them," c o n c e n t r a t i n g upon "manifest observable complaints"  (p.  E m o t i o n a l l y Focussed in  117). Treatment:  The  e m o t i o n a l l y focussed  treatment  t h i s study i s d e f i n e d as the i n t e r v e n t i o n s d e s c r i b e d i n Appendix  which are designed suppress  to b r i n g to awareness and  or d i s p o s e of emotional  u n d e r l y i n g emotional  The  r a t h e r than  e x p l o r a t i o n of  therapy.  D i s t r e s s i n t h i s study was o p e r a t i o n a l i z e d  p a r t n e r s c o r i n g below 100  ( S p a n i e r , 1976). individual  experiences.  i s s u e s i s the focus of  Marital Distress: as at l e a s t one  develop  A,  Couple  on the Dyadic Adjustment  Scale  s c o r e s were o b t a i n e d by t a k i n g the mean of the  scores f o r each c o u p l e .  T h i s study c o n s i d e r s d i s t r e s s  level  on an i n d i v i d u a l b a s i s r a t h e r than r e q u i r i n g both p a r t n e r s to score below 100,  s i n c e one  distressed  distressed  r e l a t i o n s h i p and  p a r t n e r i s adequate to c o n s t i t u t e a  i n f a c t i n couples who  request therapy  p a r t n e r u s u a l l y p r e s e n t s as s i g n i f i c a n t l y more d i s t r e s s e d other. 105,  The  pre-treatment  the mean being 92.  husbands and 90.5 The  couple s c o r e s i n t h i s study ranged The  o v e r a l l mean DAS  s c o r e s was  the  from 71  93.8  to  for  f o r wives.  f o l l o w i n g hypotheses  are under i n v e s t i g a t i o n i n t h i s  t h a t both an a f f e c t i v e l y o r i e n t e d treatment skill  than  one  o r i e n t e d treatment  will  r e l a t i o n s h i p g o a l s , reduce  and  study:  a cognitive behavioral  be more e f f e c t i v e i n h e l p i n g couples  target complaints, increase m a r i t a l  reach  adjustment and t h a t  and l e v e l s of Intimacy than a wait l i s t  control  these two treatments w i l l have d i f f e r e n t i a l  condition,  e f f e c t s on the  above v a r i a b l e s as measured at post assessment and at f o l l o w - u p .  11  CHAPTER I I LITERATURE REVIEW  The  f o l l o w i n g review w i l l  focus on the outcome l i t e r a t u r e i n  m a r i t a l t h e r a p y , c o n c e p t u a l models of i n t e r p e r s o n a l distress, interventions psychotherapy  i n marital  therapy, and  study then  Outcome Research i n M a r i t a l  Therapy  In the l a s t of m a r i t a l and  follows.  therapy has been a s t o u n d i n g .  reviews of the f a m i l y and m a r i t a l therapy r e s e a r c h by Gurman and K n i s k e r n (1978, 1981), Jacobson Miller  (1981).  i n the outcomes  Recent e x t e n s i v e have been  completed  (1978), and W i l l i a m s and  Gurman and K n i s k e r n (1981) i n t h e i r review s t a t e  the evidence suggests that both b e h a v i o r a l are  A d e s c r i p t i o n of  decade the r a t e of growth of r e s e a r c h  family  marital  the r o l e of emotion i n  and i n m a r i t a l therapy i n p a r t i c u l a r .  the treatments used i n t h i s  c o n f l i c t and  and n o n - b e h a v i o r a l  that  treatments  e f f e c t i v e beyond chance and more s p e c i f i c a l l y conclude t h a t , i n the  m a r i t a l therapy reviewed 65% of cases improved. treatment  i s c l e a r l y the treatment of c h o i c e ,  psychotherapy  They note t h a t  since  conjoint  individual  f o r the treatment of m a r i t a l problems has a poor  record  when i t comes to p o s i t i v e outcomes and a l s o a h i g h r a t e of n e g a t i v e outcomes. W i l l i a m s and M i l l e r have been l i t t l e  (1981) s t a t e t h a t , a l t h o u g h t h e r e seems to  change i n q u a l i t y , the q u a n t i t y  t h i s a r e a has r e c e n t l y t r i p l e d , and effectiveness  of outcome r e s e a r c h  the q u e s t i o n of g e n e r a l  in  therapeutic  seems to have been answered i n the a f f i r m a t i v e .  However  the  question  of the d i f f e r e n t i a l e f f e c t i v e n e s s of the key  m a r i t a l therapy does not Comparative s t u d i e s comparison of the  approaches to  seem to have been addressed. i n the m a r i t a l area have been c o n f i n e d  treatment components w i t h i n  Weiss (1978) f o r example, compared b e h a v i o r a l  one  model.  to a  Margolin  communications  and  skills  t r a i n i n g w i t h that t r a i n i n g p l u s a c o g n i t i v e r e s t r u c t i n g component and non-specific  intervention  ( f i n d i n g that  c o g n i t i v e r e s t r u c t u r i n g component was and  the  communication s k i l l s  the most e f f e c t i v e ) ; and  a  plus  O'Leary  T u r k e w i t z (1981) conducted a comparative outcome study of "good  faith"  contracting  p l u s communication enhancement and  communication  skills  t r a i n i n g i n v o l v i n g empathy t r a i n i n g , f i n d i n g that both were  e f f e c t i v e compared to a no-treatment c o n t r o l . There i s i n the compares b e h a v i o r a l therapy, and Sanders and plus  l i t e r a t u r e o n l y one  non-analogue study  i n t e r v e n t i o n s w i t h a form of n o n b e h a v i o r a l m a r i t a l  t h a t i s the  study conducted by Liberman, L e v i n e , Wheeler,  W a l l a c e (1976) who  contingency contracting  compared communications s k i l l s t r a i n i n g  group i n t e r v e n t i o n w i t h an  c o n s i s t i n g of the v e n t i l a t i o n and i n both groups improved on  problems such as the  s e l f - r e p o r t measures but  conclusions  (1973), who  the  behavioral  Methodological  compared b e h a v i o r a l  group format i n v o l v i n g n o n - d i s t r e s s e d  The  and  f i r s t of these s t u d i e s  group therapy w i t h an couples and  and  based on these d a t a .  f o u r analogue s t u d i e s which compare b e h a v i o r a l  n o n b e h a v i o r a l approaches i n e x i s t e n c e . Fisher  only  Here c o u p l e s  l a c k of a c o n t r o l group, non-random assignment  t h e r a p i s t sample q u a l i f y any  There are  approach  d i s c u s s i o n of f e e l i n g s .  group showed improvement on problem s o l v i n g methods.  a small  that  found t h a t  i s by  Adlerian both  13  interventions  increased  congruence or agreement between  husband and  wife.  groups t h a t  taught b e h a v i o r exchange s k i l l s  conjugal  The  perceptual  second study by Wieman (1973) which compared to groups i n v o l v e d  in a  r e l a t i o n s h i p enhancement program, found no s i g n i f i c a n t  p o s t - t r e a t m e n t d i f f e r e n c e s on v a r i o u s  measures of m a r i t a l  adjustment.  Venema (1975) compared a form of communication t r a i n i n g w i t h a contingency c o n t r a c t i n g  procedure given  i n the  form of seven weekly  workshops; however, none of the groups made s i g n i f i c a n t changes. L a s t l y , Cotton (1976) found no training  (Carkhuff,  1969)  and  d i f f e r e n c e s between communication a b e h a v i o r exchange treatment on  self  r e p o r t measures of m a r i t a l s a t i s f a c t i o n . This when one  shortage of across-model comparative s t u d i e s considers  the l a r g e volume of l i t e r a t u r e  p r a c t i c a l l y the whole June 1978 concerned w i t h the oriented  The  ( f o r example  i s s u e of the j o u r n a l F a m i l y P r o c e s s )  r e l a t i v e m e r i t s of b e h a v i o r a l  approaches.  is surprising  v e r s u s more d y n a m i c a l l y  shortage of such s t u d i e s may  to the homogeneity of treatment components a c r o s s  be due  models but  not  a l s o to  l a c k of i d e n t i t y among the n o n - b e h a v i o r a l treatments ( W i l l i a m s 1981).  This  l a c k of i d e n t i t y i s r e f l e c t e d by  of outcome r e s e a r c h  the  by an e a s i l y r e c o g n i z a b l e (1978) Jacobson s t a t e s  i s by not  the  & Miller,  f a c t that i n reviews  such treatments have been c a t e g o r i z e d  c h a r a c t e r i s t i c they l a c k , t h a t  only  being b e h a v i o r a l ,  c h a r a c t e r i s t i c they s h a r e .  by  a  rather  than  In h i s review  that  "few would deny the p o p u l a r i t y of e i t h e r the p s y c h o a n a l y t i c or the systems theory approaches to m a r i t a l t h e r a p y . However n e i t h e r p e r s p e c t i v e can c l a i m even a s i n g l e outcome experiment i n v e s t i g a t i n g i t s e f f e c t i v e n e s s . The absence of s t u d i e s i n v e s t i g a t i n g systems approaches i s p a r t i a l l y e x p l a i n e d by the emphasis of these t h e o r i s t s on f a m i l y as opposed to m a r i t a l therapy" (p. 397).  14  The  b e h a v i o r i s t s , on the other hand, have been c h a r a c t e r i z e d  rigorous  methodological stance.  research  development would be  He  also stated  by  their  that a most welcome  a number of w e l l c o n t r o l l e d  outcome s t u d i e s examining approaches that have not  comparative  been e m p i r i c a l l y  validated. The  experiential/dynamic  of theory and  p r a c t i c e but  approach which has  little  research  that i s r e l a t i v e l y u n i n v e s t i g a t e d .  i s then one  I t would seem that  f o r a c o n t r o l l e d study comparing a b e h a v i o r a l dynamic approach to m a r i t a l be  homogeneous a c r o s s  interventions  different the  therapy.  schools,  (Perls,  1973;  time i s r i p e  a more e x p e r i e n t i a l /  treatment of d y s f u n c t i o n a l i n the  there  interventions  does appear to be  (Jacobson & M a r g o l i n , 1979;  marital  used by  tend  to  operations  typically  Satir,  A comparison of these two  p o s s i b l e and  pertinent.  of  by  O'Leary & T u r k e w i t z , 1981) the  to  emotional  dynamic approaches  types of i n t e r v e n t i o n s  and  i s then  C o n f l i c t and M a r i t a l D i s t r e s s  In o r d e r to understand the process and i s n e c e s s a r y to c o n s i d e r  therapists  1973), to change p e r c e p t i o n  experience.  C o n c e p t u a l Models of I n t e r p e r s o n a l  examine  conflict.  employed  of the more e x p e r i e n t i a l and  Feldman, 1982;  and  a c l e a r d i s t i n c t i o n between  environment response r e l a t i o n s h i p s , and  exploration  approaches  Since treatment o p e r a t i o n s  r a t i o n a l problem s o l v i n g o p e r a t i o n s  change the  the  deal  models, i t i s n e c e s s a r y to s p e c i f y d i f f e r e n t  similarity  behaviorists  and  of the  taken from d i f f e r i n g t h e o r e t i c a l p e r s p e c t i v e s  t h e i r e f f i c a c y i n the D e s p i t e the  produced a great  goals  of m a r i t a l therapy i t  the phenomenon of i n t e r p e r s o n a l  conflict,  and  v/  15  the v a r i o u s  conceptual  models u n d e r l y i n g  the p r a c t i c e of m a r i t a l  therapy. C o n f l i c t may  be viewed as a process i n which i n c o m p a t i b l e  or b e h a v i o r s r e s u l t i n n e g a t i v e i n e v i t a b l e but not example may  i n t e r a c t i o n (Deutsch, 1969).  n e c e s s a r i l y a d e s t r u c t i v e phenomena.  stimulate  i n t e r e s t and  c u r i o s i t y , provide  v e n t i l a t i o n of problems or the g e n e r a t i o n c r e a t e new  adaptive  usually defined  norms.  that  leads  r e s o l u t i o n and  conflict  "the  coercion,  usually  o f t e n a r i s e s when c o n f l i c t u a l i s s u e s are  cumulatively  impaired"  of the  person's s e l f being  to  and  discord.  conflict  is  than  ignored  elicit destructive and  suppressed  Rausch, B a r r y , H e r t e l & Swain, 1974), s i n c e are  i r r e p r e s s i b l e and  (Jacobson & M a r g o l i n ,  Rausch et a l . (1974) suggest that d i f f e r e n c e s and  the  involves  t a c t i c s which tend to  e f f e c t s of unattended c o n f l i c t  w i l l be  conflict  A l l t h e o r i s t s seem to concur that  1979;  help  an expansion of i s s u e s r a t h e r  e f f e c t i v e problem s o l v i n g , and  (Jacobson & M a r g o l i n ,  for  an impetus f o r  the p r o c e s s of d y s f u n c t i o n a l  to e s c a l a t i o n and  reciprocation i n kind.  Conflict  of s o l u t i o n s and  as the presence of d y s f u n c t i o n a l  components of t h r e a t and  I t i s an  However problems i n m a r i t a l r e l a t i o n s are  Deutsch (1969) suggests that one  demands  the  suppression  f e e l i n g s attached  communicated and  of  1979,  satisfaction p.  23).  interpersonal  to them r e s u l t s i n l e s s of each  t h i s often leads  to an e r o s i o n  of  trust. C o n f l i c t u a l m a r i t a l i n t e r a c t i o n may  a l s o be viewed as an  i n i n t e r p e r s o n a l c o n t r o l whereby spouses attempt toward i n c o m p a t i b l e example one  goals  to sway each  exercise other  (Morton, Alexander & Altman, 1976); f o r  spouse attempts to persuade the other  to adopt a p o i n t  of  16  view or problem s o l u t i o n w h i l e  the other  argues or r e s i s t s .  C a r l t o n and Shaw (1980) s t a t e that m a r i t a l c o n f l i c t event w i t h i n the context p l a c e on a content character  of an ongoing i n t i m a t e  i s an  Koren, adversary  r e l a t i o n s h i p taking  l e v e l and a l s o s e r v i n g t o a f f i r m or r e d e f i n e t h e  o f the r e l a t i o n s h p .  T h i s viewpoint  i s consistent with  that of  Watzlawick, Beavin and Jackson (1967), who view a l l communications as c o n t a i n i n g a content  or d i g i t a l  analogic  Gurman (1978) a l s o p o i n t s out t h a t w h i l e  component.  component and a r e l a t i o n s h i p d e f i n i n g or there are  many ways to d e f i n e c o n f l i c t , as a demand f o r immediate change, as the e s c a l a t i o n of r e c i p r o c a l aversiveness,  as i n e f f e c t i v e problem s o l v i n g ,  or as the f r u s t r a t i o n o f i n a p p r o p r i a t e needs a l l models of dyadic conflict  see t h i s phenomena as a r e s u l t of attempts to d e f i n e the  r e l a t i o n s h i p between spouses i n a c e r t a i n way.  Effective conflict  r e s o l u t i o n i n t e r a c t i o n s which Koren et a l . (1980) suggest c o n s i s t s o f two  f a c t o r s , mutual s a t i s f a c t i o n w i t h outcomes and the attainment of  o b j e c t i v e r e s o l u t i o n s , would appear to be e s s e n t i a l f o r a marriage to remain v i a b l e and s a t i s f y i n g Vincent,  ( G l i c k & Gross, 1975; B i r c h l e r , Weiss &  1975; B i r c h l e r & Webb, 1977).  Dysfunctional  conflict  has a l s o been a s s o c i a t e d w i t h p a r t i c u l a r  i n t e r a c t i o n a l p a t t e r n s , such as the frequent derogatory  o c c u r r e n c e of c r i t i c i s m and  blaming (Koren e t a l . , 1980, B e r n a l  frequent  negative  affect  as c r o s s  complaining  & Baker, 1979); more  r e c i p r o c i t y i n general;  s p e c i f i c responses such  (Gottman, 1979); h i g h r e a c t i v i t y , that i s  f u n c t i o n i n g on the b a s i s of immediate c o n t i n g e n c i e s  (Jacobson,  & Waggoner Mcdonald, 1982); and s e l e c t i v e f o c u s s i n g upon behavior  (Robinson & P r i c e , 1980).  These p a t t e r n s  tend  Follette  negative to be  17  s e l f - r e i n f o r c i n g and r e s u l t i n a d e c l i n e i n g e n e r a l m a r i t a l  satisfac-  t i o n , the a l i e n a t i o n o f the p a r t n e r s from each o t h e r and i n e f f e c t i v e problem s o l v i n g .  These k i n d s of b e h a v i o r s a r e p a r t i c u l a r l y potent s i n c e  n e g a t i v e b e h a v i o r s account i n g e n e r a l f o r a l a r g e r p r o p o r t i o n o f the v a r i a n c e i n the spouses r a t i n g s of m a r i t a l s a t i s f a c t i o n than do p l e a s i n g behaviors  ( P a t t e r s o n , Hops & Weiss,  1975).  The approaches towards m a r i t a l c o n f l i c t to t h e o r e t i c a l o r i e n t a t i o n .  Gurman (1978) i d e n t i f i e s  t h e o r e t i c a l approaches t o m a r i t a l t h e r a p y : b e h a v i o r a l and the systems The Systems Approach:  and d i s t r e s s v a r y a c c o r d i n g three major  the p s y c h o a n a l y t i c , the  approach. T h i s approach emphasises  the i n t e r c o n n e c t e d -  ness o f i n t e r a c t i o n s and i s a p e r s p e c t i v e t h a t , a l t h o u g h f o c u s s i n g more on f a m i l y r a t h e r than on s p e c i f i c a l l y m a r i t a l i n t e r a c t i o n s , has i n f l u e n c e d a l l o t h e r approaches to m a r i t a l t h e r a p y . such as W i l e (1981) and b e h a v i o r i s t s such as Weiss acknowledge  (1980) both  t h e i r debt to the systems t r a n s a c t i o n a l model and have  incorporated this perspective into their  approaches.  The systems approach to m a r i t a l c o n f l i c t circular  Dynamic t h e r a p i s t s  causality  i s one which  stresses  (Bateson, 1971; J a c k s o n , 1967), so t h a t each p a r t n e r s  b e h a v i o r i s viewed as a r e a c t i o n or adjustment to the b e h a v i o r of the other.  The i n d i v i d u a l s b e h a v i o r i s caused then not by p e r s o n a l  or " n e u r o t i c " r e a c t i o n s but by the p r e s e n t o p e r a t i n g system.  Systems  problems  transactional  t h e o r y c o n t a i n s a number of d i f f e r i n g approaches, from  Bowen (1976) who views c o n f l i c t  i n marriage i n b a s i c a l l y  and monadic terms as a r i s i n g when i n d i v i d u a l s a r e p o o r l y  psychoanalytic internally  d i f f e r e n t i a t e d , t o authors such as H a l e y , who f o c u s on the p a r t n e r s  18  s t r u g g l e f o r c o n t r o l w i t h i n the i n t e r d e p e n d e n t web t r a n s a c t i o n s which c o n s t i t u t e a "system". conflicts  of i n t e r p e r s o n a l  Haley (1963) views the major  i n a marriage as c e n t e r i n g on the problem of who  whom what to do under what c i r c u m s t a n c e s .  (Watzlawick, Weakland & F i s h ,  tell  I n d i v i d u a l symptoms may  a r i s e as a means of g a i n i n g c o n t r o l i n a r e l a t i o n s h i p . group  i s to  1974) who  The P a l o A l t o  view themselves as  " i n t e r a c t i o n a l " t h e r a p i s t s a l s o s u b s c r i b e to the systems model. Haley and the P a l o A l t o group suggest that c o n f l i c t p a r a d o x i c a l communication  when r e p o r t or d i g i t a l  Such p a r a d o x i c a l communication  Both  i s c r e a t e d by  and command or  a n a l o g i c / r e l a t i o n s h i p d e f i n i n g l e v e l s of communication dictory.  then  are c o n t r a -  i s p u r p o s e f u l i n that i t a v o i d s  the open e x p r e s s i o n of ambivalence and the c l e a r d e f i n i t i o n of an " I " p o s i t i o n , and thus defends the i n d i v i d u a l upon s e l f and r e l a t i o n s h i p  from the a n x i e t y a t t e n d e n t  definition.  Watzlawick et a l . (1974) a l s o focus on p r o b l e m a t i c c o g n i t i o n s .  He  s t a t e s t h a t o f t e n the s o l u t i o n to the problem becomes the problem, i n that what i s p r o b l e m a t i c i s the meaning a t t r i b u t e d  to the s i t u a t i o n  and  t h e r e f o r e i t s consequences, r a t h e r than i t s c o n c r e t e f a c t s  (Watzlawick,  1976).  "punctuate" a  These  communication  t h e o r i s t s suggest that i t i s how sequence  conflicts,  t h a t i s how  and e f f e c t  labels.  individuals  t h a t i s of primary importance i n u n d e r s t a n d i n g a s e r i e s of events i s grouped to produce  Gurman (1978) has p o i n t e d out the s i m i l a r i t y  cause between  t h i s approach and c o g n i t i v e b e h a v i o r a l t h e r a p i s t s such as Beck (1976), Meichenbaum (1977) and E l l i s  (1973).  o p e r a t i n g are m a i n t a i n e d , and c o n f l i c t  In t h i s model h a b i t u a l modes o f r e s o l u t i o n opposed  by an i n h e r e n t  homeostatic o r b a l a n c i n g mechanism, which i s presumed to operate i n any  "  19  system to m a i n t a i n  s t a b i l i t y and  equilibrium.  T h i s , by i m p l i c a t i o n ,  p l a c e s the t h e r a p i s t i n a p o s i t i o n where i t i s n e c e s s a r y  to  s t r a t e g i c a l l y manipulate c l i e n t s o f t e n w i t h p a r a d o x i c a l i n s t r u c t i o n s since direct The  i n t e r v e n t i o n w i l l be  resisted.  major c o n t r i b u t i o n of the systems theory o r i e n t a t i o n has  i t s emphasis on present  couple  i n t e r a c t i o n s , and  s e l f - r e i n f o r c i n g nature  of c o n f l i c t u a l  communication i s maintained  and  o r g a n i z a t i o n of  f o r behavior.  identified  to l a r g e l y i g n o r e  "within e f f e c t s " ;  such as Haley (1976) l i k e f e e l i n g s and He  output  or  "between  the problem i s  as the p a t t e r n s of i n t e r a c t i o n which c o n s t i t u t e the  r e l a t i o n s h i p r a t h e r than the i n d i v i d u a l p a r t n e r s .  change.  individual  As Gurman (1978)  t h i s approach seems to emphasise input and  e f f e c t s " and  and  1981).  at the expense of a c o n s i d e r i n g  orientated motivational explanations suggests,  on the c y c l i c a l  i n t e r a c t i o n s (Wile,  However, t h i s p e r s p e c t i v e on the process  been  other  the b e h a v i o u r a l  i n t e r n a l experience  t h e r a p i s t s tend  to  regard  as epiphenomena of o v e r t  suggests that main g o a l of therapy  behave d i f f e r e n t l y and  Systems t h e o r i s t s  so to have d i f f e r e n t  behavior  i s to get people to  subjective experiences.  d i f f i c u l t y here i s that f e e l i n g s of w e l l - b e i n g , p a r t i c u l a r l y  The  crucial  where a r e l a t i o n s h i p such as marriage i s concerned, do not always show a h i g h c o r r e l a t i o n w i t h b e h a v i o r a l changes (Strupp  & Hadley, 1977).  I n t e r v e n t i o n s used i n t h i s approach such as p a r a d o x i c a l d i r e c t i o n s t e a c h the p a r t n e r s n o t h i n g no  t o o l s to prevent Interventions  about t h e i r r e l a t i o n s h i p so t h a t they are l e f t  with  f u t u r e problems. s t i p u l a t e d by t h i s model, such as  i n s t r u c t i o n s are d i f f i c u l t  paradoxical  to t e s t e m p i r i c a l l y r e l y i n g as they do upon a  20  complex context also d i f f i c u l t i n t o other The  o f i n t e r a c t i o n s and meanings.  Comparative r e s e a r c h i s  s i n c e the systems p e r s p e c t i v e has become so i n c o r p o r a t e d  approaches.  P s y c h o a n a l y t i c / P s y c h o d y n a m i c Approach:  t r a d i t i o n focuses expectations  on c o n f l i c t  as an e x p r e s s i o n  The psychodynamic of i n t r a p s y c h i c needs,  and c o n s t r u a l s that a r i s e i n the context  relationship.  Barry  o f an i n t i m a t e  (1970) s t a t e s t h a t  " i n any i n t e r p e r s o n a l s i t u a t i o n behavior i s a t l e a s t p a r t l y determined by the i n t e r n a l r e f e r e n c e system (of each of the a c t o r s ) o f s e l f to o t h e r s and o t h e r s to s e l f , which i s the product of each ones e x p e r i e n c e w i t h s i g n i f i c a n t others up t o t h a t p o i n t i n time" (p. 4 1 ) .  C o n f l i c t s then may be p r o j e c t e d i n t r a p e r s o n a l p o l a r i t i e s o r the r e s u l t of the i n e v i t a b l e f r u s t r a t i o n of i n a p p r o p r i a t e needs ( D i c k s , 1967) o r a change i n needs as a r e s u l t of developmental changes and c r i s e s . Object foundation  r e l a t i o n s theory of t h i s approach.  ( D i c k s , 1967; M e i s s n e r , Meissner  1978) forms the  (1978) suggests that the success  of the m a r i t a l r e l a t i o n s h i p i s determined to a l a r g e extent  by the  " r e s i d u e s of i n t e r n a l i z e d o b j e c t s and the o r g a n i z a t i o n of i n t r o j e c t s which form the core o f the sense of s e l f "  (p. 2 7 ) .  confict  of n a r c i s s i s t i c needs or  i s g e n e r a l l y viewed as the r e s u l t  In t h i s model  i n f a n t i l e dependence p r o j e c t e d onto the p a r t n e r , or as a r i s i n g rigid  from  and r e l a t i v e l y u n d i f f e r e n t i a t e d o b j e c t r e l a t i o n s schemata  et a l . , 1974).  Schemata r e f e r t o the o r g a n i z e d  (Rausch  s t r u c t u r e s of images o f  the s e l f and o t h e r s and the needs and a f f e c t s c h a r a c t e r i z i n g the r e l a t i o n s h i p s between these  images i n one o r both p a r t n e r s which then  c o n s t r a i n the ways i n t e r p e r s o n a l messages w i l l be p e r c e i v e d and  21  responded t o .  R i g i d schemata then render the p a r t n e r s  r o l e s i n response to the o t h e r s needs and flexibility  results i n marital  conflict  t h i s l o s s of emotional  and  distress.  m a r i t a l d i f f i c u l t i e s are then o f t e n viewed as childhood  conflicts  impulses and  (Meissner, 1978;  f a i l u r e s i n the  Brandsma, 1977).  separation-individuation relationship.  v u l n e r a b i l i t y are  define  the  h i s or her  (p. 43).  infantile  process (Abies  case, Mahler's (1968) n o t i o n  Is a p p l i e d  to the  partners  source of m a r i t a l c o n f l i c t  increased  or p a r t n e r s  couples "are  Nadelson, 1978), or  unresolved  i n the  by  t h i s f a i l u r e and  marital  come to depend on  s e l f h o o d . . As  the  and  undifferentiated  responses of the o t h e r  Skynner (1976) s t a t e s  u s u a l l y a t t r a c t e d by  is  s i n c e dependency  the  &  of  F a i l u r e to separate from one's primary c a r e - g i v e r s  h y p o t h e s i z e d to be  partner  In t h i s model  symptoms of  separation-individuation  In the l a t t e r  unable to change  to  conflictual  shared developmental  failures"  Sager (1981), perhaps the most w e l l known p r a c t i s i n g  p s y c h o a n a l y t i c a l l y o r i e n t a t e d m a r i t a l t h e r a p i s t , speaks of unexpressed and  o f t e n unconscious e x p e c t a t i o n s  influences  that  form the b a s i s  Marital conflict ego  strength"  (Dicks,  The  1967,  is  f e a r s of i n t i m a c y goal  for dysfunctional  marital  i n t h i s model i s r e l a t e d to the p. 31)  r e l a t i v e freedom from n e u r o s i s i s s u e s as  based upon i n t r o j e c t e d  of the p a r t n e r s ,  childhood contracts.  " i d e n t i t y adequate  that i s t h e i r  or i n t r a p s y c h i c c o n f l i c t  around such  or abandonment (Feldman, 1979).  of t r a d i t i o n a l p s y c h o a n a l y t i c a l l y  oriented marital  to r e s t r u c t u r e those a s p e c t s of p e r s o n a l i t y f u n c t i o n i n g  spouses t h a t  create  d i s t r e s s and  conflict  therapy  i n both  i n the m a r i t a l r e l a t i o n s h i p  22  and  facilitate  each spouse's e n c o u n t e r i n g h i s or her mate as a s a f e  real  person. Gurman (1978) sugges.ts t h a t the p s y c h o a n a l y t i c model t h a t b r i d g e s outer and  the  b e h a v i o r , and  gap  between p r i v a t e i n n e r e x p e r i e n c e and  thus allows  meaning of m a r i t a l b e h a v i o r .  focuses  upon the a d a p t i v e  approach o f f e r s a  an u n d e r s t a n d i n g of both the He  s t r e s s e s that  public  function  t h i s model a l s o  p o t e n t i a l of m a r i t a l c o n f l i c t , f o r as Rausch  et a l . (1974) s t a t e  "of a l l human r e l a t i o n s h i p s marriage has the g r e a t e s t p o t e n t i a l f o r r e i n t e g r a t i n g the schemata a s s o c i a t e d w i t h a n x i e t i e s of c h i l d h o o d , — s c h e m a t a concerned w i t h t r u s t , g i v i n g and r e c e i v i n g l o v e , autonomy, e x p r e s s i o n and i n h i b i t i o n of anger and other f e e l i n g s , concepts of raaleness and femaleness, c l o s e n e s s and d i s t a n c e " (p. 47).  This perspective it  fails  on m a r i t a l c o n f l i c t must c o n f r o n t  to take account of the c u r r e n t  maintain m a r i t a l c o n f l i c t  beyond any  patterns  perceptual  by phenomenon such as m a r i t a l t r a n s f e r e n c e , operational  and  d e f i n i t i o n s of c e n t r a l c o n s t r u c t s  Gurman (1978) a l s o suggests t h a t w h i l e i t may u n d e r s t a n d i n g of the has  y i e l d e d few  dysfunctional limit  the  issues:  of i n t e r a c t i o n t h a t d i s t o r t i o n s engendered 2) there  are no e x i s t i n g  such as i n d i v i d u a t i o n . have added to  significant  intimate  t e c h n i c a l innovations  our  relationships.  i n the treatment  T h i s approach has  t h e r a p i s t to a c t i v i t i e s designed to c r e a t e i n each p a r t n e r  perspective  that i s s i g n i f i c a n t  of  a l s o tended  i n s i g h t as to  to  the  ( T a y l o r Segraves, 1982).  v a r i a t i o n o f , or perhaps more a c c u r a t e l y d e v i a t i o n from,  psychoanalytic  1)  s u b t l e t i e s of the m a r i t a l r e l a t i o n s h p t h i s model  unconscious o r i g i n s of c o n f l i c t One  two  the  to t h i s study i s the  23  e x p e r i e n t i a l approach which i s an outgrowth of the tial  tradition.  attributed  Whereas i n the  to u n c o n t r o l l a b l e  problems are subdued and  attributed  humanistic  p s y c h o a n a l y t i c t r a d i t i o n problems  impulses, i n the  to defenses that  experiential  assumed to have h e a l t h y f e e l i n g s and  interpersonal,  help of the  are  approach  r e s u l t i n impulses being  re-emerging i n d i s t o r t e d or exaggerated forms.  awareness w i t h the  existen-  Clients  are  needs, which w i l l emerge i n t o  therapist.  i s viewed then as the  Conflict, intrapsychic  r e s u l t of the  disowning or  of e x p e r i e n c e r e s u l t i n g i n d i s t o r t e d e x p r e s s i o n and  or denial  a l a c k of need  fulfillment. From the  e x p e r i e n t i a l perspective  & Goodman, 1951), people are construct  meanings and  t h e i r current  by  intrapsychic  r u l e s and  o r g a n i z e what they see  that  by  d e f i n i t i o n s as w e l l  intrapsychic  present e x p e r i e n c e and  the  focus of therapy r a t h e r  the  client  failure  are  t h e r a p y , i s not  the  Insight, aim  the  of  Kaplan  and  determined  relationship determine  from the  psychoanalytic  i n t e r a c t i o n s with others  than s i g n s  of  u s u a l goal of the  the  creation  of t h i s model to couple therapy has  are  impulses  of  developmental psychodynamic  of t h i s approach which regards new  meaningful e x p e r i e n c e as n e c e s s a r y f o r the applications  basis  b l o c k s or s p l i t s  than past e x p e r i e n c e s , and  viewed as h e a l t h y r a t h e r  or n e u r o s i s .  the  t h e i r partner.  e x p e r i e n t i a l approach then d i f f e r s  t r a d i t i o n i n that  who  be viewed as  context f a c t o r s , i n that as  Hefferline  experiential organization.  what people a t t e n d to i n themselves and The  or hear on  i n t e r n a l e x p e r i e n c e may  f a c t o r s and  Perls,  regarded as a c t i v e p e r c e i v e r s ,  e m o t i o n a l s t a t e and  Kaplan (1981) s t a t e  (Rogers, 1951;  emotionally  of change.  Specific  been l i m i t e d and  no  24  outcome s t u d i e s of an e x p e r i e n t i a l approach to therapy have been completed. The B e h a v i o r a l Approach: field  The  b e h a v i o r a l approach which i n t h i s  i s more a c c u r a t e l y termed a p p l i e d s o c i a l l e a r n i n g theory views  conflict  as a demand f o r immediate change (Weiss  & Margolin,  1977).  T h i s demand i n v o l v e s the i n i t i a t i o n of c o e r c i v e i n t e r a c t i o n p a t t e r n s where one  p a r t n e r seeks  to g a i n p o s i t i v e r e i n f o r c e m e n t  n e g a t i v e r e i n f o r c e m e n t r e s u l t i n g i n the e s c a l a t i o n of aversiveness. result  from  More s p e c i f i c a l l y  reciprocial  i t i s assumed t h a t m a r i t a l c o n f l i c t s  f a u l t y b e h a v i o r change o p e r a t i o n s ( P a t t e r s o n & Hops, 1972).  Thus Jacobson  (1981) suggests  b e h a v i o r of the other through t i o n and  i n exchange f o r  that d i s t r e s s e d  couples c o n t r o l  "the p r e s e n t a t i o n of n e g a t i v e  the w i t h h o l d i n g of p o s i t i v e communication"  l o g i c a l a n t i d o t e to such b e h a v i o r  communica-  (p. 562).  The  would seem to be to teach people  to be e f f e c t i v e behavior m o d i f i e r s (Jacobson, l e v e l , Jacobson  the  et a l . (1982) suggest  1978).  how  On a more g e n e r a l  t h a t the b a s i c s o c i a l  learning  h y p o t h e s i s u n d e r l y i n g t h i s model of m a r i t a l therapy i s t h a t m a r i t a l d i s t r e s s i s a s s o c i a t e d w i t h low r a t e s of rewarding r a t e s of p u n i s h i n g exchanges.  exchanges and  high  Each spouse's b e h a v i o r i s viewed as  l a r g e l y a f u n c t i o n of the consequences p r o v i d e d f o r t h a t b e h a v i o r by partner.  Thus i f a p a r t n e r i s rewarded f o r c o e r c i v e b e h a v i o r  compliance  from h i s spouse t h i s b e h a v i o r w i l l  the long-term The  detriment  of the  1959)  which suggests  as a market p l a c e i n which two  by  tend to i n c r e a s e , o f t e n t o  relationship.  b e h a v i o r a l approach i s based  (Thibaut & K e l l y ,  the  on b e h a v i o r a l exchange theory t h a t a r e l a t i o n s h i p may  be viewed  people exchange a set of b e h a v i o r s  from  25  their  r e p e r t o i r e and  rewards and maintained  that these b e h a v i o r s are exchanged w i t h  c o s t s to each of the p a r t n e r s .  S o c i a l behavior i s  by a h i g h r a t i o of rewards to c o s t s and  by the p e r c e p t i o n  that a l t e r n a t i v e r e l a t i o n s h i p s o f f e r comparatively more c o s t s . not judged  When r e i n f o r c e m e n t  quo  fewer rewards  and  i s not dispensed at an e q u i t a b l e r a t e or  to be adequate then the s i t u a t i o n f o s t e r s  interaction.  certain  conflictual  T h e o r i s t s such as S t u a r t (1969) suggest  t h a t a q u i d pro  or a "something f o r something" arrangement u n d e r l i e s s u c c e s s f u l  marriages  and  t h a t d i s t r e s s e d marriages  are ones i n which t h e r e i s a  s c a r c i t y of p o s i t i v e outcomes a v a i l a b l e f o r each p a r t n e r .  According  exchange theory then p a r t n e r s i n a s a t i s f y i n g r e l a t i o n s h i p  should  to  r e i n f o r c e each o t h e r at an e q u i t a b l e r a t e , w i t h exchanges f o l l o w i n g a norm of r e c i p r o c i t y over time so t h a t p a r i t y i s e s t a b l i s h e d . The  i s s u e of r e c i p r o c i t y i s an important  r e c e n t proponents  one  i n t h i s model s i n c e  p o i n t out t h a t i t i s not o n l y r a t e s of b e h a v i o r  but  the sequence t h a t i s important  i f b e h a v i o r i s to be viewed l a r g e l y as a  f u n c t i o n of i t s consequences.  Gottman, Markman and N o t a r i u s  (1977,  1979), and M a r g o l i n and Wampold (1981) have t e s t e d t h i s n o t i o n of r e c i p r o c i t y and  found  that there i s a g r e a t e r tendency  r e c i p r o c i t y i n d i s t r e s s e d marriages.  Gottman (1979) found however t h a t  i n n o n - d i s t r e s s e d couples p o s i t i v e responses the spouses antecedent  towards n e g a t i v e  were not c o n t i n g e n t upon  code whereas M a r g o l i n and Wampold found  evidence  f o r p o s i t i v e r e c i p r o c i t y i n non-distressed couples. Gottman (1979) noted  t h a t p a r t n e r s who  c o n f l i c t s were more f l e x i b l e and  less r i g i d  were a b l e to r e s o l v e i n the s t r u c t u r e of  i n t e r a c t i o n s and were a b l e to " u n l a t c h " (p. 122)  at any  their  stage i n an  26  i n t e r a c t i o n and so break n e g a t i v e c h a i n s w i t h agreement e d i t i n g process. exchange  Research on r e c i p r o c i t y  theory operates i n d i s t r e s s e d  non-distressed relationships.  seems to suggest then t h a t  r e l a t i o n s h i p s r a t h e r than i n  Jacobson and M a r g o l i n (1979) note t h a t  freedom from c o n t r o l by a p a r t n e r ' s immediate o p e r a t i o n a l d e f i n i t i o n of " t r u s t " . c o u p l e s seem r e l a t i v e l y dependent punishments  or some k i n d of  consequences  They p o i n t out that on immediate  i s perhaps an  distressed  as opposed  to d e l a y e d  and rewards, whereas day to day s a t i s f a c t i o n i n h a p p i l y  m a r r i e d couples i s r e l a t i v e l y independent of d a i l y f l u c t u a t i o n s i n the frequency of rewarding and p u n i s h i n g b e h a v i o r s (Jacobson et a l , 1982). The  inability  to r e s o l v e c o n f l i c t  i n t h i s model i s the r e s u l t of  n e g a t i v e h a b i t u a l b e h a v i o r s r e s u l t i n g from a d e f i c i t problem s o l v i n g s k i l l s .  Weiss  and  (1978) suggests that i n marriage  s a t i s f a c t i o n i s an accomplishment s k i l l f u l n e s s as w e l l as e f f o r t "  i n negotiation  and "accomplishment  (p. 192), and t h a t  i s r e l a t e d to  such s k i l l  involves  u s i n g r u l e s r a t h e r than the s p e c i f i c responses of the p a r t n e r to d i c t a t e ones own  next response.  such as S t u a r t  The  t r a d i t i o n a l b e h a v i o r a l model of a t h e o r i s t  (1969), i s based on the assumption that the i m p r e s s i o n  which each spouse forms of the o t h e r i s based on the b e h a v i o r of the other.  Thus when one changes b e h a v i o r t h e r e are c o r r e s p o n d i n g changes  i n each p a r t n e r s i m p r e s s i o n s and p e r c e p t i o n s of the o t h e r .  This  v i e w p o i n t g i v e s r i s e to treatment based upon t e c h n i q u e s such as contingency c o n t r a c t i n g .  S t u a r t ' s approach c o n t r a s t s somewhat w i t h that  of t h e r a p i s t s such as Jacobson and M a r g o l i n (1979) whose approach i n c l u d e s the m o d i f i c a t i o n of c o g n i t i v e c o n s t r u c t s such as the way i n which spouses a p p r a i s e the r e l a t i o n s h i p i n o r d e r to judge i t s adequacy.  27  Jacobson  & M a r g o l i n then acknowledge the r o l e o f c o g n i t i o n i n the  c r e a t i o n and maintenance of m a r i t a l c o n f l i c t , and support  the view o f  t h e o r i s t s such as B e r n a l and Baker (1979) who p o i n t out t h a t d i s t r e s s e d couples tend to a t t r i b u t e r e l a t i o n s h i p problems almost  e x c l u s i v e l y to  the d i s p o s i t i o n of t h e i r p a r t n e r (example: the problem i s t h a t you a r e s t u p i d ) r a t h e r than v i e w i n g problems i n terms of shared Jacobson  responsibility.  e t a l . (1982) i n t h e i r study on couples r e a c t i v i t y  t h e i r data suggests  found  that  t h a t n e g a t i v e b e h a v i o r s have  "a d i f f e r e n t meaning f o r d i s t r e s s e d couples than they do f o r n o n - d i s t r e s s e d c o u p l e s . These d i f f e r e n c e s i n meaning seem to i m p l i c a t e c o g n i t i v e and p e r c e p t u a l d i f f e r e n c e s between d i s t r e s s e d and n o n - d i s t r e s s e d couples i n the way they p r o c e s s and i n t e r p r e t r e l a t i o n s h i p e v e n t s " (p. 713).  These b e h a v i o r a l t h e r a p i s t s then f o l l o w i n the path o f t h e o r i s t s such as Bandura (1977) who argued  t h a t b e h a v i o r i s mediated by c o g n i t i v e  symbolic mechanisms and s e t the stage f o r the e v o l u t i o n of the c o p i n g s k i l l s paradigm and the focus upon a t t r i b u t i o n a l A r n k o f f , 1978). Jacobson  theory (Mahoney &  The t e a c h i n g o f n e g o t i a t i o n s k i l l s as put forward by  & Margolin  (1979) has come to e p i t o m i z e t h i s c o g n i t i v e  b e h a v i o r a l approach t o m a r i t a l d i s t r e s s .  Comparison o f Approaches Gurman (1978) p o i n t s out t h a t each t h e o r e t i c a l p e r s p e c t i v e o f f e r s v e r y d i f f e r e n t e x p l a n a t i o n s o f the f o r c e s o p e r a t i n g i n r e l a t i o n s h i p d e f i n i t i o n and r e l a t i o n s h i p c o n f l i c t  and indeed each of the c o n c e p t u a l i -  z a t i o n s o f d y s f u n c t i o n a l c o n f l i c t / d i s t r e s s , would seem to imply a different basis f o r intervention.  However there a r e many  similarities  28  a c r o s s models i n terms of the t h e r a p e u t i c i s p o s s i b l e to see  operations  o v e r t behavior  experience  and  conscious  to a c e r t a i n extent  being  i n t e n t i o n s behind o v e r t b e h a v i o r help  to c o n s t r u c t  and  to be  commonly found a c r o s s  how  and  f e e l i n g s and  the motives  intimate  the  and  relationships  reflect  self.  g o a l s , and  therapeutic a c t i v i t i e s  a l l models of m a r i t a l t h e r a p y .  (1978) suggests t h a t a l l models seem to value bility  behaviorists  seen as epiphenomena, w h i l e  the n a t u r e of the  Many u l t i m a t e g o a l s , process  The  c o n t r a c t s , with  psychodynamic t h e o r i s t s are more concerned w i t h  and  increased  a d a p t a b i l i t y , the r e s o l u t i o n of p r e s e n t i n g  c l e a r communication and p a r t i c u l a r confluence  increased  self-esteem.  between p s y c h o a n a l y t i c  and  systems based communicationists and  He  seem  Gurman  role  flexi-  problems  and  decreased symptomatology, a more e q u i t a b l e b a l a n c e of power, open  between the  It  the d i f f e r e n t models as geared towards d i f f e r e n t  l e v e l s of the complex dynamics between spouses. consider  a c t u a l l y used.  p o i n t s out  and  a  Bowenian g o a l s ,  and  behaviorists goals.  The  m e d i a t i n g g o a l s which seem to be of major importance a c r o s s models are: (1) the s p e c i f i c a t i o n of problems, (2) the c l a r i f i c a t i o n spouses' i n d i v i d u a l d e s i r e s and ing  the n a t u r e of the c o u p l e s '  partner's discord,  d i f f i c u l t i e s , (4) encouraging each  (5) the m o d i f i c a t i o n of communication p a t t e r n s , (7) d e c r e a s i n g  the use  (6) i n c r e a s i n g  of c o e r c i o n and  approaches a l s o a t t a c h importance to f o u r t h e r a p i s t  (1) d i r e c t i n g and the  r e l a t i o n s h i p , (3) r e d e f i n -  r e c o g n i t i o n of h i s / h e r mutual c o n t r i b u t i o n to the m a r i t a l  p o s i t i v e r e c i p r o c i t y , and All  needs i n the  of each  s t r u c t u r i n g the  sequencing of treatment g o a l s ,  blame.  activities:  flow of therapy s e s s i o n s , and  guiding  (2) c h a l l e n g i n g assumptions about  29  m a r r i a g e , and  p r o v i d i n g a l t e r n a t i v e world views, (3) c l a r i f y i n g  communication process various  sorts.  and  (4) a s s i g n i n g o u t - o f - t h e r a p y  A l l approaches, except the  an e x p l i c i t  treatment proposed. concrete new  r a t i o n a l e f o r the couple's  So how  do  f o r the t h e r a p i s t  d i f f i c u l t i e s and  Many approaches a l s o advocate the t e a c h i n g  interpersonal s k i l l s ,  more a d a p t i v e  homework of  communications-oriented  systems t h e o r i s t s , a l s o b e l i e v e that i t i s important to p r o v i d e  imparting  expert  knowledge and  the i n t e r v e n t i o n s based upon d i f f e r e n t differ?  growth than the b e h a v i o r i s t s , who Techniques guided by d i f f e r e n t implemented w i t h a d i f f e r i n g  Some t h e r a p e u t i c goals  focus  p r i m a r i l y upon  conceptualizations w i l l  For example, Jacobson (1981) p o i n t s out  The  will  intense  also  be  different  that i n the more "expres-  r e l a t i o n s h i p , and  how  treatment g o a l s , a l s o d i f f e r s i n v a r i o u s models,  the key  therapeutic  personal  "problem" not  view of the c o u p l e - t h e r a p i s t  i s used to achieve  t e c h n i q u e being  modelling  skills.  f o c u s , i n t e n t , and w i t h i n a  b e h a v i o r a l approaches, communication s k i l l s are  it  of  conceptualizations  d i f f e r , psychodynamic t h e r a p i s t s being more o r i e n t e d towards  sion" oriented.  the  behaviors.  of m a r i t a l d i s t r e s s / c o n f l i c t  context.  the  to success  i n the b e h a v i o r a l models, and  r e l a t i o n s h i p being  an  seen as c r u c i a l i n the more  psychodynamic approaches. The fied  by  d i f f e r e n c e s between the main t h e o r e t i c a l models may c o n s i d e r i n g how  tion patterns The  each approaches the m o d i f i c a t i o n of  be  clari-  communica-  i n m a r i t a l therapy.  m o d i f i c a t i o n of communication p a t t e r n s  element found i n a l l m a r i t a l t h e r a p i e s .  i s the most common  Communication here i s the  key  30  interactional defined;  content and  the means by which the  t h a t i s the medium of r e l a t i o n s h i p d e f i n i t i o n and  target for s p e c i f i c intervention i n i t s e l f . (1981) p o i n t out of rewards and  communication i s "the  resolution.  He  As Jacobson and  punishments i n a r e l a t i o n s h i p " (p.  responsiveness predicted  conflict  suggests t h a t couples use  behaviorally oriented  Margolin  distinction.  tend to c o n c e n t r a t e  (1979) w r i t e  i n s t r u c t i o n i n other  Interventions  e x p e r i e n c e d by the  are  communication Jacobson  couples communication  upon i n t e n t i o n s of the  a r e f l e c t i o n of the m o t i v a t i o n s  teach  increasing  More p s y c h o d y n a m i c a l l y  of a message as w e l l as e x p r e s s i o n  therapist w i l l  dissatisfaction.  M a r i t a l t h e r a p i s t s who on  "resembles  will  and  and  to see  personal  reflect  The  sender and  the  reception  communication p a t t e r n s construals  of  explore  behavioral  needs and  spouse's b e h a v i o r changes then changes i n the  perceptions  r e a c t i o n s t o , that p a r t n e r  psychodynamic t h e r a p i s t w i l l  follow.  tend to t r y to r e o r i e n t the  one  fears  t h e r a p i s t a c t s from  will  as  the  t h i s d i f f e r e n c e i n viewpoint;  s k i l l s another w i l l  spouse's.  oriented  premise t h a t i f one o f , and  the  k i n d of t e c h n i c a l s k i l l s such as l e a r n i n g to  t h e r a p i s t s tend to focus  partners.  that  t h e o r i s t s such as Gottman  i n verbal expression.  that t e a c h i n g  operate an automobile" (p. 192). /  high  s a t i s f a c t i o n with  root of m a r i t a l  s k i l l s e s p e c i a l l y the s k i l l s i n v o l v e d and  exchange  r e s u l t i n g i n a c o n t r a s t between  r e c e i v e d message i s the  T h i s would seem to be a key  Dallas  t h e i r communication b e h a v i o r s  to convey r e l a t i o n s h i p a t t i t u d e , whereas other  and  a  392).  c r i t i c a l n e s s and  r e s o l u t i o n and  (1978) suggest t h a t a l a c k of s k i l l  change, and  primary v e h i c l e f o r the  Koren et a l . (1980) found t h a t low  intended  relationship i s  The  spouse's  the others  31  p e r c e p t i o n s o f each other so that behavior may be viewed Thus Jacobson  (1981) suggests  " d e s c r i p t i v e " feedback  differently.  that b e h a v i o r i s t s are l i k e l y  when m o d i f y i n g  to use  couples communication whereas  psychodynamic t h e r a p i s t s would use i n t e r p r e t a t i o n . The (1981),  approach of an e g o - o r i e n t e d dynamic t h e r a p i s t , such as Wile to the m o d i f i c a t i o n of communication p a t t e r n s p r o v i d e s an  e f f e c t i v e c o n t r a s t to the more b e h a v i o r a l approach. h e l p s couples had"  Wile  s t a t e s t h a t he  to c o n s t r u c t "the d i a l o g u e or c o n v e r s a t i o n they might have  i f they had been a b l e to be open and t r u s t i n g and the e f f e c t  v i v o communication t r a i n i n g training"  ... without  is "in  the r u l e s and without the  (p. 157). C l e a r communication i s then the means by which  such  a t h e r a p i s t attempts  to c l a r i f y partners' p o s i t i o n s i n a r e l a t i o n s h i p  and  perspective.  develop  a shared  In W i l e ' s model, to s t a t e  feelings  f u l l y and have them v a l i d a t e d r a t h e r than i n t e r r u p t e d or d i s q u a l i f i e d enables p a r t n e r s to f e e l more i n c o n t a c t w i t h each other and i n g r e a t e r c o n t r o l of the r e l a t i o n s h i p . In the dynamic and e x p e r i e n t i a l approaches poor s o c i a l s k i l l s a r e seen not as samples of i n a d e q u a c i e s  i n e x p e r t i s e or performance to be  remedied by p r a c t i c e but as s i g n s of d e p r i v a t i o n and a l i e n a t i o n , o f t e n r e f l e c t i n g norms o f minimal  s e l f - d i s c l o s u r e and s e l f - e x p o s u r e .  r e s e a r c h o f B i r c h l e r , Weiss and V i n c e n t couples  show normal communication s k i l l s  encounter  with t h e i r  (1975) suggests  As the  distressed  l e v e l s when not i n v o l v e d i n an  spouse.  The more dynamic models assume t h a t i n s i g h t i n t o the m o t i v a t i o n s and  needs o f the s e l f and the o t h e r , which m a i n t a i n the p o s i t i o n s each  p a r t n e r takes i n i n t e r a c t i o n s , w i l l  c r e a t e change.  In the case of the  32  e x p e r i e n t i a l t h e r a p i e s , i t i s assumed that new  emotional  t h a t c l a r i f y u n d e r l y i n g f e e l i n g s and needs w i l l p o s i t i v e p a t t e r n s of communication.  experiences  c r e a t e new  and more  I f communication p a t t e r n s are a  r e f l e c t i o n of i n n e r e x p e r i e n c e then to change the ways the couple e x p e r i e n c e the r e l a t i o n s h i p w i l l The b e h a v i o r a l approach  change how  attempts  n e g a t i v e communication p a t t e r n s and p r a c t i c e s ; the dynamic approach  they  communicate.  to f a c i l i t a t e  the c o n t r o l of  to s u b s t i t u t e p o s i t i v e r u l e  i s to e x p l o r e such p a t t e r n s i n terms o f  the e x p e r i e n c e of the r e l a t i o n s h i p which they r e f l e c t i n s i g h t or new Woolfolk  based  and  to c r e a t e  new  experiences. (1976) s t a t e s  that,  "By and l a r g e one f i n d s that the k i n d s of techniques employed i n each approach to therapy are q u i t e c o n s i s t e n t w i t h i t s t h e o r y of a f f e c t . S i m i l a r l y the t e c h n i c a l narrowness of each s c h o o l can be viewed as r e f l e c t i n g a c o r r e s p o n d i n g l i m i t e d u n d e r s t a n d i n g of emotion" (P. 49).  The  differing  r o l e of emotion i n therapy seems to best r e f l e c t  d i f f e r e n c e s between the b e h a v i o r a l and e x p e r i e n t i a l models.  the  In the  b e h a v i o r a l i n t e r v e n t i o n s the e x p r e s s i o n of emotion i s r e l e g a t e d to c l a r i f i c a t i o n of the impact is  taught as a s k i l l .  of one p a r t n e r ' s b e h a v i o r upon the o t h e r  In e g o - o r i e n t e d dynamic approaches  (1981) or the e x p e r i e n t i a l treatment  used  and  such as W i l e ' s  i n t h i s study the e x p l o r a t i o n  of emotion i s seen as a key method f o r a l t e r i n g the s a l i e n c e of p r i v a t e events and  f a c i l i t a t i n g new  learning.  The  time would seem to be  f o r the d e l i n e a t i o n of an e m o t i o n a l l y f o c u s s e d treatment e x p e r i e n t i a l model, which s p e c i f i c a l l y addresses and uses e x p e r i e n c e i n the c r e a t i o n of change and  a comparison  right  taken from  an  emotional  of t h a t  treatment  33  w i t h an a l r e a d y solving  tested cognitive-behavioral  (Jacobson & M a r g o l i n ,  Whereas the coping s o l v i n g has  stills  been s p e c i f i e d and  therapy  (Jacobson, 1977,  general  area of emotion and  use  i n t e r v e n t i o n such as  1979). paradigm and  the  teaching  of problem  t e s t e d e m p i r i c a l l y i n the area of m a r i t a l  1978b, 1979;  O r v i s , K e l l e y & B u t l e r , 1976)  therapeutic  i n t e r v e n t i o n s centered  of emotion are l a c k i n g i n c o r r e s p o n d i n g c l a r i t y and  i s e s s e n t i a l at t h i s p o i n t  problem  to d i s c u s s  the  the  upon  the  direction.  It  r o l e of emotion i n therapy  and  i n m a r i t a l therapy i n p a r t i c u l a r .  The  R o l e of Emotion i n Therapy Authors such as Mahoney (1980) and  suggest that the c u r r e n t the  70s.  the  important  r o l e of a f f e c t i n t h e r a p e u t i c  decade, as the  The  and  change i s the  r o l e of a f f e c t i n change would seem to be  i n the context  the  been  Inferences",  arguing  independent and responses and  "Thinking  and  the  a  F e e l i n g : Preferences  t h a t a f f e c t i v e and  recognition.  where  r o l e of  provocative need  c o g n i t i v e systems are  that a f f e c t i v e responses a c t u a l l y precede  even s t i m u l u s  intimacy  unclear.  t u r n of the decade Zajonc (1980) p u b l i s h e d  p o s i t i o n paper e n t i t l e d  relation-  psychotherapy  i n the psychology l i t e r a t u r e i n g e n e r a l  e m o t i o n a l e x p e r i e n c e i n human f u n c t i o n i n g has  of  a sense of w e l l -  In the m a r i t a l therapy l i t e r a t u r e , i n the  l i t e r a t u r e and  of  the i s s u e  of a therapy t h a t attempts to change s a t i s f a c t i o n and  issue  particularly  even to encourage the c r e a t i o n of a f f e c t i o n and  possible.  At  O'Leary (1982)  r o l e of c o g n i t i o n tended to be  s h i p s i n the d i r e c t i o n of i n c r e a s e d being  Fincham and  T h i s a r t i c l e has  no  relatively  cognitive prompted  34  t h e o r i s t s , even the b e h a v i o r i s t s to c o n s i d e r therapy.  Rachman (1981) has  commented on  suggested t h a t b e h a v i o r i s t s should to i n c l u d e a f f e c t m o d i f i c a t i o n .  aim  The  the p l a c e  of a f f e c t i n  the Zajonc a r t i c l e and  to expand b e h a v i o r  research  has  modification  of Fincham and  O'Leary ( i n  p r e s s ) suggests t h a t c a u s a l a t t r i b u t i o n s i n c l o s e r e l a t i o n s h i p s do seem to a f f e c t b e h a v i o r a l and  responses to the extent  t h a t might be  not  expected  i f they do have an e f f e c t t h i s e f f e c t i s mediated by a f f e c t i v e or  f e e l i n g response e s p e c i a l l y i n the case of n e g a t i v e r e s u l t might h e l p  to e x p l a i n W i l l i a m s  extremes of the h a p p y - d i s t r e s s e d punishing  behaviors,  regardless  of the b e h a v i o r s  continuum r e p o r t e d  and  therapy r a t h e r than p l a c i n g an e x c e s s i v e He  the e x p e r i e n c e or e x p r e s s i o n  emphasis on  of a f f e c t may the  various  facilitate  theory  the  r o l e of  t h e o r i e s as to  (1982) s t a t e  how  therapeutic  that human l e a r n i n g may  to l e a r n to d e a l more e f f e c t i v e l y w i t h anger i f anger i s Safran  presence  r o l e of  (Bower, 1981), that i s that an angry c l i e n t may  Greenberg and  and  the e x p e r i e n c e of a f f e c t i n  also discusses  example, he d i s c u s s e s  s t a t e dependent  the  emitted.  f a c t o r s such as unconscious p r o c e s s i n g  For  rewarding  commented on the need to review the  r a t i o n a l i t y i n adaptation.  This  (1979) f i n d i n g that couples at  r e s p e c t i v e l y i n response to the p a r t n e r s  Mahoney (1980) has  change.  behavior.  be  present.  that:  " t h e r a p i s t s who c o n s t r u e a f f e c t as a dependent v a r i a b l e i n human f u n c t i o n i n g tend to regard emotion as d i s r u p t i v e to the t h e r a p e u t i c p r o c e s s , and t h i s l e a d s them to e i t h e r bypass emotion i n the process of therapy or to r e s t r i c t t h e i r focus to l o o k i n g f o r ways to c o n t r o l c l i e n t ' s emotion. A l t h o u g h i t i s t r u e t h a t c e r t a i n emotional r e a c t i o n s such as angry o u t b u r s t s and panic r e a c t i o n s or more c h r o n i c s t a t e s are by  be  able  35  d e f i n i t i o n r e a c t i o n s to s i t u a t i o n a l events and are d i s r u p t i v e to problem s o l v i n g i n therapy t h i s i s not t r u e of a l l emotion" (p. 2 ) .  Greenberg and instrumental a f t e r and  Safran  (1984) d i f f e r e n t i a t e between p r i m a r y , r e a c t i v e  a f f e c t ; primary a f f e c t being  clarified  i n therapy i n order  T h e o r i s t s such as A r n o l d  that which needs to be  (1960), P l u t c h i k (1980), and  f u n c t i o n so as to enhance human a d a p t i o n , behaviors.  E p s t e i n and  sought  to a i d problem s o l v i n g .  s t r e s s t h a t emotions, not j u s t r a t i o n a l i t y and  for adaptive  and  Izard  cognitive  (1977)  processes,  providing a motivating  force  Bishop (1981) i n t h e i r approach to  f a m i l y therapy a l s o s t r e s s that emotions f u n c t i o n as  facilitating  f a c t o r s i n problem s o l v i n g . The  r o l e of a f f e c t i n therapy i s then r e c o g n i z e d  issue i n current t h e r a p i s t s now generally fied.  recognize  by  Behaviorally  important  orientated  t h a t t h i s i s s u e of i t must be addressed  see a f f e c t as a d i s r u p t i v e phenomena which should  Dynamic and  as a key ced  psychotherapy l i t e r a t u r e .  as an  e x p e r i e n t i a l t h e r a p i s t s on  v a r i a b l e i n therapy and  the c l i e n t  appropriate  and  as  used i n the  at t h i s p o i n t  therapeutic  some of the  i v e s from which emotional e x p e r i e n c e has  Strongman (1978) d e s c r i b e s  process.  be modi-  hand view a f f e c t  something which should  to c o n s i d e r  i m p l i c a t i o n s of these p e r s p e c t i v e s  the other  but  be  experien-  I t would seem  t h e o r e t i c a l perspect-  been c o n s i d e r e d  and  the  f o r treatment.  twenty t h e o r i e s of emotion.  been viewed as e s s e n t i a l l y a m o t i v a t i o n a l  concept ( A r n o l d ,  1970), as p r i m a r i l y a s t a t e of p h y s i o l o g i c a l a r o u s a l an e s s e n t i a l l y c o g n i t i v e phenomenon and  Emotion 1960;  (Lazarus,  Leeper,  (James, 1907), as  a source of meaning and  (Solomon, 1977), as a response to c o g n i t i o n  has  1982;  values  Schatcher,  36  1971)  as simply  a learned  a form of p s y c h i c  conditioned  response ( M i l l e n s o n ,  energy (Rapaport, 1970).  1967)  and  as  Other authors have viewed  emotion as a complex e x p e r i e n c e c o n s i s t i n g of many elements.  Lang  (1977) f o r example views emotion as c o n s i s t i n g of s u b j e c t i v e ,  behavioral  and  p h y s i o l o g i c a l elements.  A r n o l d ' s approach i s a l s o a c t u a l l y a  m i x t u r e of c o g n i t i v e , p h y s i o l o g i c a l and she  views emotion as a response to an  stimulus,  and  a p p r a i s a l s and  involving a felt appropriate  i n imagination  approaches  " i n t u i t i v e a p p r a i s a l " of a  tendency to a c t i o n .  In her model c o r r e c t  p o s i t i v e and  negative  of the a p p r o p r i a t e  a t t i t u d e s and  and  and  i r r e v o c a b l e , whereas Lazarus (1982) argues that Zajonc  e m o t i o n a l response, and awareness.  "primary"  confuses to  the  can happen as automatic d i s c r i m i n a t i o n without  However, both of these stances view e x p e r i e n c e i n terms of a  e m o t i o n a l response or Greenberg and  number of d i f f e r e n t simultaneously.  Safran  (1982) drawing on L e v e n t h a l ' s  information  considered  processing  They s t a t e , " i n f o r m a t i o n  schematic l e v e l and feeding  which element comes  first,  cognition.  suggest t h a t emotion i s a p p r o p r i a t e l y  being  of  that a p p r a i s a l i s c r u c i a l  l i n e a r c a u s a l model; the debate i s simply  constantly  the  independent  s t a t e s that a f f e c t i v e r e a c t i o n s are  c o g n i t i o n w i t h c o n s c i o u s awareness, and  motor  actions.  Zajonc (1980) views emotion as p r e c o g n i t i v e , and cognitive processing  since  a c t i o n s r e q u i r e memories of sensory and  e v e n t s , memories of p r e v i o u s rehearsal  motivational  the p e r c e p t u a l  (1979) model  as an i n t e g r a t i o n of a  components which operate from the  motor l e v e l may  conceptual be  thought of  i n t o the emotion process s i m u l t a n e o u s l y  l i n e a r l y or u n i d i r e c t i o n a l l y r e l a t e d " (p. 14).  level, as  rather  As Greenberg  than and  37  Safron  p o i n t out, L e v e n t h a l  m a i n t a i n s t h a t three  operate i n emotional p r o c e s s i n g .  d i s t i n c t mechanisms  These a r e , a predominantly  facial  expressive  motor mechanisms, a schematic or emotional memory and a  conceptual  system which s t o r e s r u l e s and b e l i e f s about emotional  experiences.  I n t h i s model schematic memory mechanisms d i r e c t a t t e n t i o n  i n the p e r c e p t u a l representations  f i e l d and s t o r e automatic r e a c t i o n s .  o f p r i o r emotional e x p e r i e n c e and can generate as w e l l  as be generated by e x p r e s s i v e  motor r e s p o n s e s .  concerned w i t h c o n s c i o u s and v o l i t i o n a l evaluate  Schemas are  concrete  The c o n c e p t u a l  processing  system i s  and can analyze and  e x p e r i e n c e , s t o r i n g the s i t u a t i o n a l antecedents and  consequences o f f e e l i n g s . synthesis  of perceptual  conceptual  cognition.  c o g n i t i o n , physiology  E x p e r i e n c e d emotion i s then a p r e a t t e n t i v e  motor i n f o r m a t i o n ,  i m p l i c i t motor schemas and  In t h i s model L e v e n t h a l  integrates  affect,  and b e h a v i o r i n t o a comprehensive model o f human  emotion. What s i g n i f i c a n c e do these d i f f e r e n t t h e o r i e s of emotion have i n terms of t h e r a p e u t i c affect  interventions?  Rachman (1981) suggests that i f  i s primary and independent then t h e r a p i s t s should  modify mood d i r e c t l y and focus  upon that  attempt t o  single dysfunctional  system.  S c h a c h t e r ' s (1971) model o f emotion, which i s t h a t emotion b a s i c a l l y c o n s i s t s o f the l a b e l l i n g or e x p l a n a t i o n implies  t h a t the t h e r a p i s t might h e l p  become d e s e n s i t i s e d to such a r o u s a l .  of p h y s i o l o g i c a l arousal,  c l i e n t s r e - l a b e l such a r o u s a l o r Cognitive  b e h a v i o r i s t s such as  Aaron Beck (1976) o r Meichenbaum (1977) who view c o g n i t i o n as primary and  e m o t i o n a l response as the product of c o g n i t i o n focus  their  t i c i n t e r v e n t i o n s upon the m o d i f i c a t i o n o f thoughts and b e l i e f  therapeustruc-  38  tures.  Therapy  c o n s i s t s then of a l t e r i n g b e l i e f s and  dysfunctional  cognitive processing styles. For the more t r a d i t i o n a l b e h a v i o r i s t  emotion  i s either a condi-  t i o n e d response to be d e c o n d i t i o n e d ( M i l l e n s o n , 1967) t e c h n i q u e s such as the use of images ( s i n c e a f f e c t  or m o d i f i e d by  i s associated with  n o n - v e r b a l channels) or music, as suggested by Rachman (1981). p s y c h o a n a l y t i c t h e o r i s t s have viewed  emotion  Other  i n therapy g e n e r a l l y as a  component o f the " c o r r e c t i v e emotional e x p e r i e n c e " (Applebaum, e x p e r i e n c e d by the c l i e n t  i n r e l a t i o n to the t h e r a p i s t .  1982)  Emotion  has  a l s o been c o n s i d e r e d as b e i n g r e p r e s s e d and e x p e r i e n c e d i n the p r o c e s s of making the unconscious c o n s c i o u s , or as a s i g n a l that m a t e r i a l i s about  to emerge i n t o  unconscious  awareness.  Some t h e o r i s t s view emotion as a form of p s y c h i c energy, and  so  have focused upon v e n t i l a t i o n and c a t h a r s i s i n the sense of p u r g i n g as the primary way  to use emotional e x p e r i e n c e to f a c i l i t a t e  ( N i c h o l s & Zax,  1977)  However, i f emotion  i s viewed  change.  a c c o r d i n g to  L e v e n t h a l ' s (1979) s y n t h e s i s model then obscure concepts such as the r e l e a s e o f p s y c h i c energy i n c a t h a r s i s are not n e c e s s a r y to j u s t i f y e x p r e s s i o n of i n t e n s e emotion the e x p r e s s i o n of emotion tion processing. comparative its  base  as a u s e f u l element  i n therapy.  the  Rather  i s understood as a complex a s p e c t of i n f o r m a -  I t i s i n t e r e s t i n g to note that i n the Liberman  et a l .  study (1976) the n o n - b e h a v i o r a l treatment seems to have as  the v e n t i l a t i o n of emotion,  that i s , i t was  a catharsis  based  intervention. Berger and Luckmann (1966) suggest t h a t language  i s an  o b j e c t i f i c a t i o n of e x p e r i e n c e which h e l p s to c r y s t a l l i z e and  ongoing stabilize  39  s u b j e c t i v e e x p e r i e n c e ; i t i s thus p o s s i b l e to see a l i n k between emotional e x p r e s s i o n and emotional s y n t h e s i s . suggests emotion  I f as L e v e n t h a l (1979)  i s an i n t e g r a t i o n of c o n c e p t s , schemas and p e r c e p t u a l  motor r e s p o n s e s , i t would seem to be a r i c h source of i n f o r m a t i o n relevant  f o r therapy.  As Greenberg  a c c e s s i n g and acknowledging  affect  and  S a f r a n (1982) p o i n t  can h e l p to m o t i v a t e change, and  to access "hot" c o g n i t i o n s which themselves a u t h o r s and c l i n i c i a n s such as W i l e  out,  r e q u i r e change.  (1981) suggest that  also  These  previously  a v o i d e d or unacknowledged a f f e c t i v e e x p e r i e n c e forms the b a s i s f o r p e r s p e c t i v e s and meaning  sets.  T h e r a p i s t s such as E p s t e i n and Bishop emotion  (1981) view the e x p e r i e n c e of  as a d a p t i v e s i n c e i t tends to s t i m u l a t e d i f f e r e n t  solutions. emotions problems,  problem  These authors t e a c h t h e i r c l i e n t s to i d e n t i f y and  that w i l l  new  facilitate  use  the r e s o l u t i o n of t h e i r p r e s e n t i n g  f o r example t e a c h i n g n o n - a s s e r t i v e c l i e n t s  to access and  use  anger. What are the t h e r a p e u t i c i m p l i c a t i o n s of a model such as L e v e n t h a l ' s (1979)? S a f r a n (1981), who  T h i s q u e s t i o n has been addressed by Greenberg suggest t h a t  " c l i n i c a l problems can r e s u l t both  the r e p e t i t i v e s y n t h e s i s of maladaptive emotions adaptive emotional synthesis"  (p. 18).  The  and the absence  a d a p t i v e emotions.  e x p e r i e n c e can be f a c i l i t a t e d  from  of  focus of t h e r a p e u t i c work i s  then m o d i f y i n g the s y n t h e s i s of maladaptive emotions s y n t h e s i s of new  and  or f a c i l i t a t i n g  the  S y n t h e s i z i n g a d a p t i v e emotional  by h e l p i n g people get i n touch w i t h a f f e c t  t h a t i s not n o r m a l l y attended t o , or encoding a f f e c t i v e i n f o r m a t i o n more accurately  ( A r n k o f f , 1980;  Davison,  1980;  G e n d l i n , 1980;  Wexler,  1974).  40  To  a c h i e v e t h i s the t h e r a p i s t c o u l d suggest  at a conceptual l e v e l that  c e r t a i n a f f e c t i v e e x p e r i e n c e s a r e a c c e p t a b l e and d i r e c t a t t e n t i o n to v a r i o u s p e r c e p t u a l motor cues.  Greenberg and S a f r a n suggest  that  "once the new i n f o r m a t i o n i s attended to the t h e r a p i s t asks the c l i e n t to v e r b a l i z e h i s or her e x p e r i e n c e and e x p l o r e s emotional memories and images and d i s c u s s e s the r u l e s and meanings s u r r o u n d i n g the f e e l i n g s i n order to h e l p s y n t h e s i z e new a f f e c t i v e e x p e r i e n c e ... Once new a d a p t i v e emotional e x p e r i e n c e s have been generated the t h e r a p i s t can h e l p the c l i e n t l e a r n to t r a n s l a t e them i n t o a p p r o p r i a t e a c t i o n s " ( p . 21).  Bower (1981) has suggested o n l y be accessed  t h a t many maladaptive  i n the presence  c o g n i t i o n s can  o f the s t a t e i n which they were  acquired, that i s i n states of a f f e c t i v e a r o u s a l .  The e x p e r i e n c e and  a m p l i f i c a t i o n of emotion may then be a p r e r e q u i s i t e to the m o d i f i c a t i o n of "hot c o g n i t i o n s " (Abelson, 1963), and to the c r e a t i o n ' o f the motivat i o n to d e a l more e f f e c t i v e l y w i t h problem responses. (1975) d i d indeed f i n d attainment  of i n s i g h t .  Green and Murray  t h a t the e x p r e s s i o n of f e e l i n g s f a c i l i t a t e d the Greenberg and S a f r a n a l s o suggest  v e n t i o n s such as the use o f v i v i d  and m e t a p h o r i c a l  general  language,  t i o n o f f e e l i n g and h e i g h t e n i n g the awareness of n o n - v e r b a l Jacobson  and M a r g o l i n  inter-  the r e f l e c expression.  (1979) present another view; they s t a t e t h a t  s i n c e change i s l a r g e l y a matter  of e f f o r t  and p r a c t i c e and t h e r e i s a  c o r r e l a t i o n between f e e l i n g s and b e h a v i o r , the c a u s a l sequence i s irrelevant.  The d e c i s i o n r e g a r d i n g i n t e r v e n t i o n can then be made on the  b a s i s o f e f f i c i e n c y , and s i n c e the t h e r a p e u t i c technology b e h a v i o r i s c o n s i d e r a b l y more developed  than the technology  f e e l i n g s and a t t i t u d e s , the most e f f i c i e n t f o c u s e s on changing  behavior.  f o r changing f o r changing  i n t e r v e n t i o n i s one which  41  Affect i n Marital The  field  Therapy  o f m a r i t a l therapy r e f l e c t s the g e n e r a l c o n t r o v e r s y  c o n c e r n i n g the r o l e of a f f e c t as opposed to more r a t i o n a l and b e h a v i o r a l approaches  i n therapeutic interventions.  "our t a c i t n o t i o n s about i n f l u e n c e on how  we  and conduct  therapy."  Gurman and Knudson  review of the more b e h a v i o r a l approaches  the b e h a v i o r a l focus upon the " r a t i o n a l o b s e r v i n g ego" client  openness to reason and a b i l i t y  rational self-interest.  follow.  t h i s approach  s a l i e n c e of p r i v a t e e v e n t s "  the assumed  f o r a lack of (p. 128) and  that i f b e h a v i o r changes then changes i n f e e l i n g s  the  will  In f a c t i n r e c e n t years c o g n i t i v e p r i v a t e events have been  i n c l u d e d even i n models of b e h a v i o r a l m a r i t a l therapy Margolin, The  and  note  to see that change i s i n t h e i r  They c r i t i c i z e  focus upon "the power and assumption  suggests  emotional p r o c e s s e s e x e r t a p e r s u a s i v e  approach  (1978) i n t h e i r c r i t i c a l  As Mahoney ( i n p r e s s )  (Jacobson &  1979), b e h a v i o r i s t s t e n d i n g to become c o g n i t i v e - b e h a v i o r i s t s .  p r i v a t e events which now  appear to be at i s s u e i n therapy, are  emotional i n nature. In problem  the more b e h a v i o r a l t h e r a p i e s couples are encouraged s o l v i n g from emotional e x p r e s s i v e n e s s and  l a t t e r i n f a v o r of problem state a s k i l l  oriented  solving.  to separate  l e a r n to c o n t r o l  As M a r g o l i n and W e i n s t e i n  the  (1983)  stance p l a c e s a "value on r a t i o n a l as opposed to  e m o t i o n a l p r o c e s s e s " (p. 334).  However these authors now  suggest  that  a f f e c t i v e e x p e r i e n c e and e x p r e s s i o n seem e s s e n t i a l  to the aims of  m a r i t a l t h e r a p y , and  be c o n c e p t u a l i z e d as  a skill,  that emotional e x p r e s s i o n may  f o r example spouses  l o g i c a l cues"  (p. 349).  can be taught  "to a s s i g n l a b e l s to p h y s i o -  The more dynamic e x p e r i e n t i a l t h e r a p i e s  42  f o c u s i n g as they do more upon i n t r a p s y c h i c phenomena and upon the r e l a t i o n s h i p not as a r e c i p r o c a l o f f e r i n g of b e h a v i o r s but as a b a r g a i n about  the d e f i n i t i o n of s e l f have tended  e x p l o r a t i o n of emotional e x p e r i e n c e .  w i t h the  As Solomon (1977) notes  experience i s e s s e n t i a l l y s e l f - r e f e r r i n g concept.  to be more concerned  and concerned  Gurman, Knudson and K n i s k e r n (1978) suggest  with that  emotional  selfthe  e x p r e s s i o n of f e e l i n g s e r v e s to d e f i n e r e l a t i o n s h i p s , and attempts d e f i n e r e l a t i o n s h i p s r e p r e s e n t fundamental self.  attempts  Gurman and Knudson (1978) go on to suggest  to d e f i n e one's  that the  emotional  v u l n e r a b i l i t y which t y p i f i e s d i s t r e s s e d m a r i t a l p a r t n e r s d i s r u p t s partners a b i l i t y  to r e c o g n i z e , respond  to or l e a r n from  e x p e r i e n c e s . I t i s a l s o not p o s s i b l e to teach responses which may  to  the  new such as r e s p e c t  be key i n a r e l a t i o n s h i p and do not always f o l l o w from a  spouse l e a r n i n g  to behave i n a more p l e a s i n g f a s h i o n .  Responses such as  l o v e , which f o r most people i s the s i n e qua non of marriage ( B r o d e r i c k , 1981), seem by t h e i r v e r y nature d i f f i c u l t under c o g n i t i v e c o n t r o l .  I t may  i f not i m p o s s i b l e to b r i n g  be that the more b e h a v i o r a l  a c t u a l l y encourage r e p r e s s i o n w i t h t h e i r focus on compromise  approaches and  p l e a s i n g b e h a v i o r s (Gurman & Knudson, 1978). Jacobson suggest  and Weiss (1978) i n t h e i r r e p l y to the above a u t h o r s  t h a t couples are " q u i t e s k i l l f u l  at e x p r e s s i n g n e g a t i v e  feelings  t h a t an encouragement of t h i s p r a c t i c e would be c o u n t e r p r o d u c t i v e " ( p . 151). attempt  They s t a t e t h a t  they encourage a focus upon the p o s i t i v e ,  to p r o v i d e couples with a new  to manage c o n f l i c t . such as problem  Couples  solving  and  armamentarium of s k i l l s w i t h which  have then to become accomplished  at tasks  "over a wide range of r e s o u r c e s , i n c l u d i n g  love,  43  a f f e c t i o n and  the use of f i n a n c e s " (p. 152), and are thus guided by  t h e r a p i s t i n the c r e a t i o n of a p o s i t i v e c o n t r o l system, and r e s t r u c t u r i n g of c o n t i n g e n c i e s i n the Jacobson  t h a t the most d i f f i c u l t  b e h a v i o r to change i n m a r i t a l therapy i s the tendency blame each other f o r m a r i t a l problems.  attempt of  rational  relationship.  and M a r g o l i n (1979) suggest  t h e o r i s t s agree.  the  the  client  of the spouse to  Most dynamic and  experiential  However, where c o g n i t i v e b e h a v i o r i s t s would tend to  to r e p l a c e such b e h a v i o r w i t h problem s o l v i n g , f o l l o w i n g a s e t  r u l e s r a t h e r than emotional  cues, dynamic and  experiential  therapists  tend to e x p l o r e the u n d e r l y i n g a n x i e t y o c c u r r i n g w i t h i n the p a r t n e r s which a c t s as a s t i m u l u s f o r and behavior.  response  to d e f e n s i v e i n t e r p e r s o n a l  In the more dynamic t h e r a p i e s i t i s not the s k i l l  the context which i s c o n s i d e r e d the Authors  who  level  but  issue.  c o n s i d e r emotional e x p e r i e n c e  to be c r u c i a l i n the  m o d i f i c a t i o n of r e l a t i o n s h i p s have then c o n s i d e r e d d e f e n s i v e b e h a v i o r , motivated  by emotional v u l n e r a b i l i t y ,  problem s o l v i n g , and  to be a b l o c k to new  p o s i t i v e intimacy experiences.  The  e x p e r i e n c e of v u l n e r a b i l i t y becomes a r e l a t i o n s h i p event f o s t e r emotional  i n t h a t i t can  bonding.  d i s c l o s u r e of emotional  i n t i m a c y enhancing,  and  (Margolin & Weinstein, for  intrapsychic  r e a c t i v i t y and d e f e n s i v e n e s s , or under p o s i t i v e  c i r c u m s t a n c e s , i n t i m a c y and The  learning,  experience  thus r e l a t e d  i s a l s o g e n e r a l l y viewed  as  c l o s e l y to m a r i t a l s a t i s f a c t i o n  1983). L'Abate (1977) f o c u s e s upon the n e c e s s i t y  the s h a r i n g of f e e l i n g s such as v u l n e r a b i l i t y and h u r t f o r the  c r e a t i o n of i n t i m a c y and be aware of and  true c o n f l i c t  resolution.  He  suggests  express h u r t i s a h e a l i n g process i n i t s e l f .  t h a t to  Knudson,  44  Sommers and G o l d i n g (1980) found i n f a c t t h a t c o u p l e s who conflict  by  resolved  'engagement' r a t h e r than avoidance had g r e a t e r access to  another's i n t e r p e r s o n a l p e r c e p t i o n s and  c o n s t r u a l s of r e a l i t y ,  one  suggest-  ing greater intimacy. However authors who affect  b e l i e v e i n the importance  i n m a r i t a l therapy, may  of the e x p l o r a t i o n of  employ v e r y d i f f e r e n t  M a r g o l i n and W e i n s t e i n (1983) focus on the s k i l l  interventions.  of emotional e x p r e s s i o n  whereas Bockus (1980) f o c u s e s upon the displacement of f a m i l y of o r i g i n p a t t e r n s onto p r e s e n t r e l a t i o n s h i p s and uses g e s t a l t t e c h n i q u e s to enact past e m o t i o n a l e x p e r i e n c e s i n the p r e s e n t . What then i s the r o l e of emotional e x p e r i e n c e i n changing  relation-  ships? I f Zajonc i s c o r r e c t  that emotion  i s primary and  somewhat  independ-  ent then i t i s not s u r p r i s i n g t h a t Fincham and O'Leary ( i n p r e s s ) found t h a t b e h a v i o r a l responses i n marriage  seemed to be p r i m a r i l y mediated  a f f e c t i v e responses r a t h e r than c a s u a l a t t r i b u t i o n s .  by  I t would seem t h a t  s t r o n g emotional e x p e r i e n c e , such as f e a r or v u l n e r a b i l i t y , which has become a s s o c i a t e d w i t h a p a r t i c u l a r  situation  ( f o r example, c l o s e n e s s  w i t h ones spouse) tends to p r o v i d e a powerful framework which g i v e s meaning to e x p e r i e n c e . threatening.  Emotion  I f we  are a f r a i d we  see our spouse's  a c t i o n s as  e x p e r i e n c e tends to dominate, to o v e r r i d e o t h e r  c o g n i t i v e and b e h a v i o r a l cues.  Weiss (1980) suggests that  i n t i m a t e r e l a t i o n s h i p s are "based r e g a r d and f u l f i l l m e n t promised  adult  l a r g e l y upon sentiment, the  by r e l a t e d n e s s " (p.243) and  love,  that  the  meaning g i v e n to i n t e r a c t i o n p a t t e r n s i s not j u s t a f u n c t i o n of the "outcome" of events but a f u n c t i o n of sentiment.  He  speaks of  "senti-  45  merit o v e r r i d e " , w h i c h e n a b l e s gently out  in positive  relationships.  to give  according  organization. positive  Thus c o u p l e s  behavior  partner's Arnold  to t h e i r current  situations  p r i m a r y and o v e r r i d e s  target  f o r change  There  is  learning. behaviors  also  o t h e r cues  may n o t  a r e more s a l i e n t  bias  If  that  use  of e x i s t i n g  learning  use  and B e n t o v i m  behind  repetitious  namely  the s u r f a c e  of  underlying  is  of  new  essential  i n the r e l a t i o n s h i p  (Mead,  1981).  this  of  is  the case  The  defensive  reactions that  and p e r s p e c t i v e s  i t may be t h a t no synthesis  the t h e r a p i s t might  of  the stimulus The t h e r a p i s t  for  depth generally spouse.  facilitated  however,  and  Kinston  from the  s u c h an  the  new  As  i n t e r a c t i o n s which are the s e l f  or  pain, fear  i n t e r p r e t the  emotional experience i s  present.  competing  v a l i d a t e d and c o n f r o n t e d .  p a t t e r n of  new  competing responses  the automatic  t h e r a p y by t h e f a c t t h a t the p a r t n e r ,  to.  experience  if  r e s p o n s e s aimed at p r o t e c t i o n of  The a c c e s s i n g marital  suggest  attended  skills  been a c c e s s e d ,  (1981)  each  problem s o l v i n g  can t a k e p l a c e u n t i l  v u l n e r a b i l i t y has  meaning  If  overlook  seem t o be an  t h e l e a r n i n g o f new s k i l l s  skills.  and  s u c h e x p e r i e n c e may b l o c k  w o u l d c e r t a i n l y seem t o be one s u c h s e t tend to b l o c k  and  experiental  emotional  e x p e r i e n c e o f e m o t i o n a l v u l n e r a b i l i t y and r e s u l t i n g  would  "see"  the a p p r a i s a l  to them. i t would  is  point  therapy.  the point  Couples  they  on n e g a t i v e s  the r e l a t i o n s h i p  reactions  in marital  what  of t h e i r spouse u n l e s s  suggests that emotions  and i n t e n s i f i e s  noncontin-  (1982) a l s o  e m o t i o n a l s t a t e and  c h a n g e s on t h e p a r t  (1960) a l s o  organise  tend to focus  emotional experience of  to each other  K a p l a n and K a p l a n  t h a t when i n t e r a c t i n g , p e o p l e w i l l  "hear"  is  people  in  experience,  offers  a  certain  46  s a f e t y to each of the p a r t n e r s , as w e l l as g u i d i n g them w i t h probes  and  interpretations. To a v o i d emotional e x p e r i e n c e i n m a r i t a l therapy or r e g u l a t e i t to a c o n f i n e d and  secondary  seem f u n c t i o n a l .  Rather  r o l e would n o t , i n l i g h t of the above remarks s t r o n g emotional e x p e r i e n c e may  be used  to  evoke and a c c e s s key c o g n i t i o n s , of which the c l i e n t has h i t h e r t o been unaware.  D y f u n c t i o n a l c o g n i t i o n s can then be c l a r i f i e d  and m o d i f i e d .  The m o d i f i c a t i o n of c o g n i t i o n s c o n c e r n i n g the nature of the s e l f i n r e l a t i o n to the o t h e r would seem to be p a r t i c u l a r l y p e r t i n e n t Bower (1981) suggests t h a t c o g n i t i o n s may client first  here.  be more e a s i l y evoked  i f the  i s e x p e r i e n c i n g the s t a t e d u r i n g which those c o g n i t i o n s were aroused and were most s a l i e n t .  c o g n i t i o n s may  A l s o p o s i t i v e and  useful  a r i s e out of emotional e x p e r i e n c e both i n terms of  c l a r i f y i n g needs and wants and evoking new  responses and  problems.  that one problem  The  b e h a v i o r i s t s have suggested  s o l u t i o n s to with  c o n t i n g e n c y c o n t r a c t i n g i s t h a t people do not know what they want, o r perhaps, are u n w i l l i n g to communicate t h e i r wants to t h e i r spouse. e x p e r i e n c e of p r e v i o u s l y unacknowledged emotion emotion  and  The  the s y n t h e s i s of  new  g i v e s r i s e to a c t i o n d i s p o s i t i o n s which p r o v i d e a sense of  d i r e c t i o n and a i d problem  solving.  Newly f o r m u l a t e d wants and needs  a r i s e out of e m o t i o n a l e x p e r i e n c e , and (Greenberg,  1984).  suggest new  a d a p t i v e responses  For example i f a p a r t n e r r e a l i z e s that she i s a f r a i d  of c l o s e c o n t a c t w i t h her spouse  and needs r e a s s u r a n c e , she i s then a b l e  to communicate her f e e l i n g s and needs. r e c o g n i z e t h a t to comfort may  T h i s a l l o w s her p a r t n e r to  be a b e t t e r s o l u t i o n than h i s u s u a l  response of withdrawal or r a t i o n a l  lecturing.  47  The  communication of deeply f e l t  acceptance  and  as o u t b u r s t s of anger.  reactive  i n a relationship  related  to m a r i t a l  1981).  Waring et a l . found  and  emotional  tolerate all  such  correlate closely  s a t i s f a c t i o n (Waring, M c E l r a t h , L e f c o e & Weisz,  of i n t i m a c y .  expressiveness Tolstedt  i n t i m a c y or f e e l i n g s  bonding, i n c l u d i n g  responses,  tend to be very  and  or s e l f - d i s c l o s u r e to be Stokes  the  (1983) d i f f e r e n t i a t e  between v e r b a l i n t i m a c y ( s e l f - d i s c l o s u r e ) , p h y s i c a l affective  to i n c r e a s e the  e s p e c i a l l y i f the  High l e v e l s of i n t i m a c y seem to  negatively with c o n f l i c t  ingredient  tends  sense of i n t i m a c y i n a r e l a t i o n s h i p  p a r t n e r s are accustomed to r e c e i v i n g  key  emotion a l s o  intimacy  of c l o s e n e s s which i n c l u d e  "emotional  i n t e n s i t y of l i k i n g , moral support, and  flaws i n the s i g n i f i c a n t o t h e r , " (p. 574).  and  ability  These authors  to found  t h r e e k i n d s of i n t i m a c y e s p e c i a l l y a f f e c t i v e i n t i m a c y , were  s i g n i f i c a n t l y related  to m a r i t a l  satisfaction.  Altman and T a y l o r (1973)  i n t h e i r s o c i a l p e n e t r a t i o n theory d i f f e r e n t i a t e the concept i n t o v e r b a l exchanges which may  vary i n b r e a d t h ,  (range  of i n t i m a c y  of t o p i c s  which an i n d i v i d u a l d i s c l o s e s ) , depth ( c l o s e n e s s to the innermost of the person) and v a l e n c e  ( p o s i t i v e or n e g a t i v e q u a l i t y ) .  communication of r e l a t i v e l y "deep" p e r s o n a l needs f e a r v u l n e r a b i l i t i e s would seem to f a c i l i t a t e through  reciprocal  be n a t u r a l l y normally  self-disclosure.  the b u i l d i n g  i n recurring  The  and  emotional  of emotional  dyadic c o n f l i c t .  The  and  disclosure  the o t h e r p a r t n e r s tendency to p r o t e c t themselves and  responsiveness.  A new  bonds  polarisation of  unacknowledged f e e l i n g s e s p e c i a l l y those of v u l n e r a b i l i t y a l s o lower  core  T h i s k i n d of process would seem to  a n t i t h e t i c a l to the d i s t a n c e , a l i e n a t i o n  found  about  view of the p a r t n e r , f o r example one  tends  to  encourages which  48  recognizes  the need f o r c o n t a c t u n d e r l y i n g a blaming stance i n a  r e l a t i o n s h i p , evokes d i f f e r e n t new bonds.  As t h i s process  responses and encourages the f o r m a t i o n o f  c o n t i n u e s , the o v e r r i d i n g emotional  climate  may become l e s s t h r e a t e n i n g and g o o d w i l l between p a r t n e r s may expand a l l o w i n g the r e l a t i o n s h i p t o be d e f i n e d The  differently.  e x p r e s s i o n o f f e e l i n g i s then n o t , as Jacobson suggests,  to  make the impact of one p a r t n e r ' s b e h a v i o r  to  defuse  formulate access  only  on the other c l e a r , but 1)  b l o c k s to new l e a r n i n g ; 2) to h e l p couples  e x p l o r e and  p r e v i o u s l y unacknowledged f e e l i n g s , needs and wants; 3) to  important  d y s f u n c t i o n a l unconscious  c o g n i t i o n s ; 4) to f a c i l i t a t e  new p e r c e p t i o n s o f the other which evoke new responses and o p p o r t u n i t i e s for  intimacy.  i s experienced and  The end r e s u l t o f t h i s process  i s that the r e l a t i o n s h i p  i n new and more i n t i m a t e ways and d e f i n e d i n a l e s s  rigid  d e f e n s i v e manner. The  E m o t i o n a l l y Focussed therapy  used i n t h i s study attempts to  h e l p c l i e n t s a c c e s s , e x p l o r e and express  key u n d e r l y i n g  emotional  responses t o t h e i r spouse t o change the way p a r t n e r s p e r c e i v e each other and  respond to each o t h e r , and thus  to c r e a t e new o p p o r t u n i t i e s f o r  intimacy.  A D e s c r i p t i o n o f I n t e r v e n t i o n s Used i n T h i s Study T h i s study w i l l study  then attempt  to address  the need f o r a comparative  of an e f f e c t i v e c o g n i t i v e - b e h a v i o r a l i n t e r v e n t i o n , problem  s o l v i n g , and e x p e r i e n t i a l e m o t i o n a l l y r e s o l u t i o n of m a r i t a l c o n f l i c t .  focused  i n t e r v e n t i o n f o r the  49  Problem S o l v i n g The  (PS)  r a t i o n a l problem s o l v i n g  M a r g o l i n (1979) and  i s outlined  treatment i s taken from Jacobson  i n Appendix A.  (Greenberg & Johnson, i n p r e s s ) i s based on in  psychotherapy which emphasises the  (Greenberg & S a f r a n , 1984; 1973)  and  the  1978;  also outlined The  i n Appendix  empirically  validated  1977,  1979,  Feelings  role  of  i n m a i n t a i n i n g problem This  Satir,  states  treatment i s  A. Intervention  seems at present to e p i t o m i z e  approach to m a r i t a l intervention  i n press).  t e a c h i n g of problem s o l v i n g skills.  r o l e of a f f e c t i n change  Watlawick, Beavin & Jackson, 1967).  behavioral  1978,  experiential tradition  P e r l s , H e f f e r l i n e & Goodman, 1951;  i n t e r a c t i o n a l cycles  Problem S o l v i n g  cognitive  a f f e c t i v e treatment  systemic t r a d i t i o n which emphasises the  communication and (Sluzki,  the  The  and  This  therapy and  the most  s p e c i f i c to t h i s model (Jacobson, intervention  focuses upon  (or p o s i t i v e c o n t r o l )  a l t h o u g h not  to be  the  i g n o r e d are  epiphenomenal i n the  context of o v e r t  Knudson (1978) p o i n t  out  and  generally  the  communication regarded  b e h a v i o r change.  As  as  Gurman  and  "The g e n e r a l g o a l s of b e h a v i o r a l marriage therapy are to i n c r e a s e the r a t e of rewarding i n t e r a c t i o n s based on p o s i t i v e b e h a v i o r change o p e r a t i o n s and decrease the r a t e of a v e r s i v e i n t e r a c t i o n s and c o e r c i v e c o n t r o l , and teach c o n c r e t e c o n f l i c t r e s o l u t i o n and problem s o l v i n g s t r a t e g i e s and skills", (p.123).  Weiss (1978) d e f i n e s  problem s o l v i n g as  i n t e l l i g e n c e or e x p e r i e n c e , to the d e c i s o n making about c h i l d r e n . s i t u a t i o n s and  the  the  a p p l i c a t i o n of  reason,  p r o d u c t i o n of some outcome such  Problem s o l v i n g may  communication process i t s e l f .  be  applied  as  to  Mahoney (1977) notes  50  that  p r a c t i t i o n e r s using  packages employ a b a s i c the  sequence o f s k i l l  problem, c o l l e c t i n g i n f o r m a t i o n ,  examining o p t i o n s , and  problem s o l v i n g t r a i n i n g i n t h e i r treatment  means ends t h i n k i n g , rehearsal  The c l i e n t  the e v a l u a t i o n  of p o s s i b l e  i s specifying  i d e n t i f y i n g causes and  narrowing o p t i o n s ,  revising solutions.  b u i l d i n g ; that  patterns,  e x p e r i m e n t i n g , comparing r e s u l t s  develops c o g n i t i v e  skills  such as  o f probable consequences, and the  options.  Jacobson and M a r g o l i n (1979) i n c l u d e  the components o u t l i n e d by  Mahoney but add refinements such as p i n p o i n t i n g  s p e c i f i c problem  b e h a v i o r s i n the problem d e f i n i t i o n stage and the b r a i n s t o r m i n g o f possible  solutions  leading  to a r e a s o n a b l e compromise and the  s p e c i f i c a t i o n o f an agreement i n the r e s o l u t i o n phase. effective  communication a r e a l s o  sequence.  taught as p a r t  Rules f o r  of the problem  solving  The problem s o l v i n g components used here are attempts to  t e a c h couples new r u l e s and a new c o g n i t i v e conflict.  s e t f o r approaching  marital  The M a r g o l i n and Weiss study (1978) emphasises the importance  of the c o g n i t i v e  r e s t r u c t u r i n g f a c t o r s i n t h i s approach p a r t i c u l a r l y the  c r e a t i o n of a c o l l a b o r a t i v e s e t and the r e a t t r i b u t i o n o f problems i n terms o f l a c k o f s k i l l spouse. and  rather  Such i n t e r v e n t i o n s  therapist  states  behavioral  of the  a r e geared to help couples abandon blaming  accept more p e r s o n a l r e s p o n s i b i l i t y f o r the r e l a t i o n s h i p  In g e n e r a l the t h e r a p i s t  be  than n e g a t i v e i n t e n t on the p a r t  failure.  r o l e i s mainly t h a t o f a t e a c h e r and coach, the  r u l e s , models new b e h a v i o r s and p r o v i d e s feedback on  rehearsal.  These r u l e s might c o n s i s t of such commands a s :  s p e c i f i c , phrase r e q u e s t s i n terms of p o s i t i v e changes, respond  directly v.  to a c r i t i c i s m  (no c r o s s - c o m p l a i n i n g ) , o r wait f o r your spouse  to  complete  a thought  b e f o r e g i v i n g your r e a c t i o n s .  These r u l e s a r e  u s u a l l y s t a t e d p o s i t i v e l y s i n c e i t i s e a s i e r to r e i n f o r c e the o c c u r r e n c e of  a b e h a v i o r than i t s non-occurence.  Negative  feedback may be g i v e n i n  the form of p o i n t i n g out n o n - p r o d u c t i v e b e h a v i o r , and e x p l a i n i n g the n e g a t i v e consequences that ensued.  Behavioral therapists also  teach  s t i m u l u s c o n t r o l s t r a t e g i e s , t h a t i s , the couple i s i n s t r u c t e d  to b r i n g  t h e i r problem  times and  settings;  s o l v i n g attempts  under the c o n t r o l of p a r t i c u l a r  f o r example, M a r g o l i n , C h r i s t e n s e n and Weiss (1975) suggest  h e l p i n g couples to l a b e l whether they are i n v o l v e d i n emotional e x p r e s s i o n o r problem  solving.  The focus i s upon the c o n t r o l o f bad  h a b i t s and c o n s c i o u s r a t i o n a l problem e f f e c t i v e n e s s o f t h i s treatment  orientated behavior.  The  as opposed to o t h e r b e h a v i o r a l  t r e a t m e n t s , such as simple c o n t i n g e n c y c o n t r a c t i n g , has been demonstrated Jacobson  (Jacobson,  1977).  and M a r g o l i n (1979) s t a t e that problem  solving i s f i r s t  "an e x p e d i t i o u s way o f t e a c h i n g b e h a v i o r management" and second " s t i m u l u s c o n t r o l over couples c o n f l i c t  related interactions,  a l t e r i n g the q u a l i t y as w e l l as the c o n n o t a t i o n s o f such (p.213).  These authors suggest  that problem  provides  thus  interactions"  solving s k i l l s  training  s e r v e s a p r e v e n t a t i v e f u n c t i o n s i n c e i t h e l p s couples to a c q u i r e self-management s k i l l s .  The e x p r e s s i o n of f e e l i n g s i s p a r t o f  communication t r a i n i n g i n t h i s model.  Couples  are encouraged  to l a b e l  i n c i d e n t s i n terms o f f e e l i n g s and v a l i d a t e t h e i r p a r t n e r ' s f e e l i n g s . The  f o c u s here i s the enhancement of p o s i t i v e exchanges r a t h e r than t h e  expression of negative The  problem  feelings.  s o l v i n g p r o c e s s begins w i t h a d i s c u s s i o n o f m a n i f e s t  52  observable  complaints  i n terms of m u t u a l i t y i n o r d e r to c r e a t e a  collaborative  set.  b e h a v i o r s and  derogatory  of  Problems are then d e f i n e d i n terms of  problem b e h a v i o r s .  l a b e l s are d i s c o u r a g e d  problems, d i s c u s s o n l y one  reading.  couples  p r e s e n t - o r i e n t a t e d i n t h e i r p r e s e n t a t i o n of problem at a time  each o t h e r s remarks, and Jacobson (1981)  problem as:  i n f a v o r of d e s c r i p t i o n s  P a r t n e r s are encouraged to admit to t h e i r p a r t i n  the problem, be b r i e f and  paraphrase  specific  (no s i d e t r a c k i n g ) ,  a v o i d making i n f e r e n c e s or mind  d e f i n e s steps towards the d e f i n i t i o n of a  Always b e g i n w i t h something p o s i t i v e  (since distressed  seem to s e l e c t i v e l y t r a c k d i s p l e a s i n g b e h a v i o r s ) , be  u s i n g p i n p o i n t i n g s k i l l s , encourage f e e l i n g e x p r e s s i o n s concerning  the n e g a t i v e impact  specific  especially  of b e h a v i o r s , help p a r t n e r s to  acknowledge t h e i r p a r t i n the problem, and keep d e f i n i t i o n s A f t e r d e f i n i t i o n , Jacobson suggests  t h a t the remaining  brief.  discussions  should be s o l u t i o n f o c u s e d , u s i n g b r a i n - s t o r m i n g to generate Behavior  change, then, i s based upon " m u t u a l i t y and  a l s o p o i n t s out  (Jacobson  spouses to defend difficult  response  themselves and  suggests  which render  to  draw.  deny the l e g i t i m a c y of  f o r a c t i o n s , or enumerate  the b e h a v i o r beyond t h e i r c o n t r o l .  Jacobson  t h a t the t h e r a p i s t d e a l w i t h t h i s by s e t t i n g the ground  rule  p a r t n e r i s upset.  l i n e between communication t r a i n i n g , problem s o l v i n g  contingency  He  that the tendency of the  Spouses w i l l  deny r e s p o n s i b i l i t y  t h a t l e g i t i m a c y i s assumed, s i n c e one The  1979)  compromise".  t h e i r t r a n s g r e s s i o n s i s the most  c l a s s to modify.  the o t h e r s c o m p l a i n t , circumstances  & Margolin,  solutions.  c o n t r a c t i n g i n b e h a v i o r a l m a r i t a l therapy  i s often  Tasks such as the a p p r o p r i a t e e x p r e s s i o n of f e e l i n g ,  and difficult or  53  p i n p o i n t i n g behaviors  ( d i s c r i m i n a t i o n t r a i n i n g ) and o p e r a t i o n a l i z i n g  one's e x p e c t a t i o n s c o u l d be problem s o l v i n g .  As may  seen as communication t a s k s or components of  be seen i n Appendix A the Problem S o l v i n g  Treatment i n t h i s study c o n s i s t e d of the t e a c h i n g of skills,  f o l l o w e d by the t e a c h i n g of problem d e f i n i t i o n and  s k i l l s and  ending  structured  so that each spouse's rewards and  i n good f a i t h c o n t r a c t i n g .  determined i n terms of h i s or her own  Emotional  solution  Good f a i t h c o n t r a c t s are p e n a l t i e s are  independently  c o n t r a c t u a l o b l i g a t i o n to change.  Focussed Therapy  E x p e r i e n t i a l models of therapy Perls  communication  based on the work of authors  such as  (1973) and Rogers (1951) have c o n s i s t e n t l y emphasised the r o l e  affect  i n changing p e r c e p t i o n (Greenberg & S a f r a n , 1982,  E m o t i o n a l l y Focused therapy a f f e c t i v e experience perception.  The  used i n t h i s study  P a r t n e r s are regarded  emotional  the  present  t h e r a p i s t i n t h i s approach attempts to e n t e r each  as i t appears to t h i s person,  meanings and  focuses on  and  i n an i n t e r a c t i o n a l framework i n order to change  person's frame of r e f e r e n c e and  events.  1984)  of  e x p l o r e the r e a l i t y of the  and  as i t t r a n s l a t e s i n t o  as a c t i v e p e r c e i v e r s who  o r g a n i s e p e r c e p t i o n s and  s t a t e s , and who  tend  relationship  relationship construct  responses on the b a s i s of c u r r e n t  to disown a s p e c t s  of t h e i r  experience  because of i n t e r n a l b l o c k s or s p l i t s or because of p e r c e i v e d requirements  of the r e l a t i o n s h i p as p r e s e n t l y d e f i n e d .  Change i n t h i s p e r s p e c t i v e can then occur by changing one experience  and  p e r c e p t i o n s of s e l f i n r e l a t i o n to o t h e r , or by  the other p a r t n e r ' s p o s i t i o n and  p a t t e r n of responses,  person's changing  or most l i k e l y  by  54  changing  both s i m u l t a n e o u s l y and  i n a r e c i p r o c a l l y determining f a s h i o n .  I n s i g h t i n t h i s approach i s not enough to b r i n g about change i n the relationship. meaningful  Rather  l e v e l , new  p a r t n e r s encounter  p a r t n e r s must e x p e r i e n c e , on an e m o t i o n a l l y a s p e c t s of themselves  and new  each o t h e r i n the s e s s i o n and  " c o r r e c t i v e emotional  experience".  The  interactions.  Thus  participate in a  use of e f f e c t i v e  communication  s k i l l s i s seen as emerging more as a r e s u l t of change r a t h e r than b r i n g i n g i t about. s o l v i n g and  The  e x p e r i e n c i n g of new  f e e l i n g s motivates  good communication as does the p e r c e p t i o n of the p a r t n e r as  more a c c e s s i b l e and  responsive.  Change occurs then i n t h i s approach by a deepening which b r i n g s new interaction.  of  a s p e c t s of s e l f i n t o f o c a l awareness and  S p e c i f i c i n t e r a c t i o n a l behaviours  to change the sequence of i n t e r a c t i o n s .  experience into  are reframed  p o s i t i v e manner i n terms of these u n d e r l y i n g emotional At l e a s t  1.  the  in a  states, i n order  f i v e p r o c e s s e s of  change appear to occur i n the e m o t i o n a l l y focused treatment (Greenberg  problem  of c o u p l e s .  & Johnson, i n p r e s s ) .  An i n d i v i d u a l p e r c e i v e s him or h e r s e l f d i f f e r e n t l y by b r i n g i n g i n t o f o c a l awareness e x p e r i e n c e s not p r e v i o u s l y dominant i n t h i s person's  view of s e l f ;  f o r example, "I see and accept  my  vulnerability." 2.  The  spouse on w i t n e s s i n g the p a r t n e r ' s new  e x p r e s s i o n , p e r c e i v e s the p a r t n e r i n a new see your need f o r c a r i n g and hostility."  affective way;  c o n t a c t r a t h e r than  f o r example, "I your  55  3.  The  i n d i v i d u a l ' s p e r s o n a l r e o r g a n i z a t i o n l e a d s to d i f f e r e n t  behaviour " I now 4.  The  i n the i n t e r a c t i o n between the spouses;  ask you  spouse's new  responses; 5.  f o r reassurance  p e r c e p t i o n s of the p a r t n e r l e a d to d i f f e r e n t you r a t h e r than withdraw."  As a f u n c t i o n of t h e i r p a r t n e r ' s new u a l s come to see themselves  to The  from a p o s i t o n of v u l n e r a b i l i t y . "  f o r example, "I comfort  can f u l f i l l  i n new  behaviours,  your needs, I see myself  combination  as v a l u a b l e and  are expressed  and  accepted  responsiveness  Different  i n the r e l a t i o n s h i p and The  to the o t h e r p a r t n e r s needs. from  p r e v i o u s l y have been unacceptable  and  of m a r i t a l s a t i s f a c t i o n training  emotional  this  leads  the c r e a t i o n of a  Spouses then are more  t h e i r p a r t n e r s , t h a t might offensive.  T h i s whole p r o c e s s ,  to i t s h i g h demand f o r d i s c l o s u r e , i s i n i t s e l f  b u i l d i n g of i n t i m a c y and  aspects of  p a r t n e r s ' p e r c e p t i o n s of  terms which f a c i l i t a t e  a b l e to accept c e r t a i n behaviours  for  necessary  of the above p r o c e s s e s l e a d s to a r e d e f i n i t i o n of  each other are framed i n new  due  individ-  you."  to a change i n i n t e r a c t i o n a l p a t t e r n s .  new  the  ways; f o r example, " s i n c e I  the s e l f i n the r e l a t i o n s h i p f o r both p a r t n e r s . the s e l f  f o r example,  conducive  to the  bonds, both of which are key  ( T o l s t e d t & Stokes,  1982).  The  aspects  treatment  i n t h i s approach c o n t a i n s the n i n e steps o u t l i n e d  manual  below:  1.  Delineate c o n f l i c t  2.  I d e n t i f y the n e g a t i v e i n t e r a c t i o n c y c l e , f o r example pursue and  3.  i s s u e s i n the core s t r u g g l e .  withdraw.  Access  unacknowedged f e e l i n g s i n h e r e n t i n the p o s i t i o n each  p a r t n e r takes i n the i n t e r a c t i o n  cycle.  56  4.  Reframe the problem i n terms of u n d e r l y i n g  5.  Promote i d e n t i f i c a t i o n w i t h disowned needs.  6.  Promote acceptance  7.  F a c i l i t a t e e x p r e s s i o n of needs and  8.  E s t a b l i s h the mergence of new  9.  C o n s o l i d a t e new  The  t h e r a p i s t i n t h i s approach must e s t a b l i s h the k i n d of  of p a r t n e r ' s  confidence, p a r t i c u l a r l y experiences  responses  wants.  solutions.  The  experience  to be e x p l o r e d  with  of v u l n e r a b i l i t y f e a r and  t h e r a p i s t a l s o s t r i v e s to l e g i t i m i s e  the  of each p a r t n e r as r e f l e c t i o n s of u n i v e r s a l human needs.  o r d e r to a c c e s s and h e i g h t e n emotional methods of G e s t a l t therapy client  experience.  positions.  t h e r a p e u t i c a l l i a n c e which a l l o w s new  unexpressed resentment.  feelings.  c e n t e r e d therapy  responses  ( P e r l s , et a l , 1951)  ( R i c e , 1974).  f o r m u l a t i o n of meanings as new  The  experiences  the t h e r a p i s t uses and  t h e r a p i s t a l s o guides  the  o c c u r , f o r example,  t h a t t h i s r e c o n s t r u c t i o n remains t r u e to the c l i e n t s present from both the e x p e r i e n c i n g and  promotes c o n t a c t between the p a r t n e r s .  the  i n n o v a t i o n s from  r e f r a m i n g h o s t i l i t y as d e s p e r a t i o n or d i s t a n c e as f e a r i n such a  evokes acceptance  In  way  experience,  o b s e r v i n g spouse, and  57  CHAPTER  HI  THE METHODOLOGY OF THE STUDY  T h i s c h a p t e r begins w i t h a d e s c r i p t i o n of the c l i e n t  p o p u l a t i o n and  t h e r a p i s t s , f o l l o w e d by a d e l i n e a t i o n of the i n s t r u m e n t s used and research procedures.  The  hypotheses  of the study are then  f o l l o w e d by a d e s c r i p t i o n of data a n a l y s i s  the  outlined,  procedures.  C l i e n t Population The  s u b j e c t s f o r t h i s study requested c o u n s e l l i n g a f t e r r e a d i n g a  newspaper a r t i c l e Project.  (Long,  1983)  d e s c r i b i n g the Couples  Problem S o l v i n g  Couples were o f f e r e d e i g h t m a r i t a l therapy s e s s i o n s designed  to h e l p them r e s o l v e m a r i t a l c o n f l i c t .  The  c l i e n t s a f t e r s c r e e n i n g and  an assessment i n t e r v i e w then attended the E d u c a t i o n C l i n i c at U n i v e r s i t y of B r i t i s h Columbia Client  f o r therapy.  couples were screened on the telephone and a g a i n i n the  assessment i n t e r v i e w a c c o r d i n g to the f o l l o w i n g 1.  The  C l i e n t s had  criteria:  to have been c o h a b i t i n g f o r a minimum of  twelve  months. 2.  C l i e n t s had  to have no immediate plans f o r d i v o r c e o r  separation. 3.  I n d i v i d u a l c l i e n t s had treatment  4.  to have r e c e i v e d no  psychiatric  or h o s p i t a l i z a t i o n w i t h i n the l a s t  I n d i v i d u a l c l i e n t s had  two  years.  to r e p o r t having no problems w i t h  a l c o h o l or drugs. 5.  I n d i v i d u a l c l i e n t s had sexual dysfunciton.  to r e p o r t e x p e r i e n c i n g no  primary  58  6.  C l i e n t s had  to score i n the d i s t r e s s e d  range on the  Dyadic  Adjustment S c a l e ( S p a n i e r , 1976); i n t h i s study t h a t i s d e f i n e d as at l e a s t one p a r t n e r s c o r i n g below 100 7.  C l i e n t s had  to be w i l l i n g  to consent  on t h i s  to r e s e a r c h  scale. procedures,  t e s t i n g and v i d e o - t a p i n g . 8.  C l i e n t s had  to be c u r r e n t l y u n i n v o l v e d i n any  l o g i c a l l y o r i e n t e d treatment  other psycho-  e i t h e r on an i n d i v i d u a l or  couple  basis. There were 45 couples i n c l u d e d i n the study, treatment  groups and  demographic data was  15 i n the wait l i s t collected  number of y e a r s couples had 1-24).  There was  of 1.75  two  The f o l l o w i n g  from these 45 c o u p l e s .  been l i v i n g  an average  control.  15 i n each of the  t o g e t h e r was  The mean f o r the 8.6  years  (range:  c h i l d r e n per f a m i l y (range:  0-7).  Seven c o u p l e s had been i n v o l v e d i n p r e v i o u s m a r i t a l c o u n s e l l i n g (15% of the t o t a l ) , and  20 i n d i v i d u a l s  m a r r i e d b e f o r e engaging of  (22% of the t o t a l ) had  upon t h e i r present r e l a t i o n s h i p .  the p a r t n e r s i n v o l v e d i n the study was  The median range of f a m i l y income was Canadian d o l l a r s per y e a r . completed  by spouses was  h a v i n g completed  been p r e v i o u s l y  35.3  years  r e p o r t e d to be  The mean age  (range: 25 - 55). $35,000 -45,000  The mean number of years of e d u c a t i o n  15;  t h i s was  d e f i n e d on the q u e s t i o n n a i r e as  a community c o l l e g e program or p a r t of a degree.  The  o c c u p a t i o n s of the spouses were c a t e g o r i s e d on the B l i s h e n S c a l e (1971).  T y p i c a l l y the male spouses f e l l  c a t e g o r y , w h i l e the female scale. female  The  spouses f e l l  i n t o the s e m i - p r o f e s s i o n a l i n t o the t r a d e s c a t a g o r y on  this  v a r i a b l e s , number of years t o g e t h e r , f a m i l y income, male and  o c c u p a t i o n , e d u c a t i o n a l l e v e l and  age were examined f o r  59  differences  u s i n g an a n a l y s i s o f v a r i a n c e and no s t a t i s t i c a l l y  ant d i f f e r e n c e s were found g r o u p s and t h e c o n t r o l ) . successfully variables. A p p e n d i x E.  Thus t h e r a n d o m i s a t i o n  process  s e l e c t g r o u p s t h a t w e r e e q u i v a l e n t on t h e s e For d e t a i l s of t h i s a n a l y s i s please These s u b j e c t s were p r e d o m i n a n t l y  causcasian cultural particular  between t h e t h r e e groups (two  group not from d i s t i n c t  c u l t u r a l v a l u e s may  signific-  treatment seemed t o demographic  turn to Table E - l , members o f t h e d o m i n a n t  e t h n i c b a c k g r o u n d s where  influence expectations  concerning  marriage. The a s s i g n m e n t o f s u b j e c t s t o g r o u p was s e q u e n c e o f o n e , two and t h r e e f o u n d designated and  as ones were a s s i g n e d  three's to the C o n t r o l .  after  DAS  as a b o v e .  was a c c e p t e d  the study  number on t h e l i s t .  I f a couple  three such  into  couples  scored  There  u n d e r 80 on t h e  were c o l l e c t e d  t o e n s u r e t h a t a n y one t r e a t m e n t  and  to group, treatment  s i x ) according  couples  t o a random number  table. the Test  of Emotional  ( A l l e n & Hamsher, 1974), w h i c h measures O r i e n t a t i o n towards  significant  and R e s p o n s i v e n e s s  d i f f e r e n c e s were found  D e t a i l s of t h i s  a n a l y s i s may  After  were p l a c e d w i t h t h e r a p i s t s (one  The s u b j e c t s w e r e a l s o a d m i n i s t e r e d  Expressiveness,  then  group d i d  c o n t a i n a d i s p r o p o r t i o n a l number o f v e r y l o w s c o r i n g c o u p l e s .  assignment to  procedure.  T h i s was  Couples  t o t h e EF g r o u p , t w o ' s t o t h e PS g r o u p  As a c o u p l e  they were s e t a s i d e u n t i l  assigned not  i n a random number t a b l e .  assessment they were g i v e n t h e f i r s t  was one e x c e p t i o n t o t h i s  completed using the  to emotional  stimuli,  i n Table  emotion,  and no  between the t h r e e s u b j e c t  a l s o be f o u n d  Style  groups.  E-2, Appendix  E.  60  Therapists There were 12 t h e r a p i s t s four age  females) a d m i n i s t e r i n g from 28 to 43.  Solving  students.  t h i s group was 4.6 The  therapists  F i v e of the t h e r a p i s t s  The t h e r a p i s t s ranged i n administering  the Problem  or r e c e n t l y graduated c l i n i c a l  psychology  The mean number of years of academic t r a i n i n g f o r (range: 2-6). administering  the E m o t i o n a l l y Focussed Treatment  were s o c i a l workers or c o u n s e l l i n g masters degree.  i n t h i s study; s i x (two males and  each treatment.  Treatment were s e n i o r  doctoral  involved  psychologists,  a l l possessing a  The mean number of years of academic t r a i n i n g f o r t h i s  group was 3 (range: 2-5)  This  difference  i n years of academic t r a i n i n g  between t h e r a p i s t groups was not s t a t i s t i c a l l y  s i g n i f i c a n t , and was not  taken t o be o p e r a t i o n a l l y s i g n i f i c a n t . All  PS t h e r a p i s t s were t r a i n e d  primarily i n a behavioral  to psychotherapy and t h e i r p r o f e s s e d Cognitive  - Behavioral.  approach  o r i e n t a t i o n was B e h a v i o r a l  A l l EF t h e r a p i s t s were t r a i n e d  or  i n systemic and  h u m a n i s t i c approaches to psychotherapy, and t h e i r p r o f e s s e d  orientations  were E x p e r i e n t i a l and S y s t e m i c . In terms of c l i n i c a l e x p e r i e n c e the mean f o r both the EF and PS t h e r a p i s t s was 4 y e a r s . therapists  The d i s t r i b u t i o n of years of e x p e r i e n c e  i n each group was a l s o v e r y s i m i l a r (range: 2 - 7 ) .  In g e n e r a l the t h e r a p i s t s as  possible  therapists  across  c o n d u c t i n g the two treatments were as f a r  balanced as to t r a i n i n g and e x p e r i e n c e , however the PS d i d possess s l i g h t l y more years of academic t r a i n i n g on  average. In each group four  therapists  t h r e e couples and one t h e r a p i s t  saw two c o u p l e s , one t h e r a p i s t  saw four  couples.  saw  The t h e r a p i s t s had  61  been t r a i n e d  i n a group s e t t i n g ( a p p r o x i m a t e l y 12 hours of t r a i n i n g ) to  implement the two therapy manuals. Dr.  The EF t h e r a p i s t s were t r a i n e d by  L . Greenberg of The U n i v e r s i t y of B r i t i s h Columbia and the PS  t h e r a p i s t s were t r a i n e d by Ms. L i s a Wood who c o l l a b o r a t e s Jacobson o f the U n i v e r s i t y of Washington. ings were conducted d u r i n g  Two group s u p e r v i s i o n  feedback d u r i n g An  treating therapists  measures as dependent v a r i a b l e s  differential  consultation  the study (not exceeding 15 minutes per c o u p l e ) .  a n a l y s i s of v a r i a n c e  post-test  meet-  the study, one f o r each t h e r a p i s t group. A l l  t h e r a p i s t s were a l s o g i v e n a minimal amount of telephone and  w i t h Dr. N.  therapist  effects.  as a f i x e d v a r i a b l e and  found no s i g n i f i c a n t  D e t a i l s of t h i s a n a l y s i s may be found  i n T a b l e s E5 and E6, Appendix E .  Instruments All  constructed  instruments, questionnaires  and i n s t r u c t i o n s f o r  t h e i r completion are to be found i n Appendix B.  Subject  1.  Variables  Demographic Q u e s t i o n n a i r e This  questionnaire  addressed the f o l l o w i n g  years spent t o g e t h e r as a c o h a b i t i n g living  and  c o u p l e , the number of c h i l d r e n  i n the home, whether spouses has been p r e v i o u s l y  been i n v o l v e d family  q u e s t i o n s : the number of  i n previous m a r i t a l  m a r r i e d or had  therapy, the approximate amount of t h e  income, the age of the spouses as w e l l as t h e i r e d u c a t i o n a l  present o c c u p a t i o n s .  to the B l i s h e n  Scale  This  l a s t v a r i a b l e was c a t e g o r i s e d  ( B l i s h e n & McRoberts, 1976).  level  according  The purpose o f t h i s  62  q u e s t i o n n a i r e was population. and  to p r o v i d e an a c c u r a t e d e s c r i p t i o n of the  Couples completed r e l e v a n t p a r t s of t h i s measure  i n d i v i d u a l l y focused p a r t s s e p a r a t e l y .  completed s e p a r a t e l y by both  2.  The T e s t of E m o t i o n a l T h i s t e s t was  initially  A l l other measures were  S t y l e s (ES)  ( A l l e n & Hamsher, 1974).  g i v e n to a s c e r t a i n i f the treatment  groups were  e q u i v a l e n t on scores i n d e x i n g the three f a c t o r s of and Responsiveness.  This  emotional was  s i n c e a h i g h l e v e l of these f a c t o r s i n the couples a s s i g n e d  the EF treatment  might p o s i t i v e l y b i a s the treatment  dimensions of e m o t i o n a l i t y addressed responsiveness,  i n the t e s t may  as i n t e n s i t y of e x p e r i e n c e d  the p r e d i s p o s i t i o n to communicate a f f e c t o r i e n t a t i o n as a t t i t u d e towards emotion.  choose between two  statements  d e s c r i p t i o n of themselves. reliability  data.  consistency levels Expressiveness  .90,  On  effects.  The  S u b j e c t s are  A l l e n and Hamsher r e p o r t v a l i d i t y  Responsiveness  .85,  and  found  internal  .92,  these s u b s c a l e s to  be unconfounded w i t h independent measures of adjustment or desirability.  items  requested  they i n d i c a t e t h a t  and  social  Females s c o r e d s i g n i f i c a n t l y h i g h e r than males on a l l  dimensions. An a n a l y s i s of v a r i a n c e r e v e a l e d no  as  t h a t i s most t r u e as a  ( c o e f f i c i e n t alpha) were, O r i e n t a t i o n and  three  and  t e s t c o n s i s t s of 75  marking the one  to  be d e f i n e d thus;  interpersonally,  t h e i r sample (N = 173)  The  a f f e c t , expressiveness,  (25 per s u b s c a l e ) i n the form of f o r c e d c h o i c e s . to  together  spouses.  s t y l e , O r i e n t a t i o n , Expressiveness necessary  sample  statistically  d i f f e r e n c e s between the t h r e e s u b j e c t groups i n t h i s  significant  study on  this  63  measure.  The  d e t a i l s of t h i s a n a l y s i s may  be  found i n T a b l e  E-2,  Appendix E.  Therapy P r o c e s s V a r i a b l e s  3.  The  Couples Therapy A l l i a n c e S c a l e  T h i s instrument was  (AS)  (Pinsoff & Catherall,  completed by each c l i e n t  a f t e r the  therapy s e s s i o n as a measure of the c l i e n t ' s view of the relationship. client  and  The  measure has  by  c l i e n t and  concept of t h e r a p e u t i c  (1979) as the key  relationship.  s e l f , the other  r e l a t i o n s h i p as a whole.  measure c o n s i s t s of 28  self,  11 to o t h e r  subject  p a r t n e r , and  responds to on a L i k e r t  T h i s instrument was  of  personal that  are  These  elements i n the  These t h r e e components are  viewed i n r e l a t i o n s h i p to the The  therapeutic  the development of tasks  the c l i e n t as r e l e v a n t to h i s / h e r c o n c e r n s .  components are i d e n t i f i e d by B o r d i n  third  components, agreement between  t h e r a p i s t on t h e r a p e u t i c g o a l s , the e x i s t e n c e  bonds between t h e r a p i s t and perceived  three  1983)  partner  and  the  also  couple's  items (11  r e l a t e to  6 to the couple r e l a t i o n s h i p ) which  the  type f i v e p o i n t s c a l e .  intended  to c o n t r o l f o r the g e n e r a l  or  r e l a t i o n s h i p f a c t o r s which have been shown to be important i n p r e d i c t i n g therapeutic the  outcomes.  The  task dimension which measures engagement i n  t a s k s of therapy would a l s o appear to be p a r t i c u l a r l y r e l e v a n t i n  t h i s study to show that c l i e n t s were e q u i v a l e n t l y engaged i n both types of therapy and Since  perceived  them as e q u a l l y  t h i s instrument i s s t i l l  item a n a l y s i s was  relevant.  i n the process  of being  conducted to determine r e l i a b i l i t y  revised  for this  sample  an  64  population.  The  r e s u l t s of t h i s a n a l y s i s are presented  i n the r e s u l t s  chapter.  4.  The  Implementation C h e c k l i s t  T h i s c h e c k l i s t of t h e r a p i s t i n t e r v e n t i o n s was researcher was  f o r the purposes of t h i s  study.  The  devised  by  the  purpose of the c h e c k l i s t  to enable t r a i n e d r a t e r s ( t h r e e hours of t r a i n i n g ) to a s c e r t a i n  whether the i n t e r v e n t i o n s s t i p u l a t e d i n the treatment manuals These r a t e r s examined two second and  final  occurred.  ten minute samples of therapy taken from  t h i r d of randomly s e l e c t e d s e s s i o n s .  The c h e c k l i s t  c o n s i s t s of 20 c a t e g o r i e s of t h e r a p i s t i n t e r v e n t i o n s taken from treatment manuals.  were i n c l u d e d , namely, i n f o r m a t i o n  f o u r couples process  5.  The and  the  As w e l l as ten c a t e g o r i e s of i n t e r v e n t i o n s from each  treatment t h r e e a d d i t i o n a l c a t e g o r i e s not  non-codable.  assignable  gathering,  judged to be  of treatment was  to e i t h e r treatment  refocus  implementation c h e c k l i s t was  on t o p i c , and  pilot-tested  s a t i s f a c t o r y , i n the  first  sense that  e a s i l y codable i n t o the given  on  the  catagories.  T h e r a p i s t I n t e r v e n t i o n Report T h e r a p i s t s were r e q u i r e d  session.  to complete a c h e c k l i s t at the end  T h i s c h e c k l i s t c o n s i s t e d of the  same c a t e g o r i e s  t h e r a p i s t s were  requested  used i n the  to check o f f the i n t e r v e n t i o n s they had  r e p o r t an e s t i m a t e  recorded  how  each s e s s i o n .  of the frequency of use.  " r e s o l v e d " they c o n s i d e r e d  of each  of  i n t e r v e n t i o n s as the Implementation C h e c k l i s t and  and  the  Therapists  session  also  the couple to be at the end  These r e p o r t s were simply monitored by  the r e s e a r c h e r  of and  65  the r e s e a r c h a s s i s t a n t and a l s o served to remind t h e r a p i s t s o f the i n t e r v e n t i o n s r e q u i r e d i n the treatment  manuals.  Outcome V a r i a b l e s  6.  The Dyadic Adjustment S c a l e (DAS) ( S p a n i e r , 1976). T h i s instrument was used as a s c r e e n i n g and pre-treatment  measure  and as a g e n e r a l measure o f outcome at t e r m i n a t i o n and f o l l o w - u p . DAS c o n s i s t s o f 32 items arranged  The  i n t o f o u r s u b s c a l e s measuring d y a d i c  consensus (13 i t e m s ) , s a t i s f a c t i o n  (10 i t e m s ) , c o h e s i o n  a f f e c t i o n a l e x p r e s s i o n (4 i t e m s ) .  I t i s at present c o n s i d e r e d to be the  instrument of  o f c h o i c e f o r the assessment o f m a r i t a l adjustment  reliability  validity.  (5 items) and  (coefficient  i n terms  alpha i n S p a n i e r ' s sample, .96) and  Spanier p r e s e n t s v a l i d i t y data such as a c o r r e l a t i o n between  the DAS and the Locke Wallace M a r i t a l Adjustment S c a l e (1959) of .86. In  the Koren e t a l . study  instrument  (1980) d i s t r e s s l e v e l measured on t h i s  c o r r e l a t e d with s a t i s f a c t i o n concerning c o n f l i c t  objective conflict  outcomes and  resolution.  C o n c e p t u a l l y , Spanier suggests be a measure o f the adjustment  t h a t the s c a l e can be c o n s i d e r e d to  o f the dyad as a f u n c t i o n i n g group r a t h e r  than a measure of I n d i v i d u a l adjustment  to the r e l a t i o n s h i p .  has a maximum p o s s i b l e range of 0 t o 151.  The mean t o t a l  The s c a l e  score i n  S p a n i e r ' s sample f o r m a r r i e d and d i v o r c e d couples was 114.8 (S.D. 17.8) and  70.7respectively.  S p a n i e r r e p o r t s the r e l i a b i l i t y  as Consensus .90, S a t i s f a c t i o n E x p r e s s i o n .73.  .94, Cohesion  of the s u b s c a l e s  .86 and A f f e c t i o n a l  Most o f the items i n v o l v e a s i x or f i v e p o i n t L i k e r t  66  scale defining  the amount o f agreement or the frequency o f an event.  I n c l u d e d i n the s a t i s f a c t i o n s u b s c a l e i s a l s o a g l o b a l happiness and  a rating  rating  of committment.  An item a n a l y s i s was conducted  on t h i s instrument  f o r the purposes  o f t h i s study, the r e s u l t s o f which a r e presented i n the r e s u l t s chapter.  7.  T a r g e t Complaints Frank,  (TC)  ( B a t t l e , Imber, Hoehn-Saric,  Stone, Nash &  1966).  A d e s c r i p t i o n o f the main complaint a r i s i n g i n the r e l a t i o n s h i p was a r t i c u l a t e d by each spouse to the a s s e s s o r d u r i n g the i n i t i a l i n t e r v i e w and  r a t e d as to improvement o r d e t e r i o r a t i o n at the t e r m i n a t i o n of the  s e s s i o n s and a t f o l l o w - u p . Parloff  (1975) as a core b a t t e r y Instrument  outcome r e s e a r c h . client  The measure i s recommended by Waskow and  I t c o n s i s t s of t h r e e f i v e p o i n t s c a l e s on which  i n t h i s study was asked  different  f o r use i n psychotherapy  complaints r e l a t e d  each  to r a t e the amount of change on t h r e e  to the core c o n f l i c t  In t h i s study one s c o r e (TC) was computed based of the s t a t u s o f the primary t a r g e t  i n the r e l a t i o n s h i p .  on the c l i e n t ' s  rating  complaint.  B a t t l e e t a l . (1966), g i v e evidence as to the v a l i d i t y o f t h i s measure i n terms o f s i g n i f i c a n t  c o r r e l a t i o n s w i t h o t h e r outcome measures  particularly  of t a r g e t complaints to the complaints  the correspondence  o b t a i n e d i n an i n t e n s i v e p s y c h i a t r i c i n t e r v i e w . that  These authors  state  they found t h i s measure to be " i n f o r m a t i v e , and i t made good  clinical  sense and seemed to respond  differentially  to experimental  m a n i p u l a t i o n " ( p . 187). The authors r e p o r t the c o r r e l a t i o n between t h e  h  67  r a n k i n g s of problems by p a t i e n t s on two d i f f e r e n t  o c c a s i o n s as .68.  The  s e v e r i t y r a t i n g s o f the t a r g e t complaints d i d not change.  A final  by the above authors a l s o found  complaints  d i d not d i f f e r different clients  s i g n i f i c a n t l y when these r a t i n g s were r e p o r t e d to  interviewers.  i n this  Jacobson,  that the content of t a r g e t  study  The type o f T a r g e t Complaints  articulated  by  study a r e d e s c r i b e d i n Appendix B. Follette  and Elwood ( i n press), suggest  that measures  which t a p the couples p r e s e n t i n g problems most d i r e c t l y such as problem checklists like  t h i s instrument and g o a l attainment  instruments of choice i n m a r i t a l  8.  Goal Attainment The  Scaling  therapy.  (GAS) ( K i r e s u k & Sherman, 1968)  GAS measurement procedure  g o a l measurement.  s c a l e s a r e the  i s a method of g o a l d e f i n i t i o n and  I t i s a method o f o b t a i n i n g from c l i e n t s  o b s e r v a b l e and q u a n t i f i a b l e i n d i v i d u a l  goals.  The procedure  means o f f o r m a l l y s p e c i f y i n g the a c t u a l g o a l s undertaken relation  to h i s / h e r p r e s e n t i n g concerns.  p o s s i b l e to determine  specific includes a  by a c l i e n t i n  With t h i s procedure  i t is  the extent to which the c l i e n t ' s g o a l s have been  attained. The GAS s c o r e s a r e based  on a standard score system  h a v i n g a mean o f 50 and a standard d e v i a t i o n o f 10. range  from  "much worse than expected"  "much b e t t e r than expected" particular at  least  (-2) through  (T s c o r e s )  The g o a l outcomes  "expected"  (0) to  (+2), w i t h each outcome l e v e l d e f i n e d by a  o b s e r v a b l e b e h a v i o r o r group o f b e h a v i o r s .  A s c a l e must have  two p o i n t s that are s u f f i c i e n t l y p r e c i s e and o b j e c t i v e i n t h e i r  d e s c r i p t i o n so t h a t an u n f a m i l i a r observer would have no t r o u b l e i n  68  determining point.  whether the c l i e n t ' s p o s i t i o n l i e s above or below the chosen  The s c a l e thus becomes an e v a l u a t i v e t r a n s f o r m a t i o n o f the  treatment  outcome i n t o an approximate random v a r i a b l e w i t h a mean of  zero and a v a r i a n c e of one ( b e f o r e t r a n s f o r m a t i o n to the standard T s c o r e having a mean o f 50 and standard  d e v i a t i o n of 10).  One purpose i n the development o f the GAS system was to a l l o w outcome data to be grouped f o r easy a n a l y s i s without of i n d i v i d u a l c l i e n t client  goals.  A standard  l o s i n g the import  s c o r e may be generated  t o e v a l u a t e h i s / h e r p o s i t i o n b e f o r e and a f t e r  f o r each  therapy.  K i r e s u k and Sherman p o i n t out t h a t e s s e n t i a l l y the GAS has the f o l l o w i n g characteristics:  1) a s e t o f statements  of g o a l s f o r an i n d i v i d u a l ;  a system o f weights f o r these g o a l s ; 3) a s e t of expected these g o a l s r a n g i n g from- "most u n f a v o r a b l e " follow-up  2)  outcomes f o r  to "most f a v o r a b l e " ; 4) a  s c o r i n g o f these outcomes; and 5) a score summarizing the  outcome a c r o s s a l l g o a l s . In t h i s study the c l i e n t s were asked relation  to t h e i r m a r i t a l i s s u e s and to d e f i n e 5 l e v e l s of attainment of  t h a t g o a l i n terms o f t h r e e o b s e r v a b l e one  to focus upon the main g o a l i n  s u b j e c t i v e emotional  reaction.  and q u a n t i f i a b l e b e h a v i o r s and  One l e v e l of attainment  d e s c r i b e d as "worse", t h a t i s the i n s t r u m e n t , allows f o r d e t e r i o r a t i o n . attainment  was  l i k e the TC instrument  An example of the way i n which a l e v e l of  might be d e f i n e d may be c l a r i f y i n g .  A spouse might d e s c r i b e  the  "somewhat b e t t e r than expected"  l e v e l of g o a l attainment  i n terms  of,  1) b e i n g a b l e to r e a c h consensus on d e c i s i o n s 75% o f the time, 2)  b e i n g a b l e to t a l k c l a m l y about i s s u e s when consensus was not immediately  a t t a i n a b l e , and as a r e s u l t , 3) o n l y e n c o u n t e r i n g one  69  escalating distressing fight a month.  As a result the spouse might  expect to f e e l generally calmer and more secure i n the relationship. In the assssment interview c l i e n t s formulated their goals and rated their present l e v e l of attainment on an individual independent  basis.  At termination and follow-up the l e v e l of attainment was measured again.  9.  The Personal Assessment of Intimacy i n Relationships Inventory (PAIR) (Schaefer & Olson, 1981) This instrument consists of 36 items arranged into 6 subscales,  Emotional Intimacy, Social Intmacy, Sexual Intimacy, I n t e l l e c t u a l Intimacy, Recreational Intimacy, and Conventionality. Definitions f o r these subscales may be found i n Appendix B. entity; there i s no t o t a l score.  Each subscale i s a separate  The instrument attempts to  operationalise d i f f e r e n t kinds of intimacy.  Intimacy i s presumed to be  a key dimension of the marital relationship and one which may  be  expected to correlate p o s i t i v e l y with the resolution of relationship conflicts. The inventory measures the perceived versus the expected degree of intimacy, so that a difference score may be computed i n each of the five areas of intimacy mentioned above.  The conventionality subscale was  designed to measure s o c i a l d e s i r a b i l i t y factors and i s scored only as perceived.  Each partner responds to each item "as i t i s now"  (perceived) and then "how  he/she would l i k e i t to be",  i n d i c a t i n g agreement or disagreement  (expected)  on a five point Likert scale.  Olson and Schaefer (1982) report i n the manual that i n their sample (N = 384), the PAIR subscales correlated p o s i t i v e l y with the Locke  70  W a l l a c e M a r i t a l Adjustment S c a l e  (1959) and  S c a l e on the Moos Family Environment S c a l e the r e l i a b i l i t y for  (RC) to  (SX),  .70  subscales.  have a f a i r l y  (EM)  subscale,  normal d i s t r i b u t i o n  between 42 and  somewhat lower x*=  (IN), and  expected s u b s c a l e s  .70  38).  (x = 61)  (CON) The  and  was  f o r the  f o r the  Recreational  ranged between 80 -  that  the mean p e r c e i v e d  average score f o r for Conventionality  the r e l a t i o n s h i p (PAIR Manual, 1982).  each  Means f o r  Conventionality  " f a k i n g good" and  a tendency to  These two  a l t e r n a t i v e i n t e r p r e t a t i o n s of t h i s  formulations subscale.  (1975) suggests that the meaning of c o n v e n t i o n a l i t y as i t  r e l a t e s to the measurement of m a r i t a l adjustment may i d e a l i s a t i o n of the i d e a l i s a t i o n may process  spouse and  i n fact  of the r e l a t i o n s h i p , and  that  i n f a c t be a p o s i t i v e m a r i t a l adjustment  of i d e a l i s a t i o n has  e s s e n t i a l to the experience  been c o n s i d e r e d  be this  technique.  by many t h e o r i s t s as  of romantic attachment ( C s i k s z e n t m i h a l y i ,  C l a y t o n a l s o c r i t i z e s Edmonds (1967) o r i g i n a l work on  desirability  was  86.  suggest that a h i g h score on the  would seem to present  They found  14 - 20 p o i n t s .  idealize  1980).  .77  report .75  scores were common (0 - 70 p o i n t s on  i s the r e s u l t of the couple  The  (SO),  as  Conflict  They r e p o r t t h a t l a r g e d i s c r e p a n c i e s between  subscale  Clayton  authors  (range = 0 - 96).  58 f o r each s c a l e .  somewhat h i g h e r  female p e r c e i v e d  authors  f o r the S o c i a l  Conventionality  s c a l e ) , however the mean d i s c r e p a n c y  The  The  the  They a l s o s t a t e t h a t s c o r e s on the s u b s c a l e s were found  S o c i a l Intimacy was  male and  .71  f o r the I n t e l l e c t u a l  except f o r S o c i a l Intimacy and score f e l l  (1976).  (Cronbach's alpha) of each of the s u b s c a l e s  the E m o t i o n a l  Sexual  negatively with  f a c t o r s i n the measurement of m a r i t a l adjustment  social since  71  Edmonds o n l y recorded  one  of h i s sample spouses responses and  d e s c r i b e h i s sample's demographics.  In f a c t C l a y t o n and  such as Dean and Lucas (1974) suggest i n g e n e r a l s o c i a l d e s i r a b i l i t y i n t h i s area has  of t h i s  10.  The  item a n a l y s i s was study and  the r e s u l t s are presented  This standardised explore  i n t e r v i e w was  the s u b j e c t s e x p e r i e n c e  concerned the p e r c e i v e d  constructed  of therapy.  treatment, or h i n d e r i n g  used by the a s s e s s o r a f t e r a d m i n i s t e r i n g impessions on the above a r e a s . they were noted by the  The  A c t i v i t i e s While W a i t i n g  The  q u e s t i o n n a i r e was  group at the pre-treatment  by  Questions  the couple  The  interview  Subjects  gave t h e i r answers  assessor.  Inquiry  administered interview.  during  treatment,  the p o s t - t e s t s to o b t a i n  by the a s s e s s o r The  to the c o n t r o l  q u e s t i o n n a i r e was  to monitor p o s s i b l e t h e r a p e u t i c f a c t o r s or  experienced  to  which seemed to c o n t r i b u t e to change,  was  attempt  chapter.  f o r t h i s study  whether spouses would have p r e f e r r e d more s e s s i o n s .  11.  purposes  Interview  and  o r a l l y and  f o r the  changes i n the r e l a t i o n s h i p , the f a c t o r s each  i n c i d e n t s d u r i n g therapy  the couples  as  the r e l a t i o n s h i p .  i n the r e s u l t s  of the process  spouse p e r c e i v e d as f a c i l i t a t i n g critical  of  on the PAIR w i l l be c o n s i d e r e d  conducted on t h i s instrument  Post Treatment S t a n d a r d i s e d  authors  In the l i g h t  a measure of f u n c t i o n a l i d e a l i s a t i o n of the spouse and An  other  that the i s s u e of  been o v e r s t a t e d .  the above the c o n v e n t i o n a l i t y s u b s c a l e  d i d not  the w a i t i n g  activities  period.  given  to  72  12.  The  R a t i n g of C o n f l i c t  Observers r a t e d during  a task set by  Resolution  the  attainment of s p e c i f i c r e s o l u t i o n  the  therapist  f o r a d e s c r i p t i o n of the  task).  i n the  The  last  the  A c c o r d i n g to t h i s measure a r e s o l u t i o n can  compromise.  (see Appendix B  r a t e r s used a simple outcome c o d i n g  system suggested by Koren (1978) to r a t e  spouse c a p i t u l a t i n g to the  session  behaviors  i n therapy performance.  then take the  form of  o t h e r or both spouses r e a c h i n g some k i n d  In e i t h e r case at l e a s t one  s o l u t i o n p r o p o s a l and  subsequent statement of acceptance or agreement i s r e q u i r e d resolution classification. required  task was  influenced  by  the  not  U n f o r t u n a t e l y the  successful.  as an assessment of c o n f l i c t rated  i n the  a  the  I t seems i n t h i s study to have been  demand c h a r a c t e r i s t i c s of the  s t a t e of t h e i r r e l a t i o n s h i p .  of  for a  performance of  s i t u a t i o n , that  c o u p l e s seemed to do what t h e i r t h e r a p i s t asked them to do the  one  The  measure d i d not  is  regardless  seem to be  r e s o l u t i o n i n t h i s study and  so was  of  valid not  analysis.  Data C o l l e c t i o n Procedures Data c o l l e c t i o n took p l a c e  from A p r i l  c o u p l e s except two  requested c o u n s e l l i n g  a r t i c l e describing  the  distressed  The either  sessions  project  of m a r i t a l  f o r an assessment i n t e r v i e w assistence.  Project therapy.  and The  offering other  two  from p a r t i c i p a n t s .  couples were screened on the  f o r treatment or  All  a f t e r r e a d i n g a newspaper  Couple Problem S o l v i n g  couples e i g h t  couples heard of the  to November, 1983.  telephone and  were scheduled  or r e f e r r e d elsewhere i n the  locality  73  The  couples screened out of the study were as f o l l o w s :  were screened out because they had been l i v i n g  two couples  t o g e t h e r l e s s than a  y e a r ; f i v e couples were screened out because they had a l r e a d y separated and were l i v i n g  a p a r t ; seven couples were screened out because they had  r e c e n t l y been o r were c u r r e n t l y r e c e i v i n g  psychiatric  treatment f o r  problems such as d e p r e s s i o n ; two couples were screened out because one of  the p a r t n e r s r e p o r t e d t h a t one of them was a l c o h o l i c ;  t h r e e couples  were screened out because they r e p o r t e d t h e i r m a r i t a l problem  as  p r i m a r i l y i n v o l v i n g s e x u a l d y s f u n c t i o n ; s i x couples were screened out d u r i n g the assessment i n t e r v i e w because they scored too h i g h on the DAS; t h r e e couples were excluded because of t h e i r extremely  low DAS s c o r e s ,  t h a t i s a couple score of 65 and below ( S p a n i e r (1976) r e p o r t s 70 as the mean f o r d i v o r c e d c o u p l e s ) ; two couples o b j e c t e d to the t a p i n g of s e s s i o n s , and one couple was excluded because of e x t e n s i v e upcoming vacations. The  assessment i n t e r v i e w s were conducted  by the r e s e a c h e r plus two  a s s i s t a n t s and c o n s i s t e d of g i v i n g i n f o r m a t i o n c o n c e r n i n g the P r o j e c t and what was expected  of p a r t i c i p a n t s , a d d r e s s i n g i s s u e s such as  c o n f i d e n t i a l i t y of i n f o r m a t i o n , s i g n i n g consent the DAS, PAIR, TC, GAS, and Emotional of  the Consent  Style questionnaires.  Form may be found i n Appendix C.  a s s i g n e d randomly to treatment The  forms, and completing  treatment  couples then completed  e i g h t hours of m a r i t a l  the A l l i a n c e s c a l e a f t e r  was completed  the t h e r a p i s t had l e f t  s e a l e d envelope  The couples were then  and t h e r a p i s t .  therapy, completing after  An example  which was the l e f t  session three.  This scale  the room and p l a c e d i n a  i n the c l i n i c .  The couple  also  74  completed  a process o r i e n t e d q u e s t i o n n a i r e a f t e r every s e s s i o n .  d a t a was c o l l e c t e d  This  f o r use i n a f u t u r e study on the process of change.  A f t e r the e i g h t h s e s s i o n an a s s e s s o r , o t h e r than the r e s e a r c h e r , a d m i n i s t e r e d the post t e s t s Questionnaire.  Treatment  A l l therapy s e s s i o n s were audio and v i d e o taped and  randomly s e l e c t e d fidelity.  (DAS, PAIR, TC, GAS) and the Post  s e s s i o n s were checked  by r a t e r s f o r treatment  The c o n t r o l group c o u p l e s were t o l d t h a t i t was n e c e s s a r y f o r  them to wait u n t i l a t h e r a p i s t c o u l d be a s s i g n e d to them.  After  eight  weeks they were c o n t a c t e d , g i v e n a post wait assessment i n t e r v i e w c o n s i s t i n g of the p r e - t e s t s (DAS, PAIR, TC, GAS) and the A c t i v i t i e s While W a i t i n g Q u e s t i o n n a i r e , and began therapy. the c o n t r o l group were graduate  The t h e r a p i s t s  treating  students i n the C o u n s e l l i n g Psychology  Department of The U n i v e r s i t y of B r i t i s h Columbia  who were then  s u p e r v i s e d by Dr. Greenberg  An a n a l y s i s of the  and the r e s e a r c h e r .  outcome data f o r the c o n t r o l group i s not i n c l u d e d i n t h i s  study.  Once treatment had begun t h e r e were no drop outs from the study. T h i s unusual phenomena the r e s e a c h e r b e l i e v e s may be a t t r i b u t a b l e to the thorough  assessment procedures  and the q u a l i t y of the t h e r a p i s t s  who  were a b l e to c r e a t e a s t r o n g t h e r a p e u t i c a l l i a n c e w i t h t h e i r c l i e n t s .  A  t o t a l of 45 couples (n = 15) were i n c l u d e d i n the study. Couples  came i n t o therapy every week f o r e i g h t weeks u n l e s s summer  holidays Intervened.  A l i m i t of one break between s e s s i o n s of no l o n g e r  than 12 days was arranged one  i n the assessment i n t e r v i e w .  q u a r t e r of the couples from both treatment  of a break.  Approximately  groups d i d take t h i s k i n d  75  Eight weeks after treatment couples were contacted on the phone and asked standardised questions as to the present l e v e l on their Target Complaint and Goal Attainment. found i n Appendix C.  A description of the questions may be  The DAS and PAIR questionnaires were then sent i n  the mail to the couples who completed and returned them. A l l test scoring and key punching was v e r i f i e d .  Two errors of  recording were found and corrected.  Hypothesis The assumptions and outcome hypotheses of the study were as follows:  Assumptions 1.  That observers blind to the treatment being implemented would  r e l i a b l y d i f f e r e n t i a t e between treatments on an implementation checklist instrument applied to random samples of audio-taped interventions.  Thus  treatments would be d i f f e r e n t as implemented and the interventions used would be appropriate to the designated treatment. 2.  The treatment groups were not expected to d i f f e r s i g n i f i c a n t l y  on a measure of theraputic a l l i a n c e .  Outcome hypotheses 1.  The following means of the treatment groups were expected to  be s i g n i f i c a n t l y different at the end of treatment from the means of a wait l i s t control group:  76  a.  The  total  score and  s u b s c a l e s of the Dyadic  S c a l e , a measure of m a r i t a l b.  The  at  areas of the  c.  The Goal Attainment measure.  d.  The T a r g e t Complaint  The  treatment groups were expected  the t e r m i n a t i o n of treatment  3.  adjustment.  s i x s u b s c a l e s of the PAIR, a measure of i n t i m a c y  levels in different  2.  Adjustment  relationship.  measure. to show d i f f e r e n t i a l  effects  on:  a.  The  total  s c o r e s and  s u b s c a l e s of the  b.  The  s i x s u b s c a l e s of the PAIR.  c.  The Goal Attainment measure.  d.  The T a r g e t Complaint  e.  An observed measure of c o n f l i c t  The  treatment groups were a l s o expected  DAS.  measure. resolution. to r e t a i n  any  d i f f e r e n t i a l e f f e c t s found at the t e r m i n a t i o n of treatment when assessed i  at  follow-up.  Data A n a l y s i s The Inc.,  computer programs used  1983)  i n t h i s a n a l y s i s were, S.P.S.S.:X (SPSS  and S.P.S.S.:9 (Nie et a l . , 1975),  BMDP (Dixon, The  Procedures  LERTAP (Nelson, 1974)  1981).  data a n a l y s i s was  d i v i d e d i n t o three stages.  a n a l y s i s c o n s i s t e d of an item a n a l y s i s of the DAS, Alliance The  S c a l e to a s c e r t a i n the r e l i a b i l i t y  second  and  The  preliminary  the PAIR, and  the  of the above i n s t r u m e n t s .  stage i n v o l v e d the t e s t i n g of assumptions  concerning  group  e q u i v a l e n c e on instruments such as the A l l i a n c e S c a l e , the T e s t of  77  E m o t i o n a l S t y l e and Demographics and Checks.  The  third  d i f f e r e n c e s and measures. groups  the examination of  Implementation  stage c o n s i s t e d of t e s t i n g f o r pre-treatment  the m u l t i v a r i a t e a n a l y s i s of treatment outcome  V a r i a b l e s found to d i f f e r e n t i a t e between the two  treatment  at t e r m i n a t i o n of treatment were a l s o a n a l y s e d at f o l l o w - u p by  means of a repeated measures m u l t i v a r i a t e a n a l y s i s of v a r i a n c e .  In  a d d i t i o n , v a r i a b l e s found not to d i f f e r e n t i a t e between treatment  groups  at  t e r m i n a t i o n were a n a l y s e d to check f o r " s l e e p e r " e f f e c t s .  Some  a d d i t i o n a l a n a l y s e s of i n d i v i d u a l p o s t - t r e a t m e n t s c o r e s and f o l l o w - u p s c o r e s were a l s o  completed.  Hypotheses were t e s t e d a l l o w i n g a Type 1 e r r o r p r o b a b i l i t y of (two t a i l ) .  However when m u l t i p l e a n a l y s e s were conducted  c o n t r o l the experiment-wise was  e r r o r r a t e the c r i t i c a l  .05  i n o r d e r to  significance  level  computed as .05 d i v i d e d by the number of v a r i a b l e s i n the a n a l y s i s  (Hays,  1981).  D i f f e r e n c e s among l e v e l s  examined u s i n g Tukey's procedure In  f o r a p a r t i c u l a r f a c t o r were  (Glass & Stanley,  a l l m u l t i v a r i a t e a n a l y s e s the t e s t  Pillai-Bartlett, p o w e r f u l and  statistic  robust s t a t i s t i c  available.  the  In a l l a n a l y s e s the  were checked  d i f f e r e n c e s found, except on the Couples A l l i a n c e  and no  significant  S c a l e ( T a b l e 5) and  on  s c o r e s of the PAIR P e r c e i v e d , s u b s c a l e 6 ( T a b l e 7 ) .  A l t h o u g h i n these a n a l y s e s the assumption violated  used was  recommended by Olson (1976) as b e i n g the most g e n e r a l l y  homogeneity of v a r i a n c e assumptions  the p r e - t e s t  1970).  of homogeneity of v a r i a n c e i s  s i n c e the n's are e q u a l , i n which case the i n f l u e n c e o f t h i s  v i o l a t i o n i s v e r y s m a l l , and  the e f f e c t s of n o n - n o r m a l i t y on the  l e v e l of s i g n i f i c a n c e of the F - t e s t are extremely s l i g h t  (Glass &  S t a n l e y , 1970),  valid.  the ANOVA procedure was  c o n s i d e r e d to be  nominal  78  I n the p r e t e s t p o s t t e s t and f o l l o w - u p a n a l y s e s o f DAS s c o r e s the t o t a l DAS s c o r e , o f t e n used as a main outcome v a r i a b l e i n other m a r i t a l t h e r a p y outcome s t u d i e s (Jacobson, i n p r e s s ) c o u l d not be i n c l u d e d i n the m u l t i v a r i a t e a n a l y s e s which i n v o l v e the s u b t e s t s on t h i s such i n c l u s i o n would then v i o l a t e  the assumption  scale  since  o f independence.  A d d i t i o n a l a n a l y s e s o f the t o t a l DAS score a r e then r e p o r t e d s e p a r a t e l y . Follow-up to account  s c o r e s were a n a l y s e d u s i n g a repeated measures a n a l y s i s  f o r the dependency between p o s t t e s t and f o l l o w - u p s c o r e s .  L i m i t a t i o n s o f t h e Study S i n c e t h e r a p i s t s a r e nested w i t h i n treatments i n t h i s study the issue of d i f f e r e n t i a l  therapist  s k i l l s has to be addressed.  Both  of t h e r a p i s t s were t r a i n e d i n and o r i e n t e d towards the treatment were asked t o implement.  sets they  T h e r a p i s t s were a l l e x p e r i e n c e d and from the  p o i n t o f view o f t h e i r t r a i n i n g and amount o f e x p e r i e n c e would appear to be s i m i l a r .  The t h e r a p i s t s were a l s o monitored  r a t e r s d u r i n g implementation monitored). observed  checks;  d u r i n g the study by two  (120 out of 240 s e s s i o n s were  These r a t e r s found o n l y 2.5% of the t h e r a p i s t  t o be i n a p p r o p r i a t e to t h e i r d e s i g n a t e d treatment.  interventions When  t h e r a p i s t e f f e c t s were t e s t e d as a f i x e d v a r i a b l e i n an ANOVA a n a l y s i s (dependent  v a r i a b l e s b e i n g the p o s t - t e s t measures) no evidence f o r  d i f f e r e n t i a l e f f e c t s was found.  There were a l s o no s i g n i f i c a n t  d i f f e r e n c e s found between treatment groups  on the A l l i a n c e measure, and  mean s c o r e s were r e l a t i v e l y h i g h which suggests t h a t couples i n both groups to.  found  t h e i r t h e r a p i s t s r e l e v a n t , e f f e c t i v e and easy t o r e l a t e  O'Leary and T u r k e w i t z  (1978) d i s c u s s the i s s u e s c o n c e r n i n g the  79  c r o s s i n g versus  the n e s t i n g of t h e r a p i s t s and  t h a t c r o s s i n g t h e r a p i s t s and  treatment can  t h e r a p i s t s are as e f f e c t i v e i n and treatments. the  systematic  bias  out  unless  e q u a l l y committed to both  s t a t e that t h e i r r e s u l t s were confounded by the  that t h e r a p i s t s biased  fact  towards the b e h a v i o r a l model conducted both  Jacobson, F o l l e t t e and  t h a t the c r o s s i n g of t h e r a p i s t s and  Elwood ( i n p r e s s )  also point  out  treatments tends to i n c r e a s e  the  common elements among treatments, d i l u t i n g detect  create  They p o i n t  In f a c t i n the c r o s s model study by Liberman et a l . (1976)  researchers  treatments.  treatment.  treatment d i f f e r e n c e s .  The  the a b i l i t y of r e s e a r c h e r s  f a c t t h a t t h e r a p i s t s are nested  to  under  treatment i n t h i s study ensures a "pure" sample of each therapy i n that each treatment was and  conducted by t h e r a p i s t s committed to the  trained i n just  t h a t treatment b e f o r e  l a r g e number of t h e r a p i s t s used (n = 12) differential The  t h e r a p i s t e f f e c t s and  number of s e s s i o n s m a r i t a l therapy. continue  Eight  a l s o be  The  relatively  to p r o t e c t  increases external  against  validity.  regarded as a  s e s s i o n s were chosen as the minimum  i n which t h e r a p i s t s c o u l d  facilitate  change i n  Matarazzo (1965) suggests that most c l i e n t s do  therapy f o r more than 10 s e s s i o n s , and  psychotherapy and short  also helps  s h o r t d u r a t i o n of treatment can  l i m i t a t i o n i n t h i s study.  the p r o j e c t .  treatment  the  not  trend i n  e s p e c i a l l y i n m a r i t a l therapy seems to be  towards  term therapy i n which the t h e r a p i s t a c t i v e l y s t r u c t u r e s h i s  i n t e r v e n t i o n s toward c l e a r l y formulated nevertheless  a longer  would have g i v e n  goals  (Malan, 1976,  treatment p e r i o d o f , f o r example 12  Mann, 1973); sessions,  time to address i s s u e s such as the maintenance of  changes made d u r i n g  treatment.  There was  a l s o some concern that  the  80  s h o r t time frame i n f a c t f a v o r e d the s k i l l the e m o t i o n a l l y f o c u s s e d treatment  t e a c h i n g process and p l a c e d  a t a disadvantage.  Another i s s u e i n the implementation  of the p r e s e n t study was the  use o f the p r i n c i p a l i n v e s t i g a t o r as one o f the t h e r a p i s t s . evidence  to suggest  the A l l i a n c e  differential  therapist  There i s no  e f f e c t s however, e i t h e r on  S c a l e , the a n a l y s i s o f t h e r a p i s t e f f e c t s , or the  implementation  checks.  The p r i n c i p a l  i n v e s t i g a t o r a l s o d i d not  a d m i n i s t e r any of the post t e s t s to any couples i n v o l v e d i n the s t u d y , nor assess any o f the c o u p l e s a s s i g n e d to her as c l i e n t s .  Nevertheless  i t would have been p r e f e r a b l e to have kept the t h e r a p i s t and i n v e s t i g a t o r roles separate.  A l s o , a l t h o u g h every attempt  o p e r a t i o n a l i s e both treatments  was made to  i n a p a r a l l e l and e q u i t a b l e f a s h i o n , the  r e s e a r c h e r was not i n the p o s i t i o n of v a l u i n g the treatments e q u a l l y , b e i n g b i a s e d towards the E m o t i o n a l l y Focussed external v a l i d i t y  treatment.  To i n s u r e  the study should then be r e p l i c a t e d by other  investigators. The mean l e v e l of d i s t r e s s study suggests moderately normative  (a score o f 92.1 on the DAS) i n t h i s  t h a t t h i s sample i s most a c c u r a t e l y c o n s i d e r e d as  r a t h e r than s e v e r e l y d i s t r e s s e d ;  the mean s c o r e f o r S p a n i e r ' s  sample b e i n g 114.8 and 70.7 f o r d i v o r c e d c o u p l e s .  c o u p l e s s c o r i n g as s e v e r e l y d i s t r e s s e d were i n c l u d e d i n t h i s  Some sample,  each group c o n t a i n i n g couples w i t h couple s c o r e s under 80 on the DAS. A l s o the means i n d i c a t e t h a t couples are i n the d i s t r e s s e d s c o r e s t h a t range from m i l d l y t o s e v e r e l y d i s t r e s s e d .  range w i t h  Jacobson  et a l .  ( i n p r e s s ) make the p o i n t t h a t even though the i n c l u s i o n o f some m i l d l y d i s t r e s s e d couples may appear to ease the task o f therapy i n f a c t the  81  i n c l u s i o n of such couples i n c r e a s e s the d i f f i c u l t y treatment  of  demonstrating  effects.  As a r e s u l t of the f a c t  t h a t couples who  were s o l i c i t e d a q u e s t i o n a r i s e s as to how of a c l i n i c a l p o p u l a t i o n who Thase, Hersen,  p a r t i c i p a t e d i n the  r e p r e s e n t a t i v e t h i s sample i s  v o l u n t a r i l y seek treatment.  B e l l a c k and Himmelhoch (1984) found no  between s o l i c i t e d  and n o n - s o l i c i t e d depressed  However, L a s t ,  differences  p a t i e n t s on  treatment  outcome measures, thus s u p p o r t i n g the i n c l u s i o n of s o l i c i t e d clinical  studies.  c o n s i d e r e d or who some had  A l l couples were concerned  the assessment s e s s i o n s , therapy s e s s i o n s and  clinical The  the e i g h t  study would perhaps  and  their  to commit themselves  f o l l o w - u p procedure.  t h i s q u e s t i o n p r o p e r l y data on the average  couples would seem to be  attempt  about  s e s s i o n s , t h e r e were no drop-outs. DAS  to  All  However  scores f o r  necessary.  be enhanced by o b j e c t i v e b e h a v i o r  f o r example a measure of problem The  had  were c o n s i d e r i n g s e p a r a t i o n i n c l u d e d i n the study,  r e l a t i o n s h i p to the p o i n t t h a t they were w i l l i n g  to address  clients in  In t h i s study t h e r e c e r t a i n l y were couples who  separated p r e v i o u s l y .  couples completed  study  ratings,  s o l v i n g b e h a v i o r i n the l a s t s e s s i o n .  to s e t out a t a s k r e f l e c t i n g c o n f l i c t  r e s o l u t i o n d i d not  d i f f e r e n t i a t e between c o u p l e s ; a l l couples were a b l e to complete i t . The  study c o u l d be viewed  except  as being l i m i t e d by the f a c t t h a t a l l measures  the r a t i n g of c o n f l i c t  measures.  r e s o l u t i o n were e s s e n t i a l l y  However t h i s k i n d of measurement seems to be  self-report  particularly  a p p r o p r i a t e i n the sense t h a t m a r i t a l s a t i s f a c t i o n or w e l l - b e i n g i s by nature a q u a l i t a t i v e s u b j e c t i v e f a c t o r r a t h e r than an q u a n t i f i a b l e phenomena, and  t h i s i s perhaps  one  of the  externally reasons  82  r e s e a r c h e r s i n t h i s area have f o c u s s e d upon s e l f - r e p o r t measures. o b j e c t i v e phenomena and s u b j e c t i v e f a c t o r s do not always Margolin  Also  correspond.  (1978) found that t r a i n e d o b s e r v e r s coding of p o s i t i v e  and  n e g a t i v e communication b e h a v i o r s d i d not i n f a c t c o r r e l a t e w i t h m a r i t a l s a t i s f a c t i o n whereas spouse  r e p o r t s of p l e a s i n g b e h a v i o r s d i d .  recent s t u d i e s Jacobson et a l . ( i n p r e s s ) have suggested o b s e r v a t i o n a l coding systems are r e l a t i v e l y i n s e n s i t i v e changes produced  during b e h a v i o r a l m a r i t a l therapy.  measure c o u l d be viewed tied  Also i n  that to r e l a t i o n s h i p  The Goal  as more o b j e c t i v e i n t h a t i t was  Attainment  specifically  to o b s e r v a b l e b e h a v i o r s , a l t h o u g h the i n d i v i d u a l s t i l l  subjectively  judged, as to whether those b e h a v i o r s d i d i n f a c t occur i n the relationship.  I t i s arguable t h a t i t i s the p e r c e p t i o n of b e h a v i o r s  that i s s a l i e n t occurrence.  to m a r i t a l adjustment  r a t h e r than t h e i r  objective  The d i f f i c u l t y of a t t a i n i n g r e l e v a n t o b j e c t i v e measures i s  a l s o an i s s u e i n t h i s f i e l d , and i t has been suggested measures w i l l be j u s t i f i e d  that use of these  o n l y when i t has been demonstrated  systems measure c o n s t r u c t s t h a t are not a d e q u a t e l y measured by expensive means (Jacobson et a l . , The  less  in press).  logical  has been addressed i n t h i s c h a p t e r .  I t would  also  to presume that any demand c h a r a c t e r i s i t c s were randomly  d i s t r i b u t e d a c r o s s both groups d i f f e r e n c e s between groups.  and t h e r e f o r e not confounded  As suggested by O'Leary and  (1978) r e s e a r c h procedures were set up i n such a way clients  such  i s s u e o f s o c i a l d e s i r a b i l i t y f a c t o r s on measures such as the  PAIR and the DAS appear  that  investment  with  Turkewitz  as to minimise  i n i m p r e s s i o n management, f o r example e n s u r i n g that  t h e r a p i s t s were absent when q u e s t i o n n a i r e s were  completed.  83  CHAPTER IV RESULTS AND DATA ANALYSIS  Stage 1. The  P r e l i m i n a r y Item and T e s t A n a l y s i s first  p a r t of the p r e l i m i n a r y a n a l y s i s c o n s i s t e d of an item  a n a l y s i s of the Dyadic Adjustment S c a l e or DAS LERTAP computer program (Nelson, and  reliabilities  presented  i n Table  1974).  ( S p a n i e r , 1976) u s i n g the  The means, standard  c a l c u l a t e d f o r the pre-treatment 1.  DAS couple  deviations s c o r e s are  R e l i a b i l i t i e s were c a l c u l a t e d u s i n g Hoyt's ANOVA  ( i n t e r n a l c o n s i s t e n c y ) method; the r e l i a b i l i t y  f o r the DAS as a whole  was c a l c u l a t e d a t .84.  Table 1 DAS:  Subtests (N = 90)  Test  Statistics  Con.  Satis.  Coh.  A. Ex.  Total  Mean  41.46  31.63  12.18  6.71  91.98  S.D.  5.96  5.11  3.55  1.96  11.71  Reliability (Hoyt)  .73  .78  .79  .58  .84  Cronbach's (Alpha)  —  —  -  -  .57  Note:  Consensus c o n t a i n s 13 items S a t i s f a c t i o n c o n t a i n s 10 items Cohesion c o n t a i n s 5 times A f f e c t i o n a l expression contains 4  items  84  The  relatively  low r e l i a b i l i t y  of the A f f e c t i o n a l E x p r e s s i o n  s u b s c a l e would appear to be a r e f l e c t i o n of the l a c k of v a r i a n c e on scale.  Most of the items on the t e s t  adequate l e v e l w i t h other t e s t s u b s c a l e s appears the t o t a l  test  test  items  items and  to be s a t i s f a c t o r y .  (.57)  m a r i t a l adjustments reliability  c o r r e l a t e d at a p o s i t i v e  suggests  t h a t f o u r separate but r e l a t e d a s p e c t s of  (.84)  The  Hoyt  r e f l e c t s the i n t e r c o r r e l a t i o n of a l l  (32); the Cronbach's alpha c o e f f i c i e n t  i n t e r c o r r e l a t i o n of the f o u r s u b s c a l e s . than a .30  of the  Cronbach's Alpha l e v e l f o r  are being measured by t h i s t e s t .  f o r the t o t a l  and  the o v e r a l l r e l i a b i l i t y  The  this  reflects  Some items  the  c o r r e l a t e d at  l e v e l w i t h the other s u b s c a l e items p a r t i c u l a r l y on  Consensus s u b s c a l e (5 items out of the 13).  T h i s suggests  less  the  that  consensus c o n c e r n i n g s u b j e c t s such as ways of d e a l i n g w i t h inlaws or parents and  p h i l o s o p h y of l i f e may  m a r i t a l adjustments  not be as r e l a t e d to the concept  as consensus r e g a r d i n g other more d y a d i c a l l y  f o c u s s e d i s s u e s such as the amount of time spent c o r r e l a t i o n s are g i v e n i n T a b l e D - l , Appendix R e l i a b i l i t i e s were a l s o c a l c u l a t e d females being D-2  independently.  .86  and  and. D-3 The  The  reliability  f o r the females  i n Appendix  .80;  together.  Subtest  D.  f o r the s c o r e s of males  these data are presented  test  i n Tables  D.  s u b s c a l e s of the P e r s o n a l Assessment of Intimacy i n c o n s t r u c t e d by S c h a e f f e r and  (1981) were a l s o s u b j e c t e d to an item a n a l y s i s .  p a r t of t h i s  test  c o n t a i n s s i x s u b s c a l e s and  The  the Expected  Perceived part only  s i n c e the s u b s c a l e C o n v e n t i o n a l i t y i s not i n c l u d e d i n the second the t e s t .  and  f o r the males on the t o t a l  R e l a t i o n s h i p s I n v e n t o r y or PAIR which was Olson  of  The  means, standard d e v i a t i o n s and  reliabilities  five  p a r t of  f o r the PAIR  85  P e r c e i v e d and and  f o r the PAIR Expected  s u b s c a l e s are presented  i n Tables  2  3 respectively.  Table PAIR P e r c e i v e d :  2  Test  Statistics  Sx.  Int.  Rec.  Con.  Subtests (N = 90)  Em.  Soc.  Mean  10.60  13.89  14.09  12.18  15.06  11.38  S.D.  4.56  4.48  5.47  4.22  4.13  3.92  .69  .64  .79  .57  .72  .67  Reliability (Hoyt)  Note:  P o s s i b l e range = 0 to 24 A l l s u b s c a l e s c o n t a i n 6 items.  Although  t h i s t e s t was  Hoyt r e l i a b i l i t y as  .87  and  reliability the r e s u l t the r e s t  not  f o r the p e r c e i v e d form of the t o t a l t e s t was  the Cronbach's Alpha f o r the I n t e l l e c t u a l of items  one  and  f o r the composite as  of the s u b s c a l e items.  to a p a r t n e r who "puts last  at below the  T h i s suggests  found  and may  be  level  with  .30  a  or f i n d i n g  to a d i s t r e s s e d couple as the experience  of  that  not be  of  relating  f r e q u e n t l y t r i e s to change one's i d e a s or f r e q u e n t l y  mentioned would seem to r e l a t e  interaction  The  (item f o u r ) may  down" t h e i r p a r t n e r In a s e r i o u s d i s c u s s i o n . two  the  computed  that e x p e r i e n c i n g  one's thoughts (item one)  i s u s e l e s s to d i s c u s s some i s s u e s t o g e t h e r  the same r e l e v a n c e  .77.  s u b s c a l e i s r e l a t i v e l y low,  four c o r r e l a t i n g  p a r t n e r as h e l p i n g to c l a r i f y it  c o n s t r u c t e d to y i e l d a t o t a l score  Items such as  the  to the c o e r c i v e p a t t e r n s of  more f r e q u e n t l y i n d i s t r e s s e d couples  than items  one  86  and  four.  The .57 r e l i a b i l i t y  of t h i s s u b s c a l e however s t i l l  adequate g i v e n the. s m a l l number of items for  ( 6 ) . The s u b t e s t  correlations  the PAIR P e r c e i v e d are g i v e n i n Table D-4, Appendix D.  standard  d e v i a t i o n s and r e l i a b i l i t i e s  f o r males and females  The means, scored  independently  are to be found  reliabilities  f o r the female scores seem to be somewhat lower however  the standard reliability  i n Table D-5, Appendix D.  seems  d e v i a t i o n s are a l s o s m a l l e r s u g g e s t i n g a due to l a c k of v a r i a n c e .  that t h i s  s u b s c a l e was found  lowered  The i n t e r p r e t a t i o n of the  C o n v e n t i o n a l i t y s u b s c a l e as I d e a l i s a t i o n i s supported fact  The  somewhat by the  to c o r r e l a t e w i t h the DAS  subscale  S a t i s f a c t i o n a t the .78 l e v e l f o r male s u b j e c t s and the .60 l e v e l f o r female s u b j e c t s i n t h i s The  PAIR Expected  relationship test.  sample. scores r e p r e s e n t the c o u p l e s 1  should be i n the f i v e areas of i n t i m a c y i n c l u d e d i n the  The means, standard  Expected  i d e a l of how the  a r e presented  d e v i a t i o n s and r e l i a b i l i t i e s  f o r the PAIR  i n T a b l e 3.  Table 3 PAIR Expected:  Test  Statistics  Subtests (N = 90)  Em.  Soc.  S  Int.  Rec.  Mean  22.03  18.62  22.48  21.13  21.12  S.D.  1.97  2.99  2.08  2.48  2.42  .60  .52  .62  .52  .50  Reliability (Hoyt) Note:  Hoyt f o r t o t a l = .78 Cronbach's Alpha = .70 A l l s u b t e s t s c o n t a i n 6 items  87  These r e l i a b i l i t i e s subscales. tended  are lower  than those of the PAIR P e r c e i v e d  Once a g a i n however standard d e v i a t i o n s are a l s o low; c o u p l e s  to answer many of the items i n a s i m i l a r f a s h i o n .  t h a t on these s c a l e s and i n t h i s  sample people's  c o n s t i t u t e s a good r e l a t i o n s h i p d i d not d i f f e r subtest  c o r r e l a t i o n s f o r the PAIR Expected  Appendix D. and  females  This  i d e a l s as to what  to any great e x t e n t .  are g i v e n i n T a b l e  The means, standard d e v i a t i o n s and r e l i a b i l i t i e s scored i n d e p e n d e n t l y  suggests  are to be found  The  D-6, f o r males  i n T a b l e D-7, Appendix  D. An item a n a l y s i s was conducted Scale  (Pinsoff & Catherall,  reliabilities  a r e presented  on the Couples  Therapy A l l i a n c e  1983) and the means, standard d e v i a t i o n s and i n T a b l e 4.  Table 4 Couples  Subtests (N = 60)  Therapy A l l i a n c e S c a l e :  Test  Statistics  Self  Other  Relationship  Mean  46.12  44.55  25.17  115.83  S.D.  5.58  5.95  3.30  14.04  Reliability (Hoyt)  .88  .92  .85  .96  Cronbach's (Alpha)  -  -  —  .91  Note:  T o t a l observed range = 81-140 T o t a l p o s s i b l e range = 0 - 1 4 0 ,  28 items  Total  88  Each item i n t h i s instrument l e v e l w i t h the other t e s t performing  correctly.  c o r r e l a t e d at a p o s i t i v e and  items.  The  Thus each item can be s a i d  overall r e l i a b i l i t y  of the t e s t  sample of s u b j e c t s seems to be very s a t i s f a c t o r y . level to  f o r the t o t a l  test  (.91)  the p o i n t t h a t they may  separate f a c t o r s .  The  suggests  to be  for this  Cronbach's Alpha  that the s u b t e s t s are  be c o n s i d e r e d as a u n i t  correlated  r a t h e r than  as  means on a l l the s u b t e s t s are r e l a t i v e l y  which i m p l i e s t h a t the a l l i a n c e of couples and was  The  adequate  i n general p o s i t i v e ;  high  therapists in this  sample  t h a t i s t h a t couples were a b l e to bond w i t h  t h e i r t h e r a p i s t , p e r c e i v e d the t h e r a p i s t as working w i t h them towards the same g o a l s and viewed the t h e r a p i s t as s k i l l e d  and a b l e to help  change t h e i r r e l a t i o n s h p .  Stage I I :  T e s t i n g Assumptions of Group E q u i v a l e n c e  An a n a l y s i s of v a r i a n c e was variables  conducted  on each of 8 demographic  (group by demographic v a r i a b l e ) .  Family Income, L e v e l of Occupation  Number of Years  of both spouses,  and L e v e l of E d u c a t i o n of both spouses.  No  significant  found on these f a c t o r s when t e s t e d at the .05 c o r r e c t e d by the B o n f e r r o n i procedure a n a l y s i s may  be found  (Hays,  l e v e l of 1981).  of both  spouses,  d i f f e r e n c e s were significance  D e t a i l s of  this  i n T a b l e E - l , Appendix E.  I n d i v i d u a l responses Style  Age  Together,  on the s u b s c a l e s of the T e s t of  Emotional  ( A l l e n & Hamsher, 1974), namely O r i e n t a t i o n , E x p r e s s i v e n e s s were  a l s o a n a l y s e d u s i n g an a n a l y s i s of v a r i a n c e (group by male and subscales).  In t h i s a n a l y s i s no  significant  between groups on any of the three s u b s c a l e s .  d i f f e r e n c e s were The  critical  female found  significance  89  l e v e l was s e t a t .05, c o r r e c t e d by B o n f e r r o n i (.05/6 = .008). means, standard d e v i a t i o n s and p_ v a l u e s are p r e s e n t e d  The  i n T a b l e E-2,  Appendix E. The  s c o r e s of the two treatment  A l l i a n c e Scale (Pinsof & C a t h e r a l l , test  the assumption  groups on the Couples  Therapy  1983), were a n a l y s e d i n order to  t h a t there was no s i g n i f i c a n t  group d i f f e r e n c e s i n  the q u a l i t y of the a l l i a n c e between t h e r a p i s t and c o u p l e . significant  If a  d i f f e r e n c e e x i s t e d i t would present a confounding  the i n t e r p r e t a t i o n of treatment  effects.  factor i n  The means on t h i s s c a l e f o r  both groups were r e l a t i v e l y h i g h (maximum p o s i b l e i s 140), the EF couples mean score b e i n g 121.3 (SD = 19.8) and the PS couples mean score b e i n g 113.6 (SD = 10.9). expected  i n a treatment  experience  The h i g h e r mean i n the EF group might be i n which the t h e r a p i s t  r a t h e r than the t e a c h i n g of s k i l l s  c r e a t e bonds between t h e r a p i s t and c l i e n t . of the couples a l l i a n c e d i f f e r e n c e s were found female  alliance  scores are presented  emotional  s i n c e the former  tends t o  The r e s u l t s of the a n a l y s i s i n T a b l e 5.  No s i g n i f i c a n t  i n t h i s a n a l y s i s or i n an a n a l y s i s of male and  s c o r e s c o n s i d e r e d s e p e r a t e l y , (Table E-3, Appendix E ) ,  or i n an a n a l y s i s of the i n d i v i d u a l S i n c e the Task dimension relevant  f o c u s s e s upon  s u b t e s t s of the A l l i a n c e S c a l e .  of t h i s  s c a l e was c o n s i d e r e d  i n t h a t i t r e f l e c t s how r e l e v a n t and engaging  particularly  couples found the  t h e r a p e u t i c i n t e r v e n t i o n s t o be; an a d d i t i o n a l a n a l y s i s was conducted the items p e r t a i n i n g to t h i s dimension. t h i s dimension  The means o f both groups on  were h i g h ; the maximum p o s s i b l e score was 50, and the  mean of the EF couples was 42.6 (SD = 4.6), w h i l e the PS couples mean was 41.7 (SD = 4.2). No s i g n i f i c a n t  d i f f e r e n c e s were found  between  on  90  Table 5 Summary Anova:  Source of Variation  SS  Between Within (N = 30)  treatment  Couple Therapy A l l i a n c e S c a l e  groups  i n T a b l e E-4,  MS  433.2  433.2  1  7,178.2  256.4  28  on t h i s v a r i a b l e .  Appendix E.  F  P  1.69  .204  DF  D e t a i l s of the r e s u l t s may  These r e s u l t s suggest  that both groups  s i m i l a r e x p e c t a t i o n s as to the e f f e c t i v e n e s s of the treatment o f f e r e d and  be  found both treatments r e l e v a n t to t h e i r  found had  they were  concerns.  D i f f e r e n t i a l t h e r a p i s t e f f e c t s were t e s t e d by a s e r i e s of oneway a n a l y s e s of v a r i a n c e ( T h e r a p i s t  (N = 12) by each post-measure) i n which  t h e r a p i s t s were t r e a t e d as a f i x e d and  factor.  Although  female post-treatment s c o r e s were conducted  procedure would then r e s u l t on a c r i t i c a l .0027, these a n a l y s e s were not s i g n i f i c a n t  18 a n a l y s e s on male  and a B o n f e r r o n i  s i g n i f i c a n c e l e v e l of .05/18 = even at the .01  d e t a i l s of these a n a l y s e s are to be found i n T a b l e s E-5  and  level.  The  E-6,  Appendix E. B e f o r e a n a l y s i n g treatment outcome data i t was  n e c e s s a r y to c o n f i r m  t h a t the treatments were implemented i n accordance w i t h the manuals. For the purpose of the 240  of t h i s implementation  s e s s i o n s were observed.  chosen at random.  Two  The  check a t o t a l number of 120  out  s e s s i o n s to be observed were  segments of 10 minutes  d u r a t i o n were taken  from  91  the middle and f i n a l observed d u r i n g rated  from v i d e o  t h i r d of these 120 s e s s i o n s .  therapy f o r a t o t a l of 80 minutes.  catagories,  categories  thus  These segments were  and audio tapes by two t r a i n e d independent r a t e r s and  coded on the Implementation C h e c k l i s t . coding  Each couple was  T h i s C h e c k l i s t c o n s i s t s of 23  3 of which were g e n e r a l  c a t e g o r i e s , the remaining  d e s c r i b i n g 10 i n t e r v e n t i o n s c h a r a c t e r i s t i c of each of the  treatments.  An i n t e r v e n t i o n was d e f i n e d  as a complete t h e r a p i s t  statement, the b e g i n n i n g and end of which was noted by the r a t e r s t o ensure that  they were both coding  the same u n i t s .  In a l l 1866  i n t e r v e n t i o n s were coded by the r a t e r s who were b l i n d as to the treatment c o n d i t i o n they were Out  observing.  of the 1866 i n t e r v e n t i o n s coded 47 were c a t e g o r i s e d  way as to be i n a p p r o p r i a t e  to the treatment c o n d i t i o n being  i n such a observed.  Thus i n t o t a l 2.5% of the t o t a l i n t e r v e n t i o n s observed were r a t e d as belonging  to i n a p p r o p r i a t e  interventions Emotionally  15 o c c u r r e d  categories.  Of these 47  inappropriate  i n the Problem S o l v i n g c o n d i t i o n and 32 i n the  Focussed c o n d i t i o n .  T h i s may r e f l e c t  the f a c t  that the  former treatment i s by nature somewhat more s t r u c t u r e d and e a s i l y delineated.  In the Problem S o l v i n g  treatment the e m o t i o n a l l y  focused  i n t e r v e n t i o n most o f t e n used was i n t e r v e n t i o n number 7, where the t h e r a p i s t probes f o r emotional e x p e r i e n c e , f o r example by a s k i n g spouse "how do you f e e l when he does t h a t " .  In the E m o t i o n a l l y  one Focussed  treatment the problem s o l v i n g i n t e r v e n t i o n most o f t e n used was number 8 where the t h e r a p i s t h e l p s example by a s k i n g , react".  the couple p i n p o i n t  s p e c i f i c behaviors, f o r  "and when he does t h i s what do you do, how you  These k i n d s  of q u e s t i o n s  what k i n d of t h e r a p e u t i c  would seem to be n e c e s s a r y no matter  model the t h e r a p i s t i s u s i n g .  92  The  s m a l l p r o p o r t i o n of i n t e r v e n t i o n s a p p r o p r i a t e to the o t h e r  treatment  suggests that the treatments were v e r y e a s i l y  distinguishable  and a b l e to be implemented a c c o r d i n g to the therapy manuals. I n t e r - r a t e r r e l i a b i l i t y was from 25 randomly chosen observed).  The  two  (93% agreement).  r a t e r s agreed on 379  The  27 disagreements  (n = 2) disagreements,  (n = 20) disagreements.  c o n s e r v a t i v e e s t i m a t e of r e l i a b i l i t y  between treatment agreement was  Kappa.  treatments and  computed as .95.  The Kappa s t a t i s t i c  then computed as .99.  These s t a t i s t i c s  the end of Stage 2 of the a n a l y s i s i t was  e x p e r i m e n t a l groups S t y l e , and  significant  The  for  Kappa  (within  suggest  that  differentiated.  then p o s s i b l e to  d i f f e r e n c e s were found between  on Demographic v a r i a b l e s or the T e s t of Emotional  that treatment groups were not s i g n i f i c a n t l y d i f f e r e n t i n  terms of t h e r a p e u t i c a l l i a n c e .  T h e r a p i s t e f f e c t s were t e s t e d f o r and  found to be n o n - s i g n i f i c a n t ; a l s o Implementation inter-rater reliabilty for  is a  c o r r e c t e d f o r the p r o p o r t i o n of  i n t e r v e n t i o n s were a b l e to be r e l i a b i l y  a s s e r t t h a t no s t a t i s t i c a l l y  was  This s t a t i s t i c  f o r i n t e r - r a t e r agreement as to i n t e r v e n t i o n s  treatments) was  observed  and 25 c r o s s  Inter-rater r e l i a b i l i t y  agreement to be expected by chance a l o n e .  At  of the i n t e r v e n t i o n s  which o c c u r r e d between r a t e r s  c a l c u l a t e d u s i n g Cohen's (1960) s t a t i s t i c  statistic  o b s e r v a t i o n s taken  s e s s i o n s (20.8% of the t o t a l s e s s i o n s  c o n s i s t e d of 2 c r o s s treatment intervention  c a l c u l a t e d on 406  the purposes  Checks and  on these checks were found to be  of t h i s  investigation.  the  satisfactory,  93  Stage I I I ;  A n a l y s i s o f Treatment E f f e c t s :  Pre-Test Post-Test  and Follow-Up Measures  Pre-Treatment Measures The  final  pre-treatment important Analyses  stage of the a n a l y s i s began w i t h an examination of DAS and PAIR s c o r e s to assess whether t h e r e were any  initial  d i f f e r e n c e s between the three e x p e r i m e n t a l  of v a r i a n c e were computed on these measures and no s i g n i f i c a n t  d i f f e r e n c e s were found  ( t h e s i g n i f i c a n c e l e v e l being s e t a t .05). The  m u l t i v a r i a t e F s t a t i s t i c b e i n g F_ (20,68) = .83, £ < .665. pre-test  91.7 all  The couples  s c o r e s on the t o t a l DAS a r e presented i n T a b l e 6.  couples s c o r e s (male p l u s female 92.1.  groups.  s c o r e s d i v i d e d by 2) was c a l c u l a t e d as  The mean f o r the EF group b e i n g 92.8 (SD = 8.8),  f o r the PS group  (SD = 8.1) and f o r the C o n t r o l group 91.9 (SD = 10.7). three groups ranged  assumption  was checked  The mean f o r  from 71 t o 105.  Scores f o r  The homogeneity of v a r i a n c e  and no s i g n i f i c a n t d i f f e r e n c e s found;  Bartlett  Box _F = .59, p_ < .555.  Table 6 Summary Anova:  P r e t e s t DAS Couple  Scores  (N = 45) Source of Variation  SS  MS  Between  10.8  5.4  Within  3,645.8  86.8  DF 2 42  F .06  -  P .940  -  94  The  means, standard d e v i a t i o n s , F r a t i o s and P v a l u e s f o r the  pre-treatment were no The  PAIR P e r c e i v e d scores are presented  There  s i g n i f i c a n t d i f f e r e n c e s between groups on these s i x s u b s c a l e s .  s u b s c a l e means here  are comparable to those of Schaefer and  o r i g i n a l sample r e f e r r e d  to i n Chapter  Couples appeared to experience Expected  i n T a b l e 7.  3.  great d i f f i c u l t y  completing  s u b s c a l e s on the PAIR d u r i n g both assessment and  procedures.  T h i s was  perhaps because of the double  i n the wording of the Expected  Olson's  the  termination  negatives involved  p a r t of t h i s i n s t r u m e n t .  For  example,  a g r e e i n g or d i s a g r e e i n g w i t h whether "when i t comes to having a s e r i o u s d i s c u s s i o n i t seems we relationship.  The  have l i t t l e  assessors assisted  s c a l e s whenever p o s s i b l e but these but  s u b - t e s t s may  the r e s u l t  be not o n l y a r e s u l t of the homogeneity of  of a l a r g e amount of e r r o r v a r i a n c e .  f o r the P e r c e i v e d s u b s c a l e s .  administered  the couples i n completing  three times  s c o r e s served as v a l i d  i t was  The  First  i t was  i n the PAIR to p r o v i d e a r e f e r e n c e Since these  decided  s u b s c a l e s were  t h a t the three s e t s of P e r c e i v e d  r e f e r e n c e p o i n t s f o r each other and  Expected No  the d i f f e r e n c e s between P e r c e i v e d and Expected necessary  to t e s t  responses  Expected  t h a t i t might  be p r e f e r a b l e to use o n l y the P e r c e i v e d s c a l e s as an outcome r a t h e r than  these  the r e l a t i v e l y low r e l i a b i l i t y r e p o r t e d f o r  s u b s c a l e s were i n c l u d e d o r i g i n a l l y point  i n common" i s the i d e a l f o r a  instrument  scores.  f o r d i f f e r e n c e s i n p r e - t e s t and p o s t - t e s t  scores. statistically  significant  on the p r e - t e s t PAIR Expected  d i f f e r e n c e s were found  subscales  d e v i a t i o n s , F r a t i o s and P v a l u e s f o r these  .05).  The  between groups means, standard  s u b t e s t s are presented  in  95  Table 7 P r e - T e s t PAIR P e r c e i v e d Couple Scores  Groups Variables  ET  PS  C  (N = 45)  M/SD  M/SD  M/SD  PP1  (Em)  PP2  (Soc)  PP3  (Sx)  PP4 ( I n t )  F  P  (2,42)  52.3 13.7  53.1 15.2  52.5 18.0  .01  .990  57.5 14.4  56.1 16.6  53.1 15.6  .32  .732  54.5 22.7  57.2 18.8  57.1 17.3  .09  .917  52.0  48.1 11.3  46.0 15.8  .89  .419  9.4 PP5  (Rec)  61.2 11.9  61.1 15.5  57.7 14.8  .29  .751  PP6  (Con)  37.3 10.0  37.1  38.7 17.8  .06  .939  8.8  96  T a b l e E-7,  Appendix E.  s u b s c a l e s was significant  The m u l t i v a r i a t e F_ s t a t i s t i c  c a l c u l a t e d at .62, p_ < .794.  There were a l s o  The  no  (10, 78) being computed at  i n T a b l e E-8,  Appendix E.  In a d d i t i o n a  repeated measures a n a l y s i s of v a r i a n c e (BMDP v e r s i o n , Dixon, on the p r e - t e s t and  p o s t - t e s t treatment  significant  of  = .01,  treatment.  The  d e t a i l s of t h i s a n a l y s i s are r e p o r t e d i n T a b l e  Appendix E.  A l l these n o n - s i g n i f i c a n t  r e s u l t s suggested  s i g n i f i c a n t v a r i a t i o n between groups would be found of the above concerns  to set a s i d e the Expected the outcome v a r i a b l e .  any  c o r r e c t e d by the B o n f e r r o n i  procedure).  In l i g h t  was  scores  changes or group by time i n t e r a c t i o n s were found on  of the s u b s c a l e s (ofc = .05/5  scores.  1981)  PAIR Expected  to a s c e r t a i n i f couples changed t h e i r i d e a l s as a r e s u l t No  .42,  means, standard d e v i a t i o n s , F r a t i o s and P v a l u e s of  these s u b s c a l e s are presented  conducted  these  d i f f e r e n c e s found on any of the p o s t - t e s t PAIR Expected  s u b s c a l e s ; the m u l t i v a r i a t e F_ s t a t i s t i c _ < .930.  (10, 78) on  s u b s c a l e s and  and  that  E-9,  any  i n the P e r c e i v e d  a n a l y s e s i t was  then  decided  take the P e r c e i v e d s u b s c a l e s as  A l l subsequent a n a l y s e s then c o n s i d e r e d o n l y the  PAIR P e r c e i v e d s u b s c a l e s . On concern  the T a r g e t Complaints  measure couples d e s c r i b e d t h e i r major  i n t h e i r r e l a t i o n s h i p which was  t h e r a p e u t i c change.  then d e s i g n a t e d as the focus f o r  None of the spouses presented  i n c o m p a t i b l e w i t h each other and a l l appeared c o u p l e s at t e r m i n a t i o n and Couples goals.  The  complaints which were  to be r e l e v a n t to the  follow-up.  a l s o d e s c r i b e d i n b e h a v i o r a l terms f i v e l e v e l s of l e v e l d e s i g n a t e d as " l e s s than expected  t h r e e o b s e r v a b l e b e h a v i o r s and  one  treatment  r e s u l t s " described  feeling reaction characterizing  r e l a t i o n s h i p at the time of assessment.  the  97  Post Treatment Measures The  t o t a l DAS couples  score c o u l d not be i n c l u d e d i n the  m u l t i v a r i a t e a n a l y s i s s i n c e t h i s s c o r e was not independent of the DAS subscales.  A separate  u n i v a r i a t e a n a l y s i s was then conducted on t h i s  measure and i s presented  i n Table 8.  These s c o r e s are post-treatment  f o r the ET and PS groups and post-wait  f o r the C o n t r o l group.  The mean  f o r the EF group was computed as 112.7 (SD = 10.8), f o r the PS group the mean was 102.4 (SD = 9.5), and f o r the C o n t r o l group the mean was 91.5 (SD = 9.7). Post  hoc comparisons u s i n g the Tukey procedure (Glass &  S t a n l e y , 1970) found  a l l three groups to s i g n i f i c a n t l y d i f f e r  from each  o t h e r a t the .05 l e v e l of s i g n i f i c a n c e .  Table 8 Summary Anova:  Source of Variation  SS  P o s t - t e s t DAS T o t a l Scores  MS  Between  3,371.9  1,685.9  Within  4,215.8  100.4  DF 2 42  F  P  16.80  .001  -  -  A MANOVA (SPSS:9 v e r s i o n ) was conducted between the three over a l l 12 treatment  groups  outcome v a r i a b l e s , t h a t i s on DAS s u b s c a l e s ,  Consensus, S a t i s f a c t i o n , Cohesion and A f f e c t i o n a l E x p r e s s i o n , on PAIR Perceived  subscales, Emotional,  R e c r e a t i o n a l Intimacy Attainment.  S o c i a l , Sexual,  I n t e l l e c t u a l and  and C o n v e n t i o n a l i t y , on Target  Complaints and Goal  98  The  r e s u l t s of t h i s m u l t i v a r i a t e a n a l y s i s of treatment outcome  v a r i a b l e s are p r e s e n t e d i n T a b l e 9.  The m u l t i v a r i a t e F_ s t a t i s t i c (24,  64) was c a l c u l a t e d a t 4.33, _p < .001. In o r d e r t o guard a g a i n s t the problem of e s c a l a t i n g Type 1 e r r o r r a t e , the B o n f e r r o n i procedure was used to c a l c u l a t e the c r i t i c a l significance level  f o r each u n i v a r i a t e t e s t (.05/12 = .004).  At t h i s  l e v e l of s i g n i f i c a n c e d i f f e r e n c e s were found on DAS s u b s c a l e s 1, 2, and 3, PAIR s u b s c a l e s 4 and 6 (DAS s u b s c a l e 4 and PAIR s u b s c a l e 1 narrowly m i s s i n g s i g n i f i c a n c e ) , T a r g e t Complaint, and the Goal Attainment Post hoc comparisons significant  were conducted on the v a r i a b l e s  Scale.  showing  F r a t i o s u s i n g Tukey's procedure to a s c e r t a i n i f mean  d i f f e r e n c e s were between treatment groups and C o n t r o l s or between the two treatment groups or b o t h .  These  comparisons  yielded  the f o l l o w i n g  results: 1.  Both treatment groups were s i g n i f i c a n t l y h i g h e r than  controls  on the v a r i a b l e s DAS 1 (Consensus), PAIR 4 ( I n t e l l e c t u a l I n t i m a c y ) , T a r g e t Complaint, and Goal A t t a i n m e n t . 2.  The PS treatment group d i d not d i f f e r s i g n i f i c a n t l y  from  c o n t r o l s on the v a r i a b l e s DAS 2 ( S a t i s f a c t i o n ) , DAS 3 ( C o h e s i o n ) , and PAIR 6 ( C o n v e n t i o n a l i t y ) , whereas the EF treatment group d i d d i f f e r  s i g n i f i c a n t l y from c o n t r o l s on these  variables. 3.  The EF treatment group  s c o r e d s i g n i f i c a n t l y h i g h e r than the PS  treatment group on the v a r i a b l e s DAS 2 ( S a t i s f a c t i o n ) , DAS 3 ( C o h e s i o n ) , PAIR 4 ( I n t e l l e c t u a l I n t i m a c y ) , PAIR 6 (Conventionality,  here i n t e r p r e t e d as i d e a l i s a t i o n ) and T a r g e t  Complaint improvement.  Table 9 M u l t i v a r i a t e A n a l y s i s of V a r i a n c e :  99 Treatment Outcome V a r i a b l e s  Groups Variable  EF  PS  M/SD  M/SD  M/SD  (2,42)  DAS Consensus  8.25  .001*  31.70 4.34  8.60  .001*  11.90 3.41  13.91  .001*  7.13 1.88  5.12  .010  1.89  64.13 17.19  51.33 17.49  45.60 16.26  4.68  .015  Social  65.33 13.52  56.40 15.82  52.26 17.33  2.74  .076  Sexual  69.33 21.59  62.80 21.48  59.06 19.74  .92  .405  Intellectual  70.26 11.73  58.66 10.52  43.33 12.51  20.29  Recreational  72.0 13.46  64.67 13.06  57.27 16.19  3.98  .026  64.80 18.53  45.07 17.59  38.40 21.05  7.74  .001*  3.07  1.17 ^  0  Satisfaction  Cohesion  5  3  Affectional Expression  47.53 7.42  40.8  38.43 4.86  34.10 4.29  17.27 3.18  13.80 1.49  8.87 1.55  PAIR Emotional  Conventionality  48.13 3.27  8  7.0  4.97  .001*  TC Target C o m p l a i n t  A  3.70  4  &  g  4  69.89  .001*  GAS Goal A t t a i n m e n t  0  60.0 7.51  Note:  57.33 8.34  42.33 2.29  = 0.5/12 = .004 * = _p_ < .004 A = EF > PS > C on Post Hoc (Tukey) B = EF > PS, C on Post Hoc (Tukey) C = EF, PS > C on Post Hoc (Tukey)  31.11  .001*  100  4.  The EF and PS treatment groups the v a r i a b l e s DAS  A l t h o u g h group  d i d not d i f f e r  1 (Consensus)  and Goal  significantly  on  Attainment.  d i f f e r e n c e s on the v a r i a b l e s DAS  4  (Affectional  E x p r e s s i o n ) and PAIR 1 (Emotional Intimacy) d i d not reach the l e v e l o f statistical  s i g n i f i c a n c e set by the B o n f e r r o n i procedure  t r e n d here was  f o r the EF treatment group mean to be h i g h e r ; on the  4 s u b s c a l e the EF mean was  h i g h e r than both PS and C o n t r o l groups  the PAIR 1 s u b s c a l e the EF treatment mean was All  (.004) the  of these r e s u l t s are summarised i n T a b l e To summarise, both treatment  on Consensus (DAS),  and C o n v e n t i o n a l i t y (PAIR).  on  9. controls  (PAIR), TC and GAS.  EF treatment means were h i g h e r than c o n t r o l s on S a t i s f a c t i o n , (DAS)  and  h i g h e r than the C o n t r o l .  group means were h i g h e r than  I n t e l l e c t u a l Intimacy  DAS  A f t e r treatment  Only  the  Cohesion  the EF group  scored  s i g n i f i c a n t l y h i g h e r than the PS group on the v a r i a b l e s S a t i s f a c t i o n  and  Cohesion  on  (DAS),  TC improvement.  C o n v e n t i o n a l i t y and I n t e l l e c t u a l  g i v e n to the treatment  Standardised  groups, and a f t e r the w a i t i n g  p e r i o d an A c t i v i t i e s While W a i t i n g Q u e s t i o n n a i r e was control  treatment  treatment.  the t e r m i n a t i o n of treatment a Post Treatment  I n t e r v i e w was  (PAIR) and  R e s u l t s show both treatment and d i f f e r e n t i a l  e f f e c t s i n f a v o r of the EF At  Intimacy  a d m i n i s t e r e d to the  group.  On the A c t i v i t i e s While W a i t i n g Q u e s t i o n n a i r e the r e s u l t s were as follows. to  improve  Of the 15 c o n t r o l couples f o u r s t a t e d t h a t they had  attempted  t h e i r r e l a t i o n s h i p d u r i n g the e i g h t week w a i t i n g p e r i o d .  these c o u p l e s t h r e e had been on some k i n d of v a c a t i o n , and t h i s time t o g e t h e r had helped somewhat.  Two  Of  stated  that  of these couples had  also  101  read  s e l f h e l p books d u r i n g t h i s time.  from a f r i e n d actively  concerning h i s r e l a t i o n s h i p .  p a r t n e r had The  book, and  activity,  u s i n g h o l i d a y time to be  In g e n e r a l the responses not contaminated  couples who  fact  were  balanced  together.  seem to suggest  w i t h o t h e r powerful  by the treatment  t h a t the w a i t i n g p e r i o d  therapeutic variables.  couples who  the c o n t r o l group mean t o t a l DAS  and  9.7).  The  (SD = 10.9)  Pearson Product  assessment and f o l l o w - u p was i n treatment The  91.9  and  scores d i d not  the post-wait  p o s t - w a i t DAS  s c o r e s was  p o s s i b l e w i t h couples  change a p p r e c i a b l y  score was  scale for  91.5  (SD  computed as .87  (p < .001).  No  i n t h i s group s i n c e they were p l a c e d  I n t e r v i e w were as  s t a t e d that t h e i r r e l a t i o n s h i p The  had  couples appeared to c h a r a c t e r i z e  the p e r c e i v e d r e l a t i o n s h i p changes i n terms of three c a t e g o r i e s :  1)  c l i m a t e , here couples t a l k e d of communication becoming more l e s s d e f e n s i v e and  increasing;  the l e v e l of t r u s t and  2)awareness of each other and  responsivenessto  sense of s a f e t y  r e l a t i o n s h i p dynamics; 3)  each o t h e r s needs and a new  sense of c l o s e n e s s .  group t a l k e d more i n terms of a v o i d i n g i s s u e s l e s s and skills  =  a f t e r the w a i t i n g p e r i o d .  improved as a r e s u l t of therapy.  open and  In  C o r r e l a t i o n C o e f f i c i e n t between p r e -  A l l t r e a t e d couples  emotional  of  a l s o took v a c a t i o n s .  r e s u l t s of the Post Treatment S t a n d a r d i s e d  follows.  The  the e f f e c t  d u r i n g the w a i t i n g p e r i o d ; the pre-assessment mean on the DAS t h i s group was  therapy  t a l k i n g to a f r i e n d , r e a d i n g a  h o l i d a y v a r i a b l e would seem to be the most s i g n i f i c a n t t h i s was  received advice  s e e k i n g to improve t h e i r r e l a t i o n s h i p b e f o r e coming to  seemed to t r y more than one  was  One  and  t o o l s w i t h which to c o n f r o n t i s s u e s .  The  new  The  having more  E.F.  group t a l k e d  PS  102  more i n terms of p e r c e i v i n g each o t h e r d i f f e r e n t l y , how  we  are a c t i n g and r e a c t i n g to each o t h e r . "  f o r example, "we  They a l s o spoke of  b e i n g l e s s blaming and of c o n f l i c t s becoming l e s s i n t e n s e .  The  demand  c h a r a c t e r i s t i c s of t h i s s i t u a t i o n f o r the couple were obvious and attempt  to minimise  see  to  these as much as p o s s i b l e the a s s e s s o r attempted  w r i t e down e x a c t l y what the spouses  s a i d and to m a i n t a i n a d i s t a n t  to  and  n e u t r a l stance d u r i n g the i n t e r v i e w . In  response  to a q u e s t i o n as to what was  h e l p f u l about  therapy  both  groups spoke of the t h e r a p i s t as c r e a t i n g a s a f e p l a c e to work out i s s u e s , f u l f i l l i n g a mediator perspective. to  clarify  r o l e and c o n t r i b u t i n g an  The E.F. couples a l s o t a l k e d of the t h e r a p i s t h e l p i n g them  i s s u e s and p a t t e r n s i n the r e l a t i o n s h i p ;  spoke of the s p e c i f i c d i s c i p l i n e and had  responses  treatment  therapist  P.S.  i s based  therapy than from  treatment, as might be expected  One  s i n c e the  P.S.  s t a t e d that the impact  critical  to the r e l a t i o n s h i p and The  E.F.  couple spoke of "dramatic r e v e l a t i o n s " at home  s u c c e s s f u l l y was  between them.  those  a g r a d u a l process  f o r him.  Another  of d e a l i n g w i t h  couple s t a t e d  an i n c i d e n t o c c u r r e d which made i t c l e a r that they both f e l t committed  more  upon the c r e a t i o n of i n t e n s e emotional e x p e r i e n c e s .  couples s t a t e d that the therapy process was  teaching.  anger  i n c i d e n t s i n therapy e l i c i t e d  from the couples I n v o l v e d In the E.F.  between therapy s e s s i o n s , another his  couples  s t r u c t u r e d techniques the  question concerning c r i t i c a l  i n v o l v e d i n the P.S.  of  the P.S.  shown them. The  The  objective  E.F.  that t h i s  that  very  seemed to change the p r o c e s s  couples d e s c r i b e d c r i t i c a l  i n c i d e n t s i n terms of  times when v u l n e r a b i l i t i e s were exposed which r e s u l t e d  i n partners  103  s e e i n g t h e i r spouse i n a d i f f e r e n t way and being a b l e to respond positively realising  to t h i s new view o f each o t h e r .  One p a r t n e r spoke o f  t h a t her spouse needed h e l p from her i n knowing how t o be  c l o s e , another  of t a l k i n g of h i s hurt and h i s spouse responding  so t h a t he c o u l d d e c i d e not to withdraw, another felt  emotional  to him  of i n c i d e n t s where he  r a t h e r than " s t a y i n g l o g i c a l " and "understanding  the p a i n  t h a t our p a t t e r n s c r e a t e " . In  response  to a q u e s t i o n c o n c e r n i n g f a c t o r s which h i n d e r e d  p r o g r e s s i n therapy or were unpleasant  couples spoke o f the T.V.  cameras, s m a l l c o u n s e l l i n g rooms and the q u e s t i o n n a i r e s .  One E.F.  spouse spoke o f the c o u n s e l l o r e x p r e s s i n g f e e l i n g s i n a s t r o n g e r manner than t h a t spouse was c o m f o r t a b l e w i t h , and one spoke o f too much being p l a c e d on the other p a r t n e r s problems.  Of the P.S. couples 2  spoke of p a r a p h r a s i n g p r a c t i c e being t e d i o u s , one of the couples of  not d e a l i n g w i t h the main i s s u e , one of emotional  adequately  addressed,  and one of s k i l l  focus  spoke  i s s u e s not being  t e a c h i n g g e t t i n g i n the way o f  e m o t i o n a l d i s c u s s i o n s which the couple then had a t home. In  response  to the q u e s t i o n of whether more s e s s i o n s were needed i n  the E.F. group two couples s a i d they would have " l i k e d " a few more to r e s o l v e i s s u e s c o m p l e t e l y , o n l y one couple s t a t e d t h a t they needed more s e s s i o n s .  definitely  In the P.S. group e i g h t couples and two  i n d i v i d u a l p a r t n e r s s t a t e d t h a t they needed more s e s s i o n s .  T h i s was a  s u r p r i s i n g f i n d i n g i n t h a t the r e s e a r c h e r c o n s i d e r e d the P.S. to  be more e a s i l y accomplished  treatment. at  i n the 8 s e s s i o n s than the E.F.  I t may be perhaps e x p l a i n e d i n terms of the s k i l l  times a p p e a r i n g  immediate emotional  treatment  training  l e s s r e l e v a n t to couples than the e x p l o r a t i o n o f issues.  104  These data are i m p r e s s i o n i s t i c . couples indeed e x p e r i e n c e d  the two  They do seem to suggest  treatments  i n ways t h a t are  w i t h the intended nature of those treatments.  The E.F.  the P.S.  communication and  treatment  was  congruent  treatment  e x p e r i e n c e d as d e l v i n g i n t o emotional v u l n e r a b i l i t i e s and p a t t e r n s and  t h a t the  clarifying  e x p e r i e n c e d by the couples  problem s o l v i n g s k i l l  was  as  training.  The R a t i n g of C o n f l i c t R e s o l u t i o n All  treatment  couples succeeded  i n a t t a i n i n g agreement  concerning  the s p e c i f i c request each p a r t n e r made of t h e i r spouse i n the session. First  The  task d i d not d i s c r i m i n a t e between couples or  t h i s may  be because of the nature of the task; the  although r e l a t i n g  treatments.  requests  to the core c o n f l i c t were o f t e n v e r y s p e c i f i c  s m a l l , f o r example, "Can n i g h t ? " and  you hug me  i f I ask you  and  to when I come home a t  thus l i k e l y to evoke v e r b a l agreement even i f the  r e l a t i o n s h i p had not changed s i g n i f i c a n t l y . by the t h e r a p i s t  i n the l a s t  s e s s i o n and  p l e a s e the t h e r a p i s t might be expected s i t u a t i o n and  result  Second t h i s task was  to be a key  i n couple agreement.  The  c a t e g o r i e s i s demonstrated by t h i s measure. S o c i a l Behavior  (Benjamin,  1977)  given  the d e s i r e to comply w i t h  difficulties  The  and  factor i n this of a t t a i n i n g  r e l e v a n t i n t e r a c t i o n a l data which can be coded by r a t e r s i n t o  simple  S t r u c t u r a l A n a l y s i s of  a measure which indexes q u a l i t y of  i n t e r a c t i o n r a t h e r than v e r b a l agreement to a request might preferable .  last  be  105  A d d i t i o n a l I n d i v i d u a l Analyses Although the main u n i t of a n a l y s i s i n t h i s study was the c o u p l e , the r e s e a r c h e r d e c i d e d to a l s o examine i n d i v i d u a l male and female s c o r e s i n p a r t i c u l a r domains such as the DAS and the PAIR P e r c e i v e d a t the t e r m i n a t i o n of treatment. P r e l i m i n a r y a n a l y s i s of v a r i a n c e on male and female pre treatment PAIR s c o r e s had found no s i g n i f i c a n t d i f f e r e n c e s between groups when the critical  level  f o r s i g n i f i c a n c e was s e t a t .05.  found i n T a b l e E-10, Appendix E.  These r e s u l t s may be  I n d i v i d u a l spouses  s c o r e s were a n a l y s e d u s i n g a MANOVA (SPSS: In the a n a l y s i s of p o s t - t e s t  p o s t - t e s t PAIR  9, N i e , 1975).  s c o r e s (Table E - l l ) f o r males the  m u l t i v a r i a t e F_ (12, 76) was computed a t 2.38, £ < .011. s i g n i f i c a n t u n i v a r i a t e F_ r a t i o s  ( a = .05/6 = .008) were found on  s u b s c a l e s 4 and 6, t h a t i s I n t e l l e c t u a l Intimacy .001)  (F_ (2, 42) = 11.8, £ <  and C o n v e n t i o n a l i t y (F_ (2, 42) = 7.7, £ < .001).  a n a l y s e s u s i n g Tukey's procedure  mean of the C o n t r o l group  to be s i g n i f i c a n t l y  groups  F o r male spouses  to i n c r e a s e s i g n i f i c a n t l y  variable Intellectual  to be  on s u b s c a l e s i x , and the  lower than PS and EF  the EF treatment  the i d e a l i s a t i o n of the spouse  r e l a t i o n s h i p , but no d i f f e r e n t i a l  Post-hoc  found the mean of the EF group  s i g n i f i c a n t l y h i g h e r than PS and C o n t r o l groups  on s u b s c a l e f o u r .  The o n l y  seemed then  and the  treatment e f f e c t was found on the  Intimacy.  For Females the m u l t i v a r i a t e F_ (12, 76) was computed as 1.98, £ < .038.  The o n l y s i g n i f i c a n t  univariate F ratios  ( a = .05/6 = .008) were  found on I n t e l l e c t u a l Intimacy, s u b s c a l e 4 (F_ (2, 42) = 10.9 £ < .001), and Emotional Intimacy s u b s c a l e I (F (2, 42) = 6.22, £ < .004).  106  P o s t - h o c a n a l y s e s found the mean o f the EF group t o be s i g n i f i c a n t l y h i g h e r than PS and C o n t r o l groups on s u b s c a l e 1, and the mean o f the EF group t o be s i g n i f i c a n t l y h i g h e r than t h a t of the C o n t r o l s on s u b s c a l e 4.  F o r female spouses t h e EF treatment seemed t o i n c r e a s e the E m o t i o n a l  Intimacy i n the r e l a t i o n s h i p ; t h i s r e s u l t i s l o s t i n the a n a l y s i s on the couple u n i t .  There i s no s i g n i f i c a n t d i f f e r e n t i a l  based  treatment  e f f e c t on the v a r i a b l e I n t e l l e c t u a l I n t i m a c y when female s c o r e s a r e considered separately.  When both spouses a r e c o n s i d e r e d however t h i s  v a r i a b l e i s s i g n i f i c a n t l y e f f e c t e d by the EF t r e a t m e n t .  D e t a i l s of  these a n a l y s e s may be found i n T a b l e E - l l , Appendix E. I n d i v i d u a l spouses p o s t - t e s t DAS s c o r e s were a n a l y s e d u s i n g a MANOVA (SPSS: 9, N i e , 1975).  F o r Males t h e m u l t i v a r i a t e F ( 8 , 80) was  computed as 3.35, _ < .002. The o n l y s i g n i f i c a n t u n i v a r i a t e F r a t i o s (a = .05/4 = .0125), were found on the s u b s c a l e s 2, S a t i s f a c t i o n (F_ ( 2 , 42) = 8.39, £ < .001) and 3, Cohesion S u b s c a l e 1, Consensus,  (F ( 2 , 42) = 11.85, p < .001).  n a r r o w l y missed r e a c h i n g t h e c r i t i c a l l e v e l f o r  s i g n i f i c a n c e (p_ < .015).  Post-hoc a n a l y s e s u s i n g Tukey's procedure  found t h e mean of the EF group t o be s i g n i f i c a n t l y h i g h e r than PS and C o n t r o l groups on s u b s c a l e s 2 and 3. For Females t h e m u l t i v a r i a t e F_ ( 8 , 80) was computed as 3.61, p_ < .001.  A l l u n i v a r i a t e F r a t i o s (a = .05/4 = .0125) were found t o be  significant.  Post-hoc a n a l y s e s u s i n g Tukey's procedure found the  c o n t r o l group mean t o be lower than both treatment means on s u b s c a l e 1, Consensus.  Only EF and C o n t r o l group means d i f f e r e d s i g n i f i c a n t l y on  the s u b s c a l e S a t i s f a c t i o n .  On s u b s c a l e 3 - C o h e s i o n , and 4 -  A f f e c t i o n a l E x p r e s s i o n , t h e mean o f the EF group was found t o be  107  s i g n i f i c a n t l y h i g h e r than those of the PS and C o n t r o l group.  The o n l y  a d d i t i o n a l i n f o r m a t i o n added by t h i s i n d i v i d u a l a n a l y s i s would seem t o be  t h a t s u b s c a l e 4, A f f e c t i o n a l E x p r e s s i o n w h i l e not r e a c h i n g the  r e q u i r e d l e v e l of s i g n i f i c a n c e i n the couples a n a l y s i s appears been s i g n i f i c a n t l y a f f e c t e d by the EF treatment considered separately.  when female  to have  spouses are  The d e t a i l s o f these a n a l y s e s are p r e s e n t e d i n  T a b l e E-12, Appendix E. The male and female  s c o r e s on T a r g e t Complaints  were c o n s i s t e n t l y  s i m i l a r a c r o s s groups and were s i m i l a r to the r e s u l t s o f the a n a l y s i s of couples scores. and  The male mean score f o r the EF group was 3.7 (SD = .62)  the female mean score was 3.7 (SD = .46);  the male mean score f o r  the PS group was 3.1 (SD = .88) and the female mean score was 3.1 (SD = 1.2).  The wait l i s t  male and female means were a l s o v e r y c l o s e , 1.4 (SD  = .63) and .93 (SD = .46) r e s p e c t i v e l y a t the post-wait The  Goal Attainment  means showed a s i m i l a r p a t t e r n .  assessment. The male and  female means i n the EF group being computed as 60 (male SD = 8.6, female SD = 7.7); i n the PS group the male mean was 56.7 (SD = 9.2) and the female mean was 58.0 (SD = 9.1). The wait l i s t  group male mean a f t e r  the w a i t i n g p e r i o d was 42 (SD = 3.8) and the female mean was 42.7 (SD = 2.6).  Follow-Up Measures E i g h t weeks a f t e r t e r m i n a t i o n of treatment f o l l o w - u p measures. (n  = 29).  A l l couples except  The hypotheses  completed  one r e t u r n e d the follow-up  o f the study concerned  e f f e c t s of the two treatments  couples  EF and PS.  data  possible differential  The main focus o f the  108  f o l l o w - u p was then to examine whether the d i f f e r e n t i a l e f f e c t s treatment  found a t  t e r m i n a t i o n would a l s o be found at f o l l o w - u p .  On a p r e l i m i n a r y repeated measures a n a l y s i s of v a r i a n c e of t o t a l DAS s c o r e s f o r the two treatment found;  groups s i g n i f i c a n t  F_ (1, 27) = 9.4, _ < .0049.  d i f f e r e n c e s were  The mean f o r the EF group (n = 15)  at f o l l o w - u p was 112.4 (SD = 11.2) and f o r the PS group was 101.1 (SD = 8.9).  No s i g n i f i c a n t e f f e c t s were found  Interactions.  f o r Time, o r Time by Group  These r e s u l t s are summarised i n T a b l e 10.  T a b l e 10 Summary Repeated Measures Anova:  T o t a l DAS Follow-Up  Scores  (N = 30) Source of Variation  SS  Group  1,762.7  Error  5,076.4  MS  DF  1,762.7  F  1  9.38  27  188.0  P .005  -  -  Time  5.2  5.2  1  .25  .620  Time by Group Interaction  1.3  !«3  1  .06  .805  554.2  20.5  27  -  -  Error  A m u l t i v a r i a t e repeated measures a n a l y s i s of v a r i a n c e (2 times, that  i s t e r m i n a t i o n and f o l l o w - u p , by 2 groups,  i n g outcome v a r i a b l e s ) was then conducted and  Cohesion  (DAS 2 and 3 ) , I n t e l l e c t u a l  (PAIR 4 and 6) and T a r g e t Complaints. ated between treatment  and the 5 d i f f e r e n t i a t -  on the v a r i a b l e s , Intimacy  Satisfaction  and C o n v e n t i o n a l i t y  These v a r i a b l e s had d i f f e r e n t i -  groups a t t e r m i n a t i o n .  At f o l l o w - u p the  109  m u l t i v a r i a t e F s t a t i s t i c was  s i g n i f i c a n t , _F (5, 23) = 3.67,  £ <  .014.  Thus when a l l f i v e d i f f e r e n t i a t i n g v a r i a b l e s were c o n s i d e r e d t o g e t h e r t h e r e was  an o v e r a l l s t a t i s t i c a l l y  significant  the EF treatment between the treatment groups a n a l y s i s was r e s u l t s may  conducted  procedure time by  of  the groups  follow-up. the two  group  groups  The  corrected using Bonferroni's  In t h i s a n a l y s i s no s i g n i f i c a n t  time  effects  i n t e r a c t i o n s were found; t h i s suggests that the means  d i d not change s i g n i f i c a n t l y  The  This  Once a g a i n to a v o i d e s c a l a t i n g Type 1  s i g n i f i c a n c e l e v e l was  (.05/5 = .01).  or  at f o l l o w - u p .  u s i n g the SPSS:X program (SPSS, 1983).  be found i n T a b l e 11.  e r r o r the c r i t i c a l  d i f f e r e n c e i n f a v o r of  from post-treatment to  variable Conventionality f a i l e d at f o l l o w - u p .  to d i f f e r e n t i a t e  between  An examination of means r e v e a l e d t h a t  EF group appeared  to r e g r e s s on t h i s v a r i a b l e d u r i n g the e i g h t weeks  a f t e r treatment.  The  Complaint The  just  failed  the  v a r i a b l e s I n t e l l e c t u a l Intimacy and T a r g e t to reach s i g n i f i c a n c e  (p_ >.014) i n t h i s  analysis.  c o n s i s t e n c y of the t r e n d i n r e s u l t s and  the narrow margin  by which  these means missed  the c r i t i c a l  l e v e l f o r s i g n i f i c a n c e suggests  that  w i t h a l a r g e r sample or more powerful instruments these v a r i a b l e s have been found to be s i g n i f i c a n t l y d i f f e r e n t . S a t i s f a c t i o n , F (1, 27) = 8.48, 15.89, £ < .005, group  remained  then m a i n t a i n e d  £ < .007,  The  variables  and Cohesion, F (1, 27) =  s i g n i f i c a n t l y h i g h e r i n the EF group.  s i g n i f i c a n t l y h i g h e r l e v e l s of S a t i s f a c t i o n  Cohesion as w e l l as h i g h e r t o t a l DAS  might  s c o r e s (which i n c l u d e d  The and  the  S a t i s f a c t i o n and Cohesion s u b s c a l e s ) over the e i g h t weeks f o l l o w i n g treatment  than d i d the PS  group.  EF  110  Table 11 Repeated Measures A n a l y s i s : Differentiating  Follow-Up Scores on Variables  Groups Variables (N = 29)  Time  EF  PS  F  M/SD  M/SD  (1 ,27)  P  Satisfaction (DAS)  I II  38.6 38.3  (4.8) (4.8)  34.0 34.1  (4.2) (3.0)  G 8.48 T .03 TG .21  .007* .855 .649  Cohesion (DAS)  I II  17.6 16.9  (3.3) (3.2)  13.9 13.6  (1.3) (1.8)  G 1 5.89 T 2.11 .25 TG  .001* .158 .620  TC  I II  3.8 3.7  G 6.87 T .97 TG .00  .014 .335 .973  Intellectual I n t . (PAIR)  I II  70.3 68.7  58.3 (10.8) 58.6 (14.2)  G 6.87 T .06 .12 TG  .014 .809 .729  Conventionality (PAIR)  I II  64.8 (18.5) 55.5 (22.3)  (18.2) (19.3)  G 5.38 T 2.47 TG 2.19  .028 .128 .151  Note:  EF, n a G T TG  = = = = =  (.35) (.46)  (11.7) (16.3)  3.3 3.1  45.0 44.6  15; PS, n = 14 .05/5 = .01 Group F s t a t i s t i c Time F s t a t i s t i c I n t e r a c t i o n , Time and Group * = p < .01  (.99) (.86)  Ill  The v a r i a b l e s which d i d not d i f f e r e n t i a t e between treatment at  groups  t e r m i n a t i o n of treatments were a l s o a n a l y s e d to a s s e s s whether  treatment had assessment,  c r e a t e d e f f e c t s that were not immediately  so c a l l e d  "sleeper e f f e c t s " .  and A f f e c t i o n a l E x p r e s s i o n (DAS R e c r e a t i o n a l Intimacy  apparent at post  These v a r i a b l e s were Consensus  1 and 4 ) , E m o t i o n a l , S o c i a l , Sexual  (PAIR 1, 2, 3 and 5 ) , and Goal A t t a i n m e n t .  mutivariate F s t a t i s t i c  The  not s i g n i f i c a n t , F_ (7, 21) = 1.26,  p_ <  and none of the u n i v a r i a t e F r a t i o s on these v a r i a b l e s reached  the  critical  was  level for significance  (.05/7 = .007).  statistically  significant  effects.  r e s u l t s of t h i s a n a l y s i s may  The  Appendix E.  Thus t h e r e was  evidence found f o r any treatment  and  .315,  no  "sleeper"  be found i n T a b l e  E-13,  There were no s i g n i f i c a n t Time or Time by Group  I n t e r a c t i o n s found i n t h i s  analysis.  A d d i t i o n a l I n d i v i d u a l A n a l y s i s on Follow-Up  Data  As w i t h post-treatment data a d d i t i o n a l i n d i v i d u a l a n a l y s e s were conducted  on f o l l o w - u p d a t a .  A p r e l i m i n a r y repeated measures a n a l y s i s of v a r i a n c e on both male and  female t o t a l DAS  groups; (1,  for  d i f f e r e n c e s between  the F r a t i o s being computed a t F (1, 27) = 9.08,  27) = 7.48,  113.0  s c o r e s found s i g n i f i c a n t  _p < .011  (SD = 11.4)  and  the EF females was  (SD = 10.0). were found.  No  respectively.  The mean f o r the EF males  f o r the PS males was 111.8  (SD = 12.0)  p_ < .006,  102.2  and  (SD = 10.0).  and J_ was  The means  f o r the PS females was  100  s i g n i f i c a n t Time e f f e c t s or Time by Group I n t e r a c t i o n s  R e s u l t s are shown i n T a b l e E-14,  Appendix E.  112  A repeated measures a n a l y s i s  of the v a r i a b l e s  which  differentiated  between the treatment groups at t e r m i n a t i o n and the v a r i a b l e s not  differentiate  between the groups was  u s i n g the BMPD program (Dixon, 1981). analysis  of d i f f e r e n t i a t i n g v a r i a b l e s  Cohesion  (DAS  2 and 3 ) , I n t e l l e c t u a l  Complaints are found i n T a b l e E-15, non-differentiating No  variables  may  conducted  The  results  f o r males and f o r the  and  Intimacy (PAIR 4 and 6 ) , and T a r g e t Appendix  E.  The r e s u l t s  be found i n T a b l e E-16,  f o r the  Appendix  variables  e f f e c t s were found i n  when s c o r e s on the  are a n a l y s e d i n d i v i d u a l l y  significance  level  (.01)  differentiating  the female means miss the  critical  except f o r Cohesion; t h i s s i g n i f i c a n t  however i s best c o n s i d e r e d as a Type 1 e r r o r ,  s i n c e the  means however were found to be s i g n i f i c a n t l y d i f f e r e n t on the v a r i a b l e s  Satisfaction,  Complaints j u s t m i s s i n g the c r i t i c a l m u l t i v a r i a t e F was treatment appears  level for significance;  computed a t , F_ (5, 23) = 5.75,  p < .001.  then to have shown a d i f f e r e n t i a l e f f e c t  the  overall  The  EF  on the l e v e l  the  treatment groups at f o l l o w - u p .  variables  f o r males ( m u l t i v a r i a t e  £ < .37) or females ( m u l t i v a r i a t e  on  female  significant.  shows none of the n o n - d i f f e r e n t i a t i n g  found to be s i g n i f i c a n t l y d i f f e r e n t  PS  and Cohesion, w i t h T a r g e t  and Cohesion were not s t a t i s t i c a l l y  As T a b l e E-16  the male  i n the EF and  of male s a t i s f a c t i o n and c o h e s i o n at f o l l o w - u p whereas e f f e c t s Satisfaction  result  overall  m u l t i v a r i a t e F i s not s i g n i f i c a n t , F_ (5, 23) = 2.31, £ < .077;  1.16,  E.  of these a n a l y s e s .  As can be seen i n T a b l e E-15  groups  females  individual  that i s f o r S a t i s f a c t i o n  s i g n i f i c a n t Time or Time by Group I n t e r a c t i o n  either  which d i d  were  F_ (7, 21) =  F (7, 21) = 1.09, £ < .40) i n  113  D e s c r i p t i v e . Data Authors  such as Gurman and K n i s k e r n (1978) have emphasised  that  outcome s t u d i e s must i n c l u d e i n f o r m a t i o n on d e t e r i o r a t i o n as w e l l as on improvement. conflict  A l l the instruments used  i n this  study except  observed  r e s o l u t i o n allowed f o r d e t e r i o r a t i o n of the r e l a t i o n s h i p d u r i n g  the p r o c e s s of therapy.  Jacobson F o l l e t t e and Elwood ( i n p r e s s )  t h a t i n r e s e a r c h i n b e h a v i o r a l m a r i t a l therapy approximately t r e a t e d couples a c t u a l l y d e t e r i o r a t e , i n t h i s c o u p l e s would show s c o r e s d e t e r i o r a t i n g significance.  to t h i s p o i n t .  dipped below pre-treatment  5% of  study t h a t would mean 1-2  to the p o i n t of s t a t i s t i c a l  In f a c t none o f the t r e a t e d couples t o t a l  s c o r e s decreased  stated  The post-treatment  adjustment  s c o r e s of 2 couples  scores by 5 and 4 p o i n t s (both couples were  i n the PS group) and 2 couples f o l l o w - u p s c o r e s dipped below t h e i r pre-treatment  s c o r e s , an EF couple by 7.5 and a PS couple by 2 p o i n t s .  One d e c i s i o n to separate was r e p o r t e d by a couple i n the PS group a f t e r treatment  t e r m i n a t i o n but t h i s s e p a r a t i o n was amicable  and by mutual  consent. Another 1977).  way o f v i e w i n g the data i s i n terms o f e f f e c t  Here the d i f f e r e n c e i n means between treatment  size  (Cohen,  groups and  c o n t r o l s i s d i v i d e d by the standard d e v i a t i o n of the c o n t r o l group; p r o v i d e s an e s t i m a t e o f the magnitude of change. couples post-treatment  t o t a l d y a d i c adjustment  group (112.7 f o r the EF group,  this  I n t h i s study i f the  score f o r each  treatment  102.4 f o r the PS group) i s s u b t r a c t e d  from the mean o f the c o n t r o l group (91.5) and d i v i d e d by the standard d e v i a t i o n f o r t h a t group (9.7) the e f f e c t group and 1.12 f o r the PS group.  s i z e s are 2.19 f o r the EF  The mean e f f e c t of the a f f e c t i v e l y  114  f o c u s s e d treatment, EF, i s then over two standard d e v i a t i o n s from the mean of the c o n t r o l measured a f t e r  the w a i t i n g p e r i o d .  to be a s i z a b l e treatment  However t h i s  address  effect.  T h i s would seem  s t a t i s t i c does not  the i s s u e of v a r i a b i l i t y i n outcome a c r o s s a sample of  subjects.  The e t a s t a t i s t i c f o r the t o t a l  post DAS  couples s c o r e s  computed at .67; t h a t i s 45% of the v a r i a n c e i n the t o t a l DAS after  treatment  significant group  was a b l e to be e x p l a i n e d by group membership.  Thus a  membership. by Jacobson  p r e s s ) i s to r e p o r t the p r o p o r t i o n of t r e a t e d couples who Jacobson  et a l . ( i n p r e s s ) suggest  s i n c e c o n t r o l group couples changed v e r y l i t t l e change s c o r e s i n the c o n t r o l suggested  f o r improvement  17.8) r e p o r t e d by Spanier improvement.  (66%) and 6 PS couples follow-up  i n this  9 EF couples  i n this  sample.  SE.  that a  However  sample (SD. f o r  Since t h i s  seems s m a l l (SD,  (1976) i s used here as the b a s i s f o r c r i t e r i o n e s t a b l i s h e d f o r improvement i s a  score of 17 - 18 p o i n t s , then 10 EF couples (40%) met t h i s  criterion  ( 6 0 % ) , (2 couples j u s t  at post-assessment. f a i l i n g to reach the  c r i t e r i o n w i t h a 16 p o i n t improvement) and 4 PS couples criterion.  improve.  the standard d e v i a t i o n of the DAS  I f then the c r i t e r i o n  i n t o t a l adjustment  1.96  (in  group = 5.38, x" = 1.07) the s t a t i s t i c  above i s equal to 4.22  as a c r i t e r i o n  et a l .  as a c r i t e r i a f o r improvement  couple change from p r e - t e s t to p o s t - t e s t by at l e a s t  rise  score  amount of the v a r i a n c e i n t h i s v a r i a b l e was a t t r i b u t a b l e t o  Another way of v i e w i n g the data suggested  for  was  These data are d i s p l a y e d i n T a b l e  12.  (26%) met the  At  115  T a b l e 12 Percentages  of Couples  Improved on T o t a l DAS  Post-Test n  Group  Improved  Follow-Up n  Unimproved  Improved  Unimproved  EF  15  66  34  15  60  40  PS  15  40  60  14  26  74  C  15  0  100  Improvement = 17 p o i n t s on t o t a l DAS.  Another way of v i e w i n g the data i s to c o n s i d e r not the amount of change but the p o i n t a t which couples f i n i s h . therapy n o n - d i s t r e s s e d ? of  Do couples come out o f  I f the c r i t e r i a f o r n o n - d i s t r e s s e d i s a score  114 or over on the t o t a l post-treatment  S p a n i e r ' s mean f o r married  adjustment  score (114.8 being  c o u p l e s ) then 7 o f the EF couples  as n o n - d i s t r e s s e d a t p o s t - t e s t and f o l l o w - u p assessment the PS couples q u a l i f i e d  at post-assessment  qualified  ( 4 6 % ) , and 2 o f  and f o l l o w - u p  (13%).  The  mean o f the EF group, 112.7, i s however very c l o s e to S p a n i e r ' s norm. I f the c r i t e r i a f o r m a r i t a l happiness and  are made a l i t t l e  taken as 114.8 means h a l f of a standard d e v i a t i o n  less  stringent  (17.8/2 = 8.9)  then couples s c o r i n g above 106 would be c o n s i d e r e d n o n - d i s t r e s s e d . this  case  13 o f the EF couples  (86%) and 6 of the PS couples  be c o n s i d e r e d n o n - d i s t r e s s e d a t post-assessment and  4 PS couples  In  (40%) would  and 11 EF couples (73%)  (27%) would be c o n s i d e r e d n o n - d i s t r e s s e d at f o l l o w - u p .  116  The  same k i n d o f a n a l y s e s can be a p p l i e d to o t h e r outcome measures  such as Target Complaint.  In the EF group 14 couples scored 3 or above  (somewhat improved) a t post-assessment  and at f o l l o w - u p , i n the PS group  11 couples scored 3 or above a t post-assessment at  and 7 reached  this  level  f o l l o w - u p (n = 14). I n the EF group n i n e couples scored f o u r (very  much improved) a t post assessment and seven at f o l l o w - u p .  In the PS  group f o u r couples scored at t h i s  l e v e l at post assessment and one  reached  The d i f f e r e n c e s i n group means a t  this  l e v e l at follow-up.  p r e t e s t p o s t - t e s t and follow-up assessment on t o t a l adjustment are shown i n F i g u r e I .  scores  116a-  F i g u r e 1. ~  Group Means on T o t a l DAS C o u p l e S c o r e s a t P r e t e s t , P o s t t e s t and Follow-up Assesment.  DAS SCORES 120  r  115 EF  110  105  PS 100  J^0N-DISTRES_SED DISTRESSED  95  90 POST  PRE  FOLLOW-UP  TIME OF ASSESSMENT NOTE:  EF PS  c  • •  No F measures were p o s s i b l e on t h e C g r o u p . S p a n i e r s (1976) sample mean f o r n o n - d i s t r e s s e d A t F t h e PS group mean i s b a s e d on n = 14  couples  114  117  CHAPTER V DISCUSSION OF RESULTS  Summary The purpose  of t h i s study was  e x p e r i e n t i a l treatment to  test  to d e l i n e a t e an e m o t i o n a l l y f o c u s s e d  for marital conflict  t h i s treatment e m p i r i c a l l y and  a problem  solving s k i l l  o r i e n t e d b e h a v i o u r a l treatment which had a l r e a d y  i n the study were r e c r u i t e d  randomly a s s i g n e d to one c o n t r o l group.  relationships,  to compare i t s e f f e c t i v e n e s s w i t h  received extensive empirical v a l i d a t i o n . participated  i n distressed  of the two  The  f o r t y - f i v e couples  from a newspaper a r t i c l e  treatment groups  Each couple i n the treatment groups  or the wait received  Implementation  checks  and list  eight  s e s s i o n s of c o n j o i n t m a r i t a l therapy implemented a c c o r d i n g to the treatment manuals.  who  two  found that treatments were  a b l e to be r e l i a b l y d i f f e r e n t i a t e d and were implemented i n accordance w i t h the manuals. in  No  the three groups  s i g n i f i c a n t d i f f e r e n c e s were found between c o u p l e s  on demographic v a r i a b l e s , a measure of emotional  s t y l e , or pre-measures of m a r i t a l adjustment a l s o no d i f f e r e n c e s found between the two of  and  intimacy.  treatment groups  There were on a measure  the q u a l i t y of the couples a l l i a n c e w i t h t h e i r t h e r a p i s t .  therapists  ( s i x implementing  therapist effects.  m a r i t a l adjustment, attainment found  twelve  each treatment) were balanced as to  e x p e r i e n c e and e d u c a t i o n and no evidence was tial  The  found to suggest  differen-  A m u l t i v a r i a t e a n a l y s i s of post-measures  of  i n t i m a c y , r e d u c t i o n i n t a r g e t c o m p l a i n t , and g o a l  that couples i n both treatments r e p o r t e d s i g n i f i c a n t l y  more t h e r a p u t i c gains than those i n the c o n t r o l group.  Both  treatment  118  groups were s u p e r i o r on the measure of t o t a l m a r i t a l adjustment, consensus  aspect of t h i s adjustment,  on the measure of  on the  intellectual  Intimacy, improvement i n the t a r g e t complaint and g o a l a t t a i n m e n t . differential  treatment e f f e c t was  a l s o found.  There were  A  significant  d i f f e r e n c e s between treatments i n f a v o r of the e m o t i o n a l l y f o c u s s e d treatment on the t o t a l adjustment  s c o r e , s a t i s f a c t i o n and  cohesion  a s p e c t s of m a r i t a l adjustment,  on a measure of i n t e l l e c t u a l i n t i m a c y ,  i d e a l i s a t i o n of the spouse  the r e l a t i o n s h i p and on the amount o f  and  improvement i n the t a r g e t c o m p l a i n t .  Thus s i g n i f i c a n t  found to s u b s t a n t i a t e both r e s e a r c h hypotheses e f f e c t i v e n e s s of b o t h treatments and treatment e f f e c t s . continued Problem  the e x i s t e n c e of  overall  differential  At f o l l o w - u p the e m o t i o n a l l y focused  S o l v i n g treatment, and  significantly  treatment  greater s p e c i f i c e f f e c t s  on  score and on the S a t i s f a c t i o n and Cohesion a s p e c t s of t h i s  D i f f e r e n c e s between treatment groups  Complaint critical  c o n c e r n i n g the  was  to show s i g n i f i c a n t l y g r e a t e r o v e r a l l e f f e c t s compared to the  the t o t a l DAS score.  evidence  Improvement and I n t e l l e c t u a l significance level;  on the v a r i a b l e s Target  Intimacy j u s t  failed  the t r e n d however remained  f a v o r of the E m o t i o n a l l y Focused  to reach the  consistently in  teatment.  Discussion The primary s i g n i f i c a n c e of these r e s u l t s i s t h a t a treatment f o r m a r i t a l d i s t r e s s which does not focus upon changing behaviour has been t e s t e d e m p i r i c a l l y and found to be e f f e c t i v e .  Gurman has  suggested  (1978) t h a t the psychodynamic model has tended to o f f e r ways of u n d e r s t a n d i n g i n t i m a t e r e l a t i o n s h i p s r a t h e r than a c l e a r s e t of  119  i n t e r v e n t i o n s or a technology f o r the process of t h e r a p y . s p e c i f i c interventions directed  In t h i s  towards a l l i e v i a t i n g m a r i t a l  study  conflict  were s t i p u l a t e d i n a therapy manual, implemented a c c o r d i n g to that manual, monitored effectiveness.  d u r i n g implementation, and  t e s t e d as to t h e i r  T h i s would seem to r e p r e s e n t an advance i n the f i e l d  m a r i t a l therapy and  of  suggests that f o c u s i n g upon i n n e r e x p e r i e n c e as i t  i s t r a n s l a t e d i n t o r e l a t i o n s h i p events d u r i n g i n t e r a c t i o n , may  be a  p o w e r f u l t o o l f o r changing the nature of r e l a t i o n s h i p s . The  f i n d i n g that the Problem  the manner of Jacobson  Solving  (PS) treatment implemented i n  and M a r g o l i n (1979) was  w i t h a l l the p r e v i o u s r e s e a r c h on the Problem (Jacobson, 1977,  1978,  1979,  supports the assumption  that  effective i s consistent Solving  Jacobson & Anderson, skill  treatment  1980)  and  t r a i n i n g of t h i s type does h e l p  couples l e a r n to n e g o t i a t e and change t a r g e t b e h a v i o u r s . treatment i n c r e a s e d the t o t a l adjustment consensus  level  (DAS)  between p a r t n e r s as w e l l as, t h e i r a b i l i t y  t a l k about facilitated  further  and  The  PS  the amount of  to share i d e a s and  issues with understanding ( i n t e l l e c t u a l intimacy).  It also  the attainment of treatment g o a l s formulated i n terms of  r e a c h i n g a predetermined  l e v e l on t h r e e s p e c i f i c b e h a v i o u r s , as w e l l as  an improvement i n t a r g e t  complaint.  However as Jacobson c o n t r o l s t r a t e g i e s may  (1983) suggests t e a c h i n g couples p o s i t i v e  change behaviour without improving e i t h e r  c o g n i t i v e or a f f e c t i v e components of m a r i t a l s a t i s f a c t i o n , s i n c e t r u s t would seem to be c o n s t i t u t e d by independence c o n t i g e n c i e s and i t i s t h i s independence marital relationships.  the  especially  from  which c h a r a c t e r i s e s  immediate positive  M u r s t e i n et a l . (1977) found that a q u i d pro  quo  120  c o n c e p t i o n o f a r e l a t i o n s h i p where spouses n e g o t i a t e f o r r e c i p r o c a l exchanges was i n v e r s e l y r e l a t e d to m a r i t a l s a t i s f a c t i o n and o n l y worked well i n rather distant relationships. t h a t the PS treatment the g o a l attainment  d i d impact  measure:  I n t h i s study there i s evidence  the c o u p l e s ' s behaviours  as r e p o r t e d on  i t d i d increase their a b i l i t y  to t a l k to  each other i n a r a t i o n a l manner and to problem s o l v e on pragmatic and  reach consensus w i t h the r e s u l t  t h a t t h e r e was an improvement i n the  t a r g e t c o m p l a i n t , however i t d i d not seem to a f f e c t satisfaction,  has  suggested  couples sense o f  c o h e s i o n o r a f f e c t i o n a l e x p r e s s s i o n (DAS s u b s c a l e s )  l e v e l s of i n t i m a c y except  issues  f o r the i n t e l l e c t u a l i n t i m a c y ; M a r g o l i n  or (1983)  t h a t i n c r e a s i n g i n t i m a c y has not up to t h i s p o i n t been  p a r t o f the process of b e h a v i o u r a l m a r i t a l therapy.  An i n c r e a s e i n  s a t i s f a c t i o n has been found  i n o t h e r outcome s t u d i e s u s i n g problem  solving training  1977, 1978), although T e i c h e r t (1978) found  (Jacobson,  t h a t problem s o l v i n g t r a i n i n g i n c r e a s e d the m a r i t a l s a t i s f a c t i o n i n h i s study o n l y f o r female  spouses and not f o r the males.  i n c r e a s e i n s a t i s f a c t i o n was found  The f a c t  t h a t an  i n o t h e r b e h a v i o r a l outcome s t u d i e s  but not here would seem t o be a r e f l e c t i o n o f how t h i s v a r i a b l e i s d e f i n e d . Jacobson and  i f i t i s so d e f i n e d , then the P.S. treatment  c o n t r o l s was found study. and  ( i n p r e s s ) d e f i n e s s a t i s f a c t i o n as the t o t a l DAS s c o r e  to have a s i g n i f i c a n t  when compared w i t h  e f f e c t on s a t i s f a c t i o n i n t h i s  However when the s u b s c a l e s o f the DAS a r e a n a l y s e d s e p a r a t e l y  s a t i s f a c t i o n i s separated from other elements o f m a r i t a l  then the PS treatment  d i d not seem to s i g n i f i c a n t l y a f f e c t  satisfaction within their  relationship.  adjustment  couples  121  Weiss, Hops and P a t t e r s o n (1973) have a l s o suggested t h a t i t may from  be t h a t t r a i n i n g i n behaviour  the k i n d s of h u r t s brought  i s s u e i s how It did  to r e l a t e s k i l l  significantly  to us by c l i e n t s "  couples a b i l i t y  (p. 339)  that E m o t i o n a l l y Focussed  from  as w e l l as the PS  t o n e g o t i a t e and  (EF)  T h i s would seem to  treatment  had  that the  couples on  the  suggest  an e f f e c t  change s p e c i f i c behaviours  these areas were not f o c u s s e d upon i n terms of s k i l l be t h a t the i n c r e a s e d a b i l i t y  and  the PS couples a f t e r treatment  Consensus v a r i a b l e or on Goal Attainment. t h a t the EF treatment  change can appear " f a r removed  b u i l d i n g and m a r i t a l s a t i s f a c t i o n .  i s i n t e r e s t i n g to note  not d i f f e r  i n general  on  although  training.  It  may  to n e g o t i a t e i n the EF couples i s a  consequence of an i n c r e a s e i n t r u s t o c c u r i n g as a r e s u l t of the s h a r i n g of may  emotional  experience.  As t r u s t  be more a b l e to formulate  a way  increases i n a relationship  spouses  t h e i r needs and ask f o r them to be met  t h a t evokes a c a r i n g response.  Responses based  in  on c a r i n g tend to  l e a d to e f f e c t i v e n e g o t i a t i o n s f o r they are blame f r e e and  are  motivated  by a s i n c e r e d e s i r e to reach agreement. These r e s u l t s suggest require s k i l l  t h a t d i s t r e s s e d couples do not  necessarily  t r a i n i n g i n order to be a b l e to n e g o t i a t e d i f f e r e n c e s  e f f e c t i v e l y and  change t h e i r performance towards t h e i r spouse.  This  i n t e r p r e t a t i o n would concur w i t h the r e s e a r c h of B i r c h l e r et a l . (1975) who  found  that d i s t r e s s e d  couples show normal problem s o l v i n g  when i n t e r a c t i n g w i t h o p p o s i t e sex s t r a n g e r s . poor s o c i a l of  minimal  skills  skills  As Gurman (1981) suggests  i n a marital relationship often r e f l e c t basic rules  i n t i m a c y , s e l f - d i s c l o s u r e and  self-exposure.  The EF  spoke i n the Post Treatment Q u e s t i o n a i r e of s e e i n g each o t h e r  couples  122  differently;  perhaps a new  and  less threatening  perception  of one's  spouse and  a c l a r i f i c a t i o n of the p o s i t i o n s spouses take i n r e l a t i o n  each other  can a i d the n e g o t i a t i o n process as much as a set  negotiating rules. goodwill  I t would c e r t a i n l y appear l o g i c a l that  are h e l p f u l p r e r e q u i s i t e s to the attainment of  resolution.  These r e s u l t s imply that  of trust  for  by  both the The  the performance of  behaviours  e f f e c t i v e n e s s of the EF  The  treatment i n d i c a t e s t h a t f o c u s i n g  v u l n e r a b i l i t i e s evoked by  i s a valuable  and  the  upon  marital  powerful i n t e r v e n t i o n i n m a r i t a l  EF treatment as w e l l as i n c r e a s i n g consensus and  attainment a l s o was  goal  found to i n f l u e n c e couples sense of s a t i s f a c t i o n  c o h e s i o n i n the r e l a t i o n s h i p , and  t h e i r tendency to i d e a l i s e  Complaint above the l e v e l a t t a i n e d by  the  and  the  r e l a t i o n s h i p , as w e l l as improving spouses I n t e l l e c t u a l Intimacy  PS  be  spouses as w e l l as by d i r e c t t r a i n i n g i n n e g o t i a t i o n .  i n t e r a c t i o n patterns  Target  can  f o c u s i n g upon the emotional r e a l i t y of the r e l a t i o n s h i p  unacknowledged f e e l i n g s and  therapy.  and  conflict  which enhance r e l a t i o n s h i p q u a l i t y through e f f e c t i v e n e g o t i a t i o n facilitated  to  and  couples i n v o l v e d  i n the  treatment. The  increase  couples may  i n s a t i s f a c t i o n and  reflect  the  c o h e s i o n a t t a i n e d by  f a c t t h a t the EF  I f as B r o d e r i c k  by most to be  EF  treatment attempts to address  d i r e c t l y what Gurman (1978) r e f e r s to as the couple.  the  "felt  needs" of  the  (1981) suggests " p o s i t i v e a f f e c t " i s  considered  the goal of a good r e l a t i o n s h i p an i n t e r v e n t i o n which  works d i r e c t l y w i t h a f f e c t might be expected, i f e f f e c t i v e , to  influence  m a r i t a l s a t i s f a c t i o n more immediately than a growth i n n e g o t i a t i o n skills.  Hahlweg, S c h i n d l e r , R e v e n s t o r f and  Brengelmann ( i n p r e s s ) found  123  in  t h e i r study that the e m o t i o n a l - a f f e c t i v e q u a l i t y of the  p r e d i c t e d s u c c e s s f u l outcome i n t h e r a p y , and b e h a v i o u r a l approach such as problem  facilitates  relationship  they suggest that whereas a  the improvement of m a n i f e s t behaviours  s o l v i n g i t i s l e s s w e l l s u i t e d to " d e a l w i t h the  i n t e r n a l events a f f e c t i n g the emotional q u a l i t i e s of a r e l a t i o n s h i p . " If  i t i s p o s s i b l e to e x p l o r e and address the f e l t needs of couples and  facilitate  spouses  responding to each o t h e r s needs then the c o u p l e s  e x p e r i e n c e of an s a t i s f a c t i o n w i t h the r e l a t i o n s h i p would be expected change.  I t may  a l s o be t h a t i f the emotional e x p e r i e n c e of the  r e l a t i o n s h i p o v e r r i d e s o t h e r cues spouses may and a c c e p t i n g new spouse  be more open to p e r c e i v i n g  and more c o o p e r a t i v e behaviours and a t t i t u d e s i n t h e i r  a f t e r the emotional c l i m a t e has  The  to  i n c r e a s e i n s a t i s f a c t i o n and  terms of i n t i m a c y and  changed. c o h e s i o n may  the enhancement of bonds.  a l s o be understood i n  In the d e s c r i p t i o n of  couples i n h e a l t h y f a m i l i e s g i v e n by Lewis et a l . (1976) they note three c h a r a c t e r i s t i c s of these h e a l t h y r e l a t i o n s h i p s ;  first,  the presence of  profound emotional bonds, second, o p p o r t u n i t i e s f o r i n t i m a c y , and the use of r e s p e c t f u l n e g o t i a t i o n .  The  c o h e s i o n i n the EF treatment group may  increase i n s a t i s f a c t i o n  third and  be regarded as a r e f l e c t i o n of  the f a c t t h a t t h i s treatment d i r e c t l y addresses the f i r s t  two  issues.  T h i s i s supported by the f a c t t h a t the A f f e c t i o n a l E x p r e s s i o n aspect of the Dyadic Adjustment  S c a l e and the E m o t i o n a l Intimacy s u b s c a l e on the  Intimacy I n v e n t o r y showed a t r e n d i n f a v o r of the EF treatment. f a c t o r s were a c t u a l l y found t o be s i g n i f i c a n t  f o r the female  spouses  an a n a l y s i s of i n d i v i d u a l data; the reason f o r the d i f f e r e n t i a l by females may  Both on  response  be t h a t they are more s e n s i t i v e to these a s p e c t s of a  124  relationship  or  that they were more a f f e c t e d  treatment.  These f a c t o r s  i n c r e a s e as  i n t i m a c y and  suggests s a t i s f a c t i o n l e v e l and  are  the  i n t i m a c y Is enhanced by  would appear to be  the  would expect  related of  be  mainly a r e f l e c t i o n of  spouses.  One  to  intimacy  r e l a t i v e l y "deep"  effective  of  the  d i s c u s s i o n of  t h a t males began to  romantic l i g h t . spoke of  The  the  analysis  this result  responses on  i s c o n s i s t e n t w i t h the of  of  spouse and  cohesion  implementation  relationship of  the  trend of  the  of  results  to male  male spouses However, t h i s  as a whole and  see  t h e i r spouses i n a more p o s i t i v e  in  the  and  Post-Therapy Q u e s t i o n n a i r e r e s u l t s where couples perceiving their  vulnerability  would seem to support t h i s i n t e r p r e t a t i o n .  s i n c e men  generally less  responsive to,  their  generalisation  of  the  overall  c o u p l e s i n the  EF  group.  spouse.  T h i s r e s u l t may  be  that  and  a b l e openly  to express emotions to t h e i r spouse t h i s r e s u l t s e s t i m a t i o n of  partner's  I t may  o r i e n t e d towards  e x p r e s s i v e of emotional e x p e r i e n c e , when males are  positive  scores  t h i s s u b s c a l e i n Chapter 3 i t seems more  s e e i n g t h e i r p a r t n e r d i f f e r e n t l y and  are  the  p a r t of the  i s that the  Intimacy S c a l e . the  found i n  individual  i n c r e a s e d i d e a l i s a t i o n on  interpretation  were f a k i n g p o s i t i v e  safely  to  i n c r e a s e i n s a t i s f a c t i o n and  i n c r e a s e d i d e a l i s a t i o n of  treatment seems as a r e s u l t  likely  disclosure  n a t u r a l outcome of an  EF  light  the  of  treatment.  The  result  elements  I f as Waring et a l . (1981)  f o r most couples i s c l o s e l y  f e a r s then an  EF  the  k i n d s of elements one  bonding p r o g r e s s e d .  p e r s o n a l needs and  the  by  and  In a more  also  be  a  increase i n s a t i s f a c t i o n experienced  by  125  I n t e l l e c t u a l Intimacy a l s o changed to a s i g n i f i c a n t l y h i g h e r i n the EF couples compared to the PS c o u p l e s . and  t r u s t evoked  I t may  level  be t h a t openness  by the EF therapy g e n e r a l i z e d from the e x p r e s s i o n of  e m o t i o n a l i s s u e s to c o g n i t i v e r a t i o n a l ^ d i s c u s s i o n .  In an emotional  c l i m a t e of h o s t i l i t y and d e f e n s i v e n e s s i s s u e s c o n s i d e r e d at the l e v e l of r a t i o n a l d i s c u s s i o n can q u i c k l y e s c a l a t e i n t o heated s t r u g g l e s and i n t e l l e c t u a l d i s c u s s i o n may  be s t i f l e d  so  or a v o i d e d .  Other f a c e t s of i n t i m a c y measured by the PAIR appeared u n a f f e c t e d by e i t h e r treatment, namely S o c i a l , Sexual and R e c r e a t i o n a l Intimacy. S o c i a l Intimacy as a f a c t o r c o r r e l a t e d at a n o t i c a b l y and u n i q u e l y low l e v e l w i t h a l l other outcome s u b s c a l e s , which suggests t h a t i s s u e s as whether couples have many f r i e n d s i n common are not r e l a t e d m a r i t a l adjustment  such  to  i n the same manner as the o t h e r outcome v a r i a b l e s .  R e c r e a t i o n a l Intimacy seemed to be u n a f f e c t e d by h i g h e r l e v e l s of s a t i s f a c t i o n and g e n e r a l adjustment; part of l i f e changing  perhaps  common a c t i v i t i e s become  s t y l e and remain r e l a t i v e l y r e s i l i e n t  r e l a t i o n s h i p happiness or d i s t r e s s .  u n a f f e c t e d by treatment t h i s may  be due  Sexual Intimacy was  suggest if  The  because  s p e c i f i c a l l y d i d not focus upon t h i s a r e a .  t h a t s e x u a l a s p e c t s of a marriage  r e l a t e d a r e a w i t h i n the  also  to the s c r e e n i n g procedures  which screened out s e x u a l d y s f u n c t i o n , or perhaps procedures  i n the f a c e of  the  treatment  This results  are i n some sense a d i s t i n c t  relationship.  i n c r e a s e d r e d u c t i o n of the Target Complaint  i n the EF group  be seen as p a r t o f the g e n e r a l e f f e c t of EF on s a t i s f a c t i o n  Fincham and O'Leary ( i n p r e s s ) have  may  and  i n t i m a c y , or i t can be i n t e r p r e t e d as a r e f l e c t i o n of the importance emotional e x p e r i e n c e .  also  suggested  of  126  t h a t b e h a v i o u r a l responses i n c l o s e r e l a t i o n s h i p s seem to be mediated a f f e c t i v e response has argued  r a t h e r than c a s u a l a t t r i b u t i o n s , and Zajonc  f o r the primacy  of a f f e c t  i n general.  by  (1980)  I f emotional  e x p e r i e n c e p r o v i d e s a framework f o r the c r e a t i o n of meaning i n a r e l a t i o n s h i p and o v e r r i d e s o t h e r cues, when that emotional response i s m o d i f i e d , then i n t e r a c t i o n p a t t e r n s between spouses f l e x i b l e and open and any complaint may effectively.  Complaints  can become more  be a b l e to be d e a l t w i t h more  a l s o tended to be e m o t i o n a l i n content so t h a t  e x p l o r i n g and d i s c l o s i n g v u l n e r a b i l i t i e s and emotional needs would address the " h u r t " and  sense of d e p r i v a t i o n which Wile  i s the b a s i s f o r m a r i t a l  distress.  The main s i g n i f i c a n c e of the r e s e a r c h r e s u l t s treatment  (1981) suggests  seems to be that a  i n t e r v e n t i o n which f o c u s e s on the emotional e x p e r i e n c e  u n d e r l y i n g the i n t e r a c t i o n a l p a t t e r n s i n r e l a t i o n s h i p s can be and  i n t h i s study was  found to be a powerful t o o l to change the manner  i n which c o u p l e s e x p e r i e n c e d t h e i r r e l a t i o n s h i p and r e s o l u t i o n of m a r i t a l c o n f l i c t . The was  specified  to f a c i l i t a t e  f a c t t h a t assignment  random and t h a t the t h e r a p e u t i c a l l i a n c e was  to treatment  monitored  s i g n i f i c a n t d i f f e r e n c e s found between treatment groups  the  adds  and  no  credibility  to the c l a i m t h a t the d i f f e r e n t i a l d i f f e r e n c e s i n outcome between the treatment groups were due  to the i n t e r v e n t i o n s used r a t h e r  than  confounding f a c t o r s such as c l i e n t m o t i v a t i o n or t h e r a p i s t and relationship Alliance and  factors.  The  responses on the Task dimension of the  S c a l e a l s o suggest t h a t both treatments were e q u a l l y  r e l e v a n t to p a r t i c i p a n t s , and  from e i t h e r treatment  client  the f a c t  f u r t h e r supports t h i s  t h a t t h e r e were no view.  credible drop-outs  127  T h i s study does not occurrence  of emotional  specifically processes  and  show a c a u s a l l i n k between the outcomes i n m a r i t a l therapy,  however i t i s p o s s i b l e to p o s t u l a t e the mechanisms of change i n v o l v e d i n the EF treatment. proposed to be each o t h e r .  The  key mechanisms of change i n the EF treatment  the m o d i f y i n g  T h i s process  of spouses p e r c e p t i o n s of themselves  c r e a t e s a new  e v o c a t i o n of r e c i p r o c a l  s t a n c e s , and  the growth of i n t i m a c y and  t r u s t which r e s u l t s  d i s c l o s u r e of p e r s o n a l meanings and  Solomon (1977) has noted  t h a t emotional  concerned  h e i g h t e n i n g of primary  experience  with self-concept.  emotional  schema and make a v a i l a b l e key  experience  be l o g i c a l l y r e l a t e d r e l a t i o n s h i p and responsiveness tie  thus how  management and  e x p l o r a t i o n and  h e l p s to access the  of s e l f  as  A l s o , spouses  a f f i r m a t i o n of the o t h e r s  reality  enhances the development of c r e s i v e bonds  These bonds are formed i n the process  The  self  Such c o g n i t i o n s would seem to  the r e l a t i o n s h i p i s d e f i n e d .  the p a r t n e r s t o g e t h e r , and  interaction.  The  to the p o s i t i o n s taken by the p a r t n e r s i n a  to the o t h e r s needs and  ( T u r n e r , 1970).  needs.  is essentially  c o g n i t i o n s r e g a r d i n g the nature  d e f i n e d i n r e l a t i o n to the o t h e r spouse.  and  self-protective  from the e x p l o r a t i o n and  s e l f - r e f e r r i n g and  and  r e c i p r o c i a l responsiveness  undermines the automatic facilitates  are  a b i l i t y to abandon o r d i n a r y defence  d i s c l o s e w i t h s a f e t y , Turner  of  continued  p a t t e r n s and  (1970) suggests, not  enhances s p o n t a n e i t y but q u i c k l y c r e a t e s t i e s between  image  only  people.  Conclusions The main i m p l i c a t i o n s of t h i s study are then t h a t a treatment focuses upon the a c c e s s i n g and  e x p r e s s i o n of u n d e r l y i n g  emotional  which  128  e x p e r i e n c e can modify m a r i t a l adjustment facilitate  the attainment  and  intimacy l e v e l s  of r e l a t i o n s h i p g o a l s and  and  the r e d u c t i o n o f  t a r g e t complaints l e a d i n g to an a l l e v i a t i o n of m a r i t a l c o n f l i c t distress.  These r e s u l t s suggest  v i a b l e a l t e r n a t i v e to the s k i l l therapy and a t t e s t  and  that t h i s e x p e r i e n t i a l approach i s a o r i e n t e d b e h a v i o r a l approach to m a r i t a l  to the s i g n i f i c a n c e of emotional e x p e r i e n c e i n the  p r o c e s s of m o d i f y i n g the n a t u r e of i n t i m a t e r e l a t i o n s h i p s . On a t h e o r e t i c a l l e v e l the most important  i s s u e s a r i s i n g from  this  study would seem to be the s a l i e n c e of emotional e x p e r i e n c e i n r e l a t i o n s h i p d e f i n i t i o n and skill  o r i e n t a t i o n to i n t i m a t e r e l a t i o n s h i p s .  nature and  cannot  q u e s t i o n of how  be adequately addressed  process of change. therapist  by any  s i n g l e study. can be used  by r e s e a r c h which s p e c i f i c a l l y  The to c r e a t e  focuses upon the  T h i s study however at l e a s t d e l i n e a t e s s p e c i f i c  a c t i v i t i e s designed  to evoke and modify  i s s u e of the r e l e v a n c e of s k i l l s  marital  Both i s s u e s are complex i n  emotional processes r e l a t e to and  change must be addressed  The  the q u e s t i o n of the a p p r o p r i a t e n e s s of a  and  emotional  responses.  the t e a c h i n g of s k i l l s i n  therapy i s a l s o a m u l t i f a c e t e d one.  The  process of l e a r n i n g  a l t e r n a t i v e b e h a v i o r p a t t e r n s would seem to be an i n h e r e n t p a r t of therapy, however how l o v e and  the l e a r n i n g of s k i l l s  respect i s a d i f f i c u l t  behavioral marital  question.  r e l a t e s to the c r e a t i o n of As Weiss (1978) p o i n t s out  therapy o f f e r s a technology f o r changing  r e l a t i o n s h i p s r a t h e r than a theory of a d u l t i n t i m a c y . to  any  I t may  be  useful  p l a c e the m o d i f i c a t i o n of i n t i m a t e r e l a t i o n s h i p i n the c o n t e x t of  i n t i m a t e emotional bonds r a t h e r than viewing such r e l a t i o n s h i p s i n terms of  exchange t h e o r y .  129  On how  the l e v e l of c l i n i c a l p r a c t i c e t h i s study poses q u e s t i o n s as to  best  to d e l i n e a t e even more s p e c i f i c a l l y  the a p p r o p r i a t e  therapist  i n t e r v e n t i o n s at p a r t i c u l a r p o i n t s i n the c l i e n t ' s change p r o c e s s ,  and  how  to t r a i n t h e r a p i s t s to implement e m o t i o n a l l y focused i n t e r v e n t i o n s .  The  i s s u e of the p o s s i b l e i n t e g r a t i o n of b e h a v i o r a l and  i n t e r v e n t i o n s i s a l s o an i n t e r e s t i n g one. therapy may  be,  experiential  The most e f f e c t i v e m a r i t a l  f o r example, a s e r i e s of e m o t i o n a l l y  focused  i n t e r v e n t i o n s to change the p o s i t i o n s taken by the spouses i n r e l a t i o n to each o t h e r , f o l l o w e d by the t e a c h i n g of problem s o l v i n g s k i l l s h e l p the couple m a i n t a i n and  strengthen  these new  From the p o i n t of view of the c l i n i c i a n attest  positions.  the r e s u l t s of t h i s  study  to the e f f i c a c y of a c l i n i c a l i n t e r v e n t i o n i n which the  therapist,  1) i d e n t i f i e s  themes i n a core s t r u g g l e , 2)  n e g a t i v e i n t e r a c t i o n c y c l e s and these  to  identifies  the p o s i t i o n s each p a r t n e r takes i n  c y c l e s , 3) r e d e f i n e s the problem i n terms of newly s y n t h e s i z e d  emotional  e x p e r i e n c e s , 4) encourages p a r t n e r s to i d e n t i f y w i t h disowned  a s p e c t s of t h e i r e x p e r i e n c e ,  5) h e l p s each p a r t n e r to accept  p o s i t i o n and,  the e x p r e s s i o n of needs and wants and  6) f a c i l i t a t e s  c r e a t i o n of new  solutions.  The  focus on i n n e r experience  t r a n s l a t e s i n t o r e l a t i o n s h i p events marital  Future  the  other's the  as i t  appears to be a f r u i t f u l one  in  therapy.  Research  The  first  task i m p l i e d by the r e s u l t s of t h i s  study i s the  r e p l i c a t i o n of the study, perhaps by a b e h a v i o r a l l y o r i e n t e d researcher.  The  r e s u l t s of the treatment  of those  couples a s s i g n e d  to  130  the c o n t r o l group i n t h i s study w i l l a l s o be a n a l y s e d and  should  provide  a d d i t i o n a l evidence as to the e f f i c a c y of the EF treatment.  The  i n v o l v i n g the c o n t r o l group d i f f e r s from  the study p r e s e n t e d  in this  d i s s e r t a t i o n i n t h a t the t h e r a p i s t s used  to t r e a t  were i n e x p e r i e n c e d ; the e f f e c t e f f i c a c y of the EF treatment  of t h e r a p i s t e x p e r i e n c e  couples  l e v e l on  the  should then be a b l e to be documented.  i s a p a r t i c u l a r l y r e l e v a n t i s s u e s i n c e one treatment  the c o n t r o l  study  This  h y p o t h e s i s c o n c e r n i n g the EF  i s t h a t a r e l a t i v e l y h i g h l e v e l of t h e r a p i s t e x p e r t i s e and  e x p e r i e n c e i s n e c e s s a r y to s u c c e s s f u l l y implement t h i s Inexperienced  t h e r a p i s t s seem to f i n d  i t difficult  p r o c e s s of i n t e r a c t i o n r a t h e r than the content and emotional  treatment.  to focus on to evoke and  e x p e r i e n c e r a t h e r than r a t i o n a l l y d i s c u s s such  (Greenberg  the heighten  experience  & Johnson, i n p r e s s ) .  P o s s i b l e f u t u r e r e s e a r c h might a l s o examine the process of r e s o l u t i o n comparing the i n therapy performance of couples who c o n f l i c t s w i t h t h a t of n o n - r e s o l v e r s and  conflict resolve  r e l a t i n g process o r i e n t e d  i n d i c e s such as the l e v e l of e x p e r i e n c i n g on the E x p e r i e n c i n g S c a l e ( K l e i n , Mathieu,  K e i s l e r , G e n d l i n (1969) or the q u a l i t y of  r e c o r d e d on the S t r u c t u r a l A n a l y s i s of S o c i a l Behaviour to outcome v a r i a b l e s . events  i n therapy may  As suggested be i d e n t i f i e d  conflict  and  1977)  s u c c e s s f u l performance i n a related  Such r e s e a r c h would f a c i l i t a t e r e s o l u t i o n and  (Benjamin,  by R i c e and Greenberg (1983) change  p a r t i c u l a r change event documented and outcomes.  interactions  to s u c c e s s f u l e v e n t u a l  the b u i l d i n g of a model of  the d e t a i l e d d e s c r i p t i v e a n a l y s i s i n v o l v e d would  h o p e f u l l y b e g i n to e x p l a i n how  change occurs i n the e m o t i o n a l l y focused  131  treatment,  and  specifically  l i n k i n - t h e r a p y events  to  treatment  outcomes. 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Unpublished d o c t o r a l d i s s e r t a t i o n , Pennsylvania State U n i v e r s i t y , 1973. Wile,  D.E. Couples therapy: W i l e y & Sons, 1981.  A n o n - t r a d i t i o n a l approach.  New York:  W i l l i a m s , A.M.A. A b e h a v i o r a l a n a l y s i s o f the q u a n t i t y and q u a l i t y o f m a r i t a l i n t e r a c t i o n r e l a t e d to m a r i t a l s a t i s f a c t i o n . Journal of A p p l i e d B e h a v i o r a l A n a l y s i s , 1979, 12, 665-678. W i l l i a m s , A.M., M i l l e r , W.R. E v a l u a t i o n and Research on m a r i t a l therapy. In G. P i r o o z Sholevar ( E d . ) , The handbook o f marriage and m a r i t a l t h e r a p y , New York: Spectrum Pubs., 1981.  145  W o o l f o l k , R.L. A multimodal p e r s p e c t i v e on emotion. In A Lazarus ( E d . ) , M u l t i m o d a l b e h a v i o r a l therapy, New York: Springer, 1976. Z a j o n c , R.B. F e e l i n g and t h i n k i n g . P r e f e r e n c e s American P s y c h o l o g i s t , 1980, 35, 151-175.  need no  inferences.  APPENDIX A TREATMENT MANUALS  147  RATIONALE:  PROBLEM SOLVING INTERVENTION  These c o u n s e l l i n g s e s s i o n s are based i n t o h a b i t u a l ways of r e l a t i n g t o and  upon the i d e a t h a t couples  get  t r y i n g to change each other t h a t  tend to make the r e l a t i o n s h i p more d i s t r e s s i n g f o r both p a r t n e r s r a t h e r than e n a b l i n g them to work out t h e i r problems t o g e t h e r . will new  focus upon t e a c h i n g you both some new s t r u c t u r e d ways of d e f i n i n g and  The  sessions  communication s k i l l s and some  s o l v i n g problems i n your  r e l a t i o n s h i p so t h a t you can both l e a r n t o n e g o t i a t e e f f e c t i v e l y changes you would l i k e  to see i n each o t h e r ' s  f o r the  behavior.  S i n c e a l l problems In a r e l a t i o n s h i p have i m p l i c a t i o n s  and  consequences f o r both p a r t n e r s every problem i s a mutual problem c o l l a b o r a t i o n i s i n the i n t e r e s t  of both of the p a r t n e r s .  and  This  c o u n s e l l i n g p r o c e s s i n v o l v e s t e a c h i n g couples how  to n e g o t i a t e w i t h each  o t h e r f o r change i n a s t r u c t u r e d r a t i o n a l way  how  compromises t h a t w i l l be s a t i s f y i n g to both We  will  to f i n d  parties.  be working on m o d i f y i n g communication p a t t e r n s t h a t  i n t e r f e r e w i t h problem s o l v i n g through demonstrating together.  and  d i f f e r e n t ways of communicating which we  You w i l l  not be the way  the use of feedback  and  by  can then  practise  l e a r n a s u p p o r t i v e s t y l e of communication which  you want to i n t e r a c t w i t h each other a l l the time,  can h e l p you when s p e c i f i c i s s u e s come up i n the r e l a t i o n s h i p t h a t need t o r e s o l v e i n o r d e r t o keep the r e l a t i o n s h i p s a t i s f y i n g i n v o l v i n g f o r you  both.  and  may  but you  148  C.P.S.P.  PROBLEM SOLVING MANUAL  T h i s manual i s b r i e f s i n c e the p r o c e s s of therapy i s a l s o d e l i n e a t e d i n Jacobson  and M a r g o l i n (1979), pages 215-258.  General P r i n c i p l e s : or  A l l new  r e l a t i v e l y n e u t r a l content.  skills  are f i r s t  taught u s i n g p o s i t i v e  Each s e s s i o n begins w i t h the  therapist  s e t t i n g the agenda f o r the s e s s i o n , than r e v i e w i n g the homework, troubleshooting i f necessary t e a c h i n g new  ( e s p e c i a l l y i n s e s s i o n s 2 and 3 ) , and  skills.  FRAMEWORK Session 1 Session 2  Assessment.  P r e s e n t a t i o n of treatment  Troubleshoot i f necessary.  rationale.  Teach communication  skills,  model, rehearse and coach u s i n g p o s i t i v e content as much as possible. Session 3  Troubleshoot i f necessary. Teach problem d e f i n i t i o n and a n a l y s i s s k i l l s , model rehearse and coach u s i n g h y p o t h e t i c a l or v e r y minor r e a l i s s u e s , u s i n g communication skills.  Session 4  Troubleshoot only i f e s s e n t i a l . Review problem d e f i n i t i o n s k i l l s , a p p l y these s k i l l s to an i s s u e i n the couple's relationship.  Session 5  Teach problem s o l u t i o n s k i l l s , apply these s k i l l s to a h y p o t h e t i c a l or minor i s s u e f i r s t , then to the i s s u e d e f i n e d i n S e s s i o n 4.  Session 6  Teach c o n t r a c t i n g s k i l l s , apply to a h y p o t h e t i c a l or s m a l l i s s u e f i r s t and then t o the s o l u t i o n s to the i s s u e b r a i n s t o r m e d i n S e s s i o n 5.  Session 7  R e v i s e the c o n t r a c t implemented f o r homework. R e v i s e the complete p r o c e s s of problem d e f i n i t i o n , a n a l y s i s , s o l u t i o n , and c o n t r a c t i n g .  Session 8  Summarize p r o c e s s e s and r u l e s . generalisation issues.  Deal w i t h t r a n s f e r  and  149  PROBLEM SOLVING TREATMENT  SESSION 1 - ASSESSMENT Therapist 1.  Amplify the  2.  Tasks:  The t h e r a p i s t  How  them to each o t h e r , how d i d  courtship  they found rewarding about each  p r o c e e d , what was i t t h a t  Focus on p o s i t i v e s .  E n c a p s u l a t e problems as p r e s e n t e d , and attempted s o l u t i o n s .  the  The t h e r a p i s t  partners.  observes the couple i n t e r a c t f o r 8 minutes as they  t h e i r problem and notes t h e i r communication  The t h e r a p i s t  p r e s e n t s the treatment r a t i o n a l e .  change i n the r e l a t i o n s h i p . collaboration  e s s e n t i a l part Homework:  The t h e r a p i s t  patterns.  The problem i s  framed i n terms o f l a c k o f s k i l l s n e c e s s a r y t o c r e a t e  and  The  frames the problem as a mutual one, c o l l a b o r a t i o n being i n  i n t e r e s t s o f both  discuss 5.  enquires as t o the h i s t o r y o f the r e l a t i o n s h i p .  d i d the couple meet, what a t t r a c t e d  therapist  4.  the f u n c t i o n a l a s p e c t s of  relationship.  other. 3.  s t r e n g t h s , probe f o r and r e i n f o r c e  positive  emphasises t h a t hard work  a r e n e c e s s a r y and homework assignments a r e an  o f the c o u n s e l l i n g .  Give the couple the problem s o l v i n g manual to r e a d , encouraging them t o s e t a time i n the week t o do t h i s and any f u t u r e homework.  150  SESSION 2 The  t h e r a p i s t g i v e s the r a t i o n a l e f o r l e a r n i n g t o l i s t e n t o each  o t h e r , s h a r i n g and c l a r i f y i n g communication.  The t h e r a p i s t models  p o s i t i v e non-verbal  and shapes communication  skills  through  b e h a v i o r and p a r a p h r a s i n g  a process o f feedback i n s t r u c t i o n and r e h e a r s a l .  Feedback i s d e s c r i p t i v e , e.g. you i n t e r r u p t e d him, as opposed t o i n t e r p r e t i v e or e v a l u a t i v e .  L a t e r i n the s e s s i o n s when the couple are  f a m i l i a r w i t h the s t r u c t u r e the t h e r a p i s t may simply  stop the c o u p l e ' s  i n t e r a c t i o n and ask "Why I am s t o p p i n g you" and encouraging to  i d e n t i f y and r e c t i f y  effect  t h e i r mistake.  The t h e r a p i s t  focuses upon the  of communication p a t t e r n s , t h a t i s the responses  behaviors  elicit  from the p a r t n e r .  certain  The couple are encouraged t o l a b e l  f e e l i n g s and t o v a l i d a t e those of t h e i r spouses. p a r t i c u l a r l y upon enhancing  the couple  p o s i t i v e exchanges.  a c t i v i t i e s c o n s i s t o f g i v i n g feedback,  The t h e r a p i s t  focuses  The t h e r a p i s t ' s main  modelling, structuring behavioral  r e h e a r s a l o f e f f e c t i v e communication and r e i n f o r c i n g p o s i t i v e exchanges. These s k i l l s  should f i r s t  be p r a c t i s e d u s i n g p o s i t i v e c o n t e n t , f o r  example t a l k i n g about a p l e a s a n t memory. If  necessary  session.  the T r o u b l e s h o o t i n g procedure  can be used i n t h i s  Here the t h e r a p i s t l i s t e n s t o a problem s i t u a t i o n from  p o i n t s o f view, summarizes the problem which o c c u r r e d and asks  both  both  p a r t n e r s a t each p l a y by p l a y step what they c o u l d have done d i f f e r e n t l y to  prevent  the s i t u a t i o n becoming as n e g a t i v e .  The t h e r a p i s t l o o k s f o r  g e n e r a l p r i n c i p l e s emerging from t h i s p a r t i c u l a r i n c i d e n t and w r i t e s a c o n t r a c t t o h e l p the couple a v o i d a r e o c c u r r e n c e  o f the c o n f l i c t .  151  Homework:  F i v e minutes each of p a r a p h r a s i n g the p a r t n e r as they about a p o s i t i v e  talk  issue.  SESSION 3 The  t h e r a p i s t e x p l a i n s the r a t i o n a l e f o r l e a r n i n g problem  d e f i n i t i o n s k i l l s and process  environmental  c o n t i n g e n c i e s which support  (e.g. s e t an agenda, s e t a time frame, do not problem s o l v e i n  the heat of the b a t t l e ) .  The  couple are now  communication s k i l l s taught i n the l a s t clearly.  The  p r o c e s s and 1.  therapist  encouraged to use  g i v e s r a t i o n a l e s f o r these  the  s e s s i o n t o d e f i n e i s s u e s more  s e t s out r u l e s f o r the problem  definition  rules:  When s t a t i n g a problem b e g i n w i t h r e l e v a n t p o s i t i v e s to maximise the p a r t n e r s a b i l i t y t o l i s t e n and  2.  the  Be s p e c i f i c .  to keep i s s u e s i n p e r s p e c t i v e .  Focus on b e h a v i o r , s i t u a t i o n , and  consequence.  The  t h e r a p i s t i n s i s t s upon b e h a v i o r d e s c r i p t i o n r a t h e r than t r a i t and  labels  d i s c o u r a g e s the use of i n f e r e n c e s , s u g g e s t i n g couples speak o n l y  of what they can observe. be summarized h e r e .  D i f f e r e n t ways to view problems may  Each problem may  d e f i c i t , environmental  be viewed i n terms of  also  excess,  c o n t i n g e n c i e s , d i f f e r i n g e x p e c t a t i o n s , or  l a c k of reward f o r d e s i r e d b e h a v i o r .  T h i s s t r u c t u r e may  be  used  a g a i n when t e a c h i n g b r a i n s t o r m i n g . 3.  Avoid o v e r g e n e r a l i s a t i o n s .  4.  L a b e l your upon  you.  f e e l i n g s , t h a t i s the impact  your p a r t n e r ' s b e h a v i o r  has  152  5.  Admit t o your p a r t i n the problem., e.g., I should have brought i t up  6.  sooner.  Be b r i e f .  S i d e - t r a c k i n g and c r o s s - c o m p l a i n i n g are d i s c o u r a g e d , as  i n any d i s c u s s i o n o f causes.  The s k i l l s  a r e f i r s t modelled  t h e r a p i s t and t r i e d out u s i n g h y p o t h e t i c a l or v e r y minor problems.  Having  taught  the r u l e s the t h e r a p i s t  i n t e r a c t i o n when they a r e not observed modify  t h e i r behavior.  by the  real  then stops the  and h e l p s the couple t o  A good problem d e f i n i t i o n c o n s i s t s of a  d e s c r i p t i o n of b e h a v i o r , a s p e c i f i c a t i o n o f the s i t u a t i o n , and consequences. Homework:  P r a c t i s e p a r a p h r a s i n g , and take a v e r y minor i s s u e i n the r e l a t i o n s h i p and use the above process t o come up w i t h a c l e a r problem d e f i n i t i o n .  The t h e r a p i s t a l s o uses  Troubleshooting i n t h i s session i f necessary.  SESSION 4 In  t h i s s e s s i o n the s k i l l s o f S e s s i o n s 2 and 3 c o n t i n u e t o be  r e i n f o r c e d and p r a c t i s e d . skills  t o d e f i n e an i s s u e that i s o f concern  relationship. to  I f p o s s i b l e the couple should now use these t o them i n t h e i r  L e g i t i m a c y o f the problem i s assumed i f i t i s d i s t r e s s i n g  one of the p a r t n e r s .  The p a r t n e r s committment t o n e g o t i a t i o n i s  s t r e s s e d as e s s e n t i a l t o problem s o l v i n g .  Homework:  W r i t e a problem  d e f i n i t i o n on a s m a l l problem i n t h e i r r e l a t i o n s h i p , and put the problem i n the p e r s p e c t i v e s o f e x c e s s , d e f i c i t , e t c .  153  SESSION 5 The  procedures f o r problem s o l v i n g a r e now taught.  teaches the b r a i n s t o r m i n g problem.  The  process u s i n g a h y p o t h e t i c a l or very  A l t e r n a t i v e s o l u t i o n s are considered  b e n e f i t s t o each p a r t n e r . focus  The t h e r a p i s t  P o s s i b l e options  here i s upon n e g o t i a t i o n , p a r t n e r s  minor  i n terms o f c o s t s and  are narrowed and r e f i n e d . are encouraged t o  d i f f e r e n t i a t e between what they want i d e a l l y and what they are w i l l i n g to s e t t l e f o r .  Having p r a c t i s e d once the p a r t n e r s  s o l u t i o n s t o the problem they d e f i n e d  i n Session  4.  f e a s i b l e s o l u t i o n s a cost b e n e f i t a n a l y s i s should  brainstorm  A f t e r l i s t i n g 5-6  w h i t t l e the l i s t  down  t o 2-3.  The t h e r a p i s t h e l p s  inherent  i n the implementation of s o l u t i o n s , and the rewards they can  provide  the couple c o n s i d e r  then  the d i f f i c u l t i e s  t o r e i n f o r c e such implementation.  Homework:  Brainstorming  s o l u t i o n s f o r one of the s m a l l i s s u e s used as  problem d e f i n i t i o n homework i n the l a s t  sessions.  SESSION 6 In t h i s s e s s i o n c o n t r a c t i n g i s taught and a c o n t r a c t f o r the i s s u e brainstormed i n S e s s i o n  5.  The c o n t r a c t  c o n t r a c t , and i s w r i t t e n up i n s p e c i f i c b e h a v i o r a l helps  the couple t o c o n s i d e r  i s w r i t t e n up  i s a good  terms.  faith  The t h e r a p i s t  ways t o ensure t h a t the c o n t r a c t i s  implemented. Homework:  To implement the above c o n t r a c t . the  To w r i t e  up a c o n t r a c t f o r  s m a l l i s s u e they b r a i n s t o r m e d f o r homework.  154  SESSION 7 In this session the s p e c i f i c contract made i n Session 6 i s evaluated  and revisions are made i f necessary.  Communication, problem  d e f i n i t i o n and problem solving s k i l l s are then reviewed.  I f possible  the couple then take a small issue and rehearse a problem solving session to deal with that issue with the therapist coaching them. Homework:  Conduct a problem solving session at home on a minor issue.  SESSION 8 Processes and rules are summarised.  The therapist structures an  eight minute i n t e r a c t i o n where the couple discuss the problem they discussed during the eight minute i n t e r a c t i o n i n session one.  The  therapist also prepares the couple for relapse and teaches them how to i n i t i a t e a problem solving session; they then rehearse this  initiation.  The therapist helps the couple i d e n t i f y cues which might suggest that such a session i s necessary, and how the environment can be made conducive to problem solving, as well as ways the couple might increase the p r o b a b i l i t y of this process occurring i n the future. If necessary Session 3 may be divided into two sessions and Sessions 6 and 7 collapsed. Please inform the assessor  for your couple as to the date and time  of your l a s t session since post measures w i l l be given at the end of this session.  155  PROBLEM ANALYSIS  Problems may be viewed i n terms o f  1.  Too much of a c e r t a i n  behavior  2.  Too l i t t l e  3.  Circumstances  4.  P a r t n e r s having d i f f e r e n t  5.  P a r t n e r s not rewarding  of a b e h a v i o r i n the s i t u a t i o n which c o n t r i b u t e t o the problem expectations  each other f o r d e s i r e d b e h a v i o r s .  Each of these views may l e a d t o d i f f e r e n t  EXAMPLE - Paul not spending  solutions.  enough time w i t h Mary a t the p a r t y may be  viewed a s : 1.  Paul t a l k i n g too much t o other p e o p l e . Mary s i t t i n g too much on h e r own and not s o c i a l i z i n g .  2.  P a u l not t a l k i n g t o Mary enough. Mary not responding t o people's approaches enough.  3.  The f a c t t h a t both P a u l and Mary were t i r e d h a v i n g attended t h r e e the week b e f o r e .  4.  Mary assumed t h a t P a u l and she would be t o g e t h e r a l l evening s i n c e the p a r t y was s m a l l . P a u l assumed t h a t they would be separate s i n c e there were b u s i n e s s people a t the p a r t y he wanted to meet.  5.  Mary d i d not respond to Paul when he d i d t a l k t o h e r . P a u l d i d not i n c l u d e her i n the c o n v e r s a t i o n when she d i d approach him.  of a t t e n d i n g p a r t i e s ,  156  RATIONALE:  ?  EMOTIONALITY FOCUSED INTERVENTION  These c o u n s e l l i n g s e s s i o n s are based upon the i d e a that the more you understand and can accept the p o s i t i o n s you and your p a r t n e r take i n the r e l a t i o n s h i p , that i s the way  you see and r e a c t to each o t h e r , the  more c h o i c e you can have over what happens i n the r e l a t i o n s h i p . o f t e n u n d e r l y i n g concerns or f e e l i n g s that we cannot q u i t e express which c o l o r the way  we  It i s  are not q u i t e aware of or  react  to each o t h e r .  E m o t i o n a l c h a i n r e a c t i o n s seem to get s e t up and then take on a l i f e t h e i r own,  so that both p a r t n e r s end up f e e l i n g misunderstood  f r u s t r a t e d and  of  and  that they are somehow not r e a l l y g e t t i n g what they want  from each o t h e r .  F e e l i n g s towards each o t h e r which are not  o f t e n get i n the way  understood  o f couples b e i n g a b l e to d i s c u s s t h i n g s openly  and  resolve concrete i s s u e s . So these s e s s i o n s w i l l be geared  towards each of you h a v i n g a  c l e a r e r p i c t u r e of what happens i n your r e l a t i o n s h i p , how  each of you  e x p e r i e n c e the r e l a t i o n s h i p , and h e l p i n g you to be aware of and communicate your needs t o each o t h e r i n a way and a c c e p t .  Both o f you w i l l  that your p a r t n e r can  then h o p e f u l l y f e e l more accepted  c l o s e r to each o t h e r and as a r e s u l t be a b l e to r e s o l v e i s s u e s and f i n d new  and p o s i t i v e ways t o respond t o each o t h e r .  hear  and openly  157  THERAPY MANUAL:  EMOTIONALLY FOCUSED THERAPY  FORMAT: FRAMEWORK ASSESSMENT THERAPY STEPS AND THERAPIST ACTIVITIES TERMINATION OPERATIONAL DEFINITIONS THERAPIST INTERVENTIONS, DESCRIPTIONS  @/Greenberg and Johnson  158  SESSION 1 - ASSESSMENT  THERAPIST TASKS  1.  Delineate c o n f l i c t  i s s u e s more p r e c i s e l y and  attempted  solutions.  I d e n t i f y themes i n core s t r u g g l e . 2.  D i s c u s s each p a r t n e r s p e r c e p t i o n of the problem. Observable  b e h a v i o r s are noted but the focus i s upon how  p a r t n e r sees the s e l f and  the other i n t h i s r e l a t i o n s h i p and  stances or p o s i t i o n s each takes i n the 3.  Note and  each the  relationship.  e x p l o r e p a t t e r n s i n the process of  interaction.  I d e n t i f y sequences of p r o b l e m a t i c r e a c t i o n s as the c o u p l e s n a r r a t e or  enact  attempt  them.  How  do t h i s couple connect, m a i n t a i n d i s t a n c e ,  to i n f l u e n c e and p r o t e c t themselves  the t h e r a p i s t ?  events  are noted.  are explored. and  The  relationship.  c o u l e s ' e x p e c t a t i o n s of the  Norms as to p o w e r / c o n t r o l ,  c l o s e n e s s / d i s t a n c e are noted.  developmental 5.  purposes.  E n q u i r e r e g a r d i n g the h i s t o r y of the Key  and  A l l o w a 10 minute d i s c u s s i o n of the p r e s e n t i n g  problem f o r r e s e a r c h 4.  a g a i n s t each other  The  dependence/independence,  t h e r a p i s t a l s o c o n s i d e r s the  stage of the r e l a t i o n s h i p and  E n q u i r e about the f a m i l y of o r i g i n and Note p a r t n e r s ' views of male and mentioned above. stemming from l i f e  Hypothesize  relationship  life  female  the l e v e l of commitment. h i s t o r y of the p a r t n e r s .  r o l e s and  v u l n e r a b i l i t i e s and  e x p e r i e n c e s which may  the norms sources of a n x i e t y  be r e f l e c t e d  i n the  present  159  relationship. self-concept 6.  How and  do  i n t e r a c t i o n p a t t e r n s impact the  self-esteem?  Present Treatment  Rationale.  The  therapist  and  interacting sensitivities  frames problems i n terms of d e p r i v a t i o n , i n the  relationship.  framed i n terms of stuck emotional c h a i n r e a c t i o n s automatic and now  are  estabish  The  g o a l of the  therapist  i n f o r m a t i o n g a t h e r i n g and  diagnostic  sessions,  in building  rapport and  session  session  and  behaviour a l s o  interaction will  Since t h i s i s  much more of  increase.  c r e a t e s e x p e c t a t i o n s f o r the  f o r example by encouraging c l i e n t s  f o r the  o t h e r and  discouraging disruptive  Typical  therapist  activities:  is  t r u s t w i t h both an  the  t h e r a p i s t - c l i e n t i n n a t u r e than i n the  s e s s i o n s where c l i e n t - c l i e n t by h i s / h e r  which have become  throughout the  g i v e n them hope f o r p o s i t i v e outcomes.  i n t e r a c t i o n w i l l be  problem i s  by.  a working a l l i a n c e , to c r e a t e  p a r t n e r s and  unmet needs,  The  which both p a r t n e r s have p a r t i c i p a t e d  imprisoned  PROCESS NOTE:  individual's  following  The  therapist  process of  the  to speak f o r themselves  not  interruptions.  Empathic Responding Direct  Questions and  intrapersonal  Probes as  to i s s u e s ,  i n t e r a c t i o n patterns  anxieties  Observe/Hypothesize r e g a r d i n g the  central struggle  in  relationship Framing of problem i n terms of treatment  perspective.  the  and  160 '  Steps o f Treatment T h i s therapy  tends  to occur i n a c i r c u l a r  sequence t h e r e f o r e t h i s manual w i l l  r a t h e r than a  focus on the steps of the  r a t h e r than attempt a s e s s i o n by s e s s i o n account. process  and  the key  linear  i n t e r v e n t i o n s f o l l o w below.  The  process  steps i n the  These steps  are  e l a b o r a t i o n s of the framework s t a t e d below.  1.  D e f i n e i s s u e as  presented  D e f i n e problems as seen by the c l i e n t s . view of the problem, and how r o l e i n the problem. to make a f u l l and  Sumarizing  and  complete statement  goals. of t h e i r  person's  their  Each person  partner's  i s encouraged  position.  D i r e c t q u e s t i o n s and probes;  Empathic  each p a r t n e r ' s need to be r i g h t and  responding;  reality  claims  innocent of blame.  I d e n t i f y negative i n t e r a c t i o n cycles An example of such a c y c l e might be  withdraws by l e a v i n g the room. t a l k to you. day  and  i n t e g r a t i n g i n f o r m a t i o n ; V a l i d a t e opposing  and p o s i t i o n s and  2.  they p e r c e i v e t h e i r own  E s t a b l i s h shared  Therapist A c t i v i t i e s :  E s t a b l i s h each  You  finally  or so he i n i t i a t e s  You  "when you demand a t t e n t i o n he  become more upset  g i v e up and  a l s o withdraw.  s u p e r f i c i a l contact."  p a r t n e r s s o l u t i o n s to the problem i n t e n s i f i e s other.  The  t h e r a p i s t explores behaviours,  i n v o l v e d i n the c y c l e i n o r d e r to c l a r i f y "dance".  Behaviour  as he r e f u s e s to Finally after  In such c y c l e s each of  a the  the problem f o r the  f e e l i n g s and  perceptions  each p a r t n e r ' s p o s i t i o n i n the  towards the p a r t n e r i s l i n k e d to u n d e r l y i n g  161  feelings. occur  Such c y c l e s may  i n the therapy  asks you why and  start  or they  may  comments  For example, the t h e r a p i s t comments, I n o t i c e  to express your views on t h i s t o p i c your  see t h i n g s t h a t way,  confused  N e g a t i v e messages such as blaming the p a r t n e r are e x p l o r e d  i n terms  to e x p l a i n ...  of u n d e r l y i n g needs.  and  then you  partner  seem to get  start  you  reconstructed  s e s s i o n where the t h e r a p i s t i d e n t i f i e s and  upon them as they happen. t h a t when you  be t a l k e d about and  etc.  The  framing  of behaviour i n terms of  an  i n t e r a c t i o n a l c y c l e f o s t e r s a p e r s p e c t i v e of mutual r e s p o n s i b i l i t y . partners  are encouraged to develop t h e i r p o s i t i o n more f u l l y and  The  their  p o s i t i o n s are v a l i d a t e d . Therapist A c t i v i t i e s :  The  t h e r a p i s t i d e n t i f i e s and  connects elements i n  the c y c l e by means of q u e s t i o n i n g , e x p l o r i n g , c l a r i f y i n g i n t e r p r e t i n g each p a r t n e r ' s p e r c e p t i o n s  f e e l i n g s and  and  r e a c t i o n s to the  other.  N e g a t i v e a l i e n a t i n g r e a c t i o n s o c c u r r i n g i n the s e s s i o n are  pointed  out and  d i s c u s s e d , f o r example, mind r e a d i n g of the  p a r t n e r or making n e g a t i v e behaviour i s not search  dispositional attributions.  r u l e d out as u n h e l p f u l but  Blaming  used by the t h e r a p i s t to  f o r the f e e l i n g u n d e r l y i n g s p e c i f i c a c c u s a t i o n s .  f u r t h e r r a t h e r than c h a l l e n g e d ended e x p l o r a t i o n s and t h e i r own  experience.  Examples:  a.  To  do you  as u n a c c e p t a b l e .  The  I t i s developed  t h e r a p i s t uses open  o n l y i n t e r p r e t s i f c l i e n t s are unable to d i s c o v e r  clarify  d i d you  other  do do?  f o r being  c y c l e and  p o s i t i o n s the t h e r a p i s t says:  then? or When your p a r t n e r does You  What what  c r i t i c i z e Jack f o r never h o l d i n g you  c o l d to you, when he does t h i s how  do you  and feel?  162  b.  To draw a t t e n t i o n t o i n t e r a c t i o n a l p a t t e r n s says:  the t h e r a p i s t  I t seems that when your p a r t n e r t a l k s you  i n t e r r u p t - I'm wondering what i s happening f o r you, what i s i t t h a t you a r e e x p e r i e n c i n g  2.  when you do t h i s ?  Access and accept unacknowledged f e e l i n g s u n d e r l y i n g  problematic  intereactions. E m o t i o n a l responses at the p e r i p h e r y of awareness a r e attended t o h e i g h t e n e d and l i n k e d t o s e l f - p e r c e p t i o n s .  Particular attention  to v u l n e r a b i l i t i e s f e a r s and unexpressed resentments. events a r o u s i n g s t r o n g  Significant  emotion a r e a t times r e c o n s t r u c t e d ,  and a r e f o c u s s e d upon to r e v e a l u n d e r l y i n g  o r enacted i n  the  session  are  thus exposed t o a s p e c t s of s e l f and the o t h e r not p r e v i o u s l y  acknowledged.  This  i s to be d i s t i n g u i s h e d  s u p e r f i c i a l and/or d e f e n s i v e r e a c t i o n s ; emotional experience. be  i s paid  emotion.  Clients  from the v e n t i l a t i o n o f  i t i s a new s y n t h e s i s of  An example o f such a s u p e r f i c i a l r e a c t i o n would  an angry r e a c t i o n expressed w i t h no awareness of a sense o f t h r e a t o r  underlying  fear.  These r e a c t i o n s  a r e e x p l o r e d f o r the u n d e r l y i n g  e x p e r i e n c e of f e a r . Therapist  Activities:  E v o c a t i v e responding (see the end o f the manual  f o r a d e t a i l e d d e s c r i p t i o n o f the m o d i f i e d form o f t h i s This  intervention  involves  focused r e f l e c t i o n , p r o b i n g and  i n t e r p r e t a t i o n by the t h e r a p i s t .  The t h e r a p i s t may attempt t o s u p p l y  m i s s i n g f e e l i n g s , or supply sentences f o r a c l i e n t t h e r a p i s t may a l s o a t t e n d  intervention).  to f i n i s h .  t o b o d i l y s e n s a t i o n s the c l i e n t i s  The  163_'  e x p e r i e n c i n g and metaphors may responses.  to non-verbal  a l s o be c r e a t e d to heighten  The  The  and  Images and  clarify  emotional  T h i s experience  and  i s then v a l i d a t e d by  There i s a c o n t i n u i n g focus on the emotional  o c c u r r i n g i n the  4.  i n general.  focus i s upon l o o k i n g at i n n e r e x p e r i e n c e  of such e x p e r i e n c e . therapist.  behaviour  the owning  the experience  present.  problem i s r e d e f i n e d i n terms of newly s y n t h e s i z e d  emotional  experiences. The  problem i s now  of d e p r i v a t i o n and and  i n t e r p r e t e d and  carried  construed  alienation.  i n terms of a d u l t unmet needs and I n t e r a c t i n g s e n s i t i v i t i e s are  i n d i v i d u a l experience  f o r the other spouse and  i s translated  the r e l a t i o n s h i p .  responses  coping r e a c t i o n s are v a l i d a t e d and  taught  i n the f a m i l y of o r i g i n and  Such i n t e r p r e t a t i o n s  c u r r e n t need f o r these responses New  emotional  a blaming  may  withdrawal hurt.  response  experiences.  back to the  s e l f images.  The  i s explored.  p e r s p e c t i v e s on the r e l a t i o n s h i p and  c r e a t e d by the new  related  to key  explored  i n t o the meaning  i n t e g r a t e the c l i e n t s ' a f f e c t i v e , c o g n i t i v e and b e h a v i o u r a l Fears and  sense  the p a r t n e r s  s y n t h e s i s are now  behaviour  integrated.  For  example,  be seen as an e x p r e s s i o n of a need f o r l o v e or a  seen as a f e a r response  Attempts are made to capture  i n s t e a d of as an attempt these new  o c c u r r i n g i n i n t e r a c t i o n s d u r i n g the s e s s i o n .  to punish  f e e l i n g s as they The  clients  encouraged to i n t e r a c t w i t h each other i n the s e s s i o n s and  are  are to  share  t h e i r u n d e r l y i n g f e e l i n g s as they emerge i n the s e s s i o n i n r e a c t i o n to  or  16:4  t h e i r partners.  There i s a s t r o n g focus on what i s o c c u r r i n g i n the  p r e s e n t between the p a r t n e r s .  These f e e l i n g s a r e e x p l o r e d f u l l y ,  both  i n terms o f t h e i r p e r s o n a l meanings and t h e i r meaning t o the p a r t n e r .  Therapist A c t i v i t i e s :  The impact on the r e l a t i o n s h i p o f t h e p e r s o n a l  v u l n e r a b i l i t i e s e x p l o r e d i n Step 3 a r e now c l a r i f i e d .  The t h e r a p i s t  i n t e r p r e t s elements i n the i n t e r a c t i o n a l sequence i n terms o f u n d e r l y i n g needs and f e a r which stem from i n t e r a c t i n g s e n s i t i v i t i e s , f o r example, J i m i s v i g i l a n t r e g a r d i n g a c t i o n s of J i l l ' s t h a t he p e r c e i v e s as r e j e c t i n g and responds by b u l l y i n g ; J i l l responds by r e j e c t i n g .  i s s e n s i t i v e t o b u l l y i n g and  This c y c l e prevents  the p a r t n e r s ' needs i n t h e r e l a t i o n s h i p .  c o n t a c t and the meeting of  Evocative responding  may a l s o  be used as w e l l as i n t e r p r e t a t i o n s o f i s s u e s and d e f e n s i v e r e a c t i o n s i n terms o f f a m i l y o f o r i g i n schemata. maintained  centered  focus i s  and p a r t n e r s a r e r e g u l a r l y asked what they f e e l r i g h t now i n  response t o what t h e i r p a r t n e r s j u s t  5.  A present  said.  I d e n t i f y i n g w i t h disowned a s p e c t s o f e x p e r i e n c e  i n the redefined  cycle. The  c y c l e , r e d e f i n e d i n terms o f u n d e r l y i n g e m o t i o n a l  e x p e r i e n c e and  needs, i s enacted d e l i b e r a t e l y i n o r d e r f o r the p a r t n e r s t o become more aware o f t h e i r u n d e r l y i n g needs and t o g a i n a sense o f c o n t r o l o f t h e s e automatic  responses.  The c l i e n t s a r e i n s t r u c t e d t o become more f u l l y  "who they a r e " by engaging d e l i b e r a t e l y i n t h e i r p a r t o f t h e c y c l e  165  r a t h e r than t r y i n g not to engage i n t h i s behaviour. withdrawer and  For example, the  the pursuer are both encouraged to more f u l l y  experience  t h e i r u n d e r l y i n g f e e l i n g s and needs which were p r e v i o u s l y disowned. Aspects  of e x p e r i e n c e  such as the withdrawer's f e a r of b e i n g overwhelmed  and need to p r o t e c t and for  support are f u l l y  asked  the blamer's f e e l i n g s of being unloved and need  d i s c u s s e d and then p r e s c r i b e d .  to i d e n t i f y w i t h disowned a s p e c t s of t h e i r e x p e r i e n c e , t o  t h e i r p o s i t i o n f u l l y and behaviours needs.  Each person i s develop  t o d e l i b e r a t e l y engage i n some of the  a s s o c i a t e d w i t h t h e i r p r e v i o u s l y disowned f e e l i n g s  and  T h i s i s an i n t r a p s y c h i c a l l y o r i e n t e d i n t e r v e n t i o n f o c u s i n g on  e n a c t i n g disowned p a r t s r a t h e r than e n a c t i n g the n e g a t i v e  interactional  c y c l e as occurs i n some p a r a d o x i c a l i n t e r v e n t i o n s . D i s t a n c i n g p a r t n e r s , for  example, may  be asked  e i t h e r i n the s e s s i o n or f o r homework to  d e l i b e r a t e l y p r o t e c t themselves of  or p r a c t i c e p u t t i n g up a w a l l as a  way  becoming more aware of and g a i n i n g c o n t r o l over t h i s sometimes  p r o b l e m a t i c aspect of t h e i r own d e l i b e r a t e l y engage i n support t h e i r need to be n u r t u r e d and  behaviour.  Pursuers  s e e k i n g behaviours  and  are asked  to  to become aware of  the f e e l i n g s a s s o c i a t e d w i t h t h i s .  If  one  p a r t n e r f e e l s too dependent or f e e l s a n x i e t y about being i n t i m a t e , he or she i s asked  to i d e n t i f y w i t h the dependent or f e a r f u l aspect of  their  e x p e r i e n c e r a t h e r than to deny these p a r t s or t r y to disown them.  Both  p a r t n e r s are r e a s s u r e d at t h i s p o i n t t h a t even though i t might seem s t r a n g e or be d i f f i c u l t problematic  to a c t i n a manner t h a t they construe  (such as dependent or a f r a i d ) t h a t these are the  they are a c t u a l l y f e e l i n g and  t h a t t h i s i s o n l y being more  as feelings  congruent.  166  It  i s emphasized t h a t i t i s important  i n resolving marital conflict  take r e s p o n s i b i l i t y f o r one's f e e l i n g s and t h a t a c c e p t i n g these and  d e l i b e r a t e l y behaving  will  behaviours.  Once p a r t n e r s have i d e n t i f i e d w i t h disowned a s p e c t s o f t h e i r it  feelings  i n ways a s s o c i a t e d w i t h these f e e l i n g s  g i v e them more c o n t r o l and c h o i c e of these f e e l i n g s and  experience  i s p o s s i b l e to i n t e g r a t e these a s p e c t s both i n t r a p h y s i c a l l y and  i n t o the r e l a t i o n s h i p .  to  also  I d e n t i f y i n g w i t h disowned a s p e c t s of e x p e r i e n c e  i s worked on i n the s e s s i o n and g i v e n as homework and people are  asked  to do i t d e l i b e r a t e l y i f p o s s i b l e , or to "go w i t h " t h e i r e x p e r i e n c e when they b e g i n to f e e l t h e i r p r e v i o u s l y disowned e x p e r i e n c e r a t h e r than f i g h t i n g a g a i n s t that aspect of Therapist A c t i v i t i e s :  Suggests  themselves. people i d e n t i f y  disowned a s p e c t s o f t h e i r e x p e r i e n c e . acceptance  of each person's  The  f u l l y with p r e v i o u s l y  t h e r a p i s t conveys an u l t i m a t e  p o s i t i o n , f e e l i n g s and needs by s u g g e s t i n g  t h a t people do what they are d o i n g r a t h e r than t r y not t o .  Although  t h e r e i s a " p r e s c r i p t i o n " of c e r t a i n behaviours and e x p e r i e n c e s , the f o c u s i s on h a v i n g people do what they do w i t h f u l l awareness and responsibility  ( i n order to make p r e v i o u s l y automatic  responses  d e l i b e r a t e ) r a t h e r than to p r e s c r i b e a paradox t o g a i n t h e r a p e u t i c c o n t r o l of the i n t e r a c t i o n a l  6.  Acceptance The  cycle.  of p a r t n e r s p o s i t i o n .  f o c u s i s now  upon the communication to the spouse of the newly  e x p e r i e n c e d emotional responses, and the p a r t n e r ' s acceptance responses.  The  therapist  f a c i l i t a t e s acceptance  of these  of the o t h e r ' s needs on  i67-"  the p a r t of each spouse, p r i m a r i l y by t r a c k i n g i n t e r a c t i o n s and b l o c k i n g or e x p l o r i n g non-accepting  responses.  The t h e r a p i s t h e l p s the couple  c o n s t r u c t the c o n v e r s a t i o n they might have had i f they had been i n touch w i t h and a b l e t o r e p o r t t h e i r f e e l i n g s and v u l n e r a b i l i t i e s . avoidance  o f the e x p r e s s i o n of v u l n e r a b i l i t y  u s u a l l y confronted i n t h i s process.  The phobic  i n the r e l a i t o n s h i p i s  T h i s s e s s i o n i s not d i r e c t e d  towards the t e a c h i n g of the s p e c i f i c s k i l l  of empathic l i s t e n i n g but  toward h e l p i n g p a r t n e r s r e v e a l new a s p e c t s o f themselves t o t h e i r mates and  f a c i l i t a t i n g a new i n t i m a c y and c o n t a c t between the p a r t n e r s .  B l o c k s t o one p a r t n e r ' s a b i l i t y t o hear and accept experience  the o t h e r ' s  are examined and i n t e r p r e t e d i n terms o f t h a t p a r t n e r ' s view  of s e l f , past l e a r n i n g i n f a m i l y o f o r i g i n and c a t a s t r o p h i c f e a r s . therapist f a c i l i t a t e s  acceptance  The  o f s e l f and o t h e r s i n c o n t r a s t t o the  u s u a l p a t t e r n of r e c i p r o c a l d i s q u a l i f i c a t i o n which occurs i n d i s t r e s s e d relationship. Therapist A c t i v i t i e s : to c l a r i f y responses suggesting Example:  E v o c a t i v e responding;  r e l a t i o n s h i p events;  i n t e r p r e t a t i o n and l a b e l l i g  drawing a t t e n t i o n t o the nature of  to the p a r t n e r and the impact  of these responses, and  alternatives. a.  I f e e l alone  ( e x p e r i e n c e of abandonment and h e l p l e s s n e s s  i n t e g r a t e d i n p r e v i o u s s t e p s ) because you never show y o u r s e l f , your f e e l i n g s ; never r e a l l y show me how you feel. b.  I don't show you my f e e l i n g s , w e l l I suppose I don't, I'm a f r a i d t o show you, when I have I get a t t a c k e d .  168-  Therapist:  (to ( a ) ) .  How  can (b) show you h i s f e e l i n g s i n a way  you  can hear them.  7.  E x p r e s s i o n of needs and wants The e m o t i o n a l s y n t h e s i s  and  interpersonal  i n terms of i n t r a - i n d i v i d u a l  e x p e r i e n c e l e a d s to a c l a r i f i c a t i o n of needs and wants  i n the r e l a t i o n s h i p . she  of the i s s u e  that  One p a r t n e r can now d i r e c t l y ask f o r what he or  wants or needs from the o t h e r , and the i m p l i c a t i o n s  f o r the i n d i v i d u a l s and the r e l a t i o n s h i p u n d e r l y i n g the p o s i t i o n s  of these  can be examined.  Key  desires  attitudes  each p a r t n e r has taken i n the r e l a t i o n s h i p  b e g i n to be e x p l o r e d . Therapist  Activities:  and  wants.  8.  New  Focus i n t e r a c t i o n upon the e x p r e s s i o n of needs  C l a r i f y and i n t e r p r e t such needs i f n e c e s s a r y .  Solutions  The statement of needs and wants, a c c e s s e d , i n t e g r a t e d by the spouse, l e a d s t o the c r e a t i o n couple's struggle struggle.  and accepted  of new a l t e r n a t i v e s o l u t i o n s  to the  and the p r e s e n t i n g problem which i s sympomatic of t h i s  The t h e r a p i s t  c l a r i f i e s and e x p l o r e s a s p e c t s o f the s o l u t i o n  w i t h the couple and a g a i n h e l p s them to c o n f r o n t b l o c k s to p o s i t i v e responding.  The t h e r a p i s t  a l s o draws a t t e n t i o n  p o s i t i v e p a t t e r n s of i n t e r a c t i o n .  New  solutions  to and h i g h l i g h t s constitute  a  r e d e f i n i t i o n of the r e l a t i o n s h i p , f o r example, a r e l a t i o n s h i p may one i n which one person can s t a t e needs and the other can g i v e rather  new  become  support  than a r e l a t i o n s h i p i n which one has to coerce and b u l l y the  169.-  o t h e r i n t o s e e i n g and responding assessed  New s o l u t i o n s a r e  i n terms of the needs of both p a r t n e r s and t h e i r  feasibility  9.  i n a c e r t a i n way.  and i f p o s s i b l e enacted  general  i n the s e s s i o n .  I n t e g r a t e new p e r s p e c t i v e s The  t h e r a p i s t helps the couple develop  a shared p e r s p e c t i v e , a  d e t a i l e d p i c t u r e of the r e l a t i o n s h i p , and engage i n metacommunication as to  the past and p r e s e n t nature  o f the r e l a t i o n s h i p .  The t h e r a p i s t  c l a r i f i e s new p o s i t i o n s and p o s i t i v e sequences of emotional the new i n t e r a c t i o n a l c y c l e s .  response and  The past r e l a t i o n s h i p p o s i t i o n s taken by  the p a r t n e r s and the n e g a t i v e c y c l e a r e d i s c u s s e d .  New g o a l s f o r f u t u r e  r e l a t i o n s h i p development as w e l l as new ways of c r e a t i n g and m a i n t a i n i n g intimacy are discussed.  Therapist A c t i v i t i e s :  Summarizing.  Termination i s s u e s .  PROCESS NOTE: These nine steps tend t o be c y c l i c a l ; to p r e v i o u s steps i f n e c e s s a r y ,  the t h e r a p i s t may c i r c l e  or b e g i n the c y c l e of steps f o c u s s i n g  upon some new a s p e c t s o f the c o u p l e s ' core s t r u g g l e . the couple  back  I n the s e s s i o n s  c o n t i n u e to expand t h e i r awareness o f t h e i r stances i n t h e  r e l a t i o n s h i p and the needs and f e a r s u n d e r l y i n g these p o s i t i o n s . p o s i t i o n s , i n t e r a c t i o n p a t t e r n s and key u n d e r l y i n g emotional  As  respones  become c l e a r e r the c o u p l e s ' manner of i n t e r a c t i n g becomes l e s s r e a c t i v e and  automatic,  experienced  a l t e r n a t i v e behavours, f e e l i n g s and thoughts a r e  and experimented w i t h .  The couple  develop  a shared  170  p e r s p e c t i v e of the r e l a t i o n s h i p intimacy.  Since p r e v i o u s l y  accessed, validated,  and b e g i n t o "woo" each o t h e r back i n t o  unaccepted a s p e c t s o f the s e l f have been  expressed and i n t e g r a t e d  i n t o the r e l a t i o n s h i p  a n x i e t y r e d u c i n g defences a r e l e s s and l e s s e v i d e n t . c o n t i n u e s i d e a l l y the t h e r a p i s t and  does l e s s and the p a r t n e r i n t e r a c t more  more h e l p i n g each o t h e r through the t h e r a p u t i c  TERMINATION  process.  SESSION:  This session The  As therapy  l i k e assessment w i l l always f o l l o w  a certain  treatment p r o c e s s w i l l be reviewed, new i n t e r a c t i o n  highlighted,  and the p r e s e n t s t a t e  of the r e l a t i o n s h i p  patterns i n terms of  g o o d w i l l , t r u s t , open c o n t a c t , c l o s e n e s s and p o s i t i v e a f f e c t and  summarized.  format.  assessed  The o r i g i n a l p r e s e n t i n g problem i s d i s c u s s e d and post  treatment measures completed.  OPERATIONAL DEFINTIONS: Need - Awareness of an urgent l a c k  of n u r t u r a n c e , s a f e t y ,  or basic  r e l a t e d n e s s n e c e s s a r y f o r s u r v i v a l and a sense o f w e l l - b e i n g . Boszbrmenyi-Nagi suggests that an  individual's  "ontic  the o t h e r i s the o b j e c t ,  identity delineation  the "ground" f o r  and s e c u r i t y needs and l a b e l s  this  dependence".  Interactional  C y c l e s - Sequences o f b e h a v i o u r s where the response of  one  p a r t n e r becomes the automatic s t i m u l u s f o r an automatic r e a c t i o n i n  the  o t h e r , e.g. I nag because you i g n o r e me, no I i g n o r e you because you  nag.  Such c y c l e s  conflict.  a r e a l i e n a t i n g and u s u a l l y  s p i r a l i n t o more i n t e n s e  I n t e r a c t i n g S e n s i t i v i t i e s - The  s t r a t e g i e s designed  s p e c i a l s e n s i t i v i t y or v u l n e r a b i l i t y of one  to cope w i t h  p a r t n e r which e l i c i t s  s p e c i a l v u l n e r a b i l i t y of the o t h e r r e s u l t i n g i n an a l i e n a t i n g chain r e a c t i o n . historic  The  the  the  emotional  i s s u e to which the p a r t n e r i s s e n s i t i v e o f t e n has  significance.  T h i s term then r e f e r s to the s e n s i t i v i t y which  u n d e r l i e s core f e e l i n g r e a c t i o n s which l e a d to n e g a t i v e  interactional  cycles. P o s i t i o n - A p o i n t of view, p e r s p e c t i v e or o r i e n t a t i o n i n a relationship.  A view of the s e l f i n r e l a t i o n to the other which c r e a t e s  a set of e x p e c t a t i o n s which guide p e r c e p t i o n s , f e e l i n g s and  behaviour.  P o s i t i o n s tend to become r i g i d and p o l a r i z e d i n a context of t h r e a t to s e l f - e s t e e m or w e l l - b e i n g . Contact - to meet or come t o g e t h e r , to touch, to connect experience  r e c i p r o c a l openness, a l l o w i n g the other to impact  communicate openly on an i n t e n s e p e r s o n a l l e v e l .  or you.  To touch - to permit  p a r t of the b o d y / s e l f to come i n c o n t a c t w i t h so as to  feel.  I n t e r p r e t - To c l a r i f y meaning by c o n n e c t i n g or r e l a t i n g one i n a s i t u a t i o n to another, behaviours process  reference.  f o r example, by c o n n e c t i n g  to i n t r a p s y c h i c p e r c e p t i o n s of the s e l f .  of imposing Can  element  relationship It i s also a  meaning upon e v e n t s , or c r e a t i n g a new  frame of  be more or l e s s c o n f r o n t i v e .  C l a r i f y - To make the i m p l i c i t beyond awareness. interpretation.  To  e x p l i c i t - d e a l s w i t h what i s j u s t  Symbolize more completely.  Can  be a m i l d form of  172.  THERAPIST INTERVENTION.  EVOCATIVE RESPONDING  T h i s i n t e r v e n t i o n c o n s i s t s of probes clarify  or statements which attempt  and h e i g h t e n the c l i e n t s ' emotional e x p e r i e n c e i n t h e r a p y  to  and  make the automatic a focus of c o n s c i o u s awareness. The  elements Stimulus  of e x p e r i e n c e f o c u s s e d upon a r e : (cue and a p p r a i s a l )  Arousal Response  The  t h e r a p i s t ' s f o c u s depends upon the p r o c e s s of therapy:  SITUATION 1 I f S t i m u l u s , A r o u s a l and Response (SAR)  are a l l c l e a r l y  i n awareness, that i s i f the s t i m u l u s i s c l e a r and a r o u s a l i s present and acknowledged, and ownership  response  experienced  differentiated, i s expressed  with  and i n n e r awareness then the t h e r a p i s t pushes f o r more  d i f f e r e n t i a t e d i n n e r awareness and a c l e a r e r e x p r e s s i o n of e x p e r i e n c e and needs.  Thus spouses  are exposed to a s p e c t s of themselves  and  each  o t h e r t h a t i s beyond awareness. Examples:  Client  - When you l o o k concerned  and  s i t c l o s e to me  t h a t I f e e l very uncomfortable,  I feel  smothered,  hemmed i n , so I t u r n away, c l o s e o f f and you t i l l  you go away.  like  ignore  173.  T h e r a p i s t - Smothered, you f e e l breathe. (Client  l i k e you don't have room to  That's s c a r y , you f e e l  anxious?  n o d s ) , what w i l l happen i f you don't  turn  away? Client  - She w i l l expect me to be a c e r t a i n way, warm, and I can't  f e e l a c e r t a i n way.  I know that I'm not  the husband she wanted.  SITUATION 2 If arousal i s missing,  the t h e r a p i s t heightens u s i n g  images, probes  and i n t e r p r e t a t i o n s . Examples:  T h e r a p i s t - I s that p a i n f u l f o r you? Client  -  Yes, very.  T h e r a p i s t - I t almost sounds l i k e you're i n a cave and shouting  h e l p , h e l p , and a l l you f e e l you get i s  the echo of your own v o i c e .  Client  - I have t o d e a l w i t h  i t , not burden him w i t h my  j e a l o u s y , he's s t r u g g l i n g t o o . T h e r a p i s t - Sounds l i k e you want to h o l d h i s hand and h e l p him  while  he makes l o v e to h i s l o v e r .  SITUATION 3 I f the Stimulus i s not c l e a r s p e c i f i c  and a l i v e  the t h e r a p i s t  17.4  Examples:  Therapist  - What it  Client  is  that sparks o f f your  so c o n d e s c e n d i n g ,  T h e r a p i s t - What a b o u t - He i s his Therapist  makes  h a r d f o r you t o l i s t e n t o him?  - He's  Client  c y n i c i s m and  I  get  hostile.  t h e way he d o e s t h i s  so l o g i c a l , n e v e r l e t s g o ,  f a c e of I  gets  to  you.  and t h a t l o o k  on  know b e t t e r .  - He seems c o l d and  superior.  SITUATION 4 If  the Response i s  or helps  u n c l e a r the t h e r a p i s t  the couple enact  the sequence  so  d i f f e r e n t i a t e s the  t h a t t h e y may u n f o l d  d i s m a n t l e t h e i r i n t e r a c t i o n s i n terms of e m o t i o n , c o g n i t i o n  Stimulus and  and  behaviour. Example:  Therapist  -  So what h a p p e n s doesn't  Client  -  Nothing,  Therapist  -  I'm  when P a t  t e l l s you t h a t  want t o make l o v e , a n d t u r n s I  accept i t , might  wondering  need t o get  if  you d o n ' t  back at  her?  ask her f e e l hurt  she  away? why. or f e e l  that  APPENDIX B INSTRUMENTS USED IN THE STUDY  DEMOGRAPHIC DATA  QUESTIONNAIRE  COUPLE NUMBER 1.  How many years have you l i v e d  t o g e t h e r as a couple?  2.  How many c h i l d r e n do you have?  3.  Have the two of you had any m a r i t a l c o u n s e l l i n g b e f o r e t a k i n g p a r t i n t h i s p r o j e c t ? Yes No  4.  P l e a s e t i c k the catagory w i t h i n which you gross f a m i l y income falls: Under $15,000 $15,000 - 25,000 $25,000 - 35,000 $35,000 - 45,000 $45,000 - 55,000 Above $55,000  This section should he completed hy the male partner only 5.  P l e a s e s t a t e your age ( i n y e a r s )  6.  What i s your present  occupation?  I f you a r e c u r r e n t l y unemployed p l e a s e s t a t e reasons  why  7.  Have you had a p r e v i o u s marriage?  No  8.  P l e a s e t i c k the catagory which best d e s c r i b e s your e d u c a t i o n a l level:  Yes  Grade 10 o r l e s s Grade 12 or l e s s 2 years of post secondary e d u c a t i o n Community c o l l e g e program completed U n i v e r s i t y degree completed Graduate program completed Ph.D. o r e q u i v a l e n t completed  This section should be completed hy the female partner only 9. 10.  P l e a s e s t a t e your age ( i n y e a r s ) . What i s your present occupation? I f you a r e c u r r e n t l y unemployed p l e a s e s t a t e reasons  why  177,  11.  Have you had a p r e v i o u s marriage?  Yes  12.  P l e a s e t i c k the c a t a g o r y which best d e s c r i b e s your e d u c a t i o n a l level: Grade 10 or l e s s Grade 12 or l e s s 2 y e a r s of post secondary e d u c a t i o n Community c o l l e g e program completed U n i v e r s i t y degree completed Graduate program completed Ph.D. o r e q u i v a l e n t completed  No  17.8  DESCRIPTION OF TARGET COMPLAINTS DESCRIBED BY  The project  kinds  of s t a t e d concerns couples  SPOUSE IN THIS STUDY  brought i n t o the  research  seemed to f i t i n t o the f o l l o w i n g c a t a g o r i e s :  1.  Lack of i n t i m a c y , closeness)  2.  sexual  communication.  Lack of communication i n the sense of r e c u r r i n g power s t r u g g l e s and  seemingly u n r e s o l v a b l e  partners 3.  and  that i s p h y s i c a l ( a f f e c t i o n and  and  fights r e s u l t i n g i n distance  a l a c k of c o o p e r a t i o n  between  i n d e c i s i o n making.  S i t u a t i o n a l c o n f l i c t s which were not  r e s o l v e d and  became  the  source of r e c u r r i n g disagreements, f o r example e x t r a - m a r i t a l a f f a i r s or the b i r t h of a handicapped 4.  C o n f l i c t s concerning  Most couples and  a greater  r o l e d e f i n i t i o n s and  responsibilities.  spoke of wanting more open communiation more a f f e c t i o n  responsiveness  c a t a g o r i e s were mentioned by  to each others the m a j o r i t y  be a balance of complaints a c r o s s  needs.  one  of c o u p l e s .  couple where the male spouse had  outbursts  of u n c o n t r o l l a b l e anger, and  couple r e s o l v i n g i s s u e s c o n c e r n i n g i s s u e most o f t e n mentioned was general  The  first  two  There appeared to  groups; f o r example each group  contained  i s a vague and  child.  a p a r t i c u l a r problem  a l l groups a l s o c o n t a i n e d  past  extra-marital a f f a i r s .  with  one The  a l a c k of open communication however t h i s  term which then had In g e n e r a l  couples  to be  couple and  assessor.  expression  o r i e n t e d r a t h e r than i n s t r u m e n t a l l y  d i f f e r e n t i a t e d by  concerns appeared more oriented.  the  17$  TARGET COMPLAINTS QUESTIONNAIRE C  We a r e i n t e r e s t e d at t h i s time i n the two or three main concerns t h a t you hope t o r e s o l v e d u r i n g c o u n s e l l i n g . P l e a s e l i s t them below: (a)  (b)  (c)  180....  QUESTIONNAIRE D (at  termination)  We a r e i n t e r e s t e d i n how much the f o l l o w i n g i s s u e s i n your r e l a t i o n s h i p has (have) changed s i n c e you s t a r t e d the program. P l e a s e c i r c l e the words that d e s c r i b e your p o s i t i o n .  a.  worse... same... s l i g h t l y b e t t e r . . . somewhat b e t t e r . . . a l o t b e t t e r  b.  worse... same... s l i g h t l y b e t t e r . . . somewhat b e t t e r . . . a l o t b e t t e r  c.  worse... same... s l i g h t l y  b e t t e r . . . somewhat b e t t e r . . . a l o t b e t t e r  GOAL ATTAINMENT QUESTIONNAIRE A  Couple No. Date:  Description  o f the i s s u e you w i l l be working on.  Much worse than expected  results:  Somewhat l e s s than expected  Expected  or most l i k e l y  results:  results:  Somewhat b e t t e r than expected  Much b e t t e r  than expected  results:  results:  ( p l a c e a s t e r i s k (*) next t o l e v e l where you a r e now).  182 ..  THE PAIR INVENTORY  The  f o l l o w i n g a r e the d e f i n i t i o n s of i n t i m a c y i m p l i c i t  Emotional The  Intimacy: e x p e r i e n c i n g o f c l o s e n e s s of f e e l i n g ;  to share openly, i n a nondefensive s u p p o r t i v e n e s s and genuine  Social  i n the PAIR.  the a b i l i t y  and freedom  atmosphere when t h e r e i s  understanding.  Intimacy:  The  e x p e r i e n c e of having common f r i e n d s and a s i m i l a r  social  network.  Sexual  Intimacy:  The  e x p e r i e n c e o f showing g e n e r a l a f f e c t i o n ,  touching, p h y s i c a l  c l o s e n e s s , and/or s e x u a l a c t i v i t y .  Intellectual The  Intimacy:  e x p e r i e n c e o f s h a r i n g i d e a s , t a l k i n g about  life,  i n one's  or d i s c u s s i n g j o b - r e l a t e d I s s u e s , c u r r e n t a f f a i r s , e t c .  Recreational Shared  events  Intimacy: e x p e r i e n c e s of i n t e r e s t s i n p a s t - t i m e s or hobbies; mutual  p a r t i c i p a t i o n i n s p o r t i n g events; mutual involvement r e c r e a t i o n a l or l e i s u r e  activity.  i n any g e n e r a l  183  POST TREATMENT STANDARIZED INTERVIEW Couple No.  C.P.S.P.  Please 1.  p l a c e M o r F a f t e r recorded  statements.  Has your r e l a t i o n s h i p improved as a r e s u l t o f t h i s M. F. If  Yes Yes  counselling?  No No  so how would you d e s c r i b e the change?  2.  What d i d you f i n d most h e l p f u l about t h i s treatment?  3.  Can you remember any c r i t i c a l moments which you c o n s i d e r important i n terms o f h e l p i n g you or your p a r t n e r change your r e l a t i o n s h i p ?  4.  What was l e a s t h e l p f u l o r h i n d e r i n g f o r you about t h i s treatment?  5.  Would you have p r e f e r r e d more s e s s i o n s ? M. F.  Yes Yes  No No  .184  ACTIVITIES WHILE WAITING INQUIRY  Assessor:  Couple No.  Have you and your p a r t n e r taken any a c t i o n to t r y and improve your r e l a t i o n s h i p s i n c e the f i r s t assessment? For,example have you r e c e i v e d any o t h e r o u t s i d e h e l p , read any books which you found u s e f u l , or taken any o t h e r a c t i o n t o h e l p y o u r s e l v e s w h i l e you were w a i t i n g f o r counselling? Yes  No  Document r e p l y : Reading books Talking with friends Speaking  t o any " e x p e r t " , e.g. a m i n i s t e r  Improving the context of the r e l a t i o n s h i p f o r example buying a c a r i f t h i s was an i s s u e , t a k i n g a v a c a t i o n . Other  What was i t about t h i s a c t i v i t y  t h a t you f e e l helped your  relationship.  ,  185/  CONFLICT RESOLUTION TASK  Instructions for Therapists: In the l a s t f i f t e e n minutes of the s e s s i o n p l e a s e ask your to  couples  take a few minutes to t a l k about the i s s u e they have addressed  therapy.  Recap the i s s u e f o r them i n g e n e r a l terms.  in  Suggest to them  t h a t you would l i k e to see what i t i s l i k e f o r them to make a s p e c i f i c s o l u t i o n p r o p o s a l to t h e i r p a r t n e r t h a t addresses i s s u e , which seems r e l e v a n t to them at the moment.  some p a r t of  You would l i k e them  to keep i t as short and as simple as p o s s i b l e , and  the way  like  as to one  them to do i t i s - they each make a statement  are w i l l i n g  you would  p a r t n e r as to one  t h i n g they would l i k e  p a r t n e r to do.  The  their  I f they f i n d t h a t they cannot agree to t h e i r  and  t h i n g they  to do to help c r e a t e harmony i n the r e l a t i o n s h i p , and  make a request of t h e i r  request.  request,  their  p a r t n e r then responds,  that i s f i n e .  the t h e r a p i s t  The  gague how  purpose of t h i s  then  their  d i s a g r e e i n g or a g r e e i n g  i s to help the  to  partners  researchers  r e s o l v e d , i f at a l l , they f e e l about  their  issue. The  therapist  i n t e r v e n e s i n t h i s procedure  o n l y to s t r u c t u r e the  sequence (e.g. to prompt someone to b e g i n , cut someone o f f who rambling  i s just  or to e x p l a i n the next s t e p ) .  Example: I w i l l i n i t i a t e us spending s u g g e s t i n g the time and I ask you  a c t i v i t y , and  t o g e t h e r once a week,  I'd l i k e you  f o r a hug when I come home i n the  I n d i v i d u a l s responses observers  an evening  to respond  to me  when  evening.  to t h e i r p a r t n e r s r e q u e s t s were then r a t e d by  as f a l l i n g i n t o f o u r c a t a g o r i e s , Acceptance,  ( R e s o l u t i o n ) , or R e j e c t i o n , Disagreement.  Agreement  186.  COUPLES PROBLEM SOLVING PROJECT - IMPLEMENTATION CHECKLIST  Couple No.  Session  Instructions  to Raters:  Place  an i n t e r v e n t i o n each time that i s defined  as a t h e r a p i s t  No.  Rater  one check mark on the r a t i n g form under i n t e r v e n t i o n i s noted.  An i n t e r v e n t i o n  statement.  Intervention  Checklist  Problem D e f i n i t i o n  1.  The problem i s d e f i n e d / r e d e f i n e d  i n terms of the emotions  underlying  the p o s i t i o n s taken i n the r e l a t i o n s h i p and the sense of d e p r i v a t i o n e x p e r i e n c e d by the c o u p l e . 2.  The problem i s d e f i n e d and  3.  4.  l a c k of s k i l l s on the p a r t  The t h e r a p i s t c l a r i f i e s the  partners  complaints  of the c o u p l e .  and e l a b o r a t e s  the b a s i c p o s i t i o n s taken by  i n the r e l a t i o n s h i p .  The t h e r a p i s t frames the problem i n terms of mutual bad h a b i t s will  Attacking 5.  i n terms o f m a n i f e s t o b s e r v a b l e  that  need work t o overcome, and teaches b e h a v i o r change c o n c e p t s .  Behavior  The t h e r a p i s t v a l i d a t e s o r develops the p o s i t i o n s i m p l i e d by n e g a t i v e b e h a v i o r such as name c a l l i n g ; i n terms of u n d e r l y i n g  such b e h a v i o r i s i n t e r p r e t e d  needs and f e e l i n g s .  187^  6.  Negative  behavior such as name c a l l i n g i s l a b e l l e d as u n h e l p f u l and  r e l a t e d t o l a c k of s k i l l . are set and  A s u b s t i t u t e i s u s u a l l y suggested.  Rules  rehearsed.  P r o c e s s Focus 7.  The  t h e r a p i s t probes  f o r and heightens  emotional  experience,  e s p e c i a l l y f e a r s and v u l n e r a b i l i t i e s , c l a r i f y i n g e m o t i o n a l  8.  and  responses  and  The  therapist  f o c u s s e s upon and h e l p s the couple p i n p o i n t s p e c i f i c  behaviors.  f o c u s s i n g upon i n n e r awareness.  Observable  b e h a v i o r s are 9.  triggers  antecedents  and  consequences of problem  noted.  E m o t i o n a l meanings are d i s c o v e r e d , d i f f e r e n t i a t e d and e l a b o r a t e d upon.  10. F e e l i n g s are l a b e l l e d i n a problem/goal communicate the impact 11. The  o r i e n t e d context t o  one p a r t n e r s b e h a v i o r has upon the o t h e r .  i n t e r a c t i n g s e n s i t i v i t i e s u n d e r l y i n g b e h a v i o r are c l a r i f i e d  the meaning of i n d i v i d u a l emotional e x p e r i e n c e terms of the o t h e r p a r t n e r and 12. Problem d e f i n i n g and and used  the  and  i s interpreted i n  relationship.  s o l v i n g sequences s k i l l s and  r u l e s are  taught  to s t r u c t u r e i n t e r a c t i o n s .  LISTENING 13. B l o c k s / r e s i s t a n c e to a c c e p t i n g a p a r t n e r s e x p e r i e n c e are e x p l o r e d i n terms of u n d e r l y i n g f e e l i n g s , s e l f - c o n c e p t or e x p e r i e n c e i n f a m i l y of o r i g i n .  (Awareness of i n n e r e x p e r i e n c e i s f o c u s ) .  188  14.  Communication ground r u l e s are is and  taught  (not  rehearsed  set up  and  r e f l e c t i o n ) , responses are (skill  practised.  Paraphrasing  directed  the  by  therapist  focus).  PROBLEM SOLVING 15.  The  therapist  a c c e s s e d and 16.  The  f a c i l i a t e s a f f e c t i v e l y based needs and expressed to the  therapist  facilitates  expected from the 17.  The  therapist  p a r t n e r , and  the  wants b e i n g  partner. i d e n t i f i c a t i o n of s p e c i f i c b e h a v i o r s  p a r t n e r , without b a s i n g them i n f e e l i n g s .  h e l p s the  c l i e n t s c r y s t a l l i s e t h e i r new  to e x p l o r e t h e i r new  f e e l i n g response to  view of  their  this  perspective. 18.  B r a i n s t o r m i n g of a l t e r n a t i v e s o l u t i o n s possible  19.  solutions  are  Shared p e r s p e c t i v e s on  the  A s o l u t i o n i s chosen and r e c i p r o c i t y and  r e l a t i o n s h i p are  comprise.  clarified.  relationship is  a contract Costs and  facilitated.  i s negotiated benefits  stressing  of s o l u t i o n s  weighed.  ADDITIONAL CATEGORIES 21.  Information  22.  Refocus on  23.  Not  gathering. topic.  codable (example:  Menus of  constructed.  Metacommunciation r e g a r d i n g the 20.  i f facilitated.  therapist  assigning  homework).  are  189  EXAMPLES:  1.  EXPLICATION OF IMPLEMENTATION CHECKLIST CATEGORIES  So the problem for you i n this relationship i s that you b a s i c a l l y f e e l alone and isolated from Jim.  2.  So these problems, managing the kids and Pam's overinvolvement i n a c t i v i t i e s outside the home... right now i t seems that you need to learn some new ways to solve these problems.  3.  So your basic approach to this relationship i s that you need to manage i t , to take control so that your wife w i l l be able to overcome what you see as her problems.  Your approach on the other  hand i s to r e s i s t his taking control, not by confronting him but by withholding yourself from him? 4.  Both of you have some habits that prevent you from enjoying this r e l a t i o n s h i p , but the easiest way to get your partner to change i s to reward them for changing; to reward them by changing you own behavior.  5.  You're f e e l i n g pretty angry right now Penny?  Yes, he i s always so  l o g i c a l , and that makes me f e e l . . . , powerless perhaps?  Like you  can't get through to him? 6.  Jane, do you know why I am interrupting you right now? I guess I was c a l l i n g him names.  Client "Yes,  Right, and that i s not h e l p f u l ,  can you describe to him the behavior that you find so offensive? 7.  What happens to you when Linda turns her head l i k e that as you talk? or So as Cary t r i e s to take control of the situation you f e e l more and more a f r a i d , l i k e a l i t t l e c h i l d i s afraid? See Evocative Responding Sheet.  190  8.  What i s i t e x a c t l y t h a t your p a r t n e r does t h a t d i s t u r b s you? when does t h i s  9.  occur?  what happens then?  See e v o c a t i v e responding  sheet.  So a l t h o u g h you f e e l h o s t i l e  and  are too unsure of y o u r s e l f and  overwhelmed when he does t h i s  afraid  you  of h i s d i s a p p r o v a l to t e l l  him  so? 10.  So when he l e a v e s h i s c l o t h e s on the f l o o r even l e s s  11. Tom,  willing  ....  and  from you i t seems l i k e  you  to co-operate w i t h h i s d e s i r e s ?  when you e x p e r i e n c e Sue withdrawing  become a f r a i d  you f e e l angry?  t h a t you are not important  to her and you demand  r e a s s u r a n c e , but then Sue you p a n i c , when people from you you  demand  responses  tend to f e e l t h a t you are being taken over, and  so  you  withdraw more. 12. The  t h e r a p i s t models f o r the c l i e n t  i n the problem.  You  the r u l e - A d m i t t i n g your p a r t  c o u l d say, I know I can make i t d i f f i c u l t f o r  you to work because I step i n and  i n t e r r u p t but i t would be n i c e i f  .... 13. I t seems l i k e you f i n d afraid  i t hard to accept t h a t L i n d a i s sometimes  of you, t h a t you might c r e a t e t h a t k i n d of response  i n her?  or What happens to you when Mary gets mad the image of your mother a t t a c k i n g you,  l i k e t h i s . . . you know I had the way  you d e s c r i b e d  earlier. 14.  Sally to  p l e a s e repeat back the core of what Tom  him.  said  before  responding  191  15. Brenda can you t e l l r i g h t now?  Cory what i t i s that you r e a l l y want from him  How can he r e a s s u r e you?  16. The t h e r a p i s t h e l p s the c l i e n t  frame.  I want you t o g i v e me a hug and a k i s s every morning b e f o r e g e t t i n g out of bed. 17. So Cory t h i s i s a new view f o r you, to understand that Brenda i s truly afraid to t h a t ?  t o have sex w i t h you, to l e t you i n , how do you respond  Client,  "I f e e l s o f t e r , not so angry."  So you f e e l c l o s e r t o her?  Perhaps you would  l i k e t o comfort h e r  r i g h t now? 18. L i s t  a l l possible solutions.  Example, page 142, Jacobson and  M a r g o l i n , 1979. 19. So John i t seems that you are a b l e t o h e l p Anne f e e l more secure i n the r e l a t i o n s h i p now and that she i s t h e r e f o r e more a c c e s s i b l e to you and you a r e f e e l i n g more a c c e p t e d . 20. So the agreement thirty, dinner  i s t h a t , J e r r y w i l l be home every day by s i x  and Marlene w i l l table.  ask f i v e q u e s t i o n s about J e r r y ' s day a t the  192;  Add  Frequency  of  Use:  Minimally  moderately  often  very often  THERAPIST INTERVENTION CHECKLIST  Couple  No.  S e s s i o n No.  Therapist  P l e a s e p l a c e a t i c k b e s i d e i n t e r v e n t i o n s you r e c a l l u s i n g i n t h i s session.  Problem D e f i n i t i o n 1.  D e f i n i n g the problem  i n terms of u n d e r l y i n g  emotions.  2.  D e f i n i n g the problem behaviors.  i n terms of l a c k of s k i l l ,  3.  C l a r i f y i n g / E l a b o r a t i n g b a s i c p o s i t i o n s taken by the c o u p l e .  4.  Teaching b e h a v i o r change c o n c e p t s .  observable  Management o f A t t a c k i n g B e h a v i o r 5.  V a l i d a t i n g / I n t e r p r e t i n g blame i n terms of u n d e r l y i n g  emotions.  6.  L a b e l l i n g blaming as u n h e l p f u l , s u g g e s t i n g s u b s t i t u t e s pinpointing.  -  P r o c e s s Focus 7.  P r o b i n g f o r , h e i g h t e n i n g emotional e x p e r i e n c e , e s p e c i a l l y f e a r s , c l a r i f y i n g t r i g g e r s and responses e x p e r i e n c e d .  8.  P i n p o i n t i n g s p e c i f i c b e h a v i o r s , o b s e r v a b l e antecedents  and  consequences. 9.  I n t e r p r e t i n g / E l a b o r a t i n g upon emotional meanings.  10.  L a b e l l i n g f e e l i n g to make impact clear.  consequences of b e h a v i o r  19-3  11.  C l a r i f y i n g i n t e r a c t i n g s e n s i t i v i t e s , the meaning of i n d i v i d u a l b e h a v i o r f o r the r e l a t i o n s h i p . Enacting negative c y c l e s .  12.  Teaching problem d e f i n i t i o n / s o l v i n g r u l e s . structure interactions.  Using r u l e s  to  Listening 13.  E x p l o r i n g b l o c k s to acceptance of o t h e r s communication i n terms of f e e l i n g s , s e l f - c o n c e p t , or f a m i l y of o r i g i n .  14.  T e a c h i n g communication s k i l l s as p a r a p h r a s i n g .  d i r e c t l y , rehearsing s k i l l s  such  Problem S o l v i n g 15.  Facilitating  the e x p r e s s i o n of a f f e c t i v e l y based needs and  wants. 16. 17.  I d e n t i f y i n g b e h a v i o r s expected Facilitating partner.  from p a r t n e r .  c r y s t a l l i s a t i o n of new  view o f , response  18.  Brainstorming  19.  C l a r i f y i n g shared p e r s p e c t i v e s on the r e l a t i o n s h i p , positions.  20.  Negotiate contract with partner.  to  solutions.  Weigh c o s t s and  new  benefits.  194  THERAPIST SESSION REPORT  Therapist  1.  How much progress their  2.  Couple No.  S e s s i o n No.  do you f e e l your c l i e n t s made i n d e a l i n g  issues i n this  session?  a.  A great d e a l of p r o g r e s s  b.  Considerable  c.  Moderate  d.  Some  e.  No  progress  progress  progress  progress  How r e s o l v e d do you t h i n k your c l i e n t s are r i g h t their  with  issues?  a.  Totally  resolved  b.  Considerably  c.  Moderately  d.  Somewhat r e s o l v e d  e.  Not at a l l r e s o l v e d  resolved resolved  now i n regard t o  APPENDIX C FORMS:  CONSENT AND FOLLOW-UP  196.  CONSENT FORM:  THE COUPLES PROBLEM SOLVING PROJECT  We  understand that t h i s  project  i s concerned w i t h examining methods of h e l p i n g  problems and m a r i t a l c o n f l i c t . recording  coupls  research resolve  We consent t o the use of v i d e o - t a p e  o f our m a r i t a l therapy s e s s i o n s , and the r e l e a s e o f these  v i d e o - t a p e s to the r e s e a r c h  team s u p e r v i s e d  by Dr. L. Greenberg.  We  a l s o g i v e our consent to the use of our w r i t t e n response to the questionnaires  f o r the purposes of t h i s  We understand that we w i l l sessions  and t h a t a l l r e c o r d i n g s  names d e l e t e d to r e s e a r c h right  r e c e i v e e i g h t one hour c o u n s e l l i n g and w r i t t e n responses w i l l have our  and be coded t o p r o t e c t  assistants for scoring.  our p r i v a c y b e f o r e  We a l s o understand that we have the  We understand t h a t withdrawal or tape erasure  i n any way j e o p a r d i z e  access t o f u r t h e r therapy.  We  acknowledge that n e i t h e r of us have r e c e i v e d p s y c h i a t r i c during  they a r e g i v e n  to withdraw from t h i s p r o j e c t at any time and/or to request  tapes be e r a s e d . not  research.  the l a s t two y e a r s .  that  would  further treatment  197  • • -.•  STANDARADIZED FOLLOW-UP PROCEDURE  Each couple were c a l l e d e i g h t weeks a f t e r the t e r m i n a t i o n of treatment. Target  Each p a r t n e r was spoken to s e p a r a t e l y and reminded of the  Complaints and Goal Attainment  measures.  The T.C. s c a l e anchors  were read to each p a r t n e r t w i c e , f o l l o w e d by the d e s c r i p t i o n of t h e i r T.C. which they each had g i v e n i n the assessment i n t e r v i e w . then asked to p l a c e that complaint present  s t a t u s i n the r e l a t i o n s h i p .  then p r e s e n t e d  They were  on the s c a l e so as to r e f l e c t i t s The Goal Attainment  l e v e l s were  and each p a r t n e r was asked to i d e n t i f y the l e v e l most  d e s c r i p t i v e of t h e i r r e l a t i o n s h i p at present  as the d e s c r i p t i o n s of the  l e v e l s they had each g i v e n a t assessment were read out to them. were then  They  t o l d of the other q u e s t i o n n a i r e s i n the m a i l and asked to  complete them. The  process  of the c a l l was as f o l l o w s :  Do you remember the t a r g e t complaint  you i d e n t i f i e d as the main  i s s u e i n your r e l a t i o n s h i p and r a t e d on a s c a l e a f t e r your l a s t session?  therapy  The l e v e l s of the s c a l e were, Worse, Same, S l i g h t l y B e t t e r ,  Somewhat B e t t e r , Much B e t t e r . compalint  as you experience  l e v e l s to you a g a i n .  I am going  to ask you to p l a c e your  i t now on that s c a l e , so I w i l l read the  You might even l i k e  to w r i t e them down.  The  l e v e l s were Worse, Same, S l i g h t l y B e t t e r , Somewhat B e t t e r , Much B e t t e r . Your i s s u e was compalint scale.  ..... (the c l i e n t ' s s h o r t d e s c r i p t i o n of h i s o r her  i s read).  Now I would l i k e you to p l a c e that i s s u e on the  Do you experience  i t a s , Worse, the Same, S l i g h t l y B e t t e r ,  .  -is  198' v  Somewhat B e t t e r , o r Much B e t t e r ?  Thank you.  Now I have one more  q u e s t i o n t o ask you and then I would l i k e to speak to your p a r t n e r . you remember the Goal Attainment after  levels  your l a s t therapy s e s s i o n ?  Do  you d e s c r i b e d f o r us and r a t e d  The l e v e l s  were Worse, Less  than  Expected R e s u l t s , Expected R e s u l t s , B e t t e r than Expected and Much B e t t e r than Expected.  I w i l l read out the l e v e l t o you and then your  d e s c r i p t i o n o f that l e v e l .  I w i l l read i t twice and then I would  you t o t e l l me which l e v e l d e s c r i b e s your r e l a t i o n s h i p understand? Expected  The worse l e v e l you d e s c r i b e d as  l e v e l you d e s c r i b e d as  d e s c r i b e d as and  now.  like  Do you  , the Less  , the Expected  than  l e v e l you  , the B e t t e r than expected l e v e l as  the Much B e t t e r than Expected  l e v e l as  .  I w i l l read  these a g a i n and I would l i k e you to t e l l me the l e v e l which d e s c r i b e s your r e l a t i o n s h i p  now.  Thank you.  ,  199^  FOLLOW-UP LETTER TO COUPLES  Thank you f o r p a r t i c i p a t i n g  i n our follow-up  f o r the Couples  Problem S o l v i n g P r o j e c t .  There a r e two q u e s t i o n n a i r e s f o r each o f you t o complete. and  the PAIR.  The OAS  When you have completed them p l e a s e p l a c e them i n the  stamped addressed  envelope p r o v i d e d  and m a i l .  It will  h e l p us i f you  c o u l d complete the q u e s t i o n n a i r e s w i t h i n a week o f r e c e i v i n g them.  The mailed  to you upon  The study  r e s u l t s o f the study w i l l be a v a i l a b l e e a r l y i n 1984 and can be request.  r e s e a r c h team and I would l i k e  to thank you f o r making  p o s s i b l e and s i n c e r e l y hope that you found  i ta  this  rewarding  experience.  Sue  Johnson,  Coordinator  The  Couples Problem S o l v i n g P r o j e c t  APPENDIX D ITEM ANALYSIS  T a b l e D-l DAS:  Con.  1  Satis.  2  Coh.  3  A f f . Ex.  4  Total  Subtest  Correlations  1  2  3  4  Total  -  .370  .232  .022  .736  -  .508  .275  .825  -  .238  .683  -  .349  Table DAS:  Subtests  (N = 45)  Males:  Con.  D-2  Test  Statistics  Satis.  Coh.  Aff.Ex.  Total  Mean  41.84  32.82  12.71  6.71  94.09  S.D.  5.34  5.25  3.76  2.03  12.07  .70  .82  .85  .60  .86  Reliability  Cronbach's  (Hoyt)  Alpha  .65  203  Table DAS:  Subtests  (N = 45)  Females:  Con.  D-3 Test  Statistics  Satis.  Coh.  Aff.Ex.  Total  Mean  41.07  30.44  11.64  6.71  89.87  S.D.  6.54  4.74  3.29  1.92  11.07  .76  .71  .71  .56  .80  Reliability  (Hoyt)  Cronbach's A l p h a  .47  204  Table PAIR P e r c e i v e d :  1  2  .291  3  .267  D-4  Subtest C o r r e l a t i o n s  4  5  6  Total  .559  .378  .617  .739  Em  1  Soc  2  .358  .329  .409  .238  .638  Sa  3  -  .213  .323  .292  .632  Int  4  -  .511  .482  .726  Rec  5  -  .400  .714  Con  6  —  .708  Total (N =  Note:  90)  E m o t i o n a l Intimacy c o r r e l a t e s w i t h C o n v e n t i o n a l i t y ( i d e a l i s a t i o n ) at the .617 l e v e l .  205  T a b l e D-5 PAIR P e r c e i v e d :  Subtests (N = 45)  Males:  Test  Em  Soc  Individual  Sx  Scores  Int  Rec  Con  Statistics  Mean  12.04  S.D.  4.72  3.96  5.57  4.35  4.24  4.10  .75  .49  .79  .60  .76  .71  14.22  14.38  15.11  8.60  Reliability (Hoyt)  Females:  Test  13.56  13.80  12.29  15  10.16  Statistics  Mean  9.16  S.D.  3.93  4.97  5.42  4.13  4.07  3.62  .53  .73  .79  .55  .68  .61  Reliability (Hoyt)  Note:  12.07  Males:  R e l i a b i l i t y f o r T o t a l (Hoyt) = .88 Cronbach's A l p h a = .77  Females:  R e l i a b i l i t y f o r T o t a l (Hoyt) = .87 Cronbach's Alpha = .79  206  T a b l e D-6 PAIR Expected:  1  Subtest C o r r e l a t i o n s  2  3  .276  4  5  Total  .501  .423  .420  .726  Em  1  Soc  2  .060  .294  .275  .621  Sx  3  -  .396  .418  .644  Int  4  -  .345  .719  Rec  5  —  .712  Total (N = 90)  Note: The minimal c o r r e l a t i o n s occur here m a i n l y on the S o c i a l Intimacy s u b s c a l e . When a c o r r e l a t i o n m a t r i x f o r post s c o r e s on a l l dependent v a r i a b l e s was c o n s t r u c t e d t h i s s c a l e stood out i n t h a t i t c o r r e l a t e d o n l y v e r y m i n i m a l l y w i t h any o t h e r measure. T h i s s u g g e s t s t h a t spending time w i t h o t h e r c o u p l e s o r having f r i e n d s i n common i s n o t o f the same s i g n i f i c a n c e t o c o u p l e s as o t h e r k i n d s o f i n t i m a c y or f a c e t s o f m a r i t a l adjustment.  207  Table PAIR E x p e c t e d :  Subtests (N = 45)  D-7  Individual  Em  Soc  Mean  21.89  18.13  S.D.  2.12  Scores  Int  Rec  22.36  20.58  21.07  2.94  2.14  2.88  2.39  .68  .43  .63  .53  .46  Mean  22.18  19.11  22.60  21.69  21.18  S.D.  1.83  2.05  1.88  2.48  .62  .42  .54  Males:  Test  Statistics  Reliability (Hoyt)  Females:  Test  Reliability (Hoyt)  Note:  Sx  Statistics  .51  3  .60  Males:  R e l i a b i l i t y f o r T o t a l (Hoyt) = .78 Cronbach's A l p h a = .71  Females:  R e l i a b i l i t y f o r T o t a l (Hoyt) = .78 Cronbach's Alpha = .68  APPENDIX E DATA ANALYSIS  209  Table E - l Summary o f Anovas:  Demographics  Groups Variables  ET  PS  C  (N = 45)  M/SD  M/SD  M/SD  No. o f Y e a r s  Together  9.1  Family  3.5  Income  5.8 3.8  1.4 35.6  Male Age  34.3  Male O c c u p a t i o n  Female O c c u p a t i o n  .8454  37.8  .557  .5774  .006  .9945  8.1 34.5  6.2  8.7  55.9 14.4  52.8 13.0  1.099  .3425  9.9 48.5 12.7  43.9 16.7  41.1  1.202  .3106  .290  .7499  59.6  4.2  Female Level  Educational  4.5  Note:  a = .006 (.05/8)  8.6 4.1  4.5 1.7  1.4 3.6  1.1  Catagories  .169  5.5  Male E d u c a t i o n a l Level  Occupational  .1778  1.4  5.8 34.4  (2,42) 1.8  3.8  35.3  P  3.9  1.6  7.3 Female Age  6.7  10.2 5.7  F  1.5 3.54  3.3 1.5  .038  1.2  and Numbers are taken from the B l i s h e n S c a l e .  F a m i l y Income and E d u c a t i o n a l L e v e l numerals r e p r e s e n t catagories.  nominal  210  Table Test  of Emotional  E-2  Style:  A n a l y s i s of Variance  Groups  Male  Variables  ET  PS  C  (N = 45)  M/SD  M/SD  M/SD  13.7  17.2  Orientation  Male  Expressiveness  9.7  10.5 7.2  Male Responsiveness  9.4  Orientation  Expressiveness  14.1  a = .008  (.05/6)  12.8  .07  .938  .96  .390  .48  .624  3.46  .041  .89  .417  6.8 12.9  4.5  .322  8.2  4.3 15.1  4.0  Note:  18.0  18.4  14.0  1.17  4.9  5.8  6.9 Female R e s p o n s i v e n e s s  10.9  20.3  19.5  (2,42)  4.9  4.8  5.5 Female  10.3  8.5  P  6.2  5.0  4.2 Female  13.5 8.3.  7.5  F  5.0  211  Table  E-3  C o u p l e s Therapy A l l i a n c e S c a l e :  Individual  Scores  Groups Variables  EF  PS  (N = 45)  M/SD  M/SD  Male  118.0  Female  Note: a  114.6 13.3  .23  .636  23.5  112.6 12.8  3.53  .071  20.9  124.5  = .05/3 =  .016  (1,28)  212  Table Summary Anova:  E-4  Task Dimension of A l l i a n c e  Scale  (N = 30) Source o f V a r i a t i o n  SS  MS  Between  6.1  6.1  1  19.7  28  Within  552.6  DF  .31  .583  213  Table  E-5  T h e r a p i s t E f f e c t on P o s t t e s t  T o t a l DAS  Scores  Males No. o f T h e r a p i s t s Couples  M/SD  2  1  F(ll,18)  100.0  1.17  Females p .374  M/SD 99.0  18.4 2  2  109.5  99.5  2  110.5  26.2 107.5  12.0 4  2  12.0 115.0  104.0 16.9  3  5  15.6 102.3  104.3 8.5  4  6  6.5 91.3  99.5 4.4  2  7  117.5  7.5 120.0  9.2 2  8  124.0  11.3 115.5  1.41 2  9  111.0  2.1 108.0  1.4 2  10  114.0  4.2 118.5  9.9 11  3  9.2 106.7  109.7 12.7  4  12  N = 60, a =  Bartlett  13.0 105.5  113.3 12.4  Note:  1.08 7.07  14.8 3  F(ll,18)  20.01  .01  Homogeneity  of Variance:  Males = F = .78, j _ = Females = F = .73, £ =  .659 .709  .427  214  T a b l e E-6 T h e r a p i s t E f f e c t on Post Treatment V a r i a b l e s PAIR S u b s c a l e s , GAS, TC: F V a l u e s  Variables PP1  Males  Females  F/p  F/p  1.97  1.92 .096  PP2  1.18 3.66  PP3  .82  .105 1.36 .273 .83  .820 PP4  1.33  .614 1.39  .287 PP5  1.42  .257 .51  .245 PP6  .872 1.74  2.73 .028  TC  1.34  .144 1.77  .279 GAS  1.13  1.43 .394  Note:  All  d . f . = 11,18 Set a = .01, c o r r e c t e d  Bartlett  .137  a = .05/18 = .0027  Box F v a l u e s were n o n - s i g n i f i c a n t  .242  215  Table Pretest  E-7  P a i r Expected Couple  Scores  Groups Variables  ET  PS  C  (N = 45)  M/SD  M/SD  M/SD  PE1  (Em)  87.6  86.9 6.8  PE2  (Soc)  9.7 PE3  (Sx)  90.1  85.5  (Rec)  a = .05  84.6  .574  1.67  .201  .18  .835  .30  .745  .66  .520  6.7 84.9  9.7  .56  7.9  7.4 82.5  85.5 5.6  Note:  90.5  83.5  (2,42)  8.2  6.9  7.3 PES  72.0  88.9  P  5.9  5.8  7.8 PE4 ( I n t )  89.3 6.5  74.1  77.3  F  6.3  216  Table Post-test  E-8  PAIR Expected Scores  Groups Variables  ET  PS  C  (N = 45)  M/SD  M/SD  M/SD  PEl  (Em)  88.7 5.7  PE2  (Soc)  78.9  87.4 12.5  88.8  77.2  75.2  9.9 PE3  (Sx)  89.6  89.2  PE4 ( I n t )  PES  (Rec)  Note:  86.2  5.9  85.2 14.1  .13  .874  .58  .563  .17  .846  .06  .942  .74  .483  7.2 86.7  6.1  87.3  s e t a = .05 c o r r e c t e d a = .01  88.3  86.0  (2,42)  9.3  6.2  5.4  P  4.4  8.6  5.9  F  4.5 83.1 6.4  217  T a b l e E-9 Summary Anova:  Pre and P o s t - t e s t  PAIR Expected  Scores  Groups Variables (N = 45)  ET  PS  C  F(Time)  M(SD)  M(SD)  M(SD)  (1,2,43)  PEl  (Em)  Pre Post  87.6 88.7  (6.8) (5.7)  86.9 87.4  ( 6.4) (12.5)  89.3 88.8  (5.9) (4.4)  PE2  (Soc)  Pre Post  77.3 78.9  (9.7) (9.9)  74.1 77.2  (5.8) (8.6)  72.0 75.2  PE3  (Sx)  Pre Post  90.1 89.6  (7.8) (5.9)  88.9 89.2  (6.9) (6.2)  PE4  (Int)  Pre Post  85.5 86.2  (7.3) (5.5)  83.5 86.0  PES  (Rec)  Pre Post  85.5 87.3  (5.6) (5.9)  82.5 85.2  Note:  s e t a = .01  (.05/5)  p  .06  .800  (8.18) (9.3)  4.16  .048  90.5 88.3  (7.9) (7.2)  4.2  .519  (7.4) (6.1)  84.7 86.7  (6.7) (4.5)  4.34  .043  (9.7) (4.1)  84.9 83.1  (6.3) (6.5)  .51  .480  218  Table E-10 Individual Pretest PAIR Perceived Scores  Groups F  Variables  ET  PS  C  (N = 45)  M/SD  M/SD  M/SD  PP1  46.4 15.2  45.6 17.7  53.1 22.8  PP2  56.8 16.5  51.7 17.8  54.1 13.8  PP3  52.8 24.3  56.5 21.7  56.3 21.9  .13  .882  PP4  54.1 12.5  48.7 16.6  44.5 21.7  1.16  .324  PP5  62.4 14.3  60.0 13.8  56.3 21.3  .51  .607  PP6  41.9 15.8  37.7 13.2  42.4 20.2  .35  .705  PP1  36.8 17.6  36.5 14.4  38.1 15.3  .04  .957  PP2  58.1 20.7  60.5 19.6  52.0 19.7  .73  .490  PP3  56.3 27.4  57.9 22.2  57.9 16.3  .03  .975  PP4  49.9 18.8  47.6 14.0  47.5 16.9  .10  .907  PP5  60.0 16.7  62.1 19.2  59.2 13.4  .13  .883  PP6  32.8 12.8  36.5 11.1  34.9 18.2  .26  .775  Male:  Female:  Note:  Set a =  .05  P  (2,42) .71  .  .37  .498  .693  219  Table E - l l I n d i v i d u a l P o s t - t e s t PAIR P e r c e i v e d  Scores  Groups Variables  EF  PS  C  (N = 45)  M/SD  M/SD  M/SD  PP1 (Em)  66.9 17.0  58.7 20.2  52.0 22.5  2.09  .136  PP2 (Soc)  62.9 15.4  55.4 18.2  51.2 20.2  1.62  .209  PP3 (Sa)  66.9 24.5  63.5 19.9  54.9 24.9  1.06  .355  PP4 (Int)  73.6 16.6  61.9 13.3  43.2 20.9  11.83  .001*  PP5 (Rec)  72.3 14.6  63.2 12.5  55.7 19.3  4.16  .022  PP6 (Con)  64.8 18.5  45.1 17.6  38.4 21.0 ,  7.74  .001*  61.3 20.3  44.0 18.1  39.2 15.4  6.22  .004*  PP2  67.7 16.6  57.3 18.7  53.3 18.8  2.54  .091  PP3  71.7 22.0  62.1 27.3  63.2 18.0  .80  .456  66.9 12.2  55.5 15.5  43.5 13.3  10.92  .001*  PP5  71.7 16.2  66.1 17.1  58.8 16.7  2.26  .116  PP6  53.1 22.9  35.7 21.5  32.0 12.9  4.92  .012  Male:  C  B  Female:  PP1  PP4  Note:  a a B C D  = = = = =  B  D  .05/6 = .008 _> < .008 EF > PS,C EF, PS > C EF, PS > PS, C, T h e r e f o r e , EF > C  F  P  (2,42)  220  Table  E-12  Individual Post-test  DAS  Scores  Groups Variables (N = 45) Males:  PS  C  M/SD  M/SD  M/SD  47.7  DAS 1 (Con) DAS 2 (Satis)  39.6  DAS 3 (Coh)  18.1  B  DAS  1  2  1.8  2.0  7.66 2.2 40.0  3.4  48.5 10.5 33.3  31.1  7.2  5.9 DAS  3  16.5  B  4  8.8  B  Note:  a = .05/4 = * = £ - < B = EF >  4.7  1.9  11.53 3.2  6.8 1.5  6.7 2.1  .0125  .0125 PS,C  C = EF, PS > C D = EF, PS > PS, C.  (2,42) 4.64  .015  8.39  .001*  1.85  .001*  2.96  .062  7.13  .002*  5.17  .010*  9.630  .001*  5.69  .007*  5.5  5.3 13.7  3.9 DAS  12.3 4.7  37.3  P  5.8  4.3  1.8  48.5  D  32.3  13.9  8.9  F  6.6  34.9  2.8  C  41.6 6.7  4.5  DAS 4 ( A f f . Ex.) DAS  46.5 3.8  B  Females:  EF  T h e r e f o r e , EF > C  2.1  221  Table  E-13  Repeated Measures A n a l y s i s : Follow-up Scores on N o n - D i f f e r e n t i a t i n g Variables  Groups Variables (N = 29)  PS  M(SD)  M(SD)  DAS  1 (Con)  DAS  4 ( A f f . Ex.) I II  PP1  (Emot.)  I II  64.1 63.1  (17.2) (19.4)  49.8 56.0  PP2  (Soc.)  I II  65.3 (13.5) 66.8 (10.4)  PP3  (S )  I II  PP5  (Rec)  GAS  Note:  I II  EF  48.4 ( 49.8 (  P  (1,27) 7.7) 5.3)  G T TG  1.0 0.0 4.64  .327 .983 .040  2.0) 1.7)  G T TG  6.32 .01 2.95  .018 .942 .098  (17.2) (14.8)  G T TG  3.63 .69 1.3  .067 .413 .260  55.7 63.9  (16.2) (15.0)  G T TG  1.77 5.55 1.34  .195 .026 .258  69.3 (21.6) 67.1 (20.6)  62.0 60.7  (22.1) (19.5)  G T TG  .86 .52 2.68  .363 .476 .113  I II  72.0 72.1  64.0 64.6  (13.3) (18.1)  G T TG  2.32 .02 .01  .139 .877 .923  I II  60.0 ( 61.3 (  G T TG  2.58 1.79 1.79  .120 .192 .192  9.1 8.7  ( (  3.2) 3.4)  48.0 ( 46.6 (  F  7.2 7.6  1.6) 1.5)  (13.5) (15.0)  7.5) 6.8)  ( (  57.0 ( 55.9 (  EF, n = 15; PS, n = 14 a = .05/7 = .007 G = Group F S t a t i s t i c T = Time F S t a t i s t i c TG = I n t e r a c t i o n , Time by Group  8.5) 6.8)  222  T a b l e E-14 Summary Anovas:  I n d i v i d u a l T o t a l DAS Scores a t Follow-up  Source o f V a r i a t i o n  SS  MS  DF  F  p  Males: Group Error Time TG Error  1,714.7 5099.4 22.2 .13 571.5  1,714.7 188.9 22.2 .13 21.2  1 27 1 1 27  9.08  .0056*  1.05 .01  .3149 .9378  Group Error Time TG Error  1811.3 6541.6 .03 6.86 820.1  1811.3 242.3 .03 6.86 30.4  1 27 1 1 27  7.48  .0109*  Female:  Note:  a = .05  * = £ < .05.  .00 .23  .9753 .6385  223  Table  E-15  I n d i v i d u a l Follow-Up Scores on V a r i a b l e s D i f f e r e n t i a t i n g Groups at Post-Assessment  Groups Variables (N = 29)  Time  EF  PS  M(SD)  M(SD)  F (Group)  p  (1,27)  Males - M u l t i v a r i a t e F = S DAS  2 (Satis)  I II  39.6 38.6  ( 4.5 ( 5.0  ) )  34.9 34.4  ( 4.4 ( 3.6  ) )  G T TG  8.51 1.41 .219  .007* .246 .644  DAS  3 (Coh)  I II  18.1 16.9  ( 2.8 ( 3.4  ) )  13.9 ( 1.9 13.3 ( 2.2  ) )  18.88 G T 4.70 .577 TG  .001* .039 .454  TC  I II  3.7 3.6  .92) .73)  G T TG  7.31 .787 .107  .012 .383 .747  PP4 ( I n t )  I II  PP6  I II  (Con)  ( (  .62) .51)  3.1 3.0  ( (  73.6 69.1  (16.6 ) (18.0 )  62.0 62.3  (13.8 ) (17.4 )  G T TG  3.16 .436 .519  .087 .515 .477  64.8 56.5  (18.5 ) (23.4 )  44.9 46.3  (18.2 ) (21.8 )  G T TG  4.73 1.21 2.21  .039 .281 .149  Females - M u l t i v a r i a t e F = NS DAS  2  I II  37.3 ( 6.0 37.1 ( 5.5  ) )  32.6 ( 4.7 33.3 ( 4.5  ) )  G T TG  5.46 .188 .444  .027 .668 .511  DAS  3  I II  16.5 ( 3.9 16.5 ( 3.6  ) )  13.4 13.4  ( 1.8 ( 2.3  ) )  G T TG  8.50 .006 .007  .007 .937 .935  .46) .64)  3.0 2.9  ( 1.2 ( 1.0  ) )  G T TG  6.62 .891 .024  .016 .353 .877  TC  I II  3.7 3.5  PP4  I II  66.9 68.3  (12.2 ) (17.7 )  54.6 54.9  (15.7 ) (16.7 )  G T TG  6.48 .081 .033  .017 .778 .858  PP6  I II  53.1 54.4  (23.0 ) (24.0 )  33.4 42.9  (20.3 ) (21.6 )  G T TG  4.51 1.86 1.11  .043 .184 .302  Note:  a = .05/5 = .01 * = p < .01 EF, n = 15; PS, n = 14  ( (  224  T a b l e E-16 Individual  Follow-Up Scores on V a r i a b l e s Not D i f f e r e n t i a t i n g Groups at Post-Assessment  Groups EF  PS  M(SD)  M(SD)  Variables (N - 29)  Time  F (Group)  P  (1,28)  Males - M u l t i v a r i a t e F = NS DAS  I (Con)  I-. II  47.7 ( 50.0 (  3.8) 4.3)  (47.2 ( (46.9 (  DAS  4 (Ex)  I II  8.9 ( 8.6 (  1.8) 1.5)  ( (  I II  60.0 ( 61.3 (  8.6) 7.0)  I II  PP2 (Soc)  I II  62.9 69.3  PP3  (S )  PP5  (Rec)  GAS PP1  (Em)  .42  .524  2.1) 1.7)  5.19  .031  (56.3 (54.9  9.4) 7.3)  3.39  .076  66.9 (17.0) 64.0 (20.3)  (57.7 (60.0  20.6) 19.3)  1.09  .304  (15.4) (11.7)  (55.1 (60.0  18.9) 18.7)  2.29  .142  I II  66.9 (24.5) 67.2 (24.8)  (63.7 (60.6  20.7) 19.5)  .38  .544  I II  72.3 (14.6) 72.3 (14.7)  (62.6 (64.6  12.7) 20.1)  2.71  .111  10.7) 5.7)  1.28  .268  7.2 7.6  5.9) 5.9)  Females - M u l t i v a r i a t e ¥ = NS DAS  I  I II  (48.5 (50.1  3.4 3.3  (47.9 (45.9  DAS  4  I II  ( (  1.5 1.8  ( (  6.6 7.4  2.1) 1.8)  5.81  .023  GAS  I II  (60.0 (61.3  7.7 8.0  (57.7 (57.0  9.4) 7.6)  1.30  .264  PP1  I II  (61.3 (62.3  20.3 20.5  (42.0 (52.0  17.0) 16.8)  5.85  .023  PP2  I II  (67.7 16.6 (64.3 16.3  (56.3 (67.7  18.9) 13.2)  .56  .461  PP3  I II  (71.7 22.0 (66.9 20.0  (60.3 (60.9  27.4) 22.5)  1.20  .282  PP5  I II  (71.7 16.2 (72.0 17.9  (65.4 (64.6  17.5) 19.3)  1.34  .257  Note:  8.8 8.1  a = .05/7 = .007 EF, n = 15; PS, n = 14  

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